Ensuring Our Youngest Cancer Patients Receive State-of-the-art Care Close to Home

By Douglas Scothorn, MD, and Ginna Priola, MD

Mission Children's Hospital cancer clinical trials Asheville, NC

In most people’s lives, September represents the changing of the leaves, pumpkin spice lattes and yellow school buses picking up excited kids returning to school. However, for our families at Mission Children’s Hospital, it’s a month to recognize the courageous battles being fought by their children. September is Childhood Cancer and Sickle Cell Awareness Month.

Roughly 15,600 children are diagnosed with cancer every year (that’s 43 children per day) and 1 out of every 9 will lose their battle. As in adults, childhood cancer does not discriminate: diagnoses cross all ethnic groups, socioeconomic classes and geographic regions. Cancer remains one of the leading causes of death in children. Currently, we have 429,000 childhood cancer survivors in the US, of which 95 percent will have at least one significant health related-issues due to their original diagnosis or their treatment.

Over the past 40 years, the survival rates for childhood cancer have increased from less than 60 percent to almost 85 percent. In large part, this is a result of research and clinical trials run by the Children’s Oncology Group (COG). COG is made up of over 200 hospitals that treat children and adolescents with cancer in the US, Canada, Australia, New Zealand and Europe. These hospitals work together to develop treatment approaches for all types of childhood cancer. This ensures that children can receive the same state-of-the-art cancer treatment, regardless of where they live. Mission Children’s Hospital has been a member of the COG for almost 25 years.

Since 1980, only three drugs have been approved to treat children with cancer, and four drugs have been approved for use in both adults and children. Many childhood cancer treatments haven’t changed since the 1970s. On average, the five-year survival has improved from about 50 percent in 1975 to greater than 80 percent in 2010. However, there is still a long way to go. Although there are numerous nonprofits focused on providing funding for childhood cancer research, the National Cancer Institute currently only designates 4 percent of its annual budget toward childhood cancer research.

Clinical trials for childhood cancer typically compare the current best known treatments (called the “Standard of Care”) with treatments that are hoped to be more effective and/or have fewer side effects than the standard of care treatments (known as the “Experimental Treatment”). After each clinical trial, the treatment with the best outcomes becomes the new standard of care.

As of September 2019, Mission Children’s Hospital has over 60 active clinical trials designed to treat more than 90 percent of children with cancer. This means that children in western North Carolina can be assured of receiving the best available treatment for their cancer without having to leave their friends, family or community.

Here at Mission Children’s Hospital, in our pediatric hematology/oncology clinic housed in the SECU Cancer Center, we diagnose about 20 new patients a year in western North Carolina and continue to care for them throughout their diagnosis and for many years following.

As staff and providers at Mission Children’s Hospital, we understand the tremendous opportunity and responsibility we harbor to help these kids and their families … FIGHT LIKE A KID.

To learn more about the specialty services at Mission Children’s Hospital, visit missionchildrens.org.

Douglas Scothorn, MD, is a pediatric oncologist at Mission Children’s Hospital.

Ginna Priola, MD, is a pediatric oncologist at Mission Children’s Hospital.

Cancer Center at CarolinaEast Medical Center

Posted Jun 26, 2019

SECU Comprehensive Cancer in New Bern NC is a SCOR member site NCORPWhile UNC and Duke are frequently in the news for medical research, cancer patients at CarolinaEast Medical Center can participate in national clinical trials without leaving New Bern.

One of those trials looks at treatment options for a precursor to breast cancer. The trial is named COMET, which stands for comparison of operative to monitoring and endocrine therapy for low-risk ductal carcinoma in situ (DCIS). The study enrolled 1,200 women at cancer centers across the United States, including at CarolinaEast.

Among other clinical trials underway at CarolinaEast are studies that involve lung cancer, colorectal cancer and prostate cancer, said Dr. Seth Miller, radiation oncologist and director of clinical trials.

“The goal is to open studies that are likely to be high-yield, high-accruing trials for patients in the disease types that are most representative,” Miller said. “We won’t necessarily open things that are more orphan-like. That’s probably going to remain at the university level. But big disease sites, opportunities where we can enroll a number of patients, are really what we’re focusing our initial efforts on.”

He said none of these studies are investigator-initiated trials at CarolinaEast’s level.

“We have the ability to open trials of that nature, for example if UNC or Duke had something really innovative that one of their investigators had initiated, but we focused on national, multi-institutional, largely randomized studies,” Miller said.

Patients participating in clinical trials receive at minimum of the standard care for their illness, he said.

“The investigative arm is looking at how to build upon the standard of care or the gold standard,” Miller said. “So, every patient in a trial is getting at the very least the gold standard and they’re potentially adding additional therapy that may even further improve outcomes or opportunities.”

Trials questions sometimes don’t show a benefit or, in retrospect, were more harmful than helpful to patients, he said.

Nearly all the physicians in the CarolinaEast cancer center are leading or co-principal investigators on a trial, Miller said. All investigators must meet regulatory and training guidelines.

“Lynn Harrison, our research coordinator, has been diligent on keeping us all in check, making sure we are both up to date on our training and renewed annually, so this is a huge effort on her part,” he said.

Physicians found the added paperwork valuable because it allows them to offer state-of-the-art care beyond the current standard because of clinical trial opportunities, Miller said.

“For each of the individual physicians, we’ve all had to personally say, ‘This is a really important part of how we take care of cancer patients in New Bern and the surrounding community,’” he said.

“The only way that we’re going to increase rates of cure, reduce toxicity and provide new treatment options for patients is through well-structured clinical research,” Miller said. “Being able to offer those trials at the local level provides not only additional opportunities close to home for patients, but it also sharpens the physicians.”

Miller is the principal investigator on three studies that are part of the CarolinaEast clinical trials portfolio as well as on a legacy trial for a former study opened at the hospital.

“Being a principal investigator at the community setting, or the co-PI, requires us to know the details of those studies and it creates constant dialog about potential new studies and findings that come from previously completed studies,” he said. “It sort of advances our knowledge in an ongoing and continuous way while affording patients additional close-to-home treatment options.”

As director of clinical trials, Miller works closely with Harrison to look at future trial opportunities and assess the CarolinaEast trials portfolio and enrollment goals.

He also participates in monthly phone calls with the Southern Consortium of Oncology Research, a group based out of Winston-Salem that has funding from the National Cancer Institute to further structure clinical trials enrollment in the community.

Miller said doctors involved in clinical research do so on top of their expected full-time clinical obligations.

“I think that speaks to all of our commitments to adding a research component to what we can offer here locally because it’s not something that’s carved out of our schedules per se, but rather something we’re doing in addition to our commitment to taking good clinical care of the patients in the first place,” he said.

CarolinaEast’s commitment to build a comprehensive cancer center preceded Miller’s arrival in August 2015.

“The things that go into that require some robust commitments financially from the time and staffing standpoint that don’t necessarily return revenue dollars, if you will.,” he said.

“I think clinical trials is one component that the health system has said, ‘If we’re going to make this robust comprehensive cancer center a reality, we’re going to have to support that in time, effort and financially.’ And they’ve done that to the fullest that I think should so far to date.”