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Clinical trials bring cutting-edge care to small communities

When Dr. Ronald Reimer, a medical oncologist at Harrison Medical Center, started his training back in the mid-1970s, a woman had only about 50 percent chance of surviving breast cancer. Nearly 40 years later, those odds are improved dramatically, with 80 percent chance or higher of surviving. With about 220,000 women diagnosed in the United States every year, those improved odds mean “a huge number of lives saved,” Reimer says.

Although better screening like mammography shares part of the reasons behind that success story, Reimer says it’s clinical trials that are largely responsible for the development of new drugs and treatments to fight diseases like cancer. For example, a drug called Herceptin alone helps save an estimated 5,000 to 10,000 women each year, and many of them are young women (Herceptin targets HER2+ type of breast cancer that affects many younger women).

Before Herceptin became a widely accepted treatment, it was offered in a clinical trial, including at Harrison. Some of the participants were in the control group, receiving the best chemotherapy available, while others received the drug in addition to that. As soon as Herceptin was determined to lower the death rate for breast cancer (based on ongoing statistical analyses), all physicians were notified immediately that they could start giving the treatment — free of charge —to the control arm, if the patients so desired. “Suddenly the women who were in the control group were at Ground Zero for getting the treatment,” Reimer says. “It was a $50,000 gift to the patient.”

Reimer has been credited with being one of two Kitsap County physicians who advocated for the availability of clinical trials in the local community in the 1980s. He said there has been more enthusiasm toward clinical trials in the last three decades, and more cutting-edge science is available at community hospitals; on the other hand, there is more regulatory oversight, which makes trials more elaborate but also helps better protect patients.

Harrison has more than 70 patients in clinical trials currently, and nearly 100 participated in 2007-2008 combined. The patients who participate are essentially volunteers, but each trial has very strict guidelines and patients are monitored closer than they would be under ordinary care. Some consent forms can be as long as 20 or more pages, detailing every potential side-effect down to the possible risk of having blood drawn.

“Not everybody is a candidate for it, we have to be very careful with each patient,” Reimer says.

In Gig Harbor, clinical trials are available to patients of MultiCare’s Gig Harbor Medical Park, which has a state-of-the-art cancer center. MultiCare Health Systems has three types of trials: federally funded, those sponsored by pharmaceutical companies, and trials conducted by the Seattle Cancer Care Alliance, which partnered up with MultiCare over a year ago. An average of 40 trials are open at any given time, some lasting as short as a few weeks and others following patients through their lifetime.

Clinical trials should not be considered a last-ditch effort, says Diane Miller, RN, research coordinator at MultiCare. But their availability means patients can access the latest treatments as well as receive extra oversight and monitoring. Trials often include the standard of care treatment plus the additional drugs, and patients can withdraw at any time, she says. Most studies are approved by Medicare, and the patients’ private insurance plans are not charged for the additional trial costs other than the care they would receive as a standard.

Richard Shine, PharmD, manager of pharmacy services at MultiCare, says 80 percent of children who have cancer are treated in clinical trials, vs. about five percent of adults. This has allowed for new drugs for the pediatric population to advance much faster, which is why it’s important for adults to participate more.

“Everywhere we’ve gotten in terms of cancer treatments, clinical trials have led the way in showing what works and what doesn’t work. They’re critical and they’ve gotten us to where we are today,” says Dr. Suraj Singh, radiation oncologist at MultiCare. “For several cancers, there aren’t great results and we know that. We depend on medical trials to find better treatments.”

He says having the latest innovative treatments in a small community like Gig Harbor is unusual. In the past, patients would have had to travel to Seattle to receive that level of care. “Patients are really excited” about being able to do it close to home, he says.

Reimer says as broken as the health-care system is in the United States, clinical trials are among the very few things that are working very well. Health-care providers are concerned that health-care reform that would create a centralized, public-health system of health care would put the clinical trials’ availability at risk.

“Our clinical trial system, in terms of getting clinical trials to the community hospitals, is a terrific one,” Reimer says. “We have to be careful not to take away what we have.”

Dr. Charles Springate, a Harrison radiation oncologist, says clinical trials don’t necessarily have a lot of advantages for the institution that offers but they’re good for the institution because it speaks to its quality. Offering trials requires a major investment in technology and are also very time-consuming for the medical staff due to the extensive documentation and procedures.

“Clinical trials are a sign we have the technology and the manpower to do it,” he says. “Our equipment in the building is more expensive than the building,” Springate says.

But for the patients, participating is a win-win, he says. “They help contribute to the body of knowledge. Patients can have a little bit of pride knowing they’ve helped advance the quality of care,” he says.

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