Telemedicine Program Aims To Optimize Radiation Oncology Outcomes Internationally
Innovative program enhances radiation oncology residents' global health education
A new telemedicine program is bringing collaboration and international expertise to people fighting cancer across Africa while providing innovative global health training for Cleveland Clinic residents.
The African Radiation Oncology Network (AfroNET) program strives to overcome inequalities in access to radiation therapy care and equipment across Africa’s varied geography and national borders. During the first two telemedicine collaborations in February and March 2013, clinicians from Cleveland Clinic, Canada and Africa successfully came together online to confer on complicated cases. This successful approach is the vision of the International Atomic Energy Agency (IAEA) of Vienna, Austria.
“This is an exciting collaborative effort that has far-reaching benefits for all involved,” says May Abdel-Wahab, MD, PhD, Section Head of Gastrointestinal Radiation Oncology at Cleveland Clinic. “We share cases, scans, patient histories and discuss ways to treat the patient.”
Dr. Abdel-Wahab is a consultant on the project, and was a speaker at the IAEA meeting that launched the initiative and now participates in the monthly telemedicine outreach.
“The first two collaborations generated great feedback, insight and even some lessons learned,” she says. “This is a truly international tumor board.”
Evidence-based medicine backs the specific expert recommendations that are made during the teleconference. Collaborators scrupulously protect patient confidentiality at all times; a patient code replaces names on all clinical records, scans and management plans.
Treatment centers in nine of 54 African countries participate in AfroNET: Egypt, Ethiopia, Ghana, Namibia, Nigeria, South Africa (three sites), Sudan, Uganda and Zimbabwe.
Radiation oncology resources vary a great deal among the different centers. Therefore, Dr. Abdel-Wahab says that reality requires the participants to be creative, flexible and innovative in their approach to each case.
“Not only do we discuss patient management, but the technical considerations for radiation therapy at the local level,” Dr. Abdel-Wahab adds.
Recognizing an invaluable educational component, Cleveland Clinic requires that radiation oncology trainees participate in the AfroNET program. “This is good experience for a radiation oncology resident,” Dr. Abdel-Wahab says. “So far they are impressed with the types of cases presented – they see a wide spectrum of cancer diagnoses, medical confounding factors and in some cases advanced stage cancers.”
Adobe® ConnectTM software facilitates the online collaboration and allows participants to see and hear each other. Dr. Abdel-Wahab says the ease of communication and the coordination among colleagues from different countries and across multiple time zones is very impressive.
The program holds a lot of potential. “There is always more to learn from challenging cases and difficult scenarios.” In the future, radiation oncology subspecialists at Cleveland Clinic and elsewhere may be called upon to share expertise on specific cancer types. In addition, the unique expertise that African colleagues bring in terms of interesting patient cases and alternative treatment approaches is valuable to the resident global health experience.
The IAEA is not only assessing the radiation oncology capabilities in centers worldwide (Egypt and South Africa, for example, already feature advanced training, treatments and equipment), but devising solutions to aid clinicians and patients where the need remains greatest. Future plans include providing expertise and training to developing programs and adding radiotherapy machines and brachytherapy devices and aid in establishing new centers.
The AfroNET project is initially slated to last three years. A database will be maintained and outcomes formally evaluated to determine the project’s effectiveness.
For more information, contact Dr. May Abdel-Wahab at 216.445.7930 or firstname.lastname@example.org.
There’s A Cleveland Clinic App For That
Connect more patients to cutting-edge treatment opportunities at Cleveland Clinic with a new app that helps physicians and patients find cancer clinical trials. Less than 5 percent of adult cancer patients sign up for a clinical trial, according to the National Cancer Institute (NCI). And, most patients don’t realize clinical trials are an option for their care. Cleveland Clinic’s app will help physicians connect more patients to cancer clinical trials that can improve patient outcomes and help move cancer research forward.
“Making clinical trials accessible offers patients important treatment options,” says Brian Rini, MD, a staff member in Solid Tumor Oncology. “This app is one more way for doctors to know what trials are available, in real time.”
The free app allows users to search Cleveland Clinic’s 130 active clinical trials in realtime by disease, phase, hospital location or doctor. The app neatly packages clinical trial information in an easy-to-read format, including details about trial protocols, what stage trials are in, potential benefits and drawbacks, and basic eligibility criteria. It is available from the iOS AppStore and Google Play store.
Physicians can use the app as a patient information tool, encouraging patients and their families to download it. Aside from clinical trial details, the app provides financial services information, support group contacts and treatment guides—plus it connects patients to Cleveland Clinic’s Cancer Answer line. “Engaged patients are already conducting their own research online, so the app will make information about cancer clinical trials more accessible in an easy-to-read format,” Dr. Rini says.
Physicians can use the app to stay on top of the latest cancer clinical trials so they can initiate discussions with patients about these opportunities. “This app is just one more tool to empower patients. As they face healthcare decisions, and it will do a great service in helping physicians better communicate cancer clinical trials information with patients and their families,” Dr. Rini says.
Taussig Cancer Institute Clinical Trials
- RTOG 1114 – Disease: Brain (B-Cell non-Hodgkin's Lymphoma)
A Phase II Randomized Study of Rituximab, Methotrexate, Vincristine & Cytarabine With & Without Low-Dose Whole-Brain Radiotherapy for Primary Central Nervous System Lymphoma
Objective: This study uses a multidrug regimen for an uncommon tumor type and allows patients with lymphoma in any one or more of the following CNS sites: brain, CSF, spinal cord, or eyes ECOG 3108 – Disease: Breast
Phase II Prospective Trial Correlating Progression Free Survival with CYP2D6 Activity in Patients with Metastatic Breast Cancer Treated with Single Agent Tamoxifen
Objective: The primary objective is to correlate CYP2D6 score (0 vs. 1+2) and progression-free survival.
- DFCI 2312 – Disease: Glioblastoma
An open-label, Phase II Trial of orally administered PF-00299804 in adult patients with relapsed/recurrent glioblastoma (GBM)
Objective: PF-00299804 is a potent, highly selective, irreversible small molecule inhibitor of the HER family of tyrosine kinases [HER-1 (EGFR), HER-2 and HER-4]. This study has treatment arms that allow both patients who have or have not received prior bevacizumab.
- CASE 4312 – Disease: Glioblastoma
Phase II study of TKI258(Dovitinib) in patients with recurrent or progressive Glioblastoma who have progressed on anti-angiogenic therapy (including anti-VEGF therapy)
Objective: Dovitinib targets both FGF (fibroblast growth factor) and VEGF (vascular endothelial growth factor) in this patient population for whom no active agents exist.
- ECOG 1411 – Disease: Lymphoma
Randomized Phase II Four Arm Study In Patients 60 With Previously Untreated Mantle Cell Lymphoma Of Therapy With: Arm A = Rituximab+ Bendamustine Followed By Rituximab Consolidation; Arm B = Rituximab + Bendamustine + Bortezomib Followed By Rituximab Consolidation; Arm C = Rituximab + Bendamustine Followed By Lenalidomide + Rituximab Consolidation; Arm D = Rituximab + Bendamustine + Bortezomib Followed By Lenalidomide + Rituximab Consolidation
Objective: To determine whether the addition of bortezomib (RBV) to an induction regimen of rituximab-bendamustine (RB) improves progression-free survival (PFS) compared to RB alone in patients ≥ 60 years of age with previously untreated mantle cell lymphoma. Also, to determine whether the addition of lenalidomide to a consolidation regimen of rituximab following an induction regimen of RB or RBV improves PFS compared to consolidation rituximab alone in this patient population.
- CALGB 30901 – Disease: Mesothelioma
Randomized Phase II Study of Maintenance Pemetrexed versus observation for patients with malignant pleural mesothelioma without progression after first-line chemotherapy
Objective: To determine if maintenance therapy with pemetrexed improves progression-free survival in patients with malignant pleural mesothelioma who have at least stable disease after completion of first-line therapy with pemetrexed plus cisplatin or carboplatin.
- CLGN 2912 – Disease: MDS and CML
An open-label, randomized, Phase II, parallel, dose-ranging, multicenter study of sotatercept for the treatment of patients with anemia and low- or intermediate-1 risk myelodysplastic syndromes or non-proliferative chronic myelomonocytic leukemia (CMML)
Objective: The primary objective of this study is to determine a safe, tolerable and effective dose of sotatercept that results in the greatest frequency of erythroid hematological improvement (HI-E) in patients with anemia and low- or intermediate-1 risk MDS.
- CASE 1A09 – Disease: Multiple Myeloma
A Phase I/II Trial of Very Low to Low-Doses of Continuous Azacitidine in combination with Standard Doses of Lenalidomide and Low-Dose Dexamethasone in Patients with Relapsed or Refractory Multiple Myeloma
Objective: The primary objective is to define the highest tolerated low dose (HTLD and HTLD CKD for GFR < 60 ml/min and 30-59 ml/min, respectively) and safety of azacitidine given at low but increasing doses up to 50mg/m^2 twice a week concurrently with GFR adjusted lenalidomide and low dose dexamethasone in patients with relapsed or refractory multiple myeloma.
- LILY 1Z11 – Disease: Myeloproliferative Neoplasms
A Phase II Study of LY2784544 in Patients with Myeloproliferative Neoplasms
Objective: The primary objective of the study is to assess the activity of LY2784544 therapy administered once daily, as measured by objective response rate in patients with the myeloproliferative neoplasms: PV, ET, and MF, including those who have demonstrated an intolerance to, failure of primary response to, or have demonstrated disease progression while on ruxolitinib.
- GSI 1Z12 – Disease: Myelofibrosis
A Phase II Study to Evaluate the Efficacy and Safety of GS-6624 in Adult Subjects with Primary, Post Polycythemia Vera or Post Essential Thrombocythemia Myelofibrosis
Objective: The primary objective is to evaluate the effects of GS-6624 on bone marrow fibrosis alone and in combination with stable doses of ruxolitinib in subjects with PMF and post-PV MF or post-ET MF
- BAY 1812 – Disease: Prostate
Radium-223 Chloride (Alpharadin) in Castration-Resistant (Hormone Refractory) Prostate Cancer Patients with Bone Metastasis trial
Objective: To provide radium-223 chloride (Ra-223 Cl) to patients diagnosed with castrate-resistant/hormone-refractory prostate cancer (CRPC/HRPC) with symptomatic bone metastasis. Will also assess the acute and long-term safety of Ra-223 Cl
- CASE 1812 – Disease: Prostate
High-Dose Stereotactic Radiation for Prostate Cancer
Objective: The primary object is to assess treatment related gastrointestinal (GI) and genitourinary (GU) toxicity for patients who undergo SBRT for localized prostate cancer. Our hypothesis is that toxicity will not be excessive (defined as greater than 15% for either GI or GU) compared to the historical standard of fractionated IMRT with image-guidance (which results in 5% grade 3 GU and 5% grade 3 GI toxicity).