Dr. Eric Chen and Chesley Cheatham Champion Resources for Patients
This article is a part of our CTSC Barrier Busters series.
The Government Accountability Office conducted a study, as prompted by the Henrietta Lacks Enhancing Cancer Research Act, to explore barriers to clinical trial participation and possible solutions to increase diversity in clinical trial participation. The December 2022 report noted the following barriers that affect patient enrollment into clinical trials as described in published research: unconscious bias, mistrust and historical discrimination, location, inclusion and exclusion criteria, cultural competence, linguistic, and literacy factors, costs, and other logistical barriers. Costs and other logistical barriers included: investigational care costs, routine care costs, and nonmedical, out-of-pocket costs (e.g., lodging and meals, transportation, and dependent care or childcare) that are typically the patient’s responsibility.
A California native, Dr. Eric Chen, PGY-4 in radiation oncology at University Hospitals, conducted a transportation study that identified transportation as an issue for patients who needed to complete radiation therapy. Dr. Chen observed that patients wouldn’t come to treatment that sometimes required daily attendance for six to eight-weeks. He wondered why. Most resources are dedicated to patients who need to come to treatment appointments for chemotherapy.
Dr. Chen and Chesley Cheatham, Director of Community Outreach and Engagement at UH Seidman Cancer Center, met in January and were asked what they were doing to address transportation barriers at the UH Cleveland Medical Center for radiation oncology. A grant became available, they applied and were awarded $10,000. The grant is unrestricted and will allow the team to identify what the transportation needs are (e.g., parking passes, bus passes, rideshare vouchers, gas cards, etc.). “Some patients will need all four interventions while others might need one,” Cheatham shared. The team will start assessing transportation needs for patients in April 2023.
Cheatham explained that, “Many patients have Medicaid or CareSource that have transportation components, but that transportation availability window could entail six-to-seven hours of waiting with radiation appointments lasting around 45 minutes. “This problem disproportionately affects people with limited financial resources and our Black and Brown communities,” Cheatham said.
Cheatham proposed making transportation the “fifth vital sign”. Highlighting that if you miss one appointment, you might not have the same outcome as someone who can finish the entire series. Even accounting for symptom management, if a patient comes to the appointment, the team can address symptoms from treatment. However, if a patient does not and cannot come, they are limited with what they can do to help. “In a perfect world, we’d have a concierge–door-to-door service–for 40 treatments, over a period of six to seven weeks to ensure that each patient completed treatment,” Cheatham proclaimed.
There is great opportunity to eliminate barriers to research participation. How will you help increase access to clinical research and trials?