Adolescents in Clinical Trials & the RACE for Children Act

Missy Hansen, MSN, APRN, CPNP, CPHON, Pediatric Strategy Liaison, Center for Pediatric Clinical Development, ICON a former nurse practitioner now working in pediatric clinical development, and Lori Ranney, DNP, APRN, CPNP, CPHON, Children’s Minnesota, a nurse practitioner, discuss the future of pediatric oncology development and treatment options and their experiences treating the adolescent and young adult populations in light of the passage of the RACE (Research to Accelerate Cures & Equity) for Children Act. 

Access the webinar here.

Missy Hansen MSN, APRN, CPNP, CPHON, joined ICON in 2019 as a pediatric strategy liaison. She has 25+ years of experience as a pediatric nurse practitioner, including 17+ years in pediatric hematology/oncology at Children’s Minnesota, the largest hematology/oncology service line in the region, providing care for infants through young adults diagnosed with hematologic and/or oncology conditions. Ms. Hansen gained expertise working in inpatient, outpatient, and urgent care type settings. Ms. Hansen has in-depth experience working with the Children’s Oncology Group—the largest consortium with the most open pediatric studies around the world. She also has experience working with other consortia that conduct trials for pediatric to young adult patients.

Lori Ranney DNP, APRN, CPNP, CPHON, has worked in pediatric oncology for 20 years and has been a PNP at Children’s Minnesota for over 13 years. She has a special interest in leukemia/lymphoma, patient/family education, AYA population, and oncofertility. She is a member of the Children’s Oncology Group and has actively enrolled patients in clinical trials for over 15 years.

Understanding DCTs: Decentralized Clinical Trials

Panelists provide information for patients, patient advocates & the public about what decentralized clinical trials are, how they work, and the importance of diversity in clinical research participation in a 15-minute Flash webinar. Access the webinar recording here.

Adam Samson, Moderator
Sr. Director of Clinical Operations & Customer Success

For over a decade, Adam has conducted clinical trials across multiple therapeutic areas as a research coordinator, monitor, project manager, and director at various types of organizations—investigational sites, CROs, academia, pharma, and tech. He received a master’s in clinical research from The George Washington University. In June 2020, he joined as Director of Clinical Operations at Curebase, a provider of software and services purpose-built for decentralized clinical trials (DCTs), where he is responsible for oversight of DCT services.

Arsheen Ali, Panelist
Clinical Project Manager

Arsheen Ali is a Project Manager and has served in this role with Curebase for over two years. In this capacity, she manages multiple decentralized clinical trials. Her background includes a variety of healthcare and research experience. She received her bachelor’s in integrative biology from UC Berkeley. Arsheen’s main interests are public health (population and community health focus), increasing healthcare quality and access (especially for minority/marginalized populations), and maximizing the efficiency of research.

Myra Lane
Lead Virtual Research Coordinator

Myra Lane is Lead Virtual Research Coordinator at Curebase with over three years of clinical research experience in the decentralized clinical trial space interacting directly with patients. She has worked in various therapeutic areas including neurology, dermatology, and oncology. She is passionate about the impact that the digital therapeutics approach has on addressing unmet patient needs by providing universal access to clinical research and accelerating the development of treatments.

Women in Clinical Trials

From “The Gift of Participation” by Ken Getz, Founder & Board Chair, CISCRP

Gender mix in clinical trials, overall, appears to be relatively balanced. Research conducted by the Center for the Study of Drug Development at the Tufts University School of Medicine found that, in clinical trials conducted in support of drugs submitted to the FDA, 52% of all patients who participated were men and 48% were women.

There is no question, however, that protocol designs have historically addressed disease as it manifests in adult males. Beginning in the early 1990s, public pressures fueled stricter government requirements for the presentation of data by gender in market applications to the FDA and valid analysis by gender at the NIH. In 2000, the FDA further specified that a clinical trial excluding persons having reproductive potential could be placed “on hold,” preventing further product development. This requirement helped ensure that women of childbearing potential were included in studies.

Pharmaceutical and biotechnology companies have also sought ways to increase the market potential for new and existing drugs by gathering clinical data to make specific claims about drug safety and effectiveness among women. As a result, clinical trials are increasingly being designed to assess the safety and efficacy of gender-specific medical treatment, and medical treatments are being “personalized” for gender differences in response.

Many diseases behave differently in women than in men. Risk factors, symptoms, the clinical course, and response to treatment can all be gender-specific. Among a long list of differences, men and women vary by:

  • body size, composition, and metabolism
  • the ways their bodies change during the aging process, e.g., puberty and midlife
  • endogenous hormones
  • exogenous hormones

Due to these differences and to other factors researchers have discovered that:

  • Lung cancer kills more women than any other cancer.
  • Alzheimer’s disease is twice as prevalent in women.
  • Men and women experience pain differently.
  • Women are two to three times more likely to experience depression, due to less serotonin uptake in the brain.
  • About 75% of autoimmune diseases occur in women, most frequently during childbearing years.
  • Urinary incontinence and dysfunction are more common in women and often have an entirely different cause than the same conditions in men.
  • Cardiovascular disease kills approximately 250,000 more women each year than all forms of cancer combined, accounting for 58% of all deaths. Within a year of the first myocardial infarction, 44% of women die, compared to 27% of men. Hormone-replacement therapy does not prevent heart disease, as was previously assumed.
  • The initial HIV viral load may be significantly lower in women, who represent an estimated 30% of new infections, but both sexes develop AIDS at the same rate

Although the FDA recommended in 1993 that clinical studies include enough women to understand the unique ways in which their bodies respond to drugs, women are still underrepresented in small, phase I trials. And when eligibility is restricted by age, older women are disproportionately excluded from studies of diseases that are more common in women at older ages. Although regulations prohibit the explicit exclusion of women of childbearing potential, the possibility of becoming pregnant can result in women in their childbearing years not being included in studies.

Generally, a woman capable of conceiving a child won’t be considered for a clinical trial unless she’s not pregnant and agrees to use birth control. Some studies require that women of childbearing age use two forms of contraception to participate in a study. Pharmaceutical companies don’t want their drugs tested among women who are—or might get—pregnant, mostly because the risk of exposure or a lawsuit by the mother is too high. Even in normal pregnancies, 1% to 2% end with an abnormal birth. Many parents are quick to blame poor birth outcomes on drugs. Some doctors erroneously believe that certain drugs cause fetal abnormalities. But genes and chromosomes are the primary culprits, according to Marilynn C. Frederiksen, M.D., associate professor of obstetrics and gynecology at Northwestern University Medical School.

“All of this presents a major barrier to clinical trial participation by women who don’t want, can’t afford, or are religiously opposed to contraception,” says Frederiksen.

Things aren’t bound to change unless the NIH comes up with the funds to conduct special dosing studies in pregnant women. And that probably won’t happen quickly or easily.

The NIH has an Office of Research on Women’s Health to help strengthen policies requiring inclusion of women in clinical research and to help translate new knowledge into clinical practice, but it doesn’t have any institutes that devote research dollars specifically to female health issues. As a direct result of the 1993 NIH Revitalization Act, NIH-sponsored clinical research now routinely includes sufficient numbers of non-pregnant women. In 2001, additional protections were given to pregnant women (as well as human fetuses and neonates) that spell out the conditions under which they can be involved in federally funded research— if earlier studies provide data on the potential risks, for example, and the risk to the fetus is caused solely by interventions that could directly benefit either the women or the fetus. Participation of women in NIH-funded studies, overall, is proportional to the percentage of women in the general population when sex-specific studies are excluded.

The participation of women in clinical trials is essential. The exclusion of women from early-phase studies, in particular, delays the discovery of sex-specific dosing requirements and the identification of gender-specific side effects, limiting the identification of drugs that are useful just for women. The problem is compounded by the fact that animal studies, when scientists learn about many of a drug’s potential adverse reactions, also tend to exclude females. Limiting studies to a single gender requires fewer study subjects (animal or human) and, thus, shorter and less costly studies.

There are many hopeful signs of change. Pharmaceutical companies are devoting a tremendous amount of money to trials focusing on diseases and conditions that only affect women.

For more information on clinical trials and making informed decisions about volunteering for clinical research, read “The Gift of Participation” by Ken Getz, Founder and Board Chair, CISCRP.

You can find the book here.

To search for medical conditions in a specific location, visit our Search Clinical Trials page.

To stay informed about clinical trials, visit our Resources page.

Clinical Trials: Improving Patient & Physician Education

CISCRP Perceptions & Insight Study Data Cited in Clinical Leader

A large and diverse pool of clinical trial participants scales the successful development of medications, therapies and treatments. Making trustworthy information about clinical research readily available to the public and physicians can serve to reduce mistrust of clinical studies. Clinical Leader addresses this topic in an article titled “3 Key Ways to Improve Patient & Physician Education on Clinical Trials”, citing data from CISCRP’s Perceptions & Insights Study. You can learn more about clinical research here.

CISCRP & Partners’ PLSP on Breast Cancer Study Published in Future Oncology

CISCRP (Center for Information and Study on Clinical Research Participation) and Oxford PharmaGenesis worked together with Daiichi Sankyo, AstraZeneca and Dr. Shanu Modi of Memorial Sloan Kettering Cancer Center in New York to write a plain language summary publication (PLSP) of the results of the DESTINY-Breast01 clinical study.

The participants in the study received a treatment called trastuzumab deruxtecan, also known as T-DXd. T-DXd consists of a chemotherapy drug linked to a manmade antibody. The antibody in T-DXd is a protein that specifically targets and attaches to the HER2 protein on tumor cells.

The PLSP was recently published in Future Oncology with the title “Trastuzumab Deruxtecan in Previously Treated HER2-Positive Metastatic Breast Cancer: Plain Language Summary of the DESTINY-Breast01 Study”. View the article here.

Why Clinical Trials Are Conducted

From “The Gift of Participation” by Ken Getz, Founder & Board Chair, CISCRP

Close up of African American physician listening to heart and lungs of patient

People want and expect their doctors to use treatments that work well and to stop using those that do not. Long ago, trial and error was the primary way that physicians and medical care providers learned how to recognize treatment alternatives. Later, through rigorous approaches that use clinical trials, physicians and researchers were able to gather far more meaningful information about diseases and how best to treat them.

For thousands of years, healers, shamans, and medical care providers have been administering treatments and remedies. One of the earliest known medical treatments dates back more than 3,500 years to ancient Egypt. Some ancient remedies, such as those used for simple fractures and minor injuries, are effective even today. However, many ancient medical treatments did not work and were actually harmful and even fatal. Two hundred years ago, cutting open a vein to drain a pint or more of blood and giving toxic substances to force vomiting or diarrhea were common remedies. And only a century ago, along with mention of some useful drugs such as aspirin and digitalis, the Merck Manual— one of the most respected sources for information on medical treatments then as well as now mentioned cocaine as a treatment for alcoholism; arsenic and tobacco smoke as treatments for asthma; and sulfuric acid nasal spray as a treatment for the common cold. Today these approaches are known to be very dangerous.

There are many reasons that doctors recommended ineffective and harmful treatments and that people accepted them. In many cases there were no alternatives. Doctors and patients usually prefer doing something to doing nothing. Patients also find comfort in sharing their problems and ailments with an authority figure. And doctors feel compelled to provide attention, support, and reassurance.

The primary reason doctors recommended ineffective and harmful treatments is that doctors couldn’t tell what worked from what didn’t. Doctors relied on cause-and-effect to identify potential treatments. For example, if an ill person’s fever broke after the doctor drained a pint of blood or after the shaman chanted a certain spell, then people naturally assumed those actions must have been what caused the fever to break. To the person desperately seeking relief, getting better was all the proof necessary. Unfortunately, these apparent causal relationships observed in early medicine were rarely correct. Still, they were enough to promulgate centuries of ineffective remedies. Of course, people had to be getting better in order to reassure doctors that a given treatment was working. Indeed, this is exactly what often happens. People do get better spontaneously. Sick people often get well on their own—and despite their doctor’s care—when the body heals itself or the disease runs its course. Colds are gone in a week; stomach flu passes within hours; migraine headaches typically last a day or two; and food poisoning symptoms may end in 12 hours. Many people even recover from life-threatening disorders, such as a heart attack or pneumonia, without treatment. Symptoms of chronic diseases (such as asthma or sickle-cell disease) come and go. Many treatments may seem to be effective if given enough time. And any treatment given near the time of spontaneous recovery may seem dramatically effective.

Belief in the power of a treatment or remedy is often enough to make people feel better. Belief cannot cause an underlying disorder—such as a broken bone, heart disease, or diabetes—to disappear. But people who believe they are receiving a strong, effective treatment very often feel better. Pain, nausea, fatigue, and many other symptoms can diminish. This happens even when the drug contains no active ingredients and can be of no possible benefit, such as a sugar pill or an inactive substance called a placebo. An ineffective (or even harmful) treatment prescribed by a confident doctor to a trusting, hopeful person often results in remarkable improvement of symptoms. This improvement is termed the placebo effect. People may see an actual (not simply misperceived) benefit from a treatment that has no real effect on the disease itself.

Some people argue that the only matter of importance is whether a treatment or remedy makes people feel better. Whether it works or not is of little consequence. This argument may be reasonable when the symptom is the problem, such as in many day-to-day aches and pains, or in illnesses such as colds, which always go away on their own. In such cases, doctors do sometimes prescribe treatments for their placebo effect. However, in any dangerous or potentially serious disorder, or when the treatment itself may cause side effects, it is critically important for doctors not to miss an opportunity to prescribe a treatment that really does work.

For more information on clinical trials and making informed decisions about volunteering for clinical research, read “The Gift of Participation” by Ken Getz, Founder and Board Chair, CISCRP.

You can find the book here.

To search for medical conditions in a specific location, visit our Search Clinical Trials page.

To stay informed about clinical trials, visit our Resources page.

Pros & Cons of DCTs & Virtual Clinical Trials

From "The Gift of Participation" by Ken Getz, Founder & Board Chair, CISCRP

They are known by different names: DCTs (decentralized clinical trials), remote, direct-to-patient, virtual, digital, site-less or simply patient centric clinical trials. All of these approaches share the common goal of making it easier to participate in research by reducing—or eliminating altogether—the number of study visits patients must make to conventional investigative sites or labs and allowing for more flexibility in carrying out study-related activities. Many of these approaches use smartphones, mobile devices, and wearable sensors to collect and evaluate patient data during the study.

Study volunteers often need to travel long distances to medical facilities, many need to stay overnight in a hotel, and take time off work to participate in a conventional clinical trial. Research from CISCRP shows that about one-fifth of study volunteers find clinical trial participation stressful and report the investigative site location and time-consuming study visits are among the least-liked aspects of the experience. Half of volunteers also feel that participation causes disruption to their daily routine. New, more convenient approaches are especially valuable for patients who may be too sick to travel or for those who rely on caregivers for support. Study volunteers who find it difficult to fit additional medical appointments into an already busy schedule or those who live far from the investigative site and wouldn’t otherwise be able to participate in the trial also benefit.

Not every clinical trial currently offers study volunteers an in-home or remote option, and it will take quite some time for a large number of trials to be done this way, but use of these approaches is expected to increase as pharmaceutical and biotechnology companies invest more widely in efforts to improve the clinical trial experience for patients. Research sponsors and regulators are working on initiatives that better take patient needs into account and could eventually allow patients to participate in clinical research wherever and whenever they want, whether it be their own primary-care doctor’s office, home, workplace, school, or anywhere else.

You shouldn’t feel forced to participate in a remote or at home study if you live near an investigative site and would prefer to have a face-to-face relationship with the study staff.

Pros:

  • You won’t need to travel and make frequent visits to an investigative site.
  • You’ll spend less time in a medical office.
  • You can participate in telemedicine visits at a time convenient for you, perhaps in the evening or on weekends.
  • You can contact someone on the research team 24 hours a day.
  • You may feel empowered by being able to participate whenever it is convenient to do so.

Cons:

  • You won’t have the same number of face-to-face interactions with study staff.
  • If you have a technical problem, you have to reach someone on your own to resolve the issue.
  • You’ll need to make sure you’re home to sign for clinical trial-related deliveries.
  • You may be asked to take your own vital signs or perform tests several times a day.
  • You may need to travel to a lab or medical facility for lab work or exams.
  • You may be asked to collect samples and arrange for them to be picked up.
  • You’ll likely need to send back all of the loaned devices and monitors at the end of the trial.
  • Not all wearable technologies have been validated, so you may need to repeat tests or travel to the research center for a special assessment.

When deciding whether a home-based or remote clinical trial is right for you, after you’ve learned as much as you can about the study visits and what activities you’ll need to perform on your own, discuss the pros and cons with your family, friends and primary care physician. It’s best to ask for input from people you know and trust and to involve your support network in your decision-making process.

For more information on decentralized clinical trials and making informed decisions about volunteering for clinical research, read “The Gift of Participation” by Ken Getz, Founder and Board Chair, CISCRP.

You can find the book here.

To search for medical conditions in a specific location, visit our Search Clinical Trials page.

To stay informed about clinical trials, visit our Resources page.

2021 Q2 Clinical Trials Supplement, USA Today

The Clinical Trials Supplement features a variety of informative and timely articles about clinical research. This supplement covers the importance of clinical trial participation, how clinical studies are building a brighter future for people with deafness, and stories from three different clinical trial participants sharing their own “why” about participating in clinical trials.

The “Medical Hero” spotlight cover story features Melvin Mann, a cancer survivor who shares how a clinical trial gave him a new lease on life.

A Very Special “Thank You” to the supporting organizations:

Pfizer                         Oxford PharmaGenesis             
Biogen                      Boehringer Ingelheim
Segal Trials              HyperCore International
SubjectWell             Allergy & Asthma Network
Lilly                            Praxis 

CISCRP would like to recognize and extend a “Thank You” to Praxis for donating their pro bono graphic design expertise to create the advertisement.

The Role of Clinical Trials in COVID-19 Vaccine Development

Written by Behtash Bahador, MS 

As COVID-19 vaccinations are rolled out, some people still have questions and concerns about the safety of the vaccines. How were they made so fast? How do we know they work and are safe? Were they studied in a diverse group of people? 

To help address these questions, CISCRP developed an infographic: “The Facts About COVID-19 Vaccine Clinical Trials.” The overall goal of this piece is to provide engaging educational content to people who may still be deciding if they or their family will get vaccinated.  

To complete the project, we brought together a team with years of experience sharing clear, unbiased, nonpromotional messaging about clinical trials. To create the infographic, we reviewed news and information from trustworthy sources.  These included national and global health organizations, universities, and peer-reviewed publications. This helped us learn what people still want to understand about the COVID-19 vaccine trials, and what else they may need to know.  

Then, the hard work began: we had to decide which topics and messages would be covered in the limited space of an infographic, and how. In the end, the main take-aways we aimed to provide are:  

  1. Teamwork and years of knowledge and experience allowed the vaccines to be made quickly. 
  2. Trials have shown the available vaccines are safe and effective. 
  3. The vaccines will continue to be studied and monitored for safety.  
  4. The COVID-19 vaccine trials included more diverse participants than many other trials. 
  5. There was diversity among the many professionals involved in vaccine development.  

As with all of our health communications, we received feedback from an editorial panel of patients, advocates, health professionals and members of the public. This was an essential step to make sure the infographic is clear, is not missing important information, and is not misleading in any way. We hope that the end result is an informative, easy-to-understand snapshot of some key elements of the vaccine development and rollout. 

The full infographic can be viewed on this page in CISCRP’s Education Center. The page also includes the sources used to create the infographic and additional links to useful educational content.  

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