The Challenge

Childhood cancer outcomes have seen remarkable improvements thanks to large-scale participation of children and adolescents in collaborative group clinical trials—a core component of childhood cancer care where many patients are enrolled on the same trial for more meaningful study results. For some children with cancer, the long distance between their home and the institutions engaged in these clinical trials presents a barrier to enrollment in clinical trials.  

Smaller community hospitals, like the eight with POGO Satellite Clinics, do not typically have capacity to support the regulatory and ethical oversite of niche trials such as these. Ideally, childhood cancer patients and families should not have to choose between enrolling on clinical trials and accessing the POGO Satellite Program, which allows families to remain in their communities, saving them time and money on travel, and keeping them closer to the much-needed comforts and supports of home.

The POGO Community’s Response

In an effort to prevent patients and families from having to make this choice, a system to access clinical trials was created in Ontario that allows the five specialized childhood cancer programs and the eight POGO Satellite Clinic locations to have shared responsibilities.

Some of the results, include:

• A shared-care model that meets collaborative group clinical trials requirements.
• A streamlined, consistent, provincial scientific review of clinical trials for the POGO partner hospitals referenced in this article by a single Research Ethics Board that minimizes the time required to open new clinical trials in Ontario.
• Increased equity of care and access to state-of-the-art treatment protocols across treating centres for children and youth with cancer.

POGO facilitates clinical trials education and training for the POGO Satellite Clinics on behalf of the specialized childhood cancer programs to ensure compliance with the process to participate in clinical trials. POGO also provides ongoing education for physicians working at POGO Satellite Clinics, as well as for nursing and allied health professionals via on-site visits, subsidized yearly provincial symposiums and biennial clinical education conferences.

Reference:
Alexander S, Greenberg M, Malkin D, et al. Pediatric oncology clinical trial participation where the geography is vast: Development of a clinical research system for tertiary and satellite centers in Ontario, Canada. Pediatr Blood Cancer. 2018;65:e26901;https://doi.org/10.1002/pbc.26901

The Canadian Cancer Clinical Trials Network (3CTN), in their efforts to improve access to adult oncology clinical trials for all Canadians with cancer residing in rural and remote communities, reached out to learn more about POGO’s process. 3CTN cites POGO’s model as one of two successful case studies and seeks to adapt and scale POGO’s model to the national level for adult oncology.

“POGO’s Satellite Program provides proof of concept that remote access models can effectively and efficiently provide access to trials for populations that would otherwise be excluded by virtue of geography.” ^{Canadian Centre Clinical Trials Network (3CTN). Canadian Remote Access Framework for Clinical Trials (CRAFT). May 2020. https://3ctn.ca/wp-content/uploads/2022/04/Canadian-Remote-Access-Framework-for-Clinical-Trials.pdf}