Partnership between VA, Hollings brings cancer clinical trial opportunities to veterans

If you’re practicing medicine the same way you have for years, then you’re not actually offering the same care to your latest patient as you did to your first. You’re actually moving backward while the rest of medicine moves forward – that's the way that oncologist Oleksandra Lupak, M.D., sees it.

It’s the reason she’s so enthusiastic about being able to offer clinical trials to her patients at the Ralph H. Johnson VA Health Care System through MUSC Hollings Cancer Center.

“As a clinician, I feel there’s a time lag from the time you discover something to the time it’s actually implemented in a patient so the patient can benefit,” she said. Offering clinical trials brings potential new treatments to her patients who need them now. “It's cutting-edge. We're at the edge of medicine.”

The partnership is made possible through the National Cancer Institute’s Community Oncology Research Program, or NCORP, which extends cancer clinical trials into community cancer centers so that people who don’t have access to research hospitals can still participate in research. There are 46 of these sites across the U.S., of which 14, including Hollings, are designated as minority/underserved (MU) community sites.

Hollings partners with more than a dozen sites in South Carolina to bring clinical trials to community members, but the VA in Charleston is the most active of Hollings' six NCORP-MU affiliates in enrolling people in clinical trials.

“Being able to offer clinical trials to veterans is especially gratifying,” said David Marshall, M.D., medical director of the Hollings Clinical Trials Office. “Cancer clinical trials can make a difference for patients today, and the veterans who served our country deserve access to treatments that could one day be the standard of care for all cancer patients.”

The VA has long conducted clinical research through its own investigators, but in 2018, an agreement was forged between the NCI and the VA to strengthen the infrastructure at VA sites to be able to support NCI-funded trials. Twelve VA medical centers across the country, including the Charleston VA, were chosen to be part of the initial program. The Charleston VA officially joined the Hollings NCORP-MU in 2019.

The partnership is managed by Lupak and urologic oncologist Stephen Savage, M.D., both of whom see patients at the VA and at Hollings.

The VA added Lupak to the team in 2020 because of her interest in clinical research, but clinical trials ground to a halt when the pandemic hit, she said.

Finally, in November 2020, she and her research nurse coordinator, Shannon Elam, R.N., were able to get going, later adding research nurse coordinator Kathy Jeter, R.N. Lupak is proud of how much the small team has been able to accomplish. They’ve developed relationships and systems with other departments, like pathology and radiology, to ensure smooth processes for patients – so much so that they have other VA sites calling to ask how they’ve done it, Elam said.

“We try to bundle the care so that it minimizes how many times the patient has to come to us,” she said. “So as soon as we are aware of a patient, we're quickly looking over eligibility criteria, looking several steps ahead – what do we need if the patient says yes,” Elam explained of the process of offering clinical trials to patients. “And we’re alerting other departments ahead of time so they're not caught off guard,” Elam added.

Lupak is also excited that the young doctors under her supervision are able to get hands-on experience working on NCI trials. It’s something that she didn’t get during her fellowship. Not only do the VA fellows have the chance to learn the ins and outs of running an NCI trial, but they can see firsthand how valuable clinical trials are for patients.

Patients are generally open to the idea of clinical trials because it gives them options, Elam said.

“It's always, of course, their choice,” she said. "But I think the important part is that we are providing them some sort of autonomy in making that decision because when you get cancer, you lose autonomy – you lose control. So you're giving them back the control.”

And for an oncologist, there’s satisfaction at the end of the day that you did everything possible for a patient, Lupak said. She recommends that community or VA oncologists consider taking part in a clinical trials program to be able to offer alternatives to their patients. And she reiterated the importance of building a team.

“To be successful in clinical research, you have to have a good team,” she said. “As an oncologist, I cannot be good if I don’t have one.”

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