Hawaiʻi Cancer Consortium Tackles Disparities in Clinical Trial Access for Pacific Islanders and Asian Americans

In a Pharmacy Times® interview, Naoto T. Ueno, MD, PhD, FACP, director at the University of Hawaiʻi Cancer Center, sheds light on the care disparities to efficacious cancer care experienced by Hawaiʻians, Pacific Islanders, and other Asian American populations.

Pharmacy Times: What prompted the creation of the Hawaiʻi Cancer Consortium, and how does it address equity in clinical trials?

Naoto T. Ueno, MD, PhD, FACP: Hawaiʻi Cancer Consortium was created because University of Hawaiʻi Cancer Center is an NCI designated cancer center. However, we do not have our own hospital, so the question is really how to provide clinical trials to many hospital or systems that we have. So currently, we have 4 major health system that are working together, and we cover about 2 thirds of the analytical case we have in Hawaiʻi. So, the whole purpose started, really more than a decade ago, to centralize the clinical trials and make sure that there's equity in terms of access, otherwise they will not receive the information they may not have the access of, particularly for the clinical trial perspective.

Pharmacy Times: What strategies has the Consortium implemented to overcome geographic, cultural, or socioeconomic barriers to clinical trial participation?

Ueno: So, the consortium is currently going through multiple different changes, which is further reaching out to other part of Hawaiʻi. Hawaiʻi, as you know, is made of many different islands and were geographically isolated. So, one is outreach by having a more presence in other islands. Our Cancer Center is located in Oahu, where 1 million people live, but there's another 400,000 who live on the neighboring island. So, we currently are trying to open trials outside of Oahu, which is not always therapeutic, but the future is to have that therapeutic access. Now, that said, providing access to clinical trial doesn't mean that people will engage, or people will engage in their clinical care. We have one.

We are one of the most diverse race and ethnic state compared to any other part of the United States, and each background comes with different languages and cultures. So, for example, I'll take Native Hawaiʻian, Native Hawaiʻians’ cancer mortality is higher than other ethnicity or race, such as Japanese, American or Caucasian. Native Hawaiʻians have their own indigenous culture embedded. And particularly for male patients or males generally who would not feel like going to the to the doctor. So, we have we work with community leaders or tribe leaders and to make sure that what the importance of screening or importance of the cancer participate in clinical trials. We have a cancer center working with a consortium and we embed this into the community so that they understand what's happening, and this does help to recruit people to the clinical trials.

Pharmacy Times: Looking ahead, what are the Consortium’s goals for expanding its impact on clinical trial equity in Hawaiʻi?

Ueno: So, the consortium goal is one. We're currently only covering about 2 thirds, so we want to really go above 90% to improve quality of care in general in Hawaiʻi. And we want to try to, well, we can't get rid get rid of the ocean due to geographic isolation, but because of the many new IT systems, we hope that we could have a much tighter community and consortium and cancer center that want to work together.

So that's one, and second, as I mentioned, is leading to education, and eventually to the creation of our own medical oncology fellowship. And so, it goes. And of course, we will provide clinical trials. So ultimately, we need to have people to come to practice, because many of the physicians are currently trained to not just practice, but clinical trial is part of the standard care, and they don't want to come to a place when the clinical trial infrastructure is not robust.

So, the chicken or the egg situation, they don't want to come. We have smart kids who will go for internal medicine training or surgery training, but because we don't have any training on the island, they all go to the continent North America, and they don't come back. And it's not their fault, but it's the main reason why we don't have a robust way to support professionals. And if they just want to practice, they could definitely come back. But if you ask me whether they want to participate in trial, they want to teach, we need to do a better job. So, it's a chicken or egg situation and we’re working on this.