Addressing Clinical Trial Accrual of Minority Patients With Donna Catamero, NP
At the recent International Myeloma Society (IMS) Annual Meeting, Donna Catamero, NP, the Associate Director of Myeloma Translational Research at Mount Sinai Hospital, presented her abstract regarding increasing clinical trial accrual of minority patients. In this interview, Ms. Catamero discusses her presentation, the disproportionate burden that minority patients experience, and why she believes the health care team should take action to create an equal space for everyone in the clinic.
Oncology Data Advisor: Welcome to Oncology Data Advisor, a digital resource for the multidisciplinary cancer team. My name is Lyn Brook. Today I am joined by Donna Catamero of Mount Sinai Hospital, to discuss her presentation from the recent International Myeloma Society Annual Meeting.
Thank you for joining us today, Ms. Catamero. Would you like to give a brief introduction of yourself and what you like to research?
Donna Catamero, NP: Hi, I'm Donna Catamero. I'm a Nurse Practitioner, and I currently work at Mount Sinai Hospital in New York City. I'm the Associate Director for the Multiple Myeloma Research Program, and I oversee our clinical staff in our research department. Currently, we're trying to branch out our clinical trial portfolio into our network sites.
Oncology Data Advisor: First question I have for you is, would you like to give a brief overview regarding your presentation about increasing clinical trial accrual of minority patients?
Ms. Catamero: Yes, and thank you again for your interest. I think we know that minority patient populations are underrepresented in clinical trials, and this is primarily the reason we don't see race-based data being reported out from the clinical trials. With Mount Sinai being in New York City—one of the most diverse cities in the world—I think we represent over 170 ethnicities, so we really have the opportunity to increase diverse patient population in clinical trials.
So, what we did is we queried the New York State database to look at neighborhoods or zip codes that were deemed by the state to be an underserved population. Next, we looked at where our patient population was coming from, and we overlayed the two to see that our patient population, a good percentage of the population, was coming from these underserved areas.
Next, we looked at where our network sites are. Mount Sinai Health System actually has multiple locations in the tri-state area, so New York, New Jersey, Connecticut. Then we looked at where our sites were located, and we tried to match it to where these underserved areas were. We identified two locations, Lower Manhattan and Brooklyn, and then we set up our myeloma clinic. We went in, we looked at the infrastructure—we have 10 physicians on our staff—and we had them rotate through these two centers.
We then also, again, looked at the infrastructure and looked at the feasibility of running clinical trials, and we saw that there was a big knowledge gap in these centers. For example, at Brooklyn, they had no experience with clinical trials outside of COVID vaccines. So there is a knowledge gap there with their pharmacy, with their infusional staff. We had to go in and make changes so that we could at least try to start opening and accruing patients onto clinical trials.
Oncology Data Advisor: I know you briefly started to mention it, but could you explain how minority groups are disproportionately affected by multiple myeloma?
Ms. Catamero: African Americans have a two and a half–fold increase in incidence of multiple myeloma. When we look at their outcomes, we see that their outcomes are actually worse than White patients, but if all things were equal, African Americans should actually have better outcomes; they should have the best outcomes. And why is this? This really demonstrates health disparities. So, how can we go into communities and offer them these novel therapies that we're offering uptown in our main campus so that we can overcome this disparity in outcomes?
Oncology Data Advisor: I know you also briefly mentioned deploying advanced practice providers into the communities. So how does deploying those advanced practice providers into the minority communities help?
Ms. Catamero: As I mentioned, our physician team was rotating through the sites, but we hired advanced practice providers and nurse practitioners to live at those sites. So, those nurse practitioners represented the communities, spoke the language, and were there day to day, managing patients, educating staff, educating pharmacy, infusion, phlebotomy, lab to get them all educated on clinical trials and how to run clinical trials. Then just like I said, they were really managing the patients day-to-day so that we can have those outcomes that we're looking for.
Oncology Data Advisor: If you would have any advice or a call to action for other health care professionals to be more educated and proactive on this topic, what would you say?
Ms. Catamero: As a whole, we need to do better. We need to understand what these barriers are. So, if we look at where our satellite sites are, they're not more than 10 miles from each other, and we might not think of that as really addressing the issue. But, for example, if a patient who lives in Brooklyn were to travel to our main site in Upper Manhattan—we are at the top of Central Park—for someone coming from Brooklyn, whether they take public transportation, the subway, or drive, that's a two-hour commute one way. If patients are driving, they're paying tolls, they're paying for parking, and that could be a cost of $50 a day for those patients. You have to think about time away from work, lost wages, etc. So right there, that is a big barrier. In our case, access was the barrier. So, how can we go in these communities and provide the same care that we're providing at our main site to these satellite sites? We really need to understand what the barriers are for patients that are preventing them to enroll onto clinical trials.
Oncology Data Advisor: Since your team started these clinical trials, since they are just starting up, what are you and your colleagues' hopes as far as outcomes?
Ms. Catamero: So, we want all things to be equal. For a patient who's seeing me in our main site and the person in Brooklyn at that site, I want them to do the same. I think can we offer these novel therapies everywhere. Of course, there are limitations from an infrastructure standpoint, but I think we need to really strive to get things equal in all locations. Our goal is to really have equal outcomes across all sites, across all zip codes.
Oncology Data Advisor: Final question I have for you is, since presenting, is there anything you would've liked to add that you believe the health care team should know?
Ms. Catamero: I think we were very focused on getting our research staff up and running at these network sites. It really does take a village to support patients through therapies, and I think really understanding other gaps and support staff are needed. I think one of the big gaps that we identified was having social work available for patients. There are other ancillary staff that are needed to really make a program successful.
Oncology Data Advisor: Ms. Catamero, thank you again. We are really excited to hear about the outcomes in a few months, hopefully.
Ms. Catamero: Thank you. And again, thank you for taking interest.
About Ms. Catamero
Donna Catamero, NP, is the Associate Director of Myeloma Translational Research at Mount Sinai Hospital in New York City. She has been working with myeloma patients for over 20 years and describes advancing treatment for myeloma as a life passion of hers. Ms. Catamero has travelled nationally and internationally to speak about and help further advance treatment for myeloma.
For more information:
Derman BA, Jasielec J, Langerman SS, et al (2020). Racial differences in treatment and outcomes in multiple myeloma: a multiple myeloma research foundation analysis. Blood Cancer J, 10(8):80. DOI:10.1038/s41408-020-00347-6
Waxman AJ, Mink PJ, Devesa SS, et al (2010). Racial disparities in incidence and outcome in multiple myeloma: a population-based study. Blood, 116(25):5501-5506. DOI:10.1182/blood-2010-07-298760
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.