Breaking Barriers to Cancer Care: Cleveland Clinic’s Global Approach

With an estimated 20 million new cancer cases every year, there is a growing burden of cancer around the world — and a pressing need to ensure equal access to cancer care. To address these complex challenges, Cleveland Clinic Cancer Institute is undertaking several concurrent strategies, from decentralizing clinical trials to investing in emerging technologies.

Making research generalizable

“Research is more likely to be impactful and applicable globally if it’s generalizable to a wider population,” says Cleveland Clinic Cancer Institute Chief Alex A. Adjei, MD, PhD. “Having a global presence allows for the opportunity to tap into the different epidemiology of cancers in different parts of the world and conduct studies in a way that’s cohesive.”

With sites in Northeast Ohio, Florida, London and Abu Dhabi, Cleveland Clinic is able to study various cancer treatments and their effect on patients from different backgrounds. For example, a thyroid cancer study initiated in Cleveland might take years to complete, given the scarcity of patients in the region with the disease, but the study can be expanded to Abu Dhabi where it’s more common. Doing so may help accelerate research and may provide investigators with a greater understanding of the effectiveness of treatment across a more diverse set of patients.

Analyzing trends across regions

As part of a global healthcare community, Cleveland Clinic is keenly interested in understanding how emerging public health concerns are impacting people in different regions. Researchers are seeking to understand why there are higher percentages of early-onset breast, colon, lung and skin cancers being seen in the U.S. and Abu Dhabi in particular. Working together across regions, they hope to uncover clues to how best to combat this concerning trend.

Decentralizing trials

Cleveland Clinic Cancer Institute is piloting a “hub and spoke” model to expand cancer clinical trial access, whereby patients on the east side and west side of Cleveland can participate in studies at clinic locations in their neighborhood instead of having to travel downtown.

Hillcrest and Fairview Hospitals are now being developed as additional research hubs where trial coordinators work to enroll patients in trials. Depending on trial enrollment volume, coordinators can travel to sites in the region such as Avon Hospital to make participation easier for patients. After these two hubs are established, Cleveland Clinic Akron General will be the next to be developed as a hub for the southern region.

If the pilot is successful, the plan is to introduce a similar model at Cleveland Clinic Florida. This would enable patients to participate in cancer studies in locations such as Indian River and Martin Hospitals.

From there, the plan is to roll out trials throughout Cleveland Clinic, including London and Abu Dhabi, based on the needs of each local patient population. Activating trials overseas will require additional local approvals, such as sign-offs from the Ministries of Health, but the way trials are conducted will be consistent across all sites. Having the same investigators and the same study protocols will allow for greater insights and collaboration.

Removing obstacles to trial enrollment

Dr. Adjei has a vision to decentralize trials to reduce travel burdens for patients. Although Cleveland Clinic has hospitals in multiple countries, it is a single institution, which makes decentralizing trials more straightforward. “NCI cancer centers have to go through scientific reviews individually for each site they include in a trial,” explains Dr. Adjei. “We’re fortunate in that we’re one system, so there’s one IRB and one scientific review committee for all our trials.”

Another step the institute took to remove trial barriers was to secure IRB approval to conduct informed consents remotely. This way, the research coordinator can present a study to a patient virtually, and if they decide to enroll, the patient can electronically sign the consent form and avoid a trip to the clinic.

Studying emerging technologies

In partnership with M42 and Toshiba, Cleveland Clinic is opening the first heavy-ion radiation therapy facility in the form of carbon ion therapy in the Middle East. This addresses a critical cancer care gap in the region, allowing patients to receive radiation in a safer, more effective manner. (There is no other heavy-ion radiation therapy center within a five-hour flight of Abu Dhabi.)

By delivering more energy, this innovative radiation method is safer and more effective at eradicating cancer cells. Using high-speed, heavy ions allows for much more precise delivery of radiation, improving efficacy and mitigating the risk of damage to surrounding organs. Carbon ion therapy is also ideal for treating radiation-resistant cancers as well as cases of re-irradiation. As radiation oncologists in Cleveland Clinic Abu Dhabi gain firsthand experience with this complex technology, this knowledge will be shared across the institute to support future expansion.

Expanding the global footprint

Additionally, the institute is expanding its presence in the U.K. Currently, patients at Cleveland Clinic London can receive surgical interventions for cancer but need to go outside of Cleveland Clinic for radiation and medical oncology. The institute is planning on building out these capabilities so that patients can access multidisciplinary cancer care in one central location without having to travel.

This model also makes it easier for specialists across hematology, oncology, radiation oncology and surgery to collaborate on cases and plan treatment sequencing more efficiently.

Supporting affiliates in underserved communities

In many developing countries, cancer specialists are scarce and healthcare services aren’t as robust. To address this, Cleveland Clinic establishes affiliations with local healthcare systems to deliver quality, safety, patient experience and care path support. This is one method for improving patient outcomes.

One example of a local affiliate is the Vinmec Can Gio International General Hospital, which is expected to break ground this summer. Through a collaborative effort, Vinmec Can Gio’s physicians can access Cleveland Clinic’s advisory services, including tumor boards. One of the first initiatives will be for the institute to help develop a comprehensive palliative care program for patients in Vietnam.