SUO 2019: Clinical Trials at the VA

Washington, DC (UroToday.com)  While direct patient care, ranging from consultation to counseling and surgical intervention, is foremost for the vast majority of urologists and urologic oncologists, we may arguably benefit more patients and have a greater influence through clinical research by advancing the state of knowledge used to inform the care of patients well beyond our direct clinical research. Previous work from the Society of Urologic Oncology (SUO) has identified the lack of structured education in clinical research and clinical trial design and involvement as a weakness for many physicians graduating from the Society of Urologic Oncology accredited fellowships. To this end, the SUO convened a Symposium on Clinical Research and Clinical Trials in conjunction with this year’s annual meeting.

Dr. Jennifer Taylor provided the penultimate talk in this session discussing Clinical Trials in the Veterans Health Administration System. She began by highlighting the potential benefits of conducting trials within the VA system including the unique patient population, many of whom have unique risk factors for carcinogenesis. Additionally, it is a closed health care system that allows for assessment of interesting questions regarding disparities in care and access to care. She then gave an overview of the organizational structure of the VA, as it relates to trial design and conduct. Importantly, there is a Chief Research and Development Officer who oversees, among others, the Clinical Science R&D Service and a Health Services R&D Service. Within this structure, there is a Research Service Line within each geographic VA. She highlighted the Clinical Science R&D Service and its potential to facilitate clinical trials.

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Many Veterans Health Administration (VHAS) centers are collocated with universities which allows for collaboration with university partners. This may facilitate linked research ethics (IRB) assessment and potentially linked research infrastructure.

In the realm of multi-site clinical trials, clinicians practicing at VHAS centers may participate through involvement in cooperative group trials as Dr. Lerner described earlier, through the VA Cooperative Studies Program, and through the Central VA IRB process. She then highlighted the NCI and VA Interagency Group to Accelerate Trials Enrollment (ACCELERATE) program as a what to facilitate involvement of VA medical centers in NCI-sponsored clinical trials.

Among 172 VA medical centers, Dr. Taylor pointed out that there are 102 active research sites nationwide in which 3658 active funded principal investigators are working on 7403 active funded research projects with a total research budget exceeding $1.8 billion dollars.

Further, the VA itself offers opportunities for funding, directly through the VA, through the Department of Defense, or through non-profit affiliates that handle funding from foundations, industry, and other sources.

 

Presented by: Jennifer M. Taylor, MD, MPH, Assistant Professor of Urology, Baylor College of Medicine, Houston, TX, US, Member of the Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, United States

Written by: Christopher J.D. Wallis, MD, PhD, FRCSC, Urologic Oncology Fellow, Department of Urology, Vanderbilt University Medical Center, Twitter: @WallisCJD, at the 20th Annual Meeting of the Society of Urologic Oncology (SUO), December 4 - 6, 2019,  Washington, DC