PPD, one of the largest contract research organizations, (CROs) has teamed with Cancer Treatment Centers of America (CTCA) to accelerate patient recruitment in oncology clinical trials, enhancing patient access to potentially life-changing therapies and save time in drug researchers’ quest to find cancer treatments.
With a new program titled “Just-in-Time” (JIT) at sites managed by CTCA, a comprehensive cancer care network of hospitals, they seek to shorten site activation time from as long as eight months down to as little as two weeks and other benefits to all clinical trial participants.
What is Different about this Marketing Announcement?
CROs are constantly updating offerings for competitive differentiation. A competitive buyer marketplace demands that various CRO offerings become better, higher quality for compelling economic price points—often with performance-based triggers and elements.
In the case of the JIT method what appears to be an incremental improvement is the combination of existing assets within PPD’s Accelerated Enrollment Solutions (AES) group and a national oncology network provider.
Who is Cancer Treatment Centers of America® (CTCA)?
Based in Boca Raton, Florida, CTCA is a national, for-profit network of five comprehensive cancer care and research centers and three outpatient care centers serving patients across America.
The Founder’s Mission—The Loss of Family
The founder, Richard J. Stephenson lost his mother to lung cancer. Mr. Stephenson acquired American International Hospital in Zion, Illinois in 1988 and expanded the hospital thereafter. Stephenson continued to acquire new hospital assets. By 2004 CTCA was acquiring multiple hospitals and clinics including the Parkview hospital in Northeast Philadelphia and by 2012 Atlanta.
A Sophisticated Integrated Cancer Treatment Network
As of this writing, CTCA represents a large, network of oncology hospitals and clinics nationwide. Now a comprehensive cancer network of five hospitals and growing footprint of Outpatient Care Centers, the company prides on itself on instilling the passion, commitment, and dedication that the founder brought to the founding based on the loss of his mother.
Dedicated to tailoring a combination of cancer treatments to the needs of each patient, CTCA offers advanced genomic testing to state-of-the-art technologies and evidence-informed supportive therapies that target cancer-related side effects, comprehensive services delivered by specialized cancer teams—all under one roof.
Can this Be a Good Clinical Research as a Care Option?
PPD seems to be on to a good idea. After all, they are in the business of conducting clinical research on behalf of major industry sponsors (e.g. biopharma companies) and they are under constant pressure to do more with less. It is the nature of the competitive marketplace for CRO services. Over the years they have acquired assets such as Acurian and put together offerings in some cases attempts to out-innovate the competition such as in 2018 when they introduced a new integrated offering based on acquired assets of the Acurian (patient recruitment online services) and Synexus (site network) that was branded AES. They began recruiting patients prior to site activation—shaking up some of the industry practices.
Enter CTCA and one could argue a brilliant move. Tap right into a dynamic, fast-growing, cancer provider and offer clinical research services directly to patients that may be facing terminal conditions. Moreover, as there is a push for inclusiveness a whole new channel for underrepresented patients is opened up.
An Aggressive For-Profit Provider
CTCA could be considered an aggressive for-profit provider of cancer services. Back in 2016, they were reported in not the most favorable light. They attracted scrutiny for marketing ultra-high survival metrics buoyed by disproportionately healthy and wealthy patients. StatNews reported that CTCA had spent $101.7 million on massive integrated channel marketing blitz—accounting for nearly 60% of all ad spending by U.S. cancer centers that year as was reported by an Indiana University and University of Pittsburgh study.
Now we love free enterprise as much as any other channel but in the world of cancer centers, there is a delicate line that must be respected. And when a competitive CRO pair up with a dynamic and ambitious cancer center—in the spirit to “speed up” drug development the holistic, person-centered care, holistic in nature—at times may run contrary to an expedited and accelerated paradigm.
Some Past Challenges
In the pursuit of fulfilling for-profit imperatives sometimes, in some cases, organizations—or at least some individuals within such organizations engage in questionable behavior. Apparently, commercial cancer centers in America, which we believe operate with all the best intentions end up succumbing to not the most desirable of behavior.
As reported in Wikipedia, In 2013 oncologist David Gorski penned an article in Science Blogs that CTCA “was using pseudoscientific treatments (e.g. homeopathy) in addition to mainstream treatments. Gorski believed some talented doctors were “complicit in the blurring of the line between science and pseudoscience in medicine” reported Science-Based Medicine.
The hyper-aggressive cancer-care advertising continued all the way till as recently as 2018. Truth in Advertising published a report that nearly all major cancer centers engaged in misleading advertising. Again it came to light that CTCA was at the top of the list in terms of ad spend which by itself, of course, isn’t a bad thing at all. However, as reported in Wiki cancer experts did review many of CTCA’s claims that its survival rates were better than national averages. CTCA compared its outcomes with the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER database). It was reported that these experts found that CTCA’s patients and SEER’s patients were not compatible, and there was what could be considered an inappropriate bias in the CTCA comparison. Some examples: CTCA’s cancer patients were younger and better insured reported Reuters. Moreover, CTCA, like many for-profit organizations that must balance shareholders demands alongside patient needs, screened patients for insurance coverage and it was stated at the time “has relatively few elderly patients and almost none who are uninsured or covered by Medicaid.”
CTCA maintains an active, dynamic clinical research program. They report that their trials represent part of the commitment to bringing their patients new and innovative cancer treatment options, especially for patients with advanced cancer or who may have run out of options for standard-of-care approaches. CTCA maintains a dedicated research team that undoubtedly has not only state-of-art systems and processes but also a culture driven by safety and importantly for clinical research, quality.
CTCA did have some run-ins with the FDA—many years ago one of their investigators received a warning letter but since then it would appear that there hasn’t been a lot of challenges.
PPD’s move to bundle their AES assets with CTCA for Just-in-Time driven offerings for clinical sponsors represents an appealing offering to help clinical sponsors accelerate clinical research efforts. By establishing a community of sites with pre-negotiated contracts and terms, allowing sites to immediately start the search for patients—prior to activating a site—can undoubtedly aid sponsor efforts. Turn-around times will be compressed. PPD is one of the world’s largest CROs and CTCA a sophisticated integration hospital network serving cancer patients; undoubtedly we believe with this move PPD may be able to outperform. An important message—keep the patient’s interest first. Ultimately doing the right thing for the patient—even if it slows the effort down—is the right thing for all.