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Providing Critical Clinical Trials to the Community: The ECHO Footprint

May 14, 2020

KapurJournal of Clinical Pathways spoke with Dinesh Kapur, MD, managing partner and director of clinical research, Eastern Connecticut Hematology and Oncology (ECHO) Associates, regarding the unique identity the practice has in the oncology care space as well as its involvement in the OneOncology network.

Please describe ECHO Associates and your role with the practice. How does ECHO survive and offer unique care for patients in Connecticut – especially as it is positioned in-between two large cancer systems (Yale and Hartford)?

Dr Kapur: ECHO has been in practice for approximately 35 years. It was started by one physician and has grown to seven doctors now, along with four nurse practitioners. It employs a comprehensive delivery model that we created over the last 3 plus decades.

The bulk of the patients we see have lung, colon, breast, or prostate tumors. Southeastern Connecticut has an extremely high incidence of lung cancer because of smoking and asbestos exposure. We are one of the rare places in the oncology world that sees a disproportionate number of mesothelioma cases.

We see a lot of blood-related issues. I was surprised to learn a few years ago that we see a high number of multiple myeloma and Waldenström macroglobulinemia patients. There are a lot of farmlands in north and southeastern Connecticut that could have used organophosphates in the 1950s or later that may have led to a higher incidence of multiple myeloma, Waldenström macroglobulinemia, and lymphomas.

At ECHO, we have our own lab setup, infusion center, and oral pharmacy center. ECHO has always prided itself in bringing cutting-edge cancer care to the community. As a result, we set up our own research department, headed by a PharmD.

As I see it, you can provide cutting-edge cancer care because of quality research, thus leading to the right kind of doctors who are invested in the practice. They want to provide the latest and best care for their patients.

Can you detail ECHO’s research footprint and how the practice has offered a unique clinical trial niche in the greater New England region?

Dr Kapur: From the start, it was very important for us to be actively engaged in the research world. Because of this focus, we are now able to provide the latest in therapeutics for our patients right away, to the point that our research department is offering Just In Time clinical trials. Historically, most practices—from large tertiary institutions to small community centers—have had a difficult time doing these trials. Thus, we often receive calls from various research entities that have had prior relationships with us. They know that we are not only able to open trials very quickly, but also provide them very clean datasets.

Just 2 weeks ago, we placed three patients on Just In Time trials. We are able to open these trials in 7 to 10 days at ECHO.

In fact, one patient was referred from a physician at Dana-Farber Cancer Institute. This physician called us to say, "We will not be able to open a clinical trial for 90 days here, whereas ECHO can open a trial in 7 to 10 days. I have this patient with a specific lung mutation. Can you open the trial?"

The physician reached out to the pharmaceutical company, which then connected with us. Within 10 days, we had opened the trial, had the patient enrolled, and had started therapy.

In general, patient accrual is not an issue. Believe it or not, accrual on our trials has far exceeded the national averages for several years. One of the reasons for this trend has to do with our practice aim – that every patient should be evaluated for a clinical trial, whether it be therapeutic, data, research, or supportive care.

Can you speak to ECHO’s past involvement in oncology community center networks and the current relationship with OneOncology?

Dr Kapur: ECHO has always been involved in national organizations. We were one of the founding practices for Cancer Clinics of Excellence (CCE) 10-plus years ago. The idea behind CCE was for community practices to join forces and bring a standard of care in cancer delivery, which included developing our own clinical pathways, looking at data, and doing research together. Unfortunately, we were ahead of our time at CCE.

CCE dissolved 5-plus years ago because a lot of practices had a hard time surviving against bigger networks and were being bought by hospitals and other networks.

This leads us to Quality Cancer Care Alliance (QCCA). We were one of the founding members of QCCA. The idea behind QCCA was very similar to that of CCE.

In August of 2018, we heard news of three large practices—Tennessee Oncology, West Cancer Center, and New York Blood and Cancer—joining forces to form OneOncology. The vision behind OneOncology was aligned with the goals and identity of ECHO. However, OneOncology also provided the backing of an organization from a financial and industry standpoint.

In all honesty, we were amazed that OneOncology wanted ECHO to be part of the network because we are a small practice, a stark contrast in size to the larger practices founding the network. They saw the cutting-edge care that we were providing. Furthermore, I personally had relationships with a few of the OneOncology physicians currently serving on the Community Oncology Alliance advisory board, including Drs Jeff Patton, Jeff Vacirca, and Lee Schwartzberg. All of us have a shared vision of providing cutting-edge cancer care in our patient communities and with providers that they trust. We have all been very interested and involved in oncology analytics, artificial intelligence, and value-based care. All these factors led to ECHO aligning with and joining OneOncology.

What were some of the deciding factors to join OneOncology?

Dr Kapur: The way we saw it, we could either remain independent as a practice or have an organization like OneOncology provide us with the business, management service, technology, and continued research expertise to thrive as a practice. OneOncology gave us the flexibility to remain an independent practice with a bigger support organization backing us.

We also were drawn to the invitation to a seat at the OneOncology table – that is, we would be involved in development of OneOncology with all the other practices and with a collective goal of improving cancer care and its delivery.

In turn, since our decision to join OneOncology, we provide to the network a strong base for cutting-edge research endeavors. OneOncology has expressed gratitude toward us for this offering to the business; our importance is genuinely felt.

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