Spotlights From Our Cochairs: Joseph Alvarnas, MD, Explains Barriers to Clinical Trial Diversity and Payer Participation

Joseph Alvarnas, MD, vice president of government affairs, City of Hope, and chief clinical advisor, AccessHope, Duarte, California, discusses potential payer biases against experimental or investigational clinical trials and the payer’s role in trial diversity.

Alvarnas served as cochair for the 11th Annual Patient-Centered Oncology Care^® (PCOC) meeting, presented by The American Journal of Managed Care^® November 9-10, 2022, in Nashville, Tennessee. He spoke with Evidence-Based Oncology™ (EBO) about a panel discussion he chaired on improving diversity in clinical trials.

EBO: What are some common payer barriers for participating in clinical trials?

Alvarnas: Some of the challenges historically have been related to this idea of something being experimental or investigational. The idea that you should pay for care that is an established standard or that represents best practice is something that both payers and clinicians have embraced. What makes cancer care different is that, for a significant percentage of patients that we serve, optimal care has yet to be identified—or we have therapies that may work very well, but [with associated] toxicities are not what we would want.

I think context is really important, and if we can engage payers in a discussion as to the value of a clinical trial—a well-designed, very appropriately constructed clinical trial that can actually answer specific clinical questions and potentially deliver value to patients—then I think we can reset this idea that experimental and investigational represents some irresponsible practice of medicine. For many patients in the cancer care domain, it represents the top choice for best practice.

EBO: Why do payers have a stake in greater diversity in clinical trials?

Alvarnas: [W]e’re living in a nation that’s becoming increasingly diverse, and there are 2 challenges in that increasing diversity. The first is we want to make sure that our health care system is appropriately patient-centered, and if you can’t respect or integrate that level of emerging and growing diversity into how we deliver care, then you’ve already created a system that’s not very good at delivering care to diverse populations or to the nation as a whole.

The other aspect of this is we don’t know what we don’t know. The beauty of clinical trials is we can identify new knowledge and new knowledge that’s hopefully applicable to either an entire population or to subsets within that population. In the realm of knowing to what extent clinical trial findings are generalizable, we have to diversify who’s enrolled in that trial, because we’re not all biologically identical, and not all people are superimposable. So, if we can better understand the applicability of a clinical trial and the generalizability of those results, then it helps us to empower better decision-making after that trial is complete.