The clinical research as a care option has come a long way in the large, primarily rural State of Montana.  Although one report from the Department of Health and Human Services is a few years old the data, undoubtedly, is still relevant. From 2013 to 2017, 6,100 Montanans were diagnosed per year with cancer and the disease represents the number one cause of death in Big Sky Country.  With a population of 1,080,000 Montana ranks 43^rd out of 50 while the state comes in at 35^th nationwide in cancer death rate measurement at 140.9 according to the U.S. Centers for Disease Control and Prevention.  While many rural areas become severely underserved in overall healthcare and especially in regards to accessing advanced cancer care, thanks to the ongoing funding of the National Cancer Institute (NCI) and its Community Oncology Research Program or NCORP.   As part of this rural-focused cancer research care option, a Billings Montana-based independent nonprofit known as the Montana Cancer Consortium (MCC)   was established to bring state-of-the-art cancer care to Montana, Idaho, and Wyoming via NCI-sponsored research. With its vision of supporting quality research and thereby becoming a recognized leader in clinical, quality, accrual and care delivery, MCC’s director Amanda Dinsdale recently took the time to speak with Daniel O’Connor, Chief Business Officer of CrossTx to discuss the state of oncology-based research in the State of Montana.

First an Introduction to Montana Care Consortium

Founded back in 1995, Billings-based Montana Care Consortium (MCC)  organizers sought to address urgent needs in the vast rural areas of Montana and surrounding states to unify medical and radiation oncologists to better cooperate in bringing state-of-the-art cancer treatment to what at the time was a population with little access to clinical trials.

What were the problems back then?

In the early days there were a limited number of physicians and various groups of physicians involved in developing the relationships and connections, not to mention the legal and administrative steps to secure access to NCI-based clinical trials for example, there was little in the way of direct or unified agendas, and associated initiatives and the requisite resources to aggregate a variety of different cancer trials for large many of the state’s rural residents. This meant that if a majority of state residents, most of whom lived far from any research hub, were diagnosed with a form of cancer they would more often than not need to travel afar to access any research. Most likely the answer was Salt Lake City which can run anywhere from several hours to over 12 hours depending on where one needed to drive.  Moreover, most today still make ends meet making air travel in a time of critical illness all but impossible.  That assumes the patient would be privy to relevant and potentially life-saving research in the first place—and most were not.

Enter NCI NCORP and MCC

MCC represented the injection of money, organizational capability, knowledge, support infrastructure and access to what is now 100 to 150 clinical trials occurring at any given time.    As the organization grew over its first years it attracted important members such as board-certified cancer care specialists in not only Montana but also Idaho and Wyoming.

In fact, the organization attracted considerable elements of top medical research talent in the entire region; today MCC physicians have accrued  over 4,000 patients to NCI sponsored research. It was able to do this thanks to the grant mechanism associated with the Community Oncology Research Program (NCORP), again funded by the National Cancer Institute, part of the National Institutes of Health.

Today MCC represents a hub of cancer research in the state.  What follows is more information thanks to the generous time from Amanda Dinsdale,  MHA, CCRC, Director of MCC.

How is Cancer Research organized in Montana?

MCC, which oversees the NCORP program in Montana and adjacent states includes partnerships with most of the State’s major hospitals including:

• Billings Clinic (Cody, WY)
• Benefits Healthcare—Sletten Cancer 
• Billings Clinic Cancer Center 
• Bozeman Health
• Community Hospital of Anaconda
• Community Medical Hospital
• Great Falls Clinic
• Kalispell Regional Medical Center
• Idaho Urologic Institute (Meridian, ID) 

Should an individual get diagnosed with  cancer, in many instances, guidelines suggest that that patient consider a clinical trial given the tremendous breakthrough in new therapies, from CAR-T therapy to other forms of immuno-oncology and precision treatments based on the presence of particular biomarkers in the tumor for example.

What kinds of resources does the Montana Cancer Consortium bring to Montana residents in need?

With at least ten (10) principal investigators working with MCC, in addition to a sizable support staff including clinical research coordinators (CRCs), compliance professionals and study nurses MCC starts to look like a major metropolitan areas contract research organization in scope completely dedicated to Montana with a presence in Wyoming and Idaho as well.

Can someone access a list of current MCC clinical trials?

Yes. Follow the link https://mtcancer.org/public-protocols/ for a list of studies.

But what if a patient is affiliated with other hospitals such as Sisters of Charity of Leavenworth (SCL) or Providence (St. Patrick and St. Joseph)?

In those cases, these hospitals operating in Montana are affiliated with other larger health systems. For example SCL  is based out of Colorado and the research programs would be led from there. While Providence is based in Washington State.

Do some of the hospitals have their own research programs?

Yes. For example, Billings Clinic Cancer Center in addition to MCC and NCORP offering also may conduct specific industry trials. In that case they will employ the use of their local research infrastructure and staff, including dedicated clinical research monitors.

On that note what other clinical research programs does Billings Clinic Cancer Research access?

Billings Clinic has established an impressive cancer research program tapping into and collaborating with a number of oncology research networks. First and foremost is the MCC which again is coupled with mission critical NCI-based NCORP funding for rural research access in the State of Montana.

But also and impressively Billings Clinic has aligned with the Massachusetts and Mayo Clinic- based Alliance Research Group, NRG (Radiation, Gynecologic, Breast and Colon Studies), Southwest Oncology Group (SWOG), Billings Clinic self-managed trials based on grants and directly with commercial pharmaceutical partners (e.g. biotech and pharma companies).

Presently Billings Clinical Cancer Center offers a handful of important cancer trials  including  Brain cancer, Breast Cancer, Colon/Rectal Cancer, Leukemia, Lung Cancer, Lymphoma and Ovarian Cancer.

In addition to the Cancer Center Billings Clinic Research also offers a range of clinical trials in a number of therapeutic areas.

The oncology-based research system in Montana is quite impressive affording considerable access. Are there scenarios where cancer patients might seek to go participate in studies down in Salt Lake City at Huntsman Cancer Institute,  which also happens to be an NCI-Designated Cancer Center? 

Well first we have just about every major cancer focused clinical trial that they have down in Utah.  There are some studies that Huntsman runs that we don’t, such as investigator-initiated trials or highly novel Phase 1 drugs involved with safety protocols.  Sometimes Montana patients will go there for a second opinion but most often when the physician finds out the number and type of studies up in Montana they will recommend they do it closer to home.

Are there some challenges up here in Montana?

Sure, although we have developed a sophisticated research infrastructure we can always improve. At times a patient at a particular hospital could be diagnosed with cancer and you know physicians can be incredibly busy and may not be tied into the research availability.  Many of them are but not all of them. In some cases, patients need more education–some just avoid research even when it could possibly truly help them.

Some trial protocols make it more challenging to recruit the right participant; as with precision medicine comes new complexity, including the need to exhibit certain biomarkers for example:

What is your most proud accomplishment?

“We have set up and continue to run and improve a compelling research program in a vast, rural area.  I feel happy that we are bringing state-of-the-art, cutting-edge clinical trials to people in rural communities that otherwise would not have the access to what can be life extending and even life saving-treatments.”

Conclusion

In collaboration with the Montana Care Consortium coupled with the Oncology Research Program transformed Montana over the past few decades from a state where residents had little access to cutting-edge cancer research to one that now offers access to compelling new therapies that can in fact make a difference between life and death in some cases.

MCC’s dedication, commitment and sophistication has made a huge impact in the state.  There are challenges still as some patients may slip through the cracks from time to time, diagnosed with cancer and yet for whatever reason, not paired with a study that could potentially improve their condition above the standard of care.

A sizable part of Montana’s population may not even have a medical home. Back in 2012 195,000 state residents had no health insurance.  With the Affordable Care Act (ACA) and Medicaid expansion that number fell precipitously to just about 7.8% of the state’s population by 2018; but that number may be on the rise  due to the pandemic.  Regardless even among those insured, there are a substantial number of people that may not enjoy access to a regular medical home which could impact, should they become diagnosed with a cancer, their options as generally people in these at-risk categories get diagnosed later in life.

But the prognosis looks up for Montana thanks to compelling research infrastructure typically available only in larger metropolitan areas.  As CrossTx continues to extend its digital networks to the states’ providers, from behavioral health and geriatric to palliative care to oncology referrals, the Bozeman-based cloud software-as-a-service venture offers up connections coupling its current referral and care coordination networks with the option to connect with the MCC at some point in the future to help match, and thus help even more patients take advantage of the clinical research as a care option.

Daniel O’Connor
Chief Business Officer