How Clinical Trials Have Intersected with My Practice of Clinical Medicine

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Written by: Chand Khanna, DVM, PhD, DACVIM (Onc), DACVP (Hon)

My history.

It was never intended, but innovation and clinical trials have always been part of my practice of veterinary oncology. I have spent the bulk of my professional life as a practicing veterinary oncologist and actively offering clinical trial options to my patients and clients. I am the founder of The Oncology Service LLC, which is a group of specialty veterinary oncology practices in the greater Washington DC area, recently acquired by Ethos Veterinary Health (where I now continue to seek and develop innovations for our patients, as its Chief Science Officer and President of Ethos Discovery, in the form of novel therapeutics and diagnostics developed through clinical trials). In my practice of veterinary oncology I was always on the search for new options to deliver on the unmet needs of my patients. The additional option of therapeutics only available through clinical trials has been a key feature of my practice of clinical medicine and has delivered many favorable intended and unintended consequences.

For my patients and clients.

As is the case for human cancer patients, there are times when conventional treatment options do not deliver on a patient’s/family’s goals, risks, or pragmatic needs (i.e. cost/insurance, treatment time/location), and in such instances I have found it most valuable for my clients to consider clinical trial options. Through these trials they may be better able to align their perspectives on goals, risks, and pragmatic needs with more available options than may be the case through a conventional treatment path, alone. In addition, this includes the opportunity to receive state-of-the-art and cutting-edge therapy often before any other cancer patients.

For my practice of medicine.

An obvious and expected consequence of offering clinical trials to my patients is the proximity that I have been given to the cutting edge of innovation and the feeling that I am extending my work beyond the simple delivery of historical standards. This has been highly rewarding to me personally and genuinely appreciated by my clients, and is largely responsible for my ability to stay integrated and active in clinical practice despite many distractions and other responsibilities. While drafting this document an unintended consequence of this proximity to innovation recently became apparent to me. This unintended consequence has been a distinct and clearer understanding of the shortcomings of our conventional approaches to deliver medicine to patients. This understanding is not always shared by my colleagues who have not been as motivated by innovation.

For our business.

Both during my leadership of my own practices and within my current responsibilities at Ethos, the opportunity to conduct clinical trials has created a valuable differentiation to allure innovation-minded doctors and staff and immediately deliver this differentiation to pet owners interested in state-of-the-art care.

It is not always easy.

For many reasons, delivering care through clinical trials is not simple, easy, or efficient. The repetition of conventional medicine allows efficiency and workflows that can be tailored to the needs and perspectives of a specific staff. This efficiency is immediately disrupted by the rigor, evidence, and structure of a clinical trial. In short, this creates change, and with change comes short-term pain.

Not all clinical trials are the same.

In the veterinary field, not all clinical trials are the same, and not all clinical trials come with the same levels of pain or disruption. A simple distinction of trials includes whether the trial is conducted under regulatory oversight (i.e. FDA) or whether the trial is simply a research study. Regulatory studies often result in additional demands of hospital teams and doctors and creates greater changes in existing workflows. This distinction is not absolute since there are some regulatory studies that can be conducted without as much demands, and there are research studies that can be highly intensive and disruptive. Different clinical groups can experience these pains in different ways, and experience has taught me what types of trials are most burdensome to my practice of medicine, and for the most part, I can now avoid these trial designs.

How to overcome the pain.

It often seems intuitively obvious that more money and more support will alleviate the pains associated with a clinical trial. In many different situations I found this not to be the case. Indeed, I have found that the most effective and productive way to overcome the challenges of a clinical trial is by starting with a high level of doctor and hospital curiosity in the medicine or the innovation of a trial. When such curiosity and interest is high, teams will find ways to “roll with the punches” and deliver both high accrual and high quality data to studies. When such curiosity or interest is not high, there is likely no amount of external support that can solve or even fully understand the challenges of a trial.

Our approach at Ethos.

Through Ethos, much of our scientific innovation is delivered through a standalone not-for-profit incubator of scientific innovation called Ethos Discovery (501c3; www. ethosdiscovery.org). Ethos Discovery begins its cycle of innovation by understanding the unmet therapeutic and diagnostic needs articulated by its staff to begin the process of innovation. Once understood and characterized, these needs are aligned with scientific partners around the world who may be best positioned to deliver innovation to the identified need. This results in questions that should be at the top of the list of curiosity and interest for our Ethos doctors and staff, but also at the highest level of need for our clients and patients. Accordingly, we should have an intrinsic method to manage the pains of clinical trials. Nonetheless, we are aware of the need and value of help to staff in the launch and management of trials across multiple geographically distinct practices and now have dedicated and trained staff to support our clinical trial aspirations. However, the curiosity and interest of clinical teams motivated by innovation and seeking more for their patients remains a paramount differentiator of our approach. It is therefore essential that our teams see the work of Ethos Discovery to be theirs and for Ethos Discovery to be their 501c3.

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