“One of the main takeaway points from our study is that the histology-related differences in outcomes between academic and community centers allude to potential treatment disparities — but more study is needed to determine if this trend has continued in more recent years, and to definitively determine an underlying cause for it,” Dr Sendhilnathan Ramalingam said. “[W]e are starting to look at more recent data, so hopefully [there will be] more to come in the coming months.”

According to data from the National Comprehensive Cancer Network (NCCN), presented at the ESMO 2018 Congress in Munich, Germany, molecular testing and targeted therapy are starting to move from academic to community settings, with nearly 1 in 4 patients with advanced cancers undergoing such personalized care across NCCN centers in the United States.

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Research advances are creating more options and hope for patients, but uptake can vary markedly between cancer treatment facilities, noted Emory’s Dr Suresh Ramalingam.

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“Disease-based specialization is increasingly necessary to incorporate research advances into clinical practice in a timely manner,” he said. “Better collaboration and exchange of patients between academic and community centers will help minimize the difference in outcomes.”

More clinical trials — particularly single-institution studies — are typically undertaken at academic centers, Dr Unger pointed out.

“The treatments developed in these studies are likely tailored to the greater resources that are available at academic centers, which makes dissemination of new, trial-proven treatments more challenging to community centers,” Dr Unger said.

The National Cancer Institute (NCI) has recognized this issue and has sought to establish a community oncology research program to allow patients at these facilities to participate in NCI-sponsored trials.

“This means the treatments developed by the network groups of the NCI are more likely to be more readily adopted by community sites,” Dr Unger explained.

Dr Unger was lead author of the first comprehensive comparison of survival outcomes among rural and urban patients enrolled in clinical cancer trials.3 Published in August 2018 in JAMA Network Open, that study showed that clinical trial enrollment does indeed reduce survival disparities between urban patients, who have ready access to academic cancer centers, and rural patients seeking care at community cancer centers.3

“We comprehensively examined nearly 37,000 patients with a wide variety of cancer types and cancer stages using big data strategies to link disparate data sources, including 44 clinical trials enrolling patients across all 50 states, linked to geospatial data,” Dr Unger explained. 

Importantly, Dr Unger and colleagues concluded that differences between urban and rural patient populations were less important to survival than the care they received at each of these types of institutions.3

“We found that cancer patients from rural areas receiving treatment on clinical trials had virtually the same outcomes as corresponding urban cancer patients in nearly all the cancers we examined,” he told Cancer Therapy Advisor.

That finding may come as a surprise to many. “But clinical trials are a key difference here,” Dr Unger explicated. “In trials, patients are uniformly assessed, treated, and followed under a strict, guideline-driven protocol.”

The study outcomes suggest that improving rural cancer patients’ access to guideline-based cancer care available in clinical trials should improve their survival rates, Dr Unger said. Incentives for oncologists to work in rural areas could help, he suggested — just as could provider networks between academic and community clinics.

Regardless of patient site of care, an oncologist’s commitment to staying up to date with evidence-based treatment options — and how to actually make them available to patients — is an important component to providing the best care possible for patients.


  1. Ramalingam S, Dinan MA, Crawford J. Survival comparison in patients with stage IV lung cancer in academic versus community centers in the United States [published online September 22, 2018]. J Thorac Oncol. doi: 10.1016/j.jtho.2018.09.007
  2. Morgensztern D, Waqar S, Subramanian J, Gao F, Govindan R. Improving survival for stage IV non-small cell lung cancer: a Surveillance, Epidemiology, and End Results survey from 1990 to 2005. J Thorac Oncol. 2009;4(12):1524-1529.
  3. Unger JM, Moseley A, Symington B, Chavez-MacGregor M, Ramsey SD, Hershman DL. Geographic distribution and survival outcomes for rural patients with cancer treated in clinical trials. JAMA Netw Open. 2018;1(4):e181235.