Patients might come into a hospitalist’s care when they are in the middle of a clinical trial. What then?
The first step for a hospitalist is to find out whether a patient is enrolled in a trial.
“The safety and health of a patient obviously are more important than anything else,” Dr. Khuri says, “but simply asking about participation in a trial can avert doing something that unnecessarily forces the removal of the patient from the trial, in which they might have been receiving a beneficial treatment.
“What they [hospitalists] don’t want to do, unless they have to, is something that forces the patient to come off a clinical trial. Unfortunately, that’s a relatively easy thing to do.”
Hospitalists should ask their cancer patients if they are part of a cancer clinical trial. If the answer is yes, hospitalists “need to be very careful to obtain information about that trial, to understand if the trial is in any way contributing to the illness, or is it helping improve the acute illness,” Dr. Khuri says. Hospitalists also need to know if they are “going to do something that could potentially force the patient to be ineligible to continue that treatment.”
Treatments being explored in trials are often metabolized in the liver or excreted in the kidneys, and the hospitalist might have a choice between two treatment options—one of which might interfere with how the drug is metabolized and another that does not. The steps taken by hospitalists could determine whether the patient would have to be taken off treatment they were being given in the trial.
“If that treatment option on the clinical trial constitutes the best option for the patient, I don’t need to tell you that intervening in a way that forces the patient off that experimental treatment is undesirable in all but the most important, life-saving situations,” Dr. Khuri says.
But it all starts with asking the question.
“You couldn’t even process that information,” he says, “if you didn’t know in the first place that the patient was on a clinical trial.”