Dr. Patrick Richard, MD, Radiation Oncologist
What role as a radiation oncologist specialist do you play in any given cancer research clinical trial?
As a radiation oncologist, I participate in the regularly feasibility meetings held by WSCR, in which a team of physicians and research professionals assess opening potential new clinical trials in Colorado for many different types of cancer. I weigh in on the radiation aspects of the protocol, from the technical aspects to the planning aspects to the different arms of the trial. Among the lenses we apply is ensuring the trial fits the standard of care for all patients who enroll. What is remarkable to me is that these are cooperative, national studies therefore asking very important questions.
I am based in Boulder, Colorado so it is also essential to assess the capacity of each proposed trial to be successful in enrollment of eligible cancer patients in the Boulder area specifically. Every patient population, every clinic, is different and unique in terms of its patient base.
Recently a big focus of my research has been related to prostate cancer treatments. In these, we need the partnership of urologists and other physician providers outside of Rocky Mountain Cancer Center Boulder who are likely to refer their patients to a trial. This highlights one of the chief barriers to cancer patients’ enrollment on NCI clinical trials, the healthcare systems in which people are receiving medical care. Navigation the health care system today can be complicated. Creating awareness among other outside physician providers in our geographic area and fostering collaboration are key to the success of the enrollment process.
For patients, another barrier that is important to address is to acknowledge that clinical trials are burdensome. While that is harsh to say in a sense, it is true and vital to achieving enrollment goals. For a patient who would like to explore joining a clinical trial, there are several additional steps, including screening for the trial, enrollment, adhering to study protocols and the factor of randomization, that are not a part of ordinary cancer treatment. All people will receive the standard of care in the trials on which I am the investigator, and some will receive the treatment being researched. Yet even if a patient is not receiving the experimental treatment because of randomization, s/he is contributing in a crucial way to research that could positively impact the lives of thousands of cancer patients in the future.
What specifically about Western States Cancer Research NCORP compels you to collaborate with our organization for the site management of your studies?
For good reason, trials need to be regimented. At WSCR, this compliance oversight is a strength the organization brings to the table. WSCR gives me the confidence to become the investigator on a given clinical trial because their excellent team takes care of all of the site management tasks.
Clinical Research Coordinators and Their Role in Trials
More importantly perhaps, they have a team of Clinical Research Coordinators (CRCs) as a support team for my patients on studies. I started my practice in Boulder just five years ago so I am not certain I could have taken on this level of research as part of my work without the support of our WSCR CRC, Mira Morgan. Ms. Morgan works on site with our practice in Boulder so she is readily available to our patients. She is able to conduct the enrollment process right at our office which is a plus for patients, rather than patients needing to travel to another location for enrollment, support and much more.
Radiation Clinical Trials
WSCR also has access to radiation trials. Currently, I am overseeing 15 different trials which is exciting. I also have access to the NCI’s Clinical Trial Support Unit (CTSU) database which allows me to research past protocols, as well as active current protocols across the U.S. From a scientific point of view, that’s tremendously helpful. It is this sort of cooperative research information that makes for more robust findings.
What about cancer research, from your perspective as a physician, might our readers not know that you’d like to share?
It can be an overwhelming process to participate in a clinical trial for a patient, yet these are cutting-edge treatments that could afford a better outcome for the patient. As mentioned earlier, the study results could also change our understanding of cancer treatment in the medical community for the future. That is a very powerful part of participation.
According to the US Department of Health and Human Services, fewer than 1 in 20 adult cancer patients enroll in cancer clinical trials. Although barriers to trial participation have been the subject of frequent study, the rate of trial participation has not changed substantially over time. Barriers to trial participation are structural, clinical, and attitudinal, and differ according to demographic and socioeconomic factors. To what degree do you feel the rate of trial participation by adult cancer patients can be affected and what advice would you have for WSCR-NCORP as it addresses these barriers in its physician and patient outreach?
Opening a clinical trial lends itself to more community outreach which is a delicate process. First, we must build awareness in the community in which we are located — in our case, Boulder. Enrolling on a trial involves psycho-social stressors that may be particular barriers for vulnerable populations such as patients in low-income households or patients from immigrant communities. At RMCC Boulder, we have two bilingual staff who are fluent in Spanish and in English, in order to address the barrier of language. We also have interpreter services readily available for our patients.
Additional advice I have is to ensure there is strong collaboration with primary care providers (PCPs). These are the physicians who have earned the trust over time with their patients, so PCPs are instrumental in a cancer patient’s decision to explore whether a clinical trial is right for them or not.
What lies ahead for cancer research in 2021?
Advances in radiology oncology include the delivery of very few high doses of radiation as treatment for tumors, instead of more frequent lower doses. This type of therapy is less toxic and means fewer visit for the patient to the doctor’s office. This type of radiation is called FLASH. FLASH radiotherapy is radiation treatment delivered at ultra-high dose rates compared to conventional radiation treatment.
“Radiotherapy is a cornerstone of both curative and palliative cancer care. However, radiotherapy has been severely limited by radiation-induced toxicities. If these toxicities could be reduced, a greater dose of radiation could be given therefore facilitating a better tumor response. Initial pre-clinical studies have shown that irradiation at dose rates far exceeding those currently used in clinical contexts reduce radiation-induced toxicities whilst maintaining an equivalent tumor response. This is known as the FLASH effect.” (source: Frontiers in Oncology, January 17, 2020)
Another promising care option being researched is the use of immunotherapy either alone or with radiotherapy in the treatment of oligometastatic cancers. Oligometastasis is a type of metastasis in which cancer cells from the original (primary) tumor travel through the body and form a small number of new tumors (metastatic tumors) in one or two other parts of the body. For example, cancer cells may spread from the breast to form one or two new tumors in the brain or spread from the colon to form new tumors in the liver.
In the future, these types of cancer may be more treatable with immunotherapy and radiotherapy advances being studied today. A good explanation of the new concepts is offered in an October 5, 2020 NCI article titled, A More Treatable Kind of Metastatic Cancer?. “Rarely are the terms “cure” and “metastatic cancer” used together. That’s because cancer that has spread from where it originated in the body to other organs is responsible for most deaths from the disease. But in 1995, two cancer researchers put forth a controversial concept: There is a state of cancer metastasis that isn’t necessarily fatal. They called it oligometastatic cancer, describing it as existing between a cancer that is contained to where it originated (e.g., the breast or colon) and one that has spread extensively throughout the body.”
I look forward to the findings of the studies underway across the U.S. and the impact they could have on improved treatments for tumors.
About Patrick Richard, MD
Dr. Patrick Richard is a board-certified radiation oncologist, primarily specializing in the use of external beam radiation for the treatment of several types of malignancies. He holds MD and MPH degrees from Tulane University in New Orleans. He completed his residency at the University of Washington in Seattle.
In his practice, Dr. Richard collaborates with many other cancer specialists using a multi-disciplinary approach to care. Dr. Richard is a regular attendee at Boulder Community Health’s weekly general, breast, central nervous system, and colorectal cancer conferences and contributes radiation oncology best practice recommendations for each new cancer case reviewed. He is the radiation oncology representative on Boulder Community Health’s Cancer Committee and is a member of the Breast Program Leadership Committee, where he helps maintain the clinic’s NABPC accreditation status as a comprehensive breast cancer center.
He is also an active investigator in the Western States Cancer Research Program NCORP (WSCR), which active at Rocky Mountain Cancer Center (RMCC) Boulder. Over the past year, he has been working closely with WSCR to open and recruit patients to cutting-edge radiation specific phase III clinical trials. WSCR has invited him to act as the radiation oncology co-investigator for the research program, where he will review ongoing and future protocols for possible implementation in various clinics.
Dr. Richard has a personal interest in using and recommending integrative oncology care for his patients and has recently completed a year-long training program at the University of Michigan in integrative oncology where he learned how to best use and recommend evidence-based, complementary, and integrative treatments for his patients. Through this approach, he hopes to provide comprehensive, open-minded, holistic care to his patients during their course of radiation to help them achieve their goals and possibly improve their outcomes. He has also recently completed the US Oncology tier 2 emerging physician leadership program. He is using his growing experience to lead the development of the unique integrative oncology multi-disciplinary conference at RMCC Boulder, which is starting to prospectively review new and established cancer patients receiving care at RMCC Boulder.
By working closely with medical oncologists, surgeons, radiologists, and pathologists, he ensures patients receive the highest level of care and access to cutting-edge treatment. Dr. Richard’s practice encompasses a wide range of cancers, including breast cancer, prostate cancer, colorectal cancer, head and neck cancer, lung cancer, skin cancer, gynecological, and urological cancers. This broad experience allows him to apply cutting-edge treatment and stay up to date on the newest recommendations for radiation therapy regardless of the cancer type.