Enrolling in a Clinical Trial in Rural America

In the Piedmont hills of western South Carolina, surrounded by peach and apple orchards, lies a small town with fewer than 700 residents. Kellie is one of those residents. She has two young daughters and works as a massage therapist and dental hygienist. In her spare time, she’s in her garden or fishing at a nearby pond. She’s strong in faith and considers these activities “my God time.”

While giving a massage to a client in 2021, Kellie felt an acute pain in her right shoulder. She ignored it, thinking it was a strained muscle. Over the next year, the pain became stronger. When she started coughing up blood in the summer of 2022, she took action and had a chest x-ray. What it showed concerned her doctors, who ordered additional imaging scans. The scans revealed a single spiculated mass (a lump of tissue with spikes on the surface) in the lung, with enlarged lymph nodes nearby.

Kellie was diagnosed with stage III non-small cell lung cancer (NSCLC). Her diagnosis came 2 weeks after her brother informed her that he’d been diagnosed with the same cancer. Both had been smokers, although Kellie quit 17 years earlier, after their father died of esophageal cancer.

There are several types of NSCLC, which account for nearly nine out of every 10 lung cancer diagnoses. Some people with early-stage NSCLC can have surgery to remove their tumors, followed by chemotherapy. For Kellie, surgery was not an option, as her mass had spread too far.

Enrolling in an NCORP clinical trial

Her doctors wanted her to start the standard therapy immediately: chemoradiation followed later by an immunotherapy called durvalumab (Imfinzi). They also offered her the opportunity to participate in a clinical trial that is testing the effect of giving durvalumab during and after chemoradiation.

The trial is offered through the NCI Community Oncology Research Program (NCORP), a national network that brings cancer clinical trials and care delivery studies to people in their own communities. This means that Kellie can participate in the clinical trial without having to travel far from home to receive treatment at a major cancer center. Kellie jumped at the opportunity, enrolled, and learned she was randomly assigned to the experimental arm.

Once a month, Kellie drives 20 minutes from her house to the local hospital for lab tests. While waiting for those results, she meets with her oncologist. With satisfactory blood work, she receives consecutive infusions of chemotherapy and durvalumab. Her time at the hospital starts at 8:30 a.m., and she is typically done by noon.

Kellie is thrilled that she can receive her treatment so close to home and participate in helping others. Without NCORP, she would have had to travel hundreds of miles to Charlotte, NC, or Atlanta, GA.

Looking forward as a cancer survivor

So far, the treatment is shrinking the tumor, and her side effects have been limited to a cough and some fatigue. She will continue to get the treatment through November.

“If someone can benefit, then I’m happy to participate. And if I can benefit,” she mused, “then all the better.”

Kellie is looking forward to finishing treatment and traveling. She hopes to cover the US East Coast from Maine down.

Keith Dee, Ph.D., research coordinator for the Upstate Carolina NCORP that offers the clinical trial in Kellie’s area, is pleased with her progress on durvalumab. He notes the convenience that NCORP offers to Kellie and many more Americans.

“NCORP brings national trials to many who don’t live in a big city,” Dr. Dee said. “Through this program, people in rural areas can drive 10 to 40 minutes, instead of traveling hundreds of miles and incurring expenses associated with overnight stays at hotels to receive the same treatment.” In his eyes, this makes NCORP a resounding success.