Hurricane Katrina: The Challenge to Cancer Clinical Research

Carl G. Kardinal

Clinical research can be a challenge even in the best of times, but the recent hurricane provided an opportunity to show the strength of an established Community Clinical Oncology Program (CCOP) research program. The National Cancer Institute (NCI), the research bases and sponsors, dedicated Ochsner Clinic Foundation (OCF) physicians and research staff, and many institutions across the country supported our patients enrolled in clinical trials to ensure that treatment continued with little interruption.

The NCI program director for the Ochsner CCOP was gracious in taking a common-sense approach, making every effort possible to ensure that the integrity of clinical trials remained intact, but allow-ing some discretion so that the focus remained on the patient.

On September 1, 2005, one of the Ochsner Cancer Institute's (OCI) research nurses who had evacuated to Baton Rouge went to the OCF Baton Rouge campus, and from that time forward, spearheaded the effort to care for our scattered patient population.

Some of the challenges were as follows: patients enrolled in clini-cal trials at OCI evacuated across the country from Seattle to Fort Lauderdale. They needed to find us and we needed to locate them. With the disruption in local telephone service and the widely scat-tered patient population, we were largely dependent on the patients to call. As patients called in to OCF New Orleans they were referred to the OCF Baton Rouge. There, through the dedication of a team of research and clinic staff, they were triaged to a facility near the city to which they had evacuated, or, if they lived near Baton Rouge, were encouraged to come to that facility for treatment. In addition, the clinical research staff had evacuated to remote areas, contributing to diminished resources. Fortunately, the entire oncology staff worked cooperatively to accommodate our patients. Our case report forms with the assigned numbers identifying patients to study sponsors and research bases was in New Orleans. To address this challenge, the Information Systems department at OCF New Orleans worked with owners of the software used to track OCI patients to allow the software to be accessed in Baton Rouge. Initially, it was thought this process could take weeks, but it was done in a matter of days. Another major challenge was obtaining study drug. The NCI al-lowed the Ochsner CCOP to use commercial drug when necessary to assure that the patient's treatment was not disrupted. Space is always an issue, but the clinic in Baton Rouge set up a table with telephones and a computer for the OCI research team, allowing them the opportunity to function with minimal disruption to the staff at the clinic in Baton Rouge. The staff kept a file of all patient contacts so that the information could later be entered in case report forms. Another challenge was finding a center near the patient's evacuation site that was participating in the same study. The research bases, especially the National Surgical Adjuvant Breast and Bowel Project in Pittsburgh, accepted responsibility for not only locating a center where the patient could be treated, but also contacted the center for us to facilitate matters. In one case, one of the sponsors flew a patient on study from Chicago to West Palm Beach since no center in Chicago was participating in that particular study, rented a car for the patient, and covered the cost of living expenses for the patient for four days.

Hurricane Katrina showed the strength of the CCOP network. Email poured in from other CCOPs offering to treat our relo-cated patients. The Grand Rapids CCOP, Beaumont CCOP, Pacific Northwest CCOP, Geisinger CCOP, Evanston Northwestern CCOP, Iowa CCOP in Des Moines, Atlanta CCOP, and even the Hawaii CCOP contacted us to offer their support. Although this was a very difficult situation, it is gratifying to know that the research program was strong enough to overcome the extreme stress of this challenge and meet the needs of our patients on clinical trials.

The Ochsner Cancer Institute is grateful to the entire staff from the Ochsner Clinic Foundation in both New Orleans and Baton Rouge for the professionalism and dedication shown to the patients enrolled in clinical trials during this difficult time.