After patient participation in clinical trials for new cancer treatments plummeted to half its usual level during the worst of the COVID-19 pandemic, officials at the University of Hawaii Cancer Center are ramping up supports and looking to construction of the state’s first center for stage 1 trials to restore sign-ups.

The UH Cancer Center, which has access to 85 clinical trials, is reorganizing, hiring more staff and implementing new strategies in hopes of bringing patient participation back at least to pre-pandemic levels. The center in December also welcomed a new director, Naoto T. Ueno.

Keeping cancer trials running robustly in the islands is crucial because the diverse ethnicities that are common here are underrepresented in clinical trials in other parts of the nation, said Dr. Jonathan Cho, medical director at the Cancer Trials Office of the UH Cancer Center. Hawaii can play a key role in expanding knowledge of how various cancers affect different races, he said.

But restoring patient participation will also take overcoming pervasive misconceptions about clinical trials, Cho said.

He added that patients who qualify for clinical trials stand to benefit more than many realize.

“I think a lot of patients think that clinical trials are only for patients who have advanced cancer or have no other options available. That is a myth,” he said, as there are clinical trials for all stages of cancer, as well as for prevention.

Another common concern is that a clinical trial patient will be treated like a “guinea pig” and get less than the best in treatment, Cho said, when actually, “they have the potential for better treatment. I can cite you a number of situations where we develop new treatments and have far exceeded the benefits of what was considered standard.”

Geographic distances, and hesitancy or failure of some doctors to encourage clinical trials as a treatment option, also impinge participation, he said.

Clinical trials are research studies in which researchers learn whether new methods of prevention, detection and treatment, including new drugs and surgeries, are safe and effective, and how they compare with existing methods.

In Hawaii, cancer is the second-leading cause of death, after cardiovascular disease. Each year, more than 7,000 Hawaii residents are diagnosed with invasive cancer, and more than 2,000 Hawaii residents die of cancer, according to UH Cancer Center data.

But typically, only a fraction of Hawaii’s cancer patients — approximately 150 to 200 each year — have entered clinical trials. And once the pandemic struck, participation dropped to 100 patients or fewer, mirroring a nationwide trend, Cho said.

Among the many factors for the decline, he said, were a pandemic-related shortage of clinical trials workers during “The Great Resignation”; shifts in patient attitudes, including fear of entering medical facilities during the pandemic, and skepticism about developing medicine; and the advent of telehealth, which lowered patients’ enthusiasm for in-person visits.

Cho said staffing at the UH Clinical Trials Office, which provides support for clinical trials at the UH Cancer Center and the Hawai‘i Cancer Consortium, normally is around 25 people but at one point fell to around 50%.

Improvements now at that office include hiring of more staff, reorganized workloads and a new career development program with added training and mentoring for clinical research associates who work with trial participants, plus compensation upgrades.

The addition of Ueno also is expected to add momentum. He previously was at the University of Texas MD Anderson Cancer Center as a widely regarded cancer researcher and educator, executive director of the Inflammatory Breast Cancer Research Program and a tenured professor of medicine, and he is a cancer survivor himself.

Meanwhile, Congress recently appropriated an additional $6.5 million for the cancer center’s Early Phase Clinical Research Center, which began construction last fall and is tentatively scheduled for completion in 2024. The first of its kind in the state, it will provide access to phase 1 trials so patients do not have to travel to the mainland for them.

The UH Cancer Center, an organized research unit within UH Manoa, is one of only 71 research institutions designated by the National Cancer Institute. To learn about clinical trials available in Hawaii, go to uhcancercenter.org or call the Clinical Trials Office at 808-586-2979.

Center officials hope eventually to also increase the number of trials available to Hawaii residents and expand access to the neighbor islands. Cho would like to one day see 20% of local cancer patients participate in trials. “We may not have a trial to fit everyone … but we want to raise awareness for all caregivers who get involved in the care of the patient, that local trials should be part of that conversation.”