Hidden Gems in Clinical Trials: Top Western Town Sheridan, Wyoming
With a total of 365 clinical trials conducted despite a population of just over 30,000 residents, the Sheridan, Wyoming Micropolitan Statistical Area ranks eighth among statistical areas in the country for trials per person (with about 12 per 1,000 residents)1,7. Of the 365 total trials conducted in the area, 178 (49%) are currently active, and 68 (19%) are recruiting for participation1.
Located in northern Wyoming, Sheridan is close to the Montana state line; in fact, it is about two hours southeast of Billings, the tenth-ranked Hidden Gem. Nearby Wyoming towns include Acme, Big Horn, Wyarno, and Beckton among others. Similarly to other cities in this series, healthcare appears to have a large presence in Sheridan. According to May 2017 data from bestplaces.net, 18.6% of Sheridan’s population holds occupation in “health care and social assistance,” eclipsing the national average of 13.8%. This is the most of all industries in Sheridan, followed by educational services, accommodation and food services, retail and trade, and construction. Further, Sheridan has 233 physicians per capita, exceeding the national average of 2106. These metrics highlight potential correlations with the relatively high volume of clinical trials in the area.
Sheridan’s performance in the clinical trial industry is entirely attributable to Sheridan Memorial Hospital’s Welch Cancer Center; of the 365 trials conducted in the area, 362 are or were at this location. While information on the clinical trial program of the Welch Cancer Center is scarce, there are some links and hypotheses that can be made regarding it. First, a recent profile of an oncologist at the Welch Cancer Center by The Sheridan Press notes that medical care, specifically in oncology, is rare in rural areas2. In addition, another recent article by The Sheridan Press outlines the longevity of Sheridan Memorial Hospital’s success, which is attributable to its ability to offer lower healthcare costs due to a higher patient population than other rural hospitals, allowing for financial stability3. Taken together, it is plausible that the Welch Cancer Center’s clinical trial program is the dominant one in the area due to sponsors looking for the most sustainable locations to see their trials through, in combination with a heavy focus in the industry nationwide on oncology and a need for care in the area.
Another piece of information that could partially explain the Welch Cancer Center’s performance in the clinical trial industry is potential involvement of the Billings Clinic. The first Hidden Gems piece featured Billings, Montana, and reviewed the Billings Clinic’s role as the predominant health system in the area. In addition to having a large presence in the Billings area, the Billings Clinic also partakes in outreach practice throughout the state of Montana that extends into parts of North Dakota and – you guessed it – Wyoming. In fact, the Billings Clinic provides radiation oncology services twice weekly at the Welch Cancer Center4.
In another parallel to Billings, Sheridan was also involved in a conference pertaining to a community approach to oncology clinical trials: the Association for Community Cancer’s 2018 Meeting and Cancer Center Business Summit. At this conference, Dr. Olalekan Ajayi, a pharmacist at the Welch Cancer Center, led a discussion of strategies, benefits, and barriers to this approach5. Perhaps this approach is something else to point to when considering the Welch Cancer Center’s success in the clinical trial industry.
To begin our closer look at the clinical trials of the Welch Cancer Center, its year-by-year active trial totals are plotted in the series below1:
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As seen, the cancer center saw notable growth in active clinical trials between 2008 and 2010, steadied and slightly decreased from 2010 to 2016, and has seen some growth since. As for today, the Welch Cancer Center currently has 176 active trials (48.6% of its total), 67 of which are currently recruiting for participation1.
The distribution of the active trials (based on a normalized scale) at the Welch Cancer Center by phase is shown in the chart below. For reference, the same distribution for the entire country is also displayed1.
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Like most of the locations detailed in this series so far, the Welch Cancer Center is predominantly conducting Phase 3 trials. The Welch Cancer Center is currently conducting relatively greater portions of Phase 2 and Phase 3 trials than the national average, but is well below the national averages for Phase 1, Phase 4, and “Other” trials. In fact, there is only one currently active Phase 1 trial and no active Phase 4 trials at the Welch Cancer Center1.
Next, the currently active clinical trials at the Welch Cancer Center are displayed by their intervention type. A single clinical trial can have multiple intervention types, which is why the percentages displayed exceed 100% when added together. The national distribution is also displayed for reference1.
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As seen, the Welch Cancer Center currently has relatively higher concentrations of drug, biological, procedure, dietary supplement, and “other”-type trials. However, it is well below the national average for device and behavioral trials; it is roughly 12 times below the national average for device trials and five times below the national average for behavioral trials1. This suggests oversight of Sheridan for these types of trials despite having infrastructure in place for a high capacity of clinical trials.
For a final graphic, the distribution of the Welch Cancer Center’s currently active trials (versus those of the entire country) on the basis of lead sponsor is shown below1. There are three categories of sponsor for this analysis: subsidiaries of the National Institutes of Health (NIH), Industry (usually referring to pharmaceutical companies), and sponsors labeled as “Other” (usually referring to physicians, health systems, or research groups and foundations.
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At the Welch Cancer Center, the currently active trials are virtually evenly split between being sponsored by the NIH and by an “Other” sponsor. Unsurprisingly, all of the NIH-sponsored active trials at the Welch Cancer Center are sponsored by the National Cancer Institute. Intuitively, oncology-related research groups dominate “Other” as well; the Southwest Oncology Group, Alliance for Clinical Trials in Oncology, and the ECOG-ACRIN Cancer Research Group are the most frequent trial sponsors of this category at Welch1.
Finally, we look at the conditions that are currently being studied the most at the Welch Cancer Center. In descending order, these conditions are Recurrent Squamous Cell Lung Carcinoma, Recurrent Breast Carcinoma, Stage 4 Squamous Cell Lung Carcinoma AJCC v7, Estrogen Receptor Negative, and HER2/Neu Negative Cancer. Given that the Welch Cancer Center accounts for 99% of Sheridan’s clinical trials, this order also rings true when applied to the area as a whole. This should come as no surprise due to a nationwide focus on cancer and oncology in the clinical trial industry1.
- Approximate attributable data as per the TrialScout database collapse as of 11/11/2019. All data is derived from https://clinicaltrials.gov/
- Haderlie, C. (2019, August 9). Compassionate care makes cancer doctor invaluable. Retrieved from https://thesheridanpress.com/110905/compassionate-care-makes-cancer-doctor-invaluable/
- Illiano, M. (2019, November 13). Hospital studies describe Wyoming health care struggles. Retrieved from https://thesheridanpress.com/115470/hospital-studies-describe-wyoming-health-care-struggles/
- Unknown Author. (Unknown Date). Cancer Care in the region. Retrieved from https://www.billingsclinic.com/services-specialties/cancer/cancer-care-in-the-region/
- Unknown Author. (2018, March 20). Technology Helps Solve Clinical Trial Accrual Challenges in the Community Setting. Retrieved from https://www.journalofclinicalpathways.com/news/technology-helps-solve-clinical-trial-accrual-challenges-community-setting
- Unknown Author. (Unknown Date). Sheridan, Wyoming. Retrieved from https://www.bestplaces.net/city/wyoming/sheridan
- S. Census Bureau, Population Division. (2019). Annual estimates of the resident population: April 1, 2010 to July 1, 2018 – United States – Combined statistical area; and for Puerto Rico. Retrieved from https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk
- Banks, L. (2019). Top 10 True Western Towns of 2018 - True West Magazine. [online] True West Magazine. Available at: https://truewestmagazine.com/top-10-true-western-towns-2018/ [Accessed 3 Jan. 2018].