W. Kimryn Rathmell, MD, PhD, FASCO, urged a systemic shift toward integrated, technology-enabled oncology care that improves equity and expands access in a keynote address at the American Society of Clinical Oncology Gastrointestinal Cancers Symposium, “Meeting Patients With Cancer Where They Are—The Role of Dyad Partnerships in Oncology,” held Jan. 8–10 in San Francisco.
Rathmell, CEO of The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and former director of the National Cancer Institute, warned that rapid scientific advances are outpacing the health system’s ability to deliver care, especially in rural areas where geographic isolation contributes to higher mortality and lower research participation.
Rural residents face a survival disadvantage, she said, with mortality rates of about 180 deaths per 100,000 compared with 157 per 100,000 in urban areas. Centralization of clinical research exacerbates the gap: more than 20% of trials occur in NCI-designated or academic centers while only about 4% take place in community programs, leaving many patients far from opportunities to enroll.
Rathmell proposed treating clinical research as part of standard care rather than an optional extra available only at university hospitals. Her proposed solution centers on the dyad model, which pairs academic specialists with community oncologists in unified care teams. The model establishes formal communication workflows, tracking mechanisms to prevent patients from “falling through the cracks,” and collaborative care plans that preserve the patient’s trusted relationship with local providers while providing access to specialized expertise.
Technology is key to the approach. The NCI’s Virtual Clinical Trials Office, launched in 2024, offers virtual staffing to smaller practices and has supported roughly 51,000 patient screenings across 19 protocols, enabling community sites to participate in trials previously limited to major centers. Nationwide telemedicine-enabled trials allow patients with rare mutations to enroll remotely, receive oral investigational drugs by mail, and have monitoring handled locally, reducing travel and cost burdens and widening the geographic reach of research.
Rathmell highlighted the rise in early-onset gastrointestinal cancers among people aged about 20 to 50 and described Ohio State’s Bridge Program, which uses the dyad model to coordinate research, fertility and survivorship support, and psychosocial care for younger patients facing unique clinical and workplace challenges.
Implementing these changes will require policy reform, she said, including multistate or national medical licensure for telehealth, standardized mechanisms for managing complications that arise at distant sites, and new financial support strategies to sustain high-tech, high-touch care models. Without a national framework, enrolling patients across state lines remains legally complex and limits equitable access.
By embedding clinical research into routine care, leveraging virtual tools and formal partnerships between academic and community providers, Rathmell argued the oncology field can accelerate discoveries and ensure patients—rural and urban alike—have fair access to the best possible treatments.
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