Calls for urgent investment in COVID-19 recovery for cancer clinical trials, as well as streamlined regulation and redesigned treatment pathways
Cancer experts set out a series of findings on 9 December 2021 on the barriers to carrying out clinical trials in the UK, and proposals for boosting participation by enhancing information, changing treatment pathways and streamlining regulations.
The Institute of Cancer Research (ICR), London, is publishing a report collating data on cancer trials, and the views of patients and clinicians on how barriers to making trials more widely available can be overcome. It is warning that without urgent action to open up clinical trials to patients more widely and earlier in treatment, huge opportunities could be missed to drive improvements in outcomes.
Figures obtained from the National Institute for Health Research show that the number of patients recruited onto clinical trials for cancer in England fell to 27,734 in 2020/21, down from an average of 67,057 over the three years previously. The number of patients recruited onto trials fell for almost every type of cancer analysed.
The ICR also published findings showing that issues with making clinical trials available to patients are longstanding and go far beyond the COVID-19 pandemic.
An interview-based study of 12 leading clinical trial researchers from across the UK commissioned from health charity Picker found strong agreement that more needed to be done to widen access to clinical trials for cancer patients. The study, carried out from April to July 2020 during the early part of the pandemic, identified the following issues:
- There is an excessive administrative burden in setting up clinical trials, especially for innovative trial designs such as biomarker-driven studies for precision medicine.
- The NHS does not have systems in place for rapid genetic testing of patients to select them for precision medicine trials.
- Patients face a postcode lottery in access to the latest trials. Funding for doctors to carry out clinical research varies between hospitals – meaning some patients miss out on the latest treatments.
- Information about clinical trials for patients and doctors is inadequate – existing information is spread across multiple platforms, not kept up to date and often in a format that is difficult for patients to understand.
The ICR also commissioned a YouGov survey of 500 people who had been treated for cancer, which was carried out in March 2020. It found that 95% of respondents thought it was important that cancer patients were offered access to treatment in clinical trials. But only 37% had had a conversation about clinical trials during their own treatment, and just 11% participated in a trial. There was also a difference in ability to access trials in different parts of the country, with some patients in rural areas reporting travelling more than 100 miles for treatment on a clinical trial. In light of the barriers identified, the ICR is calling for the following:
- Urgent investment in cancer clinical trial recovery post pandemic – to build patient recruitment back up and ensure new trials can enter the pipeline.
- Learning from COVID-19 to streamline regulations – making it easier and faster to set up innovative study designs including biomarker-driven trials for precision medicine, and virtually monitoring patients.
- Making trials available earlier in treatment – by having conversations about trials and offering genetic testing shortly after diagnosis, and ensuring trials are no longer seen as a last resort, but a viable alternative to some existing treatments.
- Making trial information accessible – through funding to ensure information is up to date, understandable for patients and doctors, and accessible through a single point of
- Addressing the postcode lottery in access – ensuring hospitals across the UK have trained staff in specialisms such as R&D, pathology and radiology, and that oncologists are properly supported to devote time to research.
- Tackling barriers to reaching underserved communities – since there is evidence that poorer patients and those from ethnic minorities are less likely to gain access to trials.
Professor Udai Banerji, Deputy Director of the Drug Development Unit at The Institute of Cancer Research, London said: “Cancer medicine has changed hugely over the last two decades, with patients increasingly treated with precision drugs targeted against particular genetic faults within tumours. It’s essential that our clinical trial systems keep pace with the science.
“We need streamlined and accelerated approval of promising drugs using novel trial designs. Clinical trials of drugs should be embedded into all aspects of cancer medicine from prevention, curative or non-curative therapy to palliative care. The pandemic has caused us to pause and identify areas we can do better. It’s time to make up for lost time.”
Professor Kristian Helin, Chief Executive of The Institute of Cancer Research, London, said: “Clinical trials have huge benefits for patients, both by providing access to the latest drugs and technologies, and by demonstrating the effectiveness of the next generation of treatments for use on the NHS. We would like to see a clinical trial being made available for every cancer patient who would like to participate in one. That requires both investment in recovery of clinical research post Covid-19, to get us back to where we were before the pandemic, and broader measures to widen access to trials by reshaping funding, regulation, information and treatment pathways.”