January 28- A new study involving scientists at Queen’s University has found that current cancer research efforts do not match the global burden of deaths from the disease.
The research was led by Christopher Booth, Professor of Oncology and Public Health Sciences and Canada Research Chair in Population Cancer Care. The international research team also included Drs. Bishal Gyawali and Nazik Hammad from Queen’s.
The study reviewed every randomized controlled trial (RCT) in cancer published during 2014-2017. The cohort of 694 RCTs was predominantly led by oncologists in high-income countries (HICs) and funded by the pharmaceutical industry. The trials disproportionately study breast cancer while other cancers including cervix, gastroesophagel and pancreas are under-represented even though they account for a substantial proportion of global cancer deaths.
“Randomized clinical trials remain the most powerful tool to identify new treatments for patients with cancer" says Christopher Booth, Professor of Oncology and Public Health Sciences and Canada Research Chair in Population Cancer Care at Queen's University. "While important advances come from trials in high-income countries, if we want to make an impact at the global level we need to learn from the important work that is coming from our colleagues in low-middle income countries. There is an urgent need for bi-directional collaboration and building global research capacity so that patients can get high-quality cancer care regardless of where they live. ”
RCT’s from low-middle income countries (LMICs) were less likely to be funded by the pharmaceutical industry and more likely to identify new treatments that offer substantial benefits to patients. However, clinical trials from these countries were published in lower impact journals.
“Most of the ‘practice changing trials’ in HICs are not applicable to LMICs" states Bishal Gyawali, Assistant Professor, Department of Public Health Sciences and Clinical Fellow, Department of Biology. "While I was working in Nepal, any expensive new cancer medicine that improved survival by 2-3 months would be exciting from a scientific point of view but not relevant to the reality of our clinical practice."
"It is encouraging to see that LMICs are increasingly leading trials that are relevant to the local context, but clearly more needs to be done," Gyawali continued. "HICs and LMICs should work together in the spirit of co-development to conduct robust clinical trials that are of mutual relevance and benefit, with the shared goal to improve patient outcomes.”
The findings demonstrate that the RCT landscape is dominated by investigators in high-income countries and predominantly funded by the pharmaceutical industry. Policy makers, researchers, and medical journals need to address these challenges with a range of measures, including building global capacity in RCT’s and promoting a research culture that values learning from different health systems.
The study, An analysis of contemporary oncology randomized clinical trials from low/middle-income vs. high income countries has been published in the latest edition of JAMA Oncology.