Canada needs a national system for cancer clinical trials

Clinical trials are the most effective means of ensuring we have better cancer treatments. Such an investment would help overcome many hurdles facing clinical trials – from underfunding and suboptimal testing capacity to inefficient and costly regulatory processes.

By Janet Dancey - Contributor

From the Toronto Star Opinion Page - Monday, February 19, 2024

“A bad system will beat a good person every time.” William Edwards Deming

Or lack thereof. In that sense, Deming’s famous quote holds some truth for good cancer researchers because we don’t have a Canadian clinical trials system. But we could with a modest investment in people, infrastructure, and policy changes. Modest, considering the burden of cancer on health and health systems.

A clinical trials system would assure rapid initiation, safe completion, and equitable access to trials. If one per cent (or even a fraction of a per cent) of cancer-care funding were allocated to expand trial capacity and accessibility for patients, more trials would be mounted and completed with better treatments identified and adopted into our health system.

Such an investment would help overcome many hurdles facing clinical trials — from underfunding and suboptimal testing capacity to inefficient and costly regulatory processes.

The building blocks for a national system already exist. We have the expertise.

Canada has capable clinicians and staff in cancer trial networks — large national organizations, such as Canadian Cancer Trials Group (CCTG) based at Queen’s University, and other regional and province groups based at institutions that are conducting trials that improve outcomes for cancer patients. In addition, the Canadian Cancer Clinical Trials Network (3CTN) formed to support sites conducting trials has, with peer groups and with limited funding, successfully addressed some of these clinical trial challenges.

These networks and others form the basis for a coordinated system. These capable researchers just need the proper structure to leverage their many existing strengths.

Network researchers can work together on the same problem and promising therapies of all types can be tested, in Canada and globally, generating results faster and making new treatments available sooner.

Cancer researchers in networks develop, lead, and analyze trials to ensure rapid knowledge translation and adoption of findings.

Trials identify better treatments. They also can lead to cost savings on drugs and testing.

Networks provide training, structures, and resources for ethical trial conduct. Importantly, not only do trials provide early access to potentially better treatment, studies show that clinical outcomes for all patients (not just those enrolled in clinical trials) improve at sites with clinical trial programs. 

To function, these networks receive funding to conduct trials from public funders and private industry, which is limited. Cancer research funders have invested in clinical trial research — and the networks of investigators, cancer centres, and hospitals — to mount trials designed for Canadian patients. This generosity has had a huge impact on improving outcomes for all patients with cancer — all ages, types of cancer, and treatment interventions.

However, public sources of funding for trials have always been limited for these networks and member institutions, and it has eroded further with inflation and health-care budget constraints. Currently, health institutions and ministries provide limited to no funding for these activities. When available, it is provided by charities, foundations, and some government agencies.

Health-care provider organizations, like hospitals, see clinical trials in terms of revenue and costs — with research often undervalued relative to other priorities. Ever-increasing regulatory requirements and the expanding range of scientific questions being addressed in each trial also contribute to higher costs. The result is fewer trial opportunities for patients.

Lack of support marks a failure of our health and political institutions to foster an essential catalyst for ongoing improvements of cancer care and patient outcomes.

Clinical trials are the most effective means of ensuring we have better cancer treatments. A national cancer clinical trial system, with education and training, streamlined ethics, and support for initiatives to address genomic testing for trials, and reduce regulatory and other trial burdens, would be an investment in our health-care system.

We need change makers — leaders in health care and politics — to help us to build a truly efficient, national system to the benefit of us all.

Janet Dancey is director of CCTG, scientific director at 3CTN, and an oncology professor.