Key finding
Participation in clinical trials in Ontario is decreasing, reflecting a changing environment for supporting clinical trials.
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Goal |
As of this report |
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What are clinical trials?
Clinical trials are research studies that test how well new treatments work for patients. Each study tries to answer scientific questions and to find better ways to prevent, diagnose and treat cancer 1. This indicator looks only at the recruitment for treatment-based clinical trials, and excludes prevention, screening and diagnosis trials.
What's new this year?
This report presents new data for 2008.
What do the results show?
 Figure 1: Percentage of cancer patients treated at cancer centres recruited to treatment-based clinical trials, Ontario, 2004-2008
Clinical trial participation has leveled off or decreased in Ontario
In 2008, about 4,400 cancer patients (10%) were enrolled in treatment-based clinical trials in Ontario’s cancer centres – down almost 1,000 from 2007. With the exception of the Windsor and Grand River (Kitchener) regional cancer centres, which have shown increased enrollment, cancer centres recruited fewer patients to clinical trials. The Princess Margaret Hospital in Toronto continues to lead in recruitment, with 24% of their cancer patients in treatment-based clinical trials (Figure 1).
Trials covered various treatment areas
These clinical trials were conducted in various treatment areas, including surgery, systemic treatment and radiation treatment.
Why is this important to patient care?
Benefits and opportunities for patients
The participation of cancer patients in clinical trials is essential to advancing the science of cancer medicine and improving outcomes for cancer patients 2. Patients who participate in clinical trials stand to benefit from treatments that typically reflect the current best standards, and may also receive psychological benefits from taking part in trials 3. Many cancer patients actively seek the most promising therapies; clinical trials provide some with an opportunity to access emerging treatments 4. It has also been suggested that physicians participating in clinical trials are more likely to apply the result of clinical trial into practice, thereby further enhancing treatment outcomes 5.
How does Ontario compare?
Ontario holding its own against U.S. clinical trial standards
Ontario's participation rate continues to compare favourably with the standards for designated cancer programs set by the American College of Surgeons’ Commission on Cancer. These standards require a minimum clinical trial accrual rate ranging from 4% to 6%, depending on the type of facility – for instance, a community centre versus an academic institution – and on whether or not patients are diagnosed and receiving most of their treatment at the facility 6.
What is being done?
Clinical trial programs rely on funding
Funded by the Ontario Ministry of Research and Innovation, the Ontario Institute for Cancer Research (OICR) has undertaken a comprehensive program to improve the level of participation in cancer clinical trials in Ontario. One component of the program was to provide financial support to Ontario hospitals and cancer treatment centres to expand their programs between 2004 and 2007. In the past year the contracts ended and the decrease in accrual seen in 2008 may be a reflection of less funding since 2007, but other factors may have had an impact as well. While patients may wish to participate in clinical trials, cancer centres may have fewer administrative resources to support robust clinical trial programs. And, for many reasons, the cost and complexity of conducting clinical trials has steadily increased to the point that many centres are reluctant to undertake trials because of the administrative burdens they create. The OICR is planning new initiatives to help cancer centres deal with these problems.
Enhancing public access to trial information
To make information on existing clinical trials in Canada more accessible, the Canadian Institutes of Health Research (CIHR) now requires all CIHR-funded trials to register and post trial information for the public.
Notes
1 National Cancer Insitute. Dictionary of Cancer Terms. Available at: http://www.cancer.gov/templates/db_alpha.aspx?expand=C. Accessed March 14, 2009.
2 Lara PN Jr, Paterniti DA, Chiechi C, Turrell C, Morain C, Horan N, Montell L, Gonzalez J, Davis S, Umutyan A, Martel CL, Gandara DR, Wun T, Beckett LA, Chen MS Jr. Evaluation of factors affecting awareness of and willingness to participate in cancer clinical trials. Journal of Clinical Oncology 2005; 23(36):9282-9.
3 For more information on clinical trials see http://www.cancer.ca/ccs/internet/standard/0,3182,3543_367616__langId-en,00.html.
4 For more information on clinical trials see http://www.cancer.ca/ccs/internet/standard/0,3182,3543_367616__langId-en,00.html.
5 Ellis PM. Attitudes towards and participation in randomised clinical trials in oncology: a review of the literature. Annals of Oncology 2000; 11:939-945.
6 American College of Surgeons. Commission on Cancer Cancer Program Standards 2004. Revised Edition. Available at: http://www.facs.org/cancer/coc/programstandards.html. Accessed June 18, 2008.
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