The number of cancer patients entering clinical trials has plummeted during the pandemic – denying many thousands the latest treatment options and delaying the development of cutting-edge drugs and technologies. 

New figures show recruitment to cancer trials fell by nearly 60% during the first year of the pandemic, amid warnings that Covid-19 has compounded longstanding issues with trial funding, regulation and access.

Cancer experts set out a series of findings today (Thursday) 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.

Expanding trial access

The Institute of Cancer Research, London, is publishing a report collating data on cancer trials, and the views of patients and clinicians on how we can overcome barriers to making trials more widely available. The reduction in clinical trial access is set to continue as we head into a challenging winter for the NHS with Covid-19 rates still high and expected surges in other infectious diseases such as Flu and RSV. The Institute of Cancer Research (ICR) 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.

Trial recruitment fell by 60%

Figures obtained from the National Institute for Health Research (NIHR) 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.

Series of barriers

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 survey of 500 people who had been treated for cancer, which was carried out in March 2020. 

Unequal trial access

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 one in ten (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.

A call for investment 

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 entry.
• 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.

From breakthroughs to benefits

Professor Nick James, Professor of Prostate and Bladder Cancer Research at The Institute of Cancer Research, London said:“Clinical trials are the single best way to turn advances in science into patient benefits. But trial recruitment has plummeted during the pandemic, slowing the pipeline of new treatments and robbing people with cancer access to potentially life-saving medicines. “We need urgent investment in the Covid-19 recovery of clinical trials, and to get funding to those centres that at the moment are struggling to support clinical research. We also need to learn the lessons from Covid-19. It’s clear that bureaucracy and regulatory barriers for clinical trials often do more harm than good – hindering our progress in developing the next game-changing cancer treatments.”

Make up for lost time

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 lost time.”  

Level up trial access

Professor Christina Yap, Professor of Clinical Trials Biostatistics at The Institute of Cancer Research, London said:“There is no shortage of patients who want to take part in clinical trials, but too many people go through their treatment unaware that there is a trial that could benefit them. Information about available trials is currently uncoordinated, difficult to understand and not always up to date. If we don’t adequately resource accessible information for patients and their doctors, we will continue to see deprived populations and ethnic minorities under-represented in clinical trials, with inadequate access to the latest treatments.”

A trial for every patient

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 Covid-19 clinical research recovery, 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.”