Cancer research investment across the world does not seem proportionate to the actual disease burden. Several cancers with a high burden of disease are not receiving the clinical trial investment they require, according to a University of Sydney study published in the Medical Journal of Australia.
"Four of the five cancers that result in the greatest burden of disease had relatively few clinical trials: lung, colorectal, prostate and pancreatic cancers," said Dr Rachel Dear, a medical oncologist and PhD candidate at the University of Sydney.
Disease burden is the impact of a health problem in an area measured by financial cost, mortality, morbidity, or other indicators. It is often quantified in terms of quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs), which combine the burden due to both death and morbidity into one index. This allows for the comparison of the disease burden due to various risk factors or diseases. It also makes it possible to predict the possible impact of health interventions.
Dr Dear and her coauthors explored the association between cancer clinical trial activity, burden of disease and sponsorship sources.
"We found that the number of trials for each cancer type did not always match the burden of disease caused by that cancer, thereby identifying gaps in cancer trials research," Dr Dear said.
Of 386 interventional cancer trials open to recruitment in Australia, breast cancer accounted for 62 trials. Yet only 24 trials were being conducted on lung cancer, despite it being responsible for the greatest burden of disease.
Dr Dear found that industry sponsorship is more likely for randomised controlled trials that investigate systemic therapies (drugs or biological agents) for patients with advanced cancers.
"Clinical trial registries are a largely untapped resource to describe the clinical research landscape and guide future trial activity," she said.
In an accompanying editorial, Professor Ian Olver of the Cancer Council Australia, said the study reflected the international situation, where investment in trials for specific cancer types does not correlate with the disease burden caused by those cancers.
Data from clinical trial registries have many applications. Clinicians and patients can search for trial options for specific conditions when standard treatments have been exhausted, or where no effective treatment exists, Professor Olver said.
"Data from clinical trial registries should be used to monitor the progress of such efforts to ensure Australia has a robust clinical trial capability."