International Clinical Trials Day – Increasing Cancer Clinical Trial Capacity in Wales
Every year on 20th May, the global clinical research community comes together to celebrate International Clinical Trials Day. This date marks the anniversary of the first ever randomised clinical trial, designed and conducted by Royal Navy surgeon James Lind in 1747, who investigated treatments for scurvy in British sailors.
International Clinical Trials Day represents an opportunity to raise awareness of this important area of medicine and to honour the clinical researchers and patient participants across the globe who work to deliver these life-saving studies.
The theme for this year is Decentralised Clinical Trials: Challenges and Opportunities.
The theme is very timely as the Wales Cancer Network has recently held a cancer clinical trials day and in this blog we will look at some of the challenges and opportunities highlighted at that event.
The Covid-19 pandemic caused great disruption to cancer pathways across Wales, which virtually stopped new cancer clinical trials being opened and severely affected patient recruitment for ongoing trials. While cancer clinical trials have now reopened, patient recruitment continues to remain slow, with the numbers of patients enrolling still lagging behind pre-pandemic levels. This situation is replicated across much of the UK and there is significant work to be done to make Wales (and the wider UK) the centre of excellence for clinical trials that it should be.
Embedding Research into the Heart of the Welsh NHS
Repeated studies have demonstrated that the more research takes place within a hospital or Health Board, the better the outcomes for their patients. It has been demonstrated that cancer survival in Wales could be improved by around 4% if our health care system increased its clinical research activity. Given nearly 9000 people sadly pass away from cancer each year in Wales, such an improvement could save the lives of over 350 people annually.
Latest figures show that only one in five cancer patients are offered the chance to take part in research in Wales. Healthcare systems across the UK are under immense pressure as they struggle to clear the backlog of patients that resulted from the pandemic, as well as coping with the influx of new patients. In this type of environment research is usually the first thing to be sacrificed, as it is often considered an optional add-on rather an integral part of delivering a high-quality service for patients.
Currently, Cancer Research Wales are funding four clinical trials across Wales. These cover diverse areas including reducing the side effects of radiotherapy treatments for head and neck cancer, preventing the relapse of bowel cancer, new methods for bowel cancer screening and an intervention to increase the accuracy and speed of suspected cancer diagnoses in primary care.
Embedding research into the heart of the NHS in Wales is one of the key strategic aims of Cancer Research Wales. We believe that when research is at the core of cancer service delivery, continual incremental improvements in patient outcomes will follow, helping to increase the flexibility and resilience of cancer pathways. This will ultimately serve to reduce waiting lists more quickly, as well as offering patients the very latest treatments and interventions that research provides.
Making Wales More Attractive for Clinical Trials
To increase the number of Welsh patients that participate in cancer trials, the Welsh NHS needs more resources, to be less restrictive and to make itself more attractive so that Welsh cancer centres are targeted as potential recruitment centres for industrial and academic clinical trials.
Barriers that prevent the efficient delivery of clinical trials continue to emerge. A recent example from West Wales highlighted the extent of the issues: breast cancer patients in one Health Board were prevented from participating in a clinical trial hosted by the neighbouring Health Board, due to a failure to agree cross-border contracts.
Clinical cancer studies are by nature very resource intensive and the present Welsh funding model for recruitment of patients into cancer trials does not reflect this, leading to many centres declining to open such studies. Due to these capacity and resource issues, it is not always easy for patients to transfer across health board boundaries to enter clinical trials, leading to the loss of opportunities for individual patients and Wales being seen as a less attractive place to undertake clinical trials.
It is well-known that the NHS across the UK is suffering from a staffing crisis. This has a knock-on effect for conducting clinical research as clinicians and nurses are pressured for time, with many competing priorities. In Wales, this has resulted in clinical trials having to recruit patients from outside of Wales to ensure sufficient numbers are recruited, with Welsh staff unable to dedicate enough time to complete the trial.
Failure to hit patient recruitment targets for a clinical trial is detrimental for the prospect of future clinical trials being opened in Wales, particularly for trials funded by pharmaceutical companies who need to minimise the risks to their investment. The result is that Welsh cancer patients suffer as they miss out on new cancer treatments and technologies. Wales needs to make provision for more protected research time for research nurses and clinicians if it is to increase clinical research capacity and ensure patients can be recruited in sufficient numbers to deliver clinical trials.
At Cancer Research Wales, we believe that a research-intensive environment will help to recruit and retain the very best clinical staff to Wales, as opportunities are provided for them to participate in ground-breaking medical science using the very latest technologies and therapies.
Where appropriate, protected research time for clinical staff should be made a priority. While it is appreciated not all clinical staff will have an interest in research, their allocated time could be transferred to others, in a similar manner to carbon credits that are traded to offset carbon emissions. This will help ensure that all normal clinical duties are responsibly covered while maximising the opportunities for research by ensuring those who want to undertake clinical trials feel supported to do so.
Working to Together to Provide the Best for Patients and NHS Staff Across Wales
What the recent Wales Cancer Network cancer clinical trials day highlighted was that despite the challenges, great opportunities do exist. By bringing together stakeholders including the Wales Cancer Network, Welsh Government, NHS, Industry and the Third Sector, we can make clinical research the catalyst for change and improvement within our health care systems in Wales, as it always should be.
The patients across Wales and all the hard working and dedicated staff within the Welsh NHS deserve nothing less. At Cancer Research Wales, we will strive to play our part in helping to create a better future for cancer patients in Wales by supporting the very best researchers and clinicians to deliver world class research.