Given the finite resources for cancer research, understanding the focus of current clinical research efforts and the factors influencing these efforts is important.1 Ideally, research efforts should be focused on maximizing the potential for public good.2 Understanding whether research resources are applied in relation to the quality of current clinical evidence or to societal disease burden is a key step toward their rational distribution.
One measure of the quality of current clinical evidence for a particular cancer type is the quality of the evidentiary base of clinical practice guidelines promulgated by professional societies such as NCCN. A recent analysis found substantial gaps in the quality of evidence guiding clinical decisions for numerous cancer types, because most recommendations in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for the 10 most common cancers are based on evidence rated lower than category 1 (C1).3 Furthermore, quality of evidence, as determined by the proportion of C1 recommendations, varies widely by cancer type. It is unclear whether cancer research efforts are focused in areas of lower evidence quality, in which greater opportunity may exist for discovery, or in areas of greater evidence quality, in which past successes raise additional research questions that are ripe for further study.
In addition to current evidence quality, societal disease burden should ideally guide research efforts.4 Although NIH funding seems to be allocated to diseases that pose a greater burden,5 the relationship between this burden and projected enrollment in cancer randomized clinical trials (RCTs) has never been formally studied. How RCT enrollment from all funders is distributed with respect to societal disease burden and the current quality of evidence is unknown. Therefore, to assess how current cancer research efforts are prioritized, the authors investigated whether planned enrollment in current clinical trials in oncology is distributed among cancer types proportionate to evidence quality and societal burden. Assessment of the current state of clinical trial efforts with regard to these 2 factors is the first step toward optimal allocation of the finite resources available for cancer research.
Drs. Lloyd, Buscariollo, Makarov, and Yu have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors. Dr. Gross has disclosed that he receives a research grant from Medtronic and is on the advisory board for Fair Health Inc.
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