Cancer research: Clinical trials
What are cancer clinical trials?
Clinical trials are research studies that test new approaches to cancer care. They can be used to test new cancer treatments or other ways of improving cancer care. They compare the new treatment to the best available current treatments.
Why are they important?
Clinical trials are an important way to support the development of new cancer treatments and improve cancer care.
Increasing the number of relevant cancer clinical trials taking place in NSW means that individual patients have more treatment choices. Clinical trials also provide additional treatment options and may provide access to new treatments before they are widely available. There is also evidence that, when hospitals are involved in research, this can improve their processes of care and health outcomes for all patients.[69–72]
Where do trials take place?
Cancer clinical trials are being conducted in hospitals and cancer centres across most local health districts (LHDs) in NSW.
People with cancer in NSW can take part in a trial that is suitable for them, even if it is being conducted in a different LHD from where they live.
Some clinical trials may have very small numbers of people enrolled – for example, trials that focus on rare cancers. Clinical trials are expensive to set up, so it is important for hospitals and cancer centres to review trials that are not enrolling people and have been open for a long time.
Who pays for them?
Commercially sponsored clinical trials are funded by pharmaceutical companies.
Non‑commercial clinical trials designed by cancer researchers and clinicians are funded from a variety of sources, including government or non‑government organisations. The Cancer Institute NSW supports non‑commercial trials, which it defines as ‘portfolio trials’.
Overall key findings:
- In NSW, the number of cancer clinical trials open for people with cancer to join continues to increase.
- Overall, in NSW, there are six enrolments in cancer clinical trials for every 100 people newly diagnosed with cancer.
- Bowel and neurological cancers have the highest ratio of participant enrolments in clinical trials to newly diagnosed cancer cases.
- There is a lower participation rate in cancer clinical trials that the Cancer Institute NSW supports among patients in the lower socio‑economic areas of NSW.
Ratio of cancer clinical trial enrolments to cancer incidence (per 100 cases), by local health district (LHD) (ranked), NSW, 2017–18 and 2018–19
Key findings:
- For every 100 people diagnosed with cancer in NSW, there were six enrolments in a cancer clinical trial in 2018–19.
- Cancer clinical trial enrolment ratios ranged from 1 to 18 across LHDs, in 2018–19.
N= Number of incident cancer cases in 2016.
Notes:
1. Data sources: Cancer Institute NSW Clinical Trials Portal (enrolments) and NSW Cancer Registry (incident cases).
2. Cancer incidence is determined by the LHD of residence, while clinical trial enrolments are derived from the LHD where the clinical trial is conducted.
3. The ratio is derived from the number of enrolments into cancer clinical trials divided by the number of incident cancer cases in 2016 by LHD. It has been multiplied by 100 to give the ratio per 100 incident cancer cases.
4. Northern Sydney LHD enrolments includes private institutions that are external to the LHD structure including: Melanoma Institute Australia, Northern Cancer Institute, The Mater Hospital North Sydney, and San Clinical Trials unit.
5. The NSW total includes private institutions that are external to the LHD structure, St Vincent's Health Network, and the Sydney Children's Hospitals Network.
Ratio of cancer clinical trial enrolments to cancer incidence (per 100 cases), by clinical group (ranked), NSW, 2017–18 and 2018–19
Key finding:
- Bowel and neurological cancers have the highest ratio of participant enrolments in clinical trials to newly diagnosed cancer cases.
N= Number of incident cancer cases in 2016.
Notes:
1. Data sources: Cancer Institute NSW Clinical Trials Portal (enrolments) and NSW Cancer Registry (incident cases).
2. The ratio is derived from the number of enrolments in cancer clinical trials divided by the number of incident cancer cases in 2016 by clinical group. It has been multiplied by 100 to give the ratio per 100 incident cancer cases.
3. Any cancer: Enrolments in trials where the inclusion criteria is not specific to any one cancer type , divided by the total number of incident cancers in NSW.
4. Any solid tumour: Enrolments in trials where a participant can have any solid tumours (e.g. breast, lung or bowel) not defined by a single clinical group, divided by the number of incident cancers in NSW excluding lymphohaematopoietic.
Cancer clinical trials open for recruitment, by trial category, NSW, 2016–17, 2017–18 and 2018–19
Key findings:
- In NSW, the number of cancer clinical trials open for people with cancer to join continues to increase.
- NSW is attracting more commercial cancer clinical trials funded by pharmaceutical companies.
- One-third of the trials are non‑commercial trials designed by cancer researchers and clinicians, and funded by government or non‑government organisations. The Cancer Institute NSW supports non‑commercial trials, which it defines as portfolio trials.
Notes:
1. Data source: Cancer Institute NSW Clinical Trials Portal.
2. Trials open at multiple clinical trial units or local health districts in NSW are counted only once.
3. Portfolio trials are investigator-initiated cancer clinical trials that meet the Cancer Institute NSW portfolio criteria and are eligible for funding. For more information, see: https://www.cancer.nsw.gov.au/data-research/clinical-trials/clinical-trial-program-overview.
4. Non-portfolio trials are investigator-initiated cancer clinical trials that do not meet the Cancer Institute NSW portfolio criteria.
5. Commercial trials are those that are funded by, and for which these data are owned by, pharmaceutical and biotechnology companies.
Cancer clinical trials open for recruitment, by trial category, by local health district (LHD) and specialty health network (ranked), NSW, 2018–19 FY
Key findings:
- In the 2018–19, there were differences in the number of cancer clinical trials open for recruitment between NSW LHDs and specialty health networks.
- The number of cancer clinical trials open for recruitment for portfolio trials ranged from 9 to 60, in 2018–19.
Notes:
1. Data source: Cancer Institute NSW Clinical Trials Portal.
2. Trials open at multiple clinical trial units or local health districts in NSW are counted only once.
3. Portfolio trials are investigator-initiated cancer clinical trials that meet the Cancer Institute NSW portfolio criteria and are eligible for funding. For more information, see: https://www.cancer.nsw.gov.au/data-research/clinical-trials/clinical-trial-program-overview.
4. Non-portfolio trials are investigator-initiated cancer clinical trials that do not meet the Cancer Institute NSW portfolio criteria.
5.Commercial trials are those that are funded by, and for which these data are owned by, pharmaceutical and bi otechnology companies.
Enrolments in interventional cancer clinical trials, by trial category, NSW, 2016–17, 2017–18 and 2018–19
Key finding:
- The number of enrolments in cancer clinical trials testing a drug, device or other intervention has remained similar over the past three reporting periods.
Notes:
1. Data source: Cancer Institute NSW Clinical Trials Portal.
2. An individual with cancer may be enrolled in more than one cancer clinical trial and will be counted for every enrolment.
3. Interventional trials are those where the trial is testing a drug, radiation, device, surgery or procedure.
4. Portfolio trials are investigator-initiated cancer clinical trials that meet the Cancer Institute NSW portfolio criteria and are eligible for funding. For more information, see: https://www.cancer.nsw.gov.au/data-research/clinical-trials/clinical-trial-program-overview.
5. Non-portfolio trials are investigator-initiated cancer clinical trials that do not meet the Cancer Institute NSW portfolio criteria.
6. Commercial trials are those that are funded by, and for which these data are owned by, pharmaceutical and biotechnology companies.
Enrolments in cancer clinical trials, by trial category, by local health district (LHD) and specialty health network (ranked by trial volume), NSW, 2018–19 FY
Key finding:
- There were differences in the number of enrolments in cancer clinical trials among local health districts (LHDs). Sydney LHD reported the highest number (N=365) of enrolments for portfolio trials in 2018–19, which represented 70% of its total clinical trial enrolments.
Notes:
1. Data source: Cancer Institute NSW Clinical Trials Portal.
2. An individual with cancer may be enrolled in more than one cancer clinical trial and will be counted for every enrolment.
3. Interventional trials are those where the trial is testing a drug, radiation, device, surgery or procedure.
4.Portfolio trials are investigator-initiated cancer clinical trials that meet the Cancer Institute NSW portfolio criteria and are eligible for funding. For more information, see: https://www.cancer.nsw.gov.au/data-research/clinical-trials/clinical-trial-program-overview.
5. Non-portfolio trials are investigator-initiated cancer clinical trials that do not meet the Cancer Institute NSW portfolio criteria.
6. Commercial trials are those that are funded by, and for which these data are owned by, pharmaceutical and biotechnology companies.
Ratio of portfolio* cancer clinical trial enrolments to cancer incidence (per 100 cases) in NSW, by age group and gender, 2018–19 FY
Key findings:
- In the 2018–19, for every 100 males in NSW diagnosed with cancer under the age of 14, there were 12 enrolments in a cancer clinical trial supported by the Cancer Institute NSW.
- People diagnosed with cancer in NSW under the age of 24 had the highest participation rate in trials supported by the Cancer Institute NSW.
N= Number of enrolments in portfolio cancer clinical trials.
* Portfolio trials are investigator-initiated trials and form a subgroup of the enrolments on previous slide.
Notes:
1. Data sources: Cancer Institute NSW Clinical Trials Portal (enrolments) and NSW Cancer Registry (incident cases).
2. Portfolio trials are investigator-initiated cancer clinical trials that meet the Cancer Institute NSW portfolio criteria and are eligible for funding. For more information, see: https://www.cancer.nsw.gov.au/data-research/clinical-trials/clinical-trial-program-overview.
3. The ratio is derived from the number of enrolments in portfolio clinical trials in 2018–19 FY divided by the number of incident cancer cases in 2016 by age and gender. It is multiplied by 100 to give the ratio per 100 incident cancer cases.
Enrolments in NSW portfolio cancer clinical trials, by socioeconomic disadvantage, 2018–19 FY
Key finding:
- There is a lower participation rate in cancer clinical trials that the Cancer Institute NSW supports among patients in the most deprived areas of NSW.
N= Number of enrolments in portfolio cancer clinical trials.
Notes:
1. Data sources: Cancer Institute NSW Clinical Trials Portal (enrolments) and Australian Bureau of Statistics Socio–Economic Indexes for Areas (SEIFA) 2016.
2. Quintiles within Australia of the area-based Index of Relative Socio–economic Disadvantage (IRSD).
3. 12 of the 1,499 enrolments into portfolio trials in 2018–19 were excluded from the graph above due to being unable to map to IRSD or missing demographic information.
4. An interpreter was required to assist 38 of the 1,478 enrolments in portfolio trials in 2018–19.
Proportion of cancer clinical trials open for recruitment for more than 180 days with nil recruitment, by local health district (LHD) and specialty health network (ranked), NSW, 2017–18 and 2018–19
Key findings:
- Within each NSW LHD and specialty health network, a number of cancer clinical trials have been open for six months or more without any people enrolling to take part. The proportion of these differs among LHDs, ranging from 0% to 43%.
- The reasons for this can vary. Some trials may be for rare cancers, so the numbers of people who can take part are low.
- LHDs and specialty health networks need to investigate why trials are not enrolling people to determine whether they should continue at that site.
N= Number of cancer clinical trials open for recruitment in 2018–19 that had been open for at least 180 days.
Notes:
1. Data source: Cancer Institute NSW Clinical Trials Portal.
2. The LHD, specialty health network or private institution is based on where the clinical trial is conducted.
3. The proportion is derived from the number of cancer clinical trials open for at least 180 days that had not enrolled a participant in the LHD, divided by the total number of trials open for recruitment for more than 180 days during the report period. This fraction is multiplied by 100 to give the proportion.
Why are different time periods and dates reported?
Cancer information is collected from many different sources, so it takes time to review and analyse the data. Different pieces of information may be collected over different time periods, or reported at different times. This means not all the measures reported here have the same dates.
The information presented is the most recent available for each measure at the time this report was written.
Why are confidence intervals reported here?
Confidence intervals are included when a small sample is used to represent the overall population, because there is a chance of an error due to this scaling.
In this report, a 95% confidence interval is presented only on charts where a sample of the population is used. This interval can be thought of as a margin of error.
The larger the sample size, the smaller the confidence interval range. The smaller the sample size, the larger the confidence interval range.
