Clinical Trials Need an Overhaul to Expand Access and Improve Results

If you’ve read my reporting over the years, you probably know that I’m a huge fan of participating in research studies. It’s a wonderful way to contribute to scientific knowledge and discovery — and to improve healthcare for future generations.

But there’s also a way to participate in research with the potential to improve your own healthcare, and that’s through clinical trials. We tend to think of clinical trials as a last-resort option for the most critically ill patients — advanced cancer springs to mind — but these kinds of studies are available in many more situations. Virtually every item you see in a doctor’s office or a hospital has been through some kind of clinical trial, and the fact that each of those items is there to help you means that some group of people took part in a study to bring it into clinical use.

At this year’s meeting of the American Association for Cancer Research, scientists talked about the need to make clinical trials more accessible so they’re easier for people to understand and participate in. That means expanding trials beyond the major academic medical centers that usually run them — and even finding ways to let people take part from home.

The National Cancer Institute has run pilot studies to evaluate the utility of virtual clinical trials, and it turns out these perform well in expanding access to more patients. According to Shaalan Beg, who advises NCI on clinical research, a study for colorectal cancer that implemented a direct-to-patient recruitment model enrolled participants from a much broader area than standard clinical trials. (They measured this by counting participant ZIP codes; the study spanned four times as many ZIP codes as an average clinical trial.) With a decentralized approach, more people could benefit from these valuable studies.

Another NCI-funded clinical trial was the first to allow the use of telemedicine, which reduced the number of required trips to a medical center for each participant. This makes it easier for people to take part in the study and increases access for people who can’t easily travel to the clinical site. Future clinical trials should be designed with a priority for virtual participation, requiring a site visit only when absolutely necessary, Beg said. That means relying on technology that allows participants to collect their own samples (such as blood, urine, or stool) and mail them to researchers. The goal is to “develop a clinical trial site that really has no borders,” Beg added.

Scientists also pointed to the need to communicate better with patients about enrolling in clinical studies, focusing on what they stand to gain. After all, a clinical trial can be onerous for participants; at the very least, there’s a need to test and report results more often than usual. Researchers have to find better ways of explaining how trials work, how patients could benefit, and what happens if they enroll in a trial but are assigned to the control arm that doesn’t get the new treatment. That was the upshot of a talk from Robert Winn of Virginia Commonwealth University, who said, “The defect is in us for failing to explain.”

If you’re interested in browsing clinical trials to see if there’s anything you might participate in, start at clinicaltrials.gov.

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