The blockbuster cancer drugs now in use were in clinical trials 10 years ago, and the drugs we may be using in the near future are already benefiting patients in clinical trials today. These clinical trials can deliver life-saving treatment to people that have exhausted their other options, but a study shows patients in rural and remote Canada are rarely included in this research.
Dr. Omar Abdelsalam, a professor in the University of Alberta's Department of Oncology, reviewed data from cancer clinical trials in Canada from 2005 to 2023. His study, now published in the American Journal of Oncology, revealed a significant disparity of access largely determined by where patients live.
"The main finding out of this study is that there is clear disparity, meaning that some centres, mainly the urban centres where big academic hospitals are available, do have lots of cancer clinical trials. But for some areas, for example the three Canadian territories, zero cancer clinical trials have been registered over the best two decades," Abdelsalam said.
Province to province and city to city, the availability of clinical trials varied. While the territories had none, there were 6.79 cancer clinical trials per 10,000 residents in New Brunswick. There were 10 cancer clinical trials for every 10,000 Edmontonians, about 40 per cent more than in Calgary.
Participating in a cancer clinical trial can be demanding, Abdelsalam said. Patients need to come to the hospital frequently for tests and follow ups, and if they need to drive seven hours to get to the cancer hospital, "it's just not practically feasible."
"So the unfortunate endpoint is people who are not close enough to the academic centres would be at a disadvantage in terms of their ability to join. Or else they would have a choice to relocate, to leave their home and relocate into one of the big centres just to be able to access the trial."
Not only does this inequity mean rural people miss out on early access to new treatments, the trials themselves, meant to test and approve drugs for widespread use, are consistently under-representing certain sectors of society.
"I feel like we have as a society developed a tolerance to the situation, which is obviously not a correct thing. Because if you are advocating for equity in health care access, we have to acknowledge that access to clinical trials is part of the access to health care," Abdelsalam said.
Clinical trials could be conducted virtually, connecting clinics in remote areas with research centres and removing geographic barriers. An explanation of why this isn't commonly pursued comes down to who is funding the research, he suggested.
Over two-thirds of the cancer clinical trials in Canada since 2005 reviewed in the study were sponsored by for-profit entities, mainly the pharmaceutical industry. The number of trials being funded by industry has also increased over time, while the investment coming from academia or various levels of government has been shrinking.
"For those for profit entities, they don't care about equity. They don't care about representation. They care about conducting their trials in the cheapest and fastest way possible. And this means that they would simply conduct their trials and recruit patients by convenience," he said.
Government funding for research, on the other hand, could come with stipulations that under represented groups be included or trials be accessible to rural Canadians. However, with public investment in this type of research on the decline, it is unclear whether the political will exists to erase these geographic disparities.
"Investment in cancer biomedical research is an investment worth making. It's not just an academic luxury," Abdelsalam said. "And the fact that certain sectors of the of our country might be at a disadvantage to access these innovative trial medications, I think this is wrong."
