NCI-funded clinical trials add 14.2M life-years for patients with cancer over 4 decades
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Clinical trials performed within the NCI’s National Clinical Trials Network during the past 40 years prolonged the lives of patients with cancer by at least 14.2 million life-years, according to a study in Journal of Clinical Oncology.
The findings additionally showed the costs of life-years gained to be modest, with approximately $326 in federal investment for each life-year added.
Background and methods
The combined effect of all adult NCI National Cancer Clinical Trials Network groups had never been systematically examined.
For this reason, Joseph M. Unger, PhD, SWOG Cancer Research Network health services researcher and biostatistician at Fred Hutchinson Cancer Research Center, and colleagues pooled data from 162 randomized phase 3 trials published between 1980 and 2020 that included 108,334 patients from the adult National Clinical Trials Network groups. The trials, which represented 29.8% of those conducted during the period, each had statistically significant data for one or more clinical time-dependent outcomes.
Researchers used the national cancer registry and life table data to evaluate OS benefits. They based scientific impact on citation data from Google Scholar and estimated federal investment costs per life-year gained.
Findings
The most common cancer types studied in the clinical trials included breast cancer (n = 34), gynecologic cancer (n = 28) and lung cancer (n = 14). Researchers identified 165,336 citations of clinical trials, for a mean 62.2 citations per trial per year, and most (87.7%) had been cited in cancer care guidelines in favor of the recommended treatment.
Researchers estimated the clinical trials generated 14.2 million (95% CI, 11.5-16.5) additional life-years for patients with cancer, with projected gains of 24.1 million (95% CI, 19.7-28.2) life-years by 2030. They additionally estimated a federal investment cost per life-year gained through 2020 of $326.
Limitations of the study included the likely conservative estimate of life-years gained due to the lack of assessment of the impact of negative trials, and the fact that impact metrics did not fully reflect the potential benefits of positive noninferiority or equivalency trials that benefit patients in terms of reduced toxicity, more convenient care delivery and/or reduced costs without clinically meaningful reductions in outcomes, according to the researchers.
Implications
The findings provide a clear statement about the impact of publicly funded cancer research, Unger said in a press release.
“When we discuss investments in infrastructure, it’s important to also consider scientific infrastructure,” Unger told Healio. “In the U.S., the NCI-sponsored network groups have been a vital element of the scientific infrastructure of clinical research for decades and have returned incredible value to cancer patients and to the U.S. taxpayer.”
Other substantial contributions the trials have accomplished are harder to measure, he added.
“For instance, negative trials are critical for showing what treatments should not be used, and federally sponsored research groups also provide critical opportunities to mentor new generations of clinical researchers,” Unger said. “For patients, these trials routinely provide access to treatments for underserved patient populations that may not be as accessible in industry-sponsored trials.”
References:
- Four decades of NCI-funded NCTN trials: 14.2 million life-years, at $326 per year (press release). Available at: www.eurekalert.org/news-releases/974917. Published Dec. 19, 2022. Accessed Dec. 27, 2022.
- Unger JM, et al. J Clin Oncol. 2022;doi:10.1200/JCO.22.01826.
For more information:
Joseph M. Unger, PhD, can be reached at junger@fredhutch.org.
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