Strengthening clinical cancer research in the United Kingdom

Abstract

Background:In 1999, 270 000 cases of cancer were registered in the United Kingdom, placing a large burden on the NHS. Cancer outcome data in 1999 suggested that UK survival rates were poorer than most other European countries. In the same year, a Department of Health review noted that clinical trials accrual was poor (<3.5% of incident cases) and hypothesised that increasing research activity might improve outcomes and reduce the variability of outcomes across England. Thus, the National Cancer Research Network (NCRN) was established to increase participation in cancer clinical research.Methods:The NCRN was established in 2001 to provide a robust infrastructure for cancer clinical research and improvements in patient care. Remit of NCRN is to coordinate, support and deliver cancer clinical research through the provision of research support staff across England. The NCRN works closely with similar networks in Scotland, Wales and the Northern Ireland. A key aim of NCRN is to improve the speed of research and this was also assessed by comparing the speed of study delivery of a subset of cancer studies opening before and after NCRN was established.Results:Patient recruitment increased through NCRN, with almost 32 000 (12% of annual incident cases) cancer patients being recruited each year. Study delivery has improved, with more studies meeting the recruitment target – 74% compared with 39% before NCRN was established.Conclusion:The coordinated approach to cancer clinical research has demonstrated increased accrual, wide participation and successful trial delivery, which should lead to improved outcomes and care.

Optimisation of pharmacy content in clinical cancer research protocols: Experience of the United Kingdom Chemotherapy and Pharmacy Advisory Service

“…The rising number of cancer clinical trials, the more stringent national and international legislation and Good Manufacturing Practice requirements, combined with the increasing demand for pharmacy support, prompted the National Cancer Research Network (NCRN; currently known as National Institute for Health Research Clinical Research Network (NIHR CRN)) to form a standardisation committee in 2003, which evolved into the current Chemotherapy and Pharmacy Advisory Service (CPAS) by the end of 2007. 7,8 It was set up to advise chief investigators, clinical trials units and clinical studies groups on the chemotherapy-and pharmacy-related content of their protocols, in order to maintain and enhance research quality and thereby aid development of high-quality research protocols. The aim was first to involve pharmacists, clinicians, nurses and pharmacy technicians at the early stages of protocol design to address problems with the protocol and underpin the ability of hospital pharmacies to support clinical trials of new and established drugs.…”

Using the Clinical Research Network for psychosocial cancer research: lessons learned from two observational studies

“…Timely accrual to randomised controlled trials and observational studies within the cancer trials portfolio has increased significantly since the NIHR Cancer Research Network was established, rising from <5% of incidence cases in 2001 to >20% in 2010 3. Although the majority of trials within the portfolio are clinical trials of an investigational medicinal product there is interest in developing other types of interventional studies 4. The success of the NIHR Cancer Research Network model for supporting clinical trials in England led to the establishment of a generic Clinical Research Network to provide infrastructure for other clinical groups.…”

The Royal College of Physicians Simms Lecture, 6 December 2011: Clinical research networks and the benefits of intensive healthcare systems

“…Post NCRN, these medians were both on target and 74% of trials recruited to target compared with 30% before the NCRN. 12 A large number of practice-changing randomised trials have been supported through this route (Table 1).…”

“…The delivery of study targets for recruitment in a timely way is an important part of the work of the NCRN and this was studied by Stead et al (Fig 3). 12 Before the establishment of the NCRN, the median recruitment periods exceeded the planned periods and median recruitment numbers were less than targets. Post NCRN, these medians were both on target and 74% of trials recruited to target compared with 30% before the NCRN.…”

“…9 A key component of the support for clinical research in the NHS in the UK has been the development of clinical research networks (CRN). [10][11][12] These were established sequentially in cancer, mental health, dementias and neurodegenerative diseases, diabetes, medicines for children, stroke, primary care and a comprehensive network, and are now collectively referred to in England as the NIHR CRN. In 2010-11, 564,698 people were entered into NIHR CRN portfolio studies, representing more than a doubling of previous documented recruitment; this also means that approximately 1% of the population of England entered trials or studies in each year.…”