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BREAST cancer is overrepresented in clinical trials relative to its disease burden in the community, while lung and colorectal cancers miss out on research, a study published in the latest Medical Journal of Australia has found. (1)
The study has sparked calls for Australia’s research funding to be more closely aligned with the actual cancer disease burden.
Using data extracted from clinical trial registries, the researchers examined the number of trials devoted to studying different types of cancer in Australia. This information was compared with the actual disease burden of each cancer, as measured by disability-adjusted life-years (DALYs).
The researchers identified 368 cancer trials that were recruiting patients in Australia at 31 March 2009. They found that almost 17% of the trials were devoted to studying breast cancer, yet breast cancer accounted for only 12.8% of the DALY disease burden for all cancers. The breast cancer trials also anticipated recruiting the largest number of patients, 74 247, equivalent to 38% of the total sample size for all 368 trials combined.
Cancers that had relatively few clinical trials included lung, colorectal, prostate and pancreatic cancers. Only 7% of trials were in lung cancer, which has the greatest burden of disease; and colorectal cancer, the second biggest disease burden, attracted less than 6% of research.
Professor Graeme Young, a gastroenterologist and co-director of the Flinders Centre for Cancer Prevention and Control, said the study confirmed his hunch that there is a disparity between research attention and disease burden.
Professor Young said research funding needed to correspond more closely to actual disease burden, particularly if rumoured research budget cuts materialised in next month’s federal Budget.
“If cuts do occur then it’s even more crucial to get funds strategically directed to where the need is,” he said.
Professor Young suggested that the National Health and Medical Research Council (NHMRC) could prioritise funding for specific cancers. “The NHMRC needs to take a more strategic view as to where they place the funds, and where they create the incentive for specific cancers,” he said.
He said this would encourage researchers to study the underrepresented cancers. “In my view, researchers go to where they can get the money and not necessarily to where the problems are, and I think this paper proves that,” he said.
Professor Young attributed the disproportionate number of breast cancer trials largely to consumer support for breast cancer research. “The strongest cancer groups are clearly the breast cancer ones, and good luck to them,” he said.
Sue Carrick, director of research investment at the National Breast Cancer Foundation, said the MJA research reflected the success of breast cancer advocacy and support groups.
“I don’t think you could say that breast cancer research is overrepresented, but breast cancer is doing better. There’s absolutely no apology for that,” she said.
Ms Carrick said support groups for other types of cancers could learn from breast cancer’s success. “It’s not about competing with other cancer groups, it’s about sharing our knowledge and strategies to increase research funding across the board,” she said.
The study found that, compared with other cancer types, breast cancer research was more likely to include women with early-stage disease and to be investigating non-drug treatments. Breast cancer trials were also less likely to be sponsored by the pharmaceutical industry.
Studies for any cancer type that were industry funded were more likely to investigate systemic therapies and to recruit patients with advanced disease.
The researchers also searched an international clinical trials registry and found a similar proportion of trials were recruiting for each cancer type as in Australia.
– Sophie McNamara
1. Med J Aust 2011; 194: 387-391
Posted 18 April 2011
This is an important paper showing the discrepancy between bruden of disease and cancers studied in clinical trials.
The discrepancy between research funding and disease burden is more widespread as is the discrepancy between health services and disease burden. See for example the breakdown of NHMRC funding by disease burden on in Figure 11 of the NHMRC research funding 2010 facts book (http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/nh138.pdf) and the AIHW’s latest report on disease burden (http://www.aihw.gov.au/publication-detail/?id=6442467990&libID=6442467988). Some areas of health such as mental health contribute similar disease burden to cancer but receive half the NHMRC funds and that’s only after changes in the last couple of years.
It’s also worth asking whether research funding should match disease burden or whether funding is better spent where it can achieve the best results. A similar arguement about priorities for health spending has been advanced by Mooney, Irwig & Leeder (Mooney G, Irwig L, Leeder S Priority setting in health care: unburdening from the burden of disease. Aust N Z J Public Health. 1997 Dec;21(7):680-1.)
Can we anticipate the results of research? – maybe not and certainly not from a distance. If it is possible to anticipate which research will lead to benefits I can’t think of a better system than peer review with all its warts.
In regard to the paranoid and unhelpful comments of Dr.S on my reference to woman’s health getting the most dollars is a fact of life. I see numerous advertisements on television and in other media requesting continuous donations to the breast cancer cause.
I am yet to see one advertisement to help find a cure for prostate cancer and I maintain that whilst investigation and treatment of colon cancer is important and I support the work of specialists in this field, little has been done for prostate cancer, one of the biggest killers in 50% of the population.
Interesting results. The findings from Flinders are not surprising to those of us who work in cancer care. Good luck to BS and I can understand how your energies were used up in your personal fight against the disease. Unfortunately it would seem that some cancers do not lend themselves to more adequate coverage by the media – they are internal, ‘hidden’ and perhaps seen as just not quite as ‘sexy’ as others. If true, that indeed is a tragedy in itself and perhaps part of the problem. One can’t imagine too many high profile survivors of non-breast malignancy being able to attract potential funding for multi-million dollar comprehensive treatment centres. Also part of the problem is the government not being prepared to adequately commit financially to colo-rectal cancer screening. The reality also is that breast cancer has more hormonal and chemotherapeutic treatments available than some other malignancies, and attracts more medical trials because of this. Ironically, the response of Dr S sounds more emotive and “petulant” than that of the Dr ARC to whom this is directed. “Paranoid sexist assumptions” is definitely over the top in anyone’s language and insulting. A case of rather ‘high sensitivity, limited specificity’ personalised comment it seems to me. I await other posts with interest.
Dr. ARC, this article does indeed mention prostate cancer…read carefully.
“Cancers that had relatively few clinical trials included lung, colorectal, prostate and pancreatic cancers. Only 7% of trials were in lung cancer, which has the greatest burden of disease; and colorectal cancer, the second biggest disease burden, attracted less than 6% of research.”
Petulant references to ‘the females’ regarding disparity of funding in different cancer types are seriously unhelpful. Let’s not forget that the entire history of medical research has been and continues to be predicated on the disease burden of males with females being treated as an exotic variation on ‘the norm’. You only need look at the status of obstetrics/gynaecology to see how really influential ‘the females’ are. Let’s support better and more equitable funding of all cancers, and leave the paranoid sexist assumptions out of it.
There is no question in my mind that breast cancer research and treatment gets more dollars than any other group. Perhaps it is due to the females being more vocal.
No where in this article is the mention of prostate cancer. If ever a cancer needed research and treatment it is this one. We need a positive and early means of diagnosis and a way to differentiate the 25% of prostate cancers that go on to become invasive.
Yes, hats off to the breast cancer advocates.
However, having almost died from a cancer blocking my colon, after 18 months of trying for a diagnosis, I am constantly frustrated at the lack of knowledge across this specialty.
I had to make the hard decision to not sue the two gastroenterologists – though they were eminently sueable – because I needed all my strength to fight for my life. During the time they had been doing the wrong things rather than the right ones it had progressed to Stage 3 – meaning 6 months of chemotherapy and a lifetime of rechecking to make sure it hasn’t come back somewhere and ‘done me in’ anyway.
Could it be that after colon cancer ( and of course lung cancer) we are so ill that we don’t have the strength to push through with consumer groups? And I also found that, though I showed great interest in doing anything I could towards forwarding the cause there was a paucity of interest by the specialists in listening to patients anyway.
I’m just back from delivering two workshops for doctors at a health conference in the US to help them learn how to use better words in better ways to make useful contact with their patients – so someone is listening – and I gather the situation is pretty much the same there.
We need some well intentioned people who aren’t dragged down by colon cancer to push our case. Anyone willing?