Rural Canadians face barriers to accessing cancer clinical trials, study finds

“Clinical trials are an integral part of cancer care. It's not a luxury or add-on," Dr. Omar Abdelsalam says.

Individuals residing in rural or remote areas across Canada experience barriers in accessing potentially life-saving cancer clinical trials, according to a new study from the University of Alberta.

Dr. Omar Abdelsalam, an associate professor in the department of oncology at the U of A, found individuals residing in rural and remote areas experience distance-related barriers to accessing cancer clinical trials. As well, available cancer clinical trials are limited and only target a small fraction of cancers. 

Despite advancements in early diagnosis and treatments, Dr. Abdelsalam said clinical trials are necessary to better understand cancer. Additionally, clinical trials also help develop effective treatments and improve patient quality of life, he said.

“Clinical trials are an integral part of cancer care. It’s not a luxury or add-on,” Dr. Abdelsalam said. “The trials are demanding by nature — they [are] usually conducted in big academic centres. In Canada, big academic centres are in the big urban centres.”

“Canada is a big country. It can provide challenges in terms of delivering health care,” he added.

Number of available cancer trials vary greatly across Canada, Dr. Abdelsalam says

To conduct the study, Dr. Abdelsalam reviewed data pertaining to Canadian cancer clinical trials recorded from 2005-23 in the database He tried to find where clinical trials are and aren’t available.

“[And], whether there is a proportionality between the availability of clinical trials and the population of a certain province, territory, or jurisdiction,” Dr. Abdelsalam said.

He found the number of cancer trials varied greatly across Canada. New Brunswick had 6.79 per 10,000 individuals, while Nunavut, the Yukon, and the Northwest Territories had zero. Vancouver had the highest number at 14.66 per 10,000 individuals. Edmonton had just over 10 per 10,000 people.

“The three Canadian territories have zero clinical trials registered over the past two decades. Compared to plenty of clinical trials registered in big academic centres in Vancouver, Toronto, Edmonton, [and] Calgary.”

For Dr. Abdelsalam, this was an unfortunate, yet expected, result. Clinical trials require individuals living with cancer to visit “[an] academic centre on a very frequent basis,” he said.

“If a person is living six or eight hours from an academic centre, it can be very challenging to expect them to come every week.”

Non-profit involvement “has been shrinking relative to the involvement of the for-profit sector”

Funding sources also complicate accessing cancer clinical trials, according to Dr. Abdelsalam.

“Over time, the involvement of the non-profit [sector] — which is mainly the government — has been shrinking relative to the involvement of the for-profit sector.”

While for-profit funding is valuable, Dr. Abdelsalam thinks the for-profit sector emphasizes convenience and efficient product development over equitable access to cancer clinical trials.

According to the study, presently, more than two-thirds of the funding comes from the pharmaceutical industry. “This contributes to the disparity gap. Private sponsors [usually] recruit patients from [areas] such as Toronto, Edmonton, or Vancouver,” Dr. Abdelsalam said.

Dr. Abdelsalam thinks that non-profit entities like the government should step up to fund research with “clear conditions.” This includes only providing funding to researchers who will do their best to represent underrepresented communities.

Health Canada should address disparities in access to clinical trials, Dr. Abdelsalam says

In terms of addressing disparities in accessing cancer clinical trials, Dr. Abdelsalam puts the responsibility on regulatory bodies such as Health Canada and the government sector.

According to Dr. Abdelsalam, the purpose of conducting a trial is to test the effectiveness of a drug or intervention. Prior to approving medications, Health Canada should ask investigators to prove that their study represented the different scopes of the Canadian community, Dr. Abdelsalam said.

“If you are systematically underrepresenting certain communities, then how can you be sure that this particular medicine is working for them?”

Dr. Abdelsalam further highlighted the importance of innovating the method through which clinical trials are conducted. He mentioned that during the COVID-19 pandemic, clinicians learned that some elements of health care can be delivered virtually. Dr. Abdelsalam thinks this could be an option for some elements of clinical trials.

For Dr. Abdelsalam, reducing barriers to accessing cancer clinical trials begins with recognizing the issue.

“I’m afraid that we have developed tolerance or sort of complacency. We stopped trying to solve this apparent problem and accepted this as a fact of life.”

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