Clinical Trials in Cancer: A Key to Rising Survivorship

Every three years the American Cancer Society (ACS), in collaboration with the National Cancer Institute, creates a report on U.S. cancer survivorship. The latest report (2019) estimates that there are 16.9 million cancer survivors alive in the United States and further estimates there will be 22.1 million by 2030. “Survivors” include everyone who has had cancer, from the date of diagnosis until the end of their life (Miller, et al., 2019).

Even though cancer rates among males are declining and those among women are staying stable, survivorship numbers keep rising for a number of reasons. These include growth and aging of the population, but also early detection that can catch cancer when it is less complicated to treat, and better treatments. At the time of the 2019 ACS report on cancer survivorship, co-author Robin Yabroff, PhD, senior scientific director of Health Services Research at the American Cancer Society, stated: “Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.”

Clinical trials are key among those critical evidence-based resources she is referring to. However, though cancer clinical trials are crucial for advancing innovative new treatments for patients, gaining participation can be a challenge. According to the American Cancer Society’s Cancer Action Network, approximately 20 percent of cancer clinical trials fail because of insufficient enrollment (American Cancer Society, 2019). There are many reasons people consider cancer clinical trials, but most of them choose to do so because they have been diagnosed with some form of cancer. There are differences in cancer clinical trials from most other clinical trials, so let’s look at some of those distinctions.

Cancer Studies: Not Your Typical Clinical Trial

First, when considering participation in a cancer clinical trial it is important to not confuse clinical trial phases with cancer stages. These are two very different concepts. Clinical trial phases, which are covered in detail in our article in The Guide titled, “Clinical Trial Phases and Safety,” are designed to build on one another and answer different questions about a new drug or treatment. Cancer stages, on the other hand, describe how much cancer there is and how far it has spread in the body.

Cancer clinical trials differ from other trials that people may be familiar with. For example, when researchers were trying to develop coronavirus vaccines during the pandemic, they were studying the safety and efficacy of a certain formula (potential vaccine) in guarding against infection and severity of the illness. In these trials they tested it with a large group of people who received the potential vaccine and compared it with another group of people who did not receive it. In cancer clinical trials the goal many times is to extend a person’s life or improve their quality of life.

In many clinical trials, as we explain in our article in The Guide titled, “Clinical Trial Statistics and Randomization,” it is common for subjects to be divided into two branches of the study: one in which subjects receive the new experimental product, and another in which subjects receive a placebo, which is an inert product, as was done in the coronavirus trials. In cancer trials, especially in treatment trials, subjects are typically all diagnosed patients, so placebos are never used in place of an already approved standard treatment when one is available. If a placebo is given in a cancer trial, it is administered in conjunction with other standard treatments.

Exploring the Types of Cancer Trials

According to the National Cancer Institute, there are several major types of cancer trials: prevention, screening, supportive and palliative care, and natural history studies (National Cancer Institute, 2020). The following is a brief explanation of each:

Treatment trials. The majority of clinical trials related to cancer are in this category and involve patients who have been diagnosed with various cancers. These trials test new treatments or modifications to existing treatments, which may involve studies of surgery, radiation therapy, drugs, vaccines, and combinations of two or more treatments. These trials study whether certain treatments help people with cancer live longer and/or prevent cancer from recurring after treatment. They also help determine proper dosages and applications of treatments, what potential side effects might be and how those side effects impact a patient’s quality of life.

Prevention trials. These trials generally involve people who have not been diagnosed with cancer but are at high risk for developing it, or people who have had cancer and are at high risk for developing cancer again. Prevention trials consist mainly of two types of studies: Action studies, which try to determine if doing something, like making lifestyle and/or diet changes can help prevent the cancer from occurring or recurring. Agent studies or chemoprevention studies, which test drugs or nutritional supplements for their value in lowering cancer risk.

Screening trials. In  screening trials, researchers try to find methods for discovering cancer in patients early, preferably before people have symptoms, and whether being able to do so saves lives for certain types of cancers.

Supportive care and palliative care studies. These studies, like treatment studies, are conducted with cancer patients. They focus mainly on finding ways to improve the quality of life for people living with cancer, helping them to deal with the side effects (physical, psychological, and social) of the disease and its treatments.

Natural history studies. These are long-term studies of people with cancer or at high risk of developing it. They often focus on people with family histories of cancer and genetic factors of cancer prevalence, and they seek answers to drive innovation in both treatment and prevention.

If you are considering joining a cancer clinical trial, it is important that you take time to inform yourself about what options are available to you and to discuss them with people in your circle of support. A good place to start is by contacting some of the advocacy resources at our “Cancer Advocacy Groups” page, which contains numerous resources for cancer in general and for specific types of cancer.

References
American Cancer Society (2019). Cancer Treatment & Survivorship Facts & Figures 2019-2021. Atlanta: American Cancer Society. https://www.cancer.org/research/cancer-facts-statistics/survivor-facts-figures.html

Miller, K. D., Nogueira, L., Mariotto A. B., Rowland, J. H., Yabroff, K. R., Alfano, C. M., Jemal, A., Kramer, J. L., & Siegel, R. L. (2019). Cancer treatment and survivorship statistics. CA: Cancer J Clin, 69(5) 363-385. https://doi.org/10.3322/caac.21565

National Cancer Institute. (2020, February 27). Types of clinical trials. National Institutes of Health. https://www.cancer.gov/about-cancer/treatment/clinical-trials/what-are-trials/types

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