Cancer Clinical Trials Adapted Rapidly During COVID-19 Pandemic Year

Joseph Unger, Ph.D., M.S., Associate Professor, Cancer Prevention Program, Public Health Sciences Division, Fred Hutch

Cancer clinical trial research rapidly adapted to the circumstances of enrolling and treating patients on clinical trials during the COVID-19 pandemic. That’s the conclusion drawn by authors of a study of cancer trial enrollment during 2020 and early 2021.

The study reports on pandemic enrollment to protocols run by the SWOG Cancer Research Network, a cancer clinical trials group funded by the National Cancer Institute (NCI), part of the National Institutes of Health (NIH). The findings are published last week in the medical journal JAMA Network Open.

The researchers found that during the early weeks of the pandemic, from late February through mid-April 2020, registrations to cancer clinical trials dropped precipitously compared to previous years. This drop was followed by an initial recovery period lasting through the summer of 2020; in fact, by the end of the summer, enrollment totals slightly exceeded what would have been expected without the pandemic. Enrollments again dropped during the wave of increasing COVID-19 infections in the winter of 2020 and 2021, but much more modestly compared to the initial wave of the pandemic.

To assess changes in trial registration rates, investigators led by Joseph Unger, PhD, a SWOG health services researcher and biostatistician based at the Fred Hutchinson Cancer Research Center, used interrupted time-series analysis to compare pandemic enrollment rates to expected rates based on data from the four previous years. A total of 29,398 patients were enrolled to SWOG trials from the beginning of 2016 through February 2021. About two-thirds of these enrollments were to treatment trials, with the remaining one-third to cancer control and prevention studies.

Unger explained that early in the pandemic, the NCI and U.S. Food and Drug Administration had provided guidance allowing research sites more flexibility in enrolling and following patients on trials. Key recommendations included allowing remote consent of patients and virtual visits.

During the entire one-year pandemic period measured (March 2020 through February 2021), SWOG trials enrolled 5,344 participants, whereas an estimated 6,913 participants would have been enrolled had the pandemic not occurred. Particularly steep drops in enrollment were seen within cancer control and prevention studies, which registered only 54% of expected enrollments, while enrollment overall to treatment studies was 91% of expected.

“Remarkably, treatment trial enrollment was about the same as expected,” said Unger. “Clearly the steps taken to maintain trial research programs were successful. It really is a testament to the resiliency and resourcefulness of the physicians, nurses, and staffs at the sites.”

However, the researchers conjecture, the maintenance of near-normal overall enrollment levels to treatment trials over the course of the pandemic may have occurred at the expense of support for cancer control and prevention trials, as institutions prioritized resources to conduct trials most directly related to immediate patient care.

“It’s critical for individual patients to be able to continue to choose to receive care on trials if they wish to, even in the face of a pandemic,” added Unger.

Edited by Gary Cramer