The pandemic has had a significant impact on research in the area of oncology. So much so that, in a way, it has accelerated pending reforms in the design of cancer clinical trials. This is explained by a study by a group from the American Society of Clinical Oncology (ASCO), in which experts from our country have participated, such as Jesús García-Foncillas, Javier de Castro, Víctor Moreno, Begoña de las Heras and Javier Cortés.
The starting point is greater use of technology. Remote consultations have so far been limited in scope, although they have been available for a long time. “Among other things, due to the lack of access in some countries, or due to privacy issues,” says the report.
According to these authors, throughout the COVID-19 crisis, all these problems have been solved, which has led to a more widespread use of telemedicine. In this way, electronic consent and consultation in this way could replace some clinical visits required in the protocols, especially those for which medical imaging, a collection of biological samples or the performance of physical examinations are not required.
On the other hand, virtual formats could supplement the various meetings of researchers in person or of the steering committee, thus reducing the physical, economic and environmental burden, while increasing speed and flexibility.
Similarly, using social media as an easily accessible communication tool could also help optimize care for patients enrolled in clinical trials. “Nor should we forget the potential of artificial intelligence, as a key to improving the patient experience,” the oncologists emphasize.
More commitment
With numerous societal changes underway, it is an opportunity for a radical transformation in patient participation in clinical trials. ” There is scope for a deeper engagement with patient and public engagement groups to set the global cancer research agenda, ” they explain.
It is clear that the COVID-19 pandemic has given a boost to the emerging concept of the virtual or decentralized trial, which is a study without a specific place in which the recruitment of patients is done through methods based on social networks or applications. telemedicine. However, ASCO experts note, “ a completely virtual trial is not feasible for most cancer studies, given the need for detailed and often sensitive discussions, especially at the time of informed consent , administration intravenous drugs, medical imaging and toxicity surveillance ”.
Decentralizing some of these elements “could make conventional research more efficient, potentially reducing the burden on the patient and consequent abandonment of clinical trials. At the same time, it would make it possible to optimize the use of health care resources ”, they point out. The authors consider that these hybrid trials would fall on a spectrum between interventionist and pragmatic or real-world studies.
Thus, the next era of clinical trials will require changes in the way in which oncology services are organized today , with the aim of reducing the number of times that the patient and the staff of the contracted research organization must attend. in person to a certain place. “Home visits by skilled nurses, delivery of certain medications to homes, and accurate and timely communication with family physicians or local clinics to perform laboratory tests will likely improve the patient experience.” However, they note, careful coordination will be necessary, which could be a challenge in areas with limited capacities or resources.
