A national strategy for clinical cancer research

Australia needs a visionary national research strategy for clinical cancer control, built on innovation, foresight and improved coordination of existing resources.

With cancer incidence increasing (1) along with patient expectations and pressures across the health system, now is the time to build on recent national developments in clinical cancer control with an integrated cancer research strategy based on:

• recurrent funding for independent cancer clinical trials;
• a coordinated national bio-specimens bank; and
• a plan for adopting new technologies such as genetic medicine.

Cancer Council Australia and the Clinical Oncological Society of Australia (COSA) have welcomed government commitments in recent years to support independent cancer clinical trials (2005 and 2008) and increases in NHMRC funding. We have also supported:

• the merger of Cancer Australia and the National Breast and Ovarian Cancer Centre;
• substantial capital grants for the development of new cancer centres;
• a recent audit of cancer research in Australia;
• emerging cancer technologies such as genetic medicine and immunisation; and
• a health reform agenda, working towards national coordination and standards.

These developments provide an ideal platform for a national cancer research strategy.

Recurrent funding for independent clinical trials

Independent clinical trials conducted by cooperative groups produce the vast majority of advances in cancer care,(2) with notable gains including:

• an estimated $50 million in reduced annual health costs from trials of high-dose versus standard-dose chemotherapy for advanced breast cancer (3,4,5);and
• $10 million in annual savings from unnecessarily invasive melanoma surgery.(6)

There are also major benefits in the development, maintenance and retention of world-standard local expertise in scientific and medical research and clinical care.

While Australian governments have supported cooperative trials groups since 2005-06, there has been no long-term recurrent commitment enabling the groups to plan ahead. With the current $5 million allocation finishing at the end of this financial year, (6) the next Australian government can commit to funding independent cancer clinical trials recurrently as part of an integrated national research strategy.

Banking on bio-specimens

An integrated bank for storing bio-specimens such as blood and tissue samples would significantly enhance the efficiency of independent cancer clinical trials and nurture a state-of-the-art cancer research culture in Australia.

While a number of bio-banks exist, there is no national coordination or standard approach to sample collection and access – imposing unnecessary costs and inefficiencies on clinical trials and other pathology work. Funds that could go directly into trial outcomes are wasted on inefficient management of bio-specimen samples.

Cancer Council Australia and COSA call on the next Australian government to introduce a nationally coordinated network of bio-banks in each state and territory to address these inefficiencies. The network could be established through an inter-sectoral partnership involving Cancer Australia, the NHMRC, the Department of Innovation, Industry, Science and Research and the non-government clinical cancer community – all of which (and their stakeholders) would benefit significantly.

We estimate a modest $2.5 million over five years would support an integrated national bio-specimens bank, ensuring that funds invested in cancer clinical trials provide optimal returns in terms of both economic gains and patient outcomes.

Preparing for technological change

As Australia grapples with fragmentation and inefficiencies in established medical practices, we risk being under-prepared for emerging technologies such as genetic medicine. Australia needs a platform for adopting new technologies, addressing gaps in skills development and infrastructure and a history of reactive, rather than proactive, responses to change.

While gene patent law reform is critical to freeing genetic research from commercial monopolisation (see separate recommendation), breakthroughs in related technologies such as molecular pathology will catch Australia unprepared unless we develop a national strategy now for their adoption.

Cancer Council Australia and COSA call on the next Australian Government to commit to a strategy for harnessing new cancer technologies in partnership with the nongovernment clinical cancer community. Options could include the establishment of competitive sites for technological research and development – building on substantial recent investment in new cancer centres – with the capacity to convert findings into best oncology practice as the health reform process promises the development of national standards.

An electronic health strategy and a national broadband network would also support technological change in cancer control.

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