A new study out Thursday highlights one of the indirect harms of the pandemic: Scientists are having trouble recruiting volunteers for their lung cancer research. The research found that enrollment in clinical trials declined by 43% in 2020 compared to the year before, forcing researchers to come up with some creative ways to reduce attrition as the year went on.
Both the pandemic and the restrictions on distancing and movement enacted in response to it led to significant changes in our society, especially early on. Studies have found, for instance, that visits to emergency rooms for non-covid illness declined last year, as did other important but not necessarily urgent medical services like cancer screenings. The new research, presented this week at the annual conference of the International Association for the Study of Lung Cancer (IASLC), seems to show that cancer research took a big hit, too.
Researchers affiliated with the IASLC looked at publicly available enrollment data from lung cancer trials across the world in 2019 and 2020; they also surveyed some scientists involved in these trials. According to lead author Matthew Smeltzer, an epidemiologist at the University of Memphis, they were able to look at 171 trials from 173 research sites in 45 countries, though most came from North America, Europe, and Asia.
Compared to 2019, Smeltzer and his team found, enrollment had dropped 43% in 2020, with the harshest decline spotted between April and August. When asked, scientists reported that their most common challenges were fewer eligible patients (67%); trouble maintaining the study’s pre-established protocols, like in-person visits to a site (61%); and trials being outright suspended temporarily (60%). Researchers also reported that volunteers were most worried about contracting covid-19 (83%), travel restrictions (47%), and actually securing transportation (38%).
“Declines in clinical trial enrollment are concerning and could lead to delays in trial completions,” Smeltzer told Gizmodo in an email.
The pandemic has had ripple effects throughout medicine and science. Earlier this week, a new report found that covid-19 has set back the public health fight against other major deadly illnesses like HIV, malaria, and tuberculosis, both in preventing and treating new cases. And while clinical research often takes years to wind through, lung cancer has been one of the areas that has seen relatively rapid and likely lifesaving advances in recent years.
The silver lining, Smeltzer and his team found, is that scientists were able to somewhat adjust. Despite cases of covid-19 only continuing to increase over time worldwide, the decline in enrollment slowed. Some of the strategies employed by scientists in these trials included changing the study’s design to allow for remote monitoring or telehealth visits, mailing medications to patients, and simply delaying visits.
The authors of this research (which, it should be noted, has yet to undergo formal peer review), haven’t looked at the data from 2021, so they don’t want to speculate on how lung cancer trial enrollment has gone this year. But Smeltzer does believe some of the methods used to keep trials going during the pandemic could become widely adopted even after this crisis has passed.
“I think many of the mitigation strategies sites employed during the pandemic, aimed to provide more flexibility and leverage modern technology, could improve clinical trials beyond the pandemic. There seems to be momentum to make some of these changes permanent for cancer trials,” he said.