Clinical trials are an essential part of cancer research and care, with around 1 in 6 people with cancer taking part in research to access new methods of care and help improve the care received by future patients.

But like cancer services, such as screening and diagnosis, the COVID-19 pandemic has heavily disrupted cancer research. Because clinical trials are often based in hospitals, the risk of COVID-19 infection forced many researchers to pause recruitment in order to keep patients safe.

This didn’t happen to all cancer studies, as some trials were able to keep running during lockdown, but most were disrupted.

Thankfully, the situation is starting to improve, with a growing number of paused trials now restarting recruitment in some of their study sites. However, a second wave of COVID-19 risks disrupting cancer research again and reversing progress towards recovery.

To prevent this, we need to avoid another national pause on clinical trials and support restarted trials to continue running during future waves of COVID-19. We also need Government support to protect the UK’s science base’s ability to deliver life-saving research in the future.

Here’s what happened to clinical trials so far.

How did COVID-19 affect cancer research and trials?

COVID-19 forced most clinical trials in the UK to stop recruiting patients, including 95% of our cancer trials. The pandemic caused this disruption because:

1. Researchers needed to minimise the number of patients visiting hospitals, as these visits risked infecting their patients with COVID-19.
2. Some clinical staff usually dedicated to research needed to support frontline services as part of the NHS’s response to COVID-19.

Although COVID-19 has disrupted research into all types of cancer, the pandemic’s impact has varied between cancer types. For example, research into cancers affecting children and young people was less disrupted by COVID-19. One reason for this is that children – including children with cancer – are at a lower risk of developing severe COVID-19 symptoms than adults, so some studies could safely continue recruiting patients during lockdown.

COVID-19’s impact extends beyond disrupting today’s cancer trials – it also threatens tomorrow’s cancer research.

Due to COVID-19, we expect to lose 30% (£160m) of our income this year. This has prevented us from funding new trials this year because we’ve had to focus our finite funding on supporting the restart of existing cancer trials. For comparison, we usually fund around 10 new trials each year, in addition to funding trials already underway.

The pandemic’s financial impact means we won’t be able to fund as many cancer studies in the future, as we expect our income to take several years to recover. To avoid this outcome, we’re seeking support from the Government.

What’s happening to clinical trials now?

The good news is that progress is being made to restart paused clinical trials. Since May, the number of patients being recruited to clinical trials has increased, although the speed of recovery has varied between regions and cancer types.

For example, the percentage of non-commercial (e.g. charity-funded) clinical trials that are open to recruitment has risen from 12% in mid-April to 40% in early-September. And of the non-commercial trials open to recruitment, 42% have recruited a patient since 1 June.

While these figures are heading in the right direction, the recovery of recruitment to clinical trials has been slower than we hoped, largely due to a lack of capacity in hospitals across a range of services.

Even before the pandemic, there was not enough capacity in the system in several key functions, and COVID-19 has introduced many additional barriers:

1. COVID-19 has increased pressure on the NHS and significantly reduced the capacity of services that cancer trials need to properly function, such as radiology and pharmacy.
2. This services shortage has also created a backlog of cancer patients waiting for tests and treatments. Reducing this backlog remains an urgent priority and it’s important that the recovery of research is seen as integral to this process, rather than as an ‘add-on’.
3. Research into COVID-19, though necessary, is being over-prioritised by some local decision makers, making it harder for non-COVID clinical trials to access essential resources.
4. Patients may be reluctant to come into hospital due to fear of infection.

These barriers will become more challenging as cases of COVID-19 continue to rise once again. It’s vital that we ensure that the trials that have maintained or restarted recruitment can continue to recruit during future waves of the epidemic.

“We’re going over and above to ensure patient safety”

Ben Hood is a Cancer Research UK-funded clinical research nurse based in Newcastle. Hood works on an early phase cancer research unit, which runs a lot of early stage clinical trials.

“We see a lot of patients who might not have another treatment option. One of the biggest impacts of the pandemic was that patients in many cases weren’t allowed to have family members come on the unit when they were receiving treatment or having initial discussions about taking part in research, which could be quite distressing.”

The other big concern during the first wave was getting COVID-19. “There was quite a lot of anxiety from patients about being in a hospital setting in general.” Hood says the clinical nursing team worked overtime to keep in touch with patients and families and talk through their concerns.

“Where possible, we changed things so treatments could be delivered to patients’ homes, using courier services and we linked up a lot more with primary care – local GP practices and district nurses.” Hood says they’ve also evolved how they’re consenting people into clinical trials, to reduce trips to the hospital.

“Even though the world has turned on its head, within our unit and other experimental cancer centres, everybody has gone over and above to ensure that patient safety is the top priority during this time.”

And although coronavirus cases are on the rise again the UK, Hood feels the unit is in a strong position. “During the first wave nobody knew what to expect. But we’re definitely a lot more prepared for the second wave – we’re aware of the risk factors and the precautions we need to take to ensure patient safety.”

How do we move forward?

With 8 months’ experience dealing with COVID-19, the NHS is in a better position to balance the demands of the pandemic with meeting the needs of cancer patients.

Hospitals have taken steps to allow patients to be treated as safely as possible. It’s vitally important that patients go for treatment, and if anyone is worried about symptoms that you go to your GP. You may have to wait a bit longer than usual, but you will get the help you need.

Restoring and maintaining access to cancer services must remain the priority, and this should include keeping cancer trials open during future waves of COVID-19. That’s why we’ve revised our policy on redeploying Cancer Research UK-funded researchers, which sets out that:

• There should be no national pause on recruitment to clinical trials during future waves of COVID-19. Trials should be paused locally in response to exceptional strain on hospitals.
• All Cancer Research UK-funded staff and facilities redeployed during the first wave should be restored to cancer research.
• Redeployment of Cancer Research UK-funded staff should only be considered in exceptional circumstances, and only to support frontline cancer services.

Cancer isn’t going away, so we really need to continue to offer early phase research clinical trials, because otherwise some people won’t have any treatment options. We shouldn’t give up on these patients.

– Ben Hood, research nurse.

We also need to protect our ability to deliver life-saving research in the future. As mentioned earlier, COVID-19 has significantly reduced the incomes of research funders like Cancer Research UK, meaning less money will be available to fund future clinical trials.

To avoid this, we’re asking the UK Government to commit to a Life Sciences-Charity Partnership Fund that will fill this funding shortfall and protect our ability to deliver life-saving research.

Oliver Buckley-Mellor is a policy advisor at Cancer Research UK

More on this topic