An ASCO leadership development project to understand barriers to clinical cancer research in the Asia-Pacific.
Authors: Lui Rashid N , Billod Jimmy A , Frentzas Sophia , Hoang Hang Thu , Eaton Vanessa J. , Lei Jennifer , Garrett-Mayer Elizabeth , Goldstein David , Dent Rebecca Alexandra , Chua Melvin Lee Kiang 
Published: August 2023

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Background: There are huge challenges in conducting clinical research, with gross disparities in trial access for patients in the Asia-Pacific (APAC). ASCO initiated a leadership development program in 2021, and one of the projects involved understanding the barriers to conducting clinical research and trials regionally. Methods: We conducted a cross-sectional survey on barriers to clinical research using a 29-item questionnaire which covered potential barriers to establishing clinical groups to support trials, and respondents’ demographic and other information. We targeted oncology healthcare professionals (HCPs) from APAC via national societies, locoregional hospitals, and via social media channels. Data were collected through the SurveyMonkey platform. Countries were classified into high-income (HICs), upper-middle (UMICs), and lower-middle income countries (LMICs) according to the World Bank criterion. We hypothesized substantial differences in the responses of HCPs by income (HICs vs UMICs vs LMICs) due to political, cultural, ethical, and socioeconomic factors and evaluated the univariate association of each potential barrier using Chi-square test. Multivariable logistic regression models evaluated the association between the top five significant potential barriers and country grouping, adjusting for age, gender, specialty and affiliation. Results: Three-hundred responses were received from May to July 2022, representing 21 APAC countries and regions in total. Among these, 102 (34%), 57 (19%), and 137 (46%) HCPs practiced in HICs, UMICs, and LMICs, respectively, with 51% of respondents being female. Most HCPs practiced in medical oncology (35%), radiation oncology (29%), and surgical oncology (13%). Just under 70% of respondents had <= 10 years of training. Overall, the top five reported barriers included competing demands (reported by 88% of respondents), lack of financial support (86%), healthcare access issues for patients (75%), lack of research environment and infrastructure (72%), and lack of expertise of staff (68%). Adjusting for other factors, among these barriers lack of financial support, research environment and infrastructure, expertise, and healthcare access differed significantly between HICs and LMICs with respondents from LMICs more often reporting these barriers than those from HICs (p<=0.02 for all). Conclusions: This is the largest survey exploring the research and trial landscape in APAC that revealed common and specific challenges affecting different countries, thus emphasizing the importance of targeted measures when addressing these barriers. These findings will inform future potential action plans by ASCO and the APAC Regional Council such as skills training, embedding clinical research within practice and facilitating cross border interaction; to empower research in the region.