Abstract LB-251: The cancer clinical trial landscape in the EU and the Nordic countries
Authors: Pouwels Jeroen , Soidinsalo Sebastian , Haikala Heidi , Jaakola Panu , Jalava Tarja , Joensuu Heikki , Mustonen Mika , Korhonen Pasi , Kovanen Panu , Lehtonen Anne , Mattson Johanna , Monni Outi , Westermarck Jukka , Klefström Juha 
Published: August 2019

Abstract
Background. Cancer clinical trials seek to determine the safety and efficacy of new treatment modalities. Due to the impact of cancer clinical trials on health care, economic activity and cancer research, many large-scale efforts have been undertaken around the world to create clinical trial-facilitating environments. The Nordic countries (Norway, Sweden, Denmark, Iceland and Finland) are among the countries with the highest 5-year net survival for cancer patients, which is a testimony to their high standard of early diagnosis, cancer care and functional public health care system. However, the contribution of the Nordic countries to the international cancer clinical trial landscape has remained largely unexplored.
Methods. We mined www.clinicaltrials.gov for cancer clinical trials starting between the 1st of January 2000 and the 31st of December 2017. Trials were designated Cancer Clinical Trials if the trial indication contained one of 17 cancer-specific words (e.g. “cancer”, “neoplasia”, “malignancy”). The trial databases of all European Free Trade Association (EFTA; the EU, Switzerland, Norway, Iceland and Liechtenstein) countries was downloaded and subsequently mined for specific terms, i.e. cancer indication, study location and intervention type. A trial was counted for every country with a study center and thus the same trial can be counted for multiple countries.
Results. Here, we present an analysis of the cancer clinical trial landscape in the EFTA and the Nordic countries. While in the EFTA the number of cancer clinical trials strongly increased from 2000-2014, that number has not grown between 2014 and 2017, unlike in the USA or China. Comparison of the number of cancer clinical trials in different EFTA countries showed strong variation, and indicated that Sweden, Finland and Norway have been involved in far fewer cancer clinical trials than expected for countries of their economic size or socio-economic status. Denmark is the only Nordic country to perform much better than the EFTA average.
Discussion. We show that despite a high standard of care, most Nordic countries are lagging behind in cancer clinical trials compared to countries of similar socio-economic stature. This low number of cancer clinical trials may slow down uptake of new cancer drugs to routine care, prevent patients from receiving state-of-the-art therapies, increase health care costs, and inhibit scientific progress and commercial activity. We provide recommended actions to increase the number of cancer clinical trials, with special focus on Finland as part of the national growth strategy in the health sector.
Note: This abstract was not presented at the meeting.
Citation Format: Jeroen Pouwels, Sebastian Soidinsalo, Heidi Haikala, Panu Jaakola, Tarja Jalava, Heikki Joensuu, Mika Mustonen, Pasi Korhonen, Panu Kovanen, Anne Lehtonen, Johanna Mattson, Outi Monni, Jukka Westermarck, Juha Klefström. The cancer clinical trial landscape in the EU and the Nordic countries [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-251.