Current Status of Research in Australia
Research can be classified as discovery, translational and implementation. The majority of participants in the consultation process were of the opinion that Australia is not leading the way internationally in radiation oncology research. While many hospitals with radiotherapy facilities have some level of participation in research and/or clinical trials, most respondents deemed it inadequate. In addition, out of a total of 64 respondents, only 43.7% said that their workplace made time for people to do research during work hours with 32.8% of respondents using time after work hours to do research.
Radiation oncology clinical trial research is largely implementation based research and in Australia is mostly conducted under the umbrella of the Trans-Tasman Radiation Oncology Group (TROG). TROG is Australia and New Zealand’s specialist clinical research group for cancers that can be treated with radiotherapy. TROG is a cooperative multi-disciplinary organisation dedicated to the control of a wide range of cancers through quality multi-centre research. To date, TROG has activated over 60 cancer research trials in Australia and New Zealand. Approximately 10 to 15 trials are open at any time, giving many patients the opportunity to access innovative therapeutic approaches. From the feedback obtained during the membership consultation process, of the 62 members who responded to the question of whether their workplace supports clinical trials, 35.5% answered occasionally, 30.6% answered regularly and 29.1% answered most of the time.
Descriptions of clinical trial phases have been developed for pharmaceutical studies. Their application to radiation oncology and other non-drug medical specialties is not straightforward as the implications of the unique dynamics faced by these specialties, particularly imaging2, have not been widely recognized or articulated.
|Phase of Trial3,4||Medical Description||Application in Radiation Oncology|
|1||Initial studies||Proof of concept|
|2||Short term side effects||Implemented (pilot studies, not altering treatment)|
|3||Effectiveness and risk benefit analysis||Evaluation of clinical implementation and risk benefit analysis|
|4||Post market surveillance||Post implementation studies|
The above table shows the phases of medical clinical trials and the product components that are tested in each phase. The application of the trial phases to radiotherapy can be seen in the right column.
Funding for Research
The majority of cancer research funding in Australia is provided by:
The Australian Cancer Research Foundation (ACRF)
The Australian Research Council (ARC)
The National Health and Medical Research Council (NHMRC)
State branches of Cancer Councils
Cancer Australia (Commonwealth Government funding)
The Victorian Cancer Agency
Cancer Institute NSW
Queensland Institute of Medical Research
State and Territory Health Departments
Donations (private and institutional)
And other specific cancer support groups
Funding of radiotherapy research represents a disproportionately small percentage of total cancer research funding. For example, between 2000 – 2001 and 2011 – 2012 the NHMRC directed 18.5% ($232.8 Million) of total cancer research funding ($1269 Million) towards cancer treatment research. It is estimated that only 15.1% ($35 million)5 of that sum was allocated to radiotherapy related treatment research. Similarly, in 2011, 30%6 of the NSW Cancer Council research grants funding was disbursed to cancer treatment research. Approximately 6% of that total was for radiotherapy treatment research. These allocations can be contrasted to the recommended radiotherapy utilization rate of 52.3%7 of cancer cases, and that radiotherapy is involved in 40%8 of cancer cures. As a result, donations, which are irregular and unsustainable, form a significant proportion of research funding for some radiation oncology facilities. Increased investment in radiotherapy treatment research will enable greater and faster improvements in treatments that are applicable to large numbers of cancer patients.