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The International Collaboration for Research methods Development in Oncology (CReDO) workshops: shaping the future of global oncology research

Research output: Contribution to journalReview articlepeer-review

National Cancer Grid of India

Original languageEnglish
Pages (from-to)e369-e376
JournalThe Lancet Oncology
Volume22
Issue number8
DOIs
PublishedAug 2021

Bibliographical note

Funding Information: Lack of research funding has been cited as one of the main reasons for non-progress of protocols developed at CReDO. Since 2016, the NCG has been funding multicentre collaborative research on cancers that are prevalent or unique to the region. Researchers from institutes within the NCG who wish to apply for funding are encouraged to develop their ideas at the CReDO workshop. At our last three workshops, the best seven protocols chosen by the CReDO workshop faculty each year were fast-tracked for consideration for NCG funding. Currently, the NCG is funding 11 academic trials, of which three were developed at the CReDO workshops. 52,53,54 The results of these trials will fill knowledge gaps in the management of these cancers that occur commonly in India. Funding Information: We would like to acknowledge the following organisations that have funded some or all editions of the CReDO workshops: the Tata Trusts, Kings College London, ASCO, the US National Cancer Institute, Cancer Research UK, and the ICMR. The following organisations have supported or endorsed the CReDO workshop: the Medical Research Council Clinical Trials Unit at University College London, the EORTC, and the Medical Oncology Group of Australia through its ACORD initiative. We are grateful to the following faculty who have participated in the CReDO workshops: Ajay Aggarwal, Allan Hackshaw, Amit Khot, Avijit Hazra, Camilla Zimmermann, Carlo Caduff, David Collingridge, Debashis Sarker, Diana Romero, Gareth Griffiths, Gary Clark, Hari Menon, Indranil Mallick, Jack Welch, James Spicer, Lisa McShane, Louise Brown, Marie Cecile le Deley, Moni Kuriakose, Prachi Patil, D Raghunadharao, Rakesh Aggarwal, Ramakrishnan AS, Sally Hunsberger, Sanjoy Chatterjee, Santam Chakraborty, Sarbani Ghosh-Laskar, Sreekumaran Nair, Sudha Sivaram, Usha Menon, Vikram Mathews, and Sabine Tejpar. The CReDO workshop is hosted at the Leadership Development Academy of Larsen and Toubro, Lonavla, India. The Vail MCCR workshop was founded by Daniel von Hoff, past president of the AACR. We are grateful to M Kathryn Leonard and Dean Post (AACR) and Michal Tibbits and Natalie Holloway (ASCO) for sharing data from the Vail MCCR workshop and to Saskia Liti?re and Davi Kaur (EORTC), Emiliano Calvo (ESMO), and Pat LoRusso (AACR) for sharing data from the Europe MCCR workshop. Funding Information: Health-care research undertaken in LMICs comprises a small proportion of overall global research output. A review of Cochrane evidence on non-communicable diseases reported that almost 90% of trials and 80% of research participants were from HICs. 16 Although India has approximately 17% of the world's population, it is involved in less than 2% of global clinical trials. 17 Notably, oncology research output from LMICs is very low even for prevalent cancers such as cervical and oral cancer and for essential cancer management modalities such as radiotherapy and palliative care. 18–21 Randomised trials in oncology are dominated by authors from HICs, even though trials from LMICs have been shown to be more likely to demonstrate the hypothesised difference in treatment outcome and to be associated with larger effect sizes. 22 For example, in 2012, Latin America accounted for only 4% of cancer clinical trials in the world. 23 Although it is the second most populous country in the world, between 2012 and 2017, India ranked 18th in cancer research publications, contributing to only about 2% of global output. 24 Within India, there are large regional disparities in cancer research output, with research activities largely confined to a few large academic centres. 25 The major reasons for this low research output in LMICs include lack of protected time and incentives for doing research amidst heavy clinical care demands, inadequate research infrastructure and support, few domestic funding opportunities, poor understanding of trial methodology and regulations, insufficient training on research methods, lack of exposure to high-quality clinical and translational research, and inexperience with the complexities of grant applications. 26–32 Some of these problems (for example, inadequate protected time and research infrastructure) require systemic solutions at a policy level and often reflect lack of institutional prioritisation of research as an independent endeavour worth pursuing. A few institutions such as the Tata Memorial Centre (Mumbai, India) have provided incentives to undertake practice-changing clinical research, develop clinician-scientists with Masters (translational research) training, and offer regular courses on basic clinical research methods. 33 These initiatives were supported by the creation of the Clinical Research Secretariat and the Department of Atomic Energy Clinical Trials Centre, which provided support to clinician-researchers with research funding and biostatistics facilities, and expanded the research workforce by training clinicians and research coordinators. These strategies have resulted in landmark trials that have changed the management of several common cancers, and scaling up of these efforts at the national level through the National Cancer Grid (NCG) of India and the International Collaboration for Research methods Development in Oncology (CReDO) initiative. 34–40 However, these efforts also require a concerted effort to create learning opportunities for busy clinicians and allied health-care workers without disrupting their clinical care demands. Publisher Copyright: © 2021 Elsevier Ltd Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

Abstract

Low-income and middle-income countries (LMICs) have a disproportionately high burden of cancer and cancer mortality. The unique barriers to optimum cancer care in these regions necessitate context-specific research. The conduct of research in LMICs has several challenges, not least of which is a paucity of formal training in research methods. Building capacity by training early career researchers is essential to improve research output and cancer outcomes in LMICs. The International Collaboration for Research methods Development in Oncology (CReDO) workshop is an initiative by the Tata Memorial Centre and the National Cancer Grid of India to address gaps in research training and increase capacity in oncology research. Since 2015, there have been five CReDO workshops, which have trained more than 250 oncologists from India and other countries in clinical research methods and protocol development. Participants from all oncology and allied fields were represented at these workshops. Protocols developed included clinical trials, comparative effectiveness studies, health services research, and observational studies, and many of these protocols were particularly relevant to cancer management in LMICs. A follow-up of these participants in 2020 elicited an 88% response rate and showed that 42% of participants had made progress with their CReDO protocols, and 73% had initiated other research protocols and published papers. In this Policy Review, we describe the challenges to research in LMICs, as well as the evolution, structure, and impact of CReDO and other similar workshops on global oncology research.

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