NCI-Sponsored Cancer Trials Potentially Saved Millions of Life-Years, Study Finds

A new study estimates that the cooperative research network SWOG, which is sponsored by the National Cancer Institute (NCI), has considerably impacted the US population over its 60-year history, as its 23 positive clinical trials have generated about 3.34 million life-years gained.

The research, presented at the American Society of Clinical Oncology and published simultaneously in JAMA Oncology, looks back at the founding of SWOG and its durable impact. Formerly the Southwest Oncology Group before its name was shortened, it represents one of the first cooperative research groups and is a member of several NCI initiatives, like the National Clinical Trials Network and the Community Oncology Research Program.

The idea of a cooperative research network is just as relevant today as it was when SWOG opened its doors in 1956, thanks to the presence of ambitious initiatives like the Cancer Moonshot. Researchers predicted that the aggregate benefit of the network’s positive cancer therapy trials would amount to a significant number of years of added life for patients with cancer in the United States, “given the history and durability of the cooperative group structure.”

Using a sample of all of the randomized phase 3 clinical trials conducted by SWOG, the researchers identified 23 (11.9% of the 193 completed trials) that had resulted in “statistically significant improvement in overall survival for patients receiving the new, experimental therapy.” Assuming that the novel treatments tested in these positive trials became the standard of care upon publication of the results, the study authors then estimated the life-years gained for the US population with cancer.

The estimate of cumulative life-years gained through 2015 was 3.34 million. The trials completed in recent years were responsible for fewer life-years gained than the older trials, as less time had elapsed in which the life-saving effects could be seen. However, the estimates appeared to confirm that treatments were more effective in recent years, as 84.2% of these 3.34 million life-years gained had occurred since the 1990s.

For context, the 3.34 million life-years gained would be enough to add 5.6 more life-years for each of the approximately 600,000 people who died of cancer in 2016.

Based on these estimates, the researchers projected that 4.32 million life-years would be gained through 2020, 5.38 million through 2025, and 6.29 million through 2030, representing a nearly 2-fold increase in life-years gained over the coming 15 years.

Further analyses estimated the return on investment considering the federal government’s provision of $418 million in funding to SWOG over 60 years. Accounting for trials with both positive and negative results, the researchers found a ratio of $125 in expenditures per life-year gained through 2015. The costs per life-year gained are expected to decline slightly in the future, reaching $104 per life-year gained through 2030.

“SWOG treatment trials have had a sizable impact on population survival for patients with cancer, at a modest cost,” the researchers summarized.

They noted that their results may err on the conservative side since they only accounted for overall survival, not progression-free or disease-free survival. Furthermore, clinical trials have manifested in less toxic treatments, reduced cancer morbidity, and better cancer prevention strategies, but these effects could not be quantified in the current analysis.

“Decades of NCI-sponsored clinical trial design, monitoring, and analysis have generated important insights into the science of trial conduct, which has benefited the broader clinical trial community,” the researchers concluded. “In an era of increased data sharing, the clinical trial databases of the cancer cooperative groups promise more important insights that could serve as the foundations and hypotheses for future studies.”