OnCo
ideasIdea

Randomise inside the registry that already follows every patient

Rare cancer patients are already tracked in registries. Offering randomisation inside the registry makes trials far cheaper and lets almost anyone take part.

Trials within cohorts, or registry-based randomised trials, use existing registry infrastructure for identification, consent, allocation and outcome capture, and have been used successfully in cardiology at a fraction of conventional trial cost. Rare cancers are ideal candidates because registries already exist, populations are dispersed, and conventional site-based trials cannot reach enough patients.

Hypothesis
Registry-based randomisation reduces cost per randomised patient by an order of magnitude versus conventional rare cancer trials, while achieving acceptable data completeness and regulatory-grade outcome ascertainment.
Rationale
Registry-randomised trials in interventional cardiology showed that outcome capture through linked national data can be as reliable as bespoke case report forms. The infrastructure cost is already sunk in the registry.
What would test it
Run one registry-randomised comparison of two standard-of-care options in a rare cancer, reporting cost per patient, data completeness and regulator or guideline acceptance of the result.
Maturity
early clinical
Who has to act
data
Cost to try
Medium ($1M to $50M)
Years to first evidence
5
Bottlenecks it attacks

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