Burden-matched funding for trials led in low- and middle-income countries
Seven in ten cancer deaths are in poorer countries, yet almost all trials happen in rich ones. Funders would commit a share of money for trials designed and led where the burden is.
Major funders commit a fixed fraction (say 15%) of their trials budget to studies whose principal investigator and majority of sites are in low- and middle-income countries, targeting cancers and questions that matter there: cervical cancer treatment with limited radiotherapy, oesophageal squamous cell carcinoma, hepatocellular carcinoma from hepatitis B, hypofractionation and shorter regimens, low-cost generics. Precedents include Tata Memorial's trials that changed global practice on low-dose immunotherapy and neoadjuvant chemotherapy in head and neck cancer at a fraction of Western trial costs.
- Funding follows fashion, not burden · Money goes to the cancers and questions that are easy or popular, not the ones that kill most or where a dollar would do most.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
- Trials do not represent the people who get cancer · Older, Black, Hispanic, Asian, rural, poor and multimorbid patients are under-represented, so results may not apply to them.