Visible inequalities

Underprivileged countries led only 8% of clinical trials in oncology

The increased participation of lower and upper middle-income countries in randomized clinical trials (RCT) led by high-income countries is a global phenomenon. Scientists from nine countries, including Brazil, analyzed 636 studies published between 2014 and 2017 in order to map the participating countries, the benefits of their presence for the population involved, and their impact on global research. The work was published in the journal JAMA Network Open.

According to the studies performed during the period, Russia and Brazil have the greatest presence among the upper middle-income countries (UMICs), with participation rates of 64% and 52%, respectively. As for the lower middle-income countries (LMICs), India (50%), Ukraine (46%), and the Philippines (27%) had the highest frequency. A fact that stands out from this study is that only 8% of the reviewed trials were led by underprivileged countries, with China (72%) and India (10%) responsible for most of the studies.

Researchers also compared the inclusion of UMICs and LMICs with all cancer RCTs published globally, including all types of studies (basic science, clinical research, and health system research). The study suggests that the significant presence of underprivileged countries in clinical trials is disproportionate to the total cancer bibliometric output. Ukraine, for example, enrolled in 46% of randomized trials, is present in 2% of global cancer research output. This also goes for Russia (64% vs. 2% of output), Romania (34% vs. 2% of output), and Mexico (31% vs. 2% of output), among others.

In the case of Brazil, whose population is included in 52% of studies reviewed during the period, participation in global publications is 7%. An inverse association was observed for China (31% in clinical trials and 69% of scientific output).

According to the authors, participation in clinical trials also did not correspond to the national disease burden. Public policies, they argue, are necessary for randomized trials to result in greater clinical cancer research capacity in these countries.

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