# A fixed share of trial-group funding for getting proven care to patients

Source: https://onco.cc/ideas/idea-fund-implementation-quota/  
OnCo record `idea-fund-implementation-quota` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Proven treatments, genomic tests and timely referrals routinely fail to reach the patients who qualify for them. Public trial networks such as the NCTN groups, EORTC and the UK NIHR portfolio would have to spend at least 10% of their funding on cluster-randomised or stepped-wedge trials of how to close that gap, cheap studies that use routine data.

## Summary

Public trial networks (the NCTN groups, EORTC, UK NIHR portfolio) would be required to allocate at least 10% of funding to implementation trials: cluster-randomised or stepped-wedge studies of how to raise guideline-concordant care, genomic testing rates, timely referral, geriatric assessment and survivorship follow-up. These trials are cheap per patient, use routine data and address a gap that observational studies put at tens of thousands of avoidable deaths a year in high-income countries alone.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Trial networks that spend 10% on implementation trials increase guideline-concordant care for at least two measurable indicators (for example biomarker testing before first-line therapy, adjuvant therapy completion) by 10 percentage points in participating regions within four years.
- Rationale: Implementation science has a track record in cardiovascular medicine (statin and blood-pressure programmes) and in HIV; in oncology, the gap between proven and delivered care is well documented but seldom the object of a funded trial because no drug sponsor benefits.
- Proposed test: One network runs the quota for a full funding cycle and compares indicator improvement and cost per additional patient correctly treated with a matched network that does not.
- Maturity: speculative
- Actor: policy

## Sources

- Bottleneck evidence (Funding follows fashion, not burden): Carter & Nguyen, A comparison of cancer burden and research spending (BMC Cancer 2012): https://doi.org/10.1186/1471-2407-12-526

## Connected records

- collections: [ESMO Clinical Practice Guidelines & MCBS](https://onco.cc/collections/esmo-guidelines/), [NCCN Guidelines](https://onco.cc/collections/nccn/)
- ideas: [A trials fund reserved for older and multimorbid patients](https://onco.cc/ideas/idea-fund-older-patients-trial-fund/), [Payers fund trials of cheaper, shorter or lower-dose versions of expensive treatments](https://onco.cc/ideas/idea-fund-payer-funded-pragmatic-trials/)
- technologies: [Comprehensive genomic profiling](https://onco.cc/technologies/cgp/), [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/)
- companies: [ECOG-ACRIN Cancer Research Group](https://onco.cc/companies/ecog-acrin/), [EORTC](https://onco.cc/companies/curie-nki-eortc/), [SWOG Cancer Research Network](https://onco.cc/companies/swog/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Funding follows fashion, not burden](https://onco.cc/bottlenecks/b-funding-allocation/)
- key papers: [Benefits of hyperthermic intraperitoneal chemotherapy for patients with serosal invasion in gastric cancer: a meta-analysis of the randomized controlled trials](https://onco.cc/key-papers/paper-sun-bmc-cancer/)

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