ideasIdea
Set trial enrolment targets from who actually gets the disease, and publish progress live
Each trial would set its target mix of patients from cancer registry data on who gets that cancer, by age, sex and ethnicity, and show a public running tally so gaps are visible while there is still time to fix them.
Sponsors derive enrolment targets per stratum from incidence data (SEER, GLOBOCAN, national registries) for the indication and the countries where the trial runs, publish the targets in the registry record, and update enrolled counts quarterly. Recruitment resources are reallocated during the trial toward under-enrolled strata (site additions, navigators, translated materials).
Hypothesis
Trials with live public stratum tallies will finish closer to incidence-weighted targets than trials with static goals, because course correction happens during accrual rather than being noted at the end.
Rationale
Enrolment gaps are usually discovered at analysis, when nothing can be done. Live dashboards changed vaccination and screening coverage by making gaps actionable.
What would test it
Randomise a sponsor's new trials to live public tallies or internal-only tracking and compare final representativeness.
Maturity
early clinical
Who has to act
industry
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
- 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.
- Trials enrol too few, too slowly · Fewer than one in ten adults with cancer joins a trial. Trials close for lack of patients, not lack of ideas.