ideasIdea
Randomise inside the cancer registry: registry-based trials for everyday questions
National cancer registries already collect the outcome data. Adding a randomisation button lets doctors compare two standard treatments across thousands of patients at a fraction of the usual cost.
Registry-based randomised trials, pioneered in cardiology by Sweden's TASTE trial, embed randomisation in a clinical quality registry and use routinely collected outcomes (death, recurrence, hospitalisation) as endpoints. Oncology registries in the Nordic countries, the Netherlands, the UK and some US states could support comparisons of approved treatments, schedules and follow-up strategies at a marginal cost per patient of a few hundred dollars.
Hypothesis
Registry-embedded randomised trials in oncology can enrol at least ten times more patients per year per dollar than conventional pragmatic trials and answer comparative questions (sequence, schedule, duration, surveillance) that industry will not fund.
Rationale
TASTE randomised over 7,000 patients at low cost and produced a definitive answer. Oncology registries have the same coverage in several countries; the barriers are governance and consent design rather than technology.
What would test it
Run one registry-embedded trial of a surveillance or schedule question (e.g., follow-up imaging frequency after curative resection) in a national registry and report cost per patient, accrual rate and data completeness.
Maturity
early clinical
Who has to act
research
Cost to try
Medium ($1M to $50M)
Years to first evidence
4
Bottlenecks it attacks
- 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.
- Trial design, endpoints and cost · A phase 3 trial takes years and hundreds of millions of dollars, and often answers a question that has already moved on.
- Weak real-world evidence and registries · We do not reliably know what happens to patients after approval, so we cannot tell which drugs deliver in practice.