OnCo
ideasIdea

A public map of trial deserts to steer where new sites open

Combine cancer incidence with the location of open trials to show which regions have many patients but no trial within an hour's drive. Sponsors and funders would use it to decide where to put sites.

An open, regularly updated geospatial dataset joins registry incidence (by county or district) with trial site locations and recruitment status from ClinicalTrials.gov and other registries, producing an index of trial access by disease, with travel-time isochrones and demographic overlays. Sponsors are asked to justify site selection against the map in diversity plans.

Hypothesis
Regions identified as trial deserts and targeted for new sites will show increased enrolment of rural and minority patients within two years, and site-selection decisions of sponsors using the map will shift toward under-served regions.
Rationale
Site selection is driven by past performance, not by where patients are, reinforcing concentration in the same academic centres. Maps changed resource allocation for pharmacies and emergency services.
What would test it
Publish the map for the US and one European country; compare geographic distribution of newly opened sites in the following two years with the prior two.
Maturity
speculative
Who has to act
data
Cost to try
Small (under $1M)
Years to first evidence
1
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.
  • Data silos · Records, scans, genomes and outcomes sit in separate systems that cannot talk. Every patient's experience is lost to the next.

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