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The students in the picture are Jacques Li, a doctor and entrepreneur from France; Diana Murguia Barrios, an economist and political scientist from Spain; Jason Yip, a chemistry engineer from England; and Sam Chong, a lawyer and economist from Malaysia and Australia.

Should Norway implement a clinical trial league table?

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We asked four MBA students from Cambridge University to evaluate how patient recruitment practices in Norway can be improved.

The number of clinical trials in Norway has been declining over the last few years. There are many reasons behind this trend, but until now there have been few concrete solutions. With the number of cancer patients on the rise, there is a growing need for access to better treatments.

Oslo Cancer Cluster asked four students from Judge Business School at Cambridge University to research how the number of clinical trials in Norway can be improved. The students were Jacques Li, a doctor and entrepreneur from France; Diana Murguia Barrios, an economist and political scientist from Spain; Jason Yip, a chemistry engineer from England; and Sam Chong, a lawyer and economist from Malaysia and Australia.

“The number of clinical trials in Norway is less than half of the number in Denmark.”

The group focused on one of three factors that influence the number of clinical trials in Norway, namely: the patient recruitment practices. After a comparative analysis with other European countries, they came up with two main recommendations on how Norway can improve patient recruitment.

 

Image och doctors and nurses walking in corridor

How do we motivate hospitals and doctors to recruit more patients to clinical trials?

 

One: Motivating hospitals

The group compared patient recruitment in Norway to France, United Kingdom and USA. Norway was the only country where hospitals don’t have any non-financial incentives to recruit patients to clinical trials. If a hospital’s reputation could be improved in a concrete way by having clinical trials, patient recruitment could also be improved.

The group proposed to create a league table for all hospitals, with cancer trial participation as one of the metrics. This would create competition between hospitals, encourage collaboration between smaller hospitals and larger ones, and make information about clinical trials accessible to patients.

“If hospitals were ranked against each other based on clinical trial output, they would more actively recruit into trials due to the reputational incentive.” 

The group also uncovered a misalignment between the funding source and the implementers of the clinical trials. Funding is passed from the Norwegian Health Ministry to the regional health authorities, instead of directly to the hospitals who conduct the trials. The group recommended that the hospitals need direct financial incentives to conduct the trials.

“Regional health authorities in Norway need to ensure that funding provided to them for research is passed down to the hospitals conducting clinical trials.” 

 

Two people holding hands.

How do we raise awareness among patients and doctors about clinical trial participation?

 

Two: Raising awareness

A second discovery in the report was the lack of awareness about clinical trials among both patients and doctors. Patients in Norway lack access to relevant information that would empower them to opt into clinical trials. There was similarly a lack of exposure to clinical trials among early career doctors and a lack of initiatives to collaborate on clinical trials among advanced career doctors.

“Raising awareness among stakeholders is key to improve clinical trial recruitment.” 

The students suggested working in partnership with patient organisations to raise awareness among patients. They recommended a national awareness campaign to inform where patients can find up-to-date information about clinical trials. All hospitals could keep lists of their ongoing clinical trials available on their websites.

“If patients knew the benefits of clinical research, they would select a hospital that is ranked highly.” 

The group also provided recommendations to raise awareness among doctors to work on clinical trials. Rotational programs and supplementary courses on research methods and clinical trials may spark interest among medical students to pursue work in clinical trials. Seminars and workshops can help to both raise awareness and inspire collaborative efforts among doctors in their advanced careers.

 

Oslo Cancer Cluster wishes to extend a big thank you to everyone who agreed to be interviewed for this research project:

  • Ali Areffard, Medical team, Bristol Myers Squibb
  • Øyvind Arnesen, Chairman of the Board, Oslo Cancer Cluster
  • Siri Kolle, Vice President Clinical, Inven2
  • Jónas Einarsson, former Chairman of the Board of Oslo Cancer Cluster and one of the founders of Oslo Cancer Cluster Innovation Park
  • Maiken Engelstad, Deputy Director, Ministry of Health and Care Services
  • Katrine Bryne, Senior Advisor, Legemiddelindustrien (LMI)
  • Kristin Bjordal, Business Manager for Research Support and Research Manager in Oslo Hospital Service (OSS) and Chairman of the Board of NorCrin
  • Ida Kommandtvoll, Advisor, Department of Strategy and Analysis, The Norwegian Cancer Society
  • Knut Martin Torgersen and medical team, Merck
  • Steinar Aamdal, the founder of The Clinical Trial Department, Oslo University Hospital

 

View and download the following PDF of the Cambridge report to learn more.
Note: This is a short version of the report, the fuller version also includes an Appendix containing detailed information about all the underlying data and interview material. Please get in touch with Communications Adviser Sofia Lindén if you are interested in reading the full Appendix.

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Jon Amund Kyte at the Norwegian Radium Hospital.

Attracting clinical trials to Norway

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Dr. Jon Amund Kyte at Oslo University Hospital (OUH) and Oslo Cancer Cluster share the common goal of bringing more clinical trials to Norway.

 

Jon Amund Kyte is the new Head at the Department of Experimental Cancer Treatment at OUH. He also runs three separate clinical trials and is the leader of a research group at the Department of Cancer Immunology, where he develops novel CAR T cell therapy and conducts translational studies.

Kyte aims to increase the number of and improve the quality of clinical trials in Norway. He says this will contribute to more patients gaining access to novel cancer treatments and to improving the efficacy of cancer therapies.

“The only way to improve cancer treatment is to have clinical trials,” said Kyte.

Oslo Cancer Cluster also wants to bring more clinical trials to Norway to develop innovative cancer medicines. The ambition is to enable faster patient recruitment from across the Nordic region, so that many more can benefit from new treatments, such as immunotherapy.

 

CAR T cells are produced by isolating specific cells of the immune system (T cells) from a cancer patient and modifying them so that they become more effective at recognizing and killing cancer cells.

 

Promising advances

Immunotherapy represents a new type of cancer treatment, which activates the patient’s immune-system to fight off the cancer cells. It gives doctors the opportunity to help patients that previously had limited treatment options. Most types of immunotherapy also cause less side effects than traditional cancer treatments.

“The important point is that immunotherapy can have a long-term effect,” said Kyte.

“Most patients that experience a recurrence or progression of the disease cannot be cured. The traditional treatments only have a limited, short-term effect on them. But immunotherapy may have a long-term effect on the patient – and, in some cases, even cure the disease.”

 

Two big challenges

Immunotherapy may sound like a miracle drug, but researchers still have a long way to go to perfect the treatment for all cancer patients. Kyte highlights two of the biggest barriers that remain.

“One challenge is to develop immunotherapy so that it works efficiently on all types of cancer. The other challenge is to learn how to choose personalised treatment plans: to identify an individual’s biomarkers and find out which treatment will be effective for that specific patient.”

A biomarker is a biological molecule in the patient’s body and these may be used to see how well a patient will respond to a certain treatment. Kyte said that to develop immunotherapy, there needs to be more clinical trials. It is the only way for researchers to find out how to activate an immune response in the patient’s body.

“A big potential for development lies in trying different possible combinations of cancer treatments. In my clinical trials, for example, we combine immunotherapy with immunogenic chemotherapy or radiation therapy,” Kyte explained.

 

Jon Amund Kyte presenting the Clinical Trial Unit.

The Clinical Trial Unit are experts in assisting companies and researchers to conduct clinical trials in Norway.

 

Welcome, companies

OUH has a long history of conducting clinical trials and is an appealing option for both researchers, doctors and companies that wish to initiate their own trials. Kyte welcomes more companies to conduct clinical trials at OUH:

“The more clinical trials that are conducted here by companies, the stronger our clinical research environment becomes and our ability to run our own studies is also strengthened.”

The Clinical Trial Unit in Kyte’s department offers its services to companies that want to run a clinical trial at OUH. They have extensive background knowledge of how the hospital is organised and which approvals are needed to conduct a clinical trial in Norway. They can step in as project coordinator for companies that need help to get their clinical trials up and running.

“We are highly experienced in applying for approvals in Norway. When you run a clinical trial, there are regulations from the Norwegian Medicines Agency and the ethical committee and other governmental agencies. A clinical trial also involves many different parts of the hospital – the departments of pathology and radiology, the laboratories, the infusion unit, the hospital wards and out-patient clinic and the administrative offices that oversee different agreements, data management and biobanking.”

 

Nordic clinical trials

All these administrative obstacles may appear discouraging, but there are many convincing reasons to conduct a clinical trial in Norway.

“The Oslo University Hospital is a good place to run a clinical trial, because in terms of the number of cancer patients, it is one of the largest hospitals in Europe. Norwegian healthcare is also extremely well-organised. Patients are rarely lost to follow-up, because there are no private healthcare alternatives and patients rarely move out of the country,” Kyte explained.

The Clinical Trial Unit is also taking part in the development Nordic Nect, a collaboration to recruit patients from the entire Nordic region to clinical trials. The plan is to have one hospital where the clinical study is conducted and to involve patients from Sweden, Denmark, Finland and Norway. There will then be a population of 25 million people from which to recruit patients, which opens the possibility for larger clinical trials.

“This is a good thing for the companies that want to run clinical trials in Norway. It is also good for the researchers. But most of all, it is good for the patients – who have the opportunity to take part in more novel cancer treatments,” said Kyte.