International models of investigator-initiated trials: implications for Japan

Comparison of Industry-Sponsored Trials (IST) and Investigator-Initiated Trials (IIT) in Advanced Genitourinary Cancers in the United States, Canada, United Kingdom and France

BACKGROUND

Clinical trials are categorized as industry sponsored trials (ISTs) or investigator-initiated trials (IITs) based on the source of funding and sponsor of the trial. ISTs are usually run by pharmaceutical companies, and are primarily aimed at developing new drugs that ultimately gain regulatory approval. IITs are developed by academic investigators or cooperative groups, often sparked by a clinical need. Both are vital in advancing the field of oncology. To date, little has been published about current trends in ISTs or IITs in genitourinary (GU) oncology. The aim of this study was to assess growth trends of GU oncology ISTs and IITs in 4 countries with similar healthcare infrastructures.

METHODS

We searched ClinicalTrials.gov for bladder, kidney, and prostate cancer trials conducted in the United States (US), Canada, France, and United Kingdom (UK) from January 2007 to December 2021. Trials were determined to be ISTs or IITs based on their funding source and sponsor. Trials were characterized based on type, purpose, phase, participants, masking, assignment, and allocation.

RESULTS

Overall, 5,834 GU trials were identified, with a balanced distribution of ISTs (n = 3064, n = 52.5%) and IITs (n = 2770, 47.4%). By country, the US conducted the most GU trials (n = 3814) followed by Canada (n = 709), France (n = 677), and the UK (n = 634). Most ISTs were phase 3 trials with over 500 participants while most IITs were open-label phase 2 studies with only 20-49 participants. From 2017 onwards, there was a shift towards more ISTs, most noticeably in Canada and the UK. The COVID-19 pandemic did not have a major impact on the growth of ISTs and IITs.

CONCLUSION

The gap between ISTs and IITs continues to widen, likely driven by resource and funding challenges faced by investigators. Barriers to completing IITs need to be better understood to promote IIT development and maintain their academically driven intentions.

Validation of a Questionnaire to Delineate the Clinical Trial Nursing Roles in Korea

BACKGROUND

In clinical trials, research nurses play a particularly important role in promoting cancer care best practices. However, no Korean questionnaire has been developed to define the clinical trial nursing roles based on Good Clinical Practice standards.

OBJECTIVE

The aim of this study was to cross-culturally evaluate the reliability and validity of a Korean version of the Clinical Trials Nursing Questionnaire (CTNQ) among Korean clinical research nurses.

METHODS

Cross-cultural adaptation was performed, with forward and backward translation, a pilot test (linguistic validation), and a field test. Validation was performed by questioning 53 clinical research nurses who were working in clinical cancer centers at 5 tertiary university hospitals. The distribution of the item responses and internal consistency reliability were assessed using the ceiling and floor effects, Cronbach's α, and the item-total correlation. Construct validity was assessed using Spearman correlation analysis and principal-component factor analysis.

RESULTS

The distributions of the item responses and the item-total correlation were generally appropriate. The Cronbach's α values for the frequency scale and the importance scale were 0.852 and 0.899, respectively. Eight sections of the Korean CTNQ were generally correlated with each other. The frequency subscale loaded on 1 factor, and the importance subscale loaded on 2 factors, with broadly similar factor loadings.

CONCLUSION

The Korean version of the CTNQ is reliable, valid, and interchangeable with the original CTNQ.

IMPLICATIONS FOR PRACTICE

The Korean version of the CTNQ can be used to validly and reliably assess the clinical trial nursing roles in Korea.