156). These include a diversity action plan which would require researchers and funders of clinical trials to submit concrete goals and needed steps for enrolling specific demographic groups in pivotal studies of new drugs (341). COVID-19, despite its adverse effects on all aspects of cancer research and patient care, enabled researchers to decentralize clinical trial designs, so that lifesaving therapeutics could be brought quickly to as many patients as possible (9). Adaptations implemented by NCI and FDA during the pandemic, including consenting patients remotely, permitting telehealth for routine clinical assessments (see Sidebar 29, p. 75), delivering experimental drugs to patients, and allowing the use of local laboratory or imaging facilities accessible to patients have offered a blueprint of success to further revise and reform clinical trials and the drug approval process for the benefit of all patients with cancer. Progress Across the Clinical Cancer Care Continuum Research discoveries made as a result of innovative cancer science are continually being translated into new medical products for cancer prevention, detection, diagnosis, treatment, and survivorship. The approval of new medical products, including new anticancer treatments, is not the end of a linear research Types of Clinical Trials Clinical trials can be designed to address different research questions. Furthermore, many clinical trials can provide answers to multiple questions. As one example, treatment trials—designed to primarily determine clinical outcomes, such as efficacy of an anticancer drug—can also evaluate the impact of the treatment on quality of life. Cancer clinical trials include: PREVENTION TRIALS Designed to find out whether people without a cancer diagnosis can reduce their risk of cancer by proactively taking certain actions, such as increasing physical activity and eating healthily. SCREENING TRIALS Designed to evaluate new tests to detect cancer before symptoms arise, with the goal of determining whether the screening test will reduce deaths from cancer. DIAGNOSTIC TRIALS Designed to test new ways to diagnose a certain type of cancer. TREATMENT TRIALS Designed to determine whether new treatments or new ways of using existing treatments— alone or in combinations—are safe for patients and effective in treating cancer. QUALITY OF LIFE TRIALS Designed to examine whether patients with cancer can improve their quality of life by taking certain actions, such as attending support groups or exercising more. These trials are also known as supportive care or palliative care trials, and many evaluate the effects of certain cancer medications and treatments on quality of life. NATURAL HISTORY OR OBSERVATIONAL STUDIES Designed to learn more about how cancer develops and progresses by following patients with cancer or individuals who are at high risk for developing cancer over a period of years. CORRELATIVE STUDIES Designed to examine the efficacy of a candidate anticancer drug by using biomarkers, such as proteins, as indicators of the desired clinical outcome when the effects of the drug on key clinical outcomes, such as reduction in tumor size, may not be apparent. SIDEBAR 27 Advancing the Frontiers of Cancer Science and Medicine AACR Cancer Progress Report 2023 71
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