Prof D A Cameron

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NCRN - can we mature once we have stopped
growing?

• Prof D A Cameron
• NCRN Coordinating Centre, Leeds

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Genesis

• In the beginning there was darkness
• On the first day the Lord created the NCRN
• And the Lord saw that it was good
• On the second day the Good Lord created more
  TCRNs .... MHRN, Dendron, MCRN, stroke, PCRN, DRN
• And the Lord saw that they were all good
• So in the rest of the chaos they created the NIHR
  and CLRN.

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Overall accrual 2006/2007
50
25
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Overall accrual by Incidence
Other CSGs
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Overall accrual by Incidence
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Number of studies

• NIHR portfolio
• Active funding streams
• CRUK
• HTA
• Other charities
• Other NIHR funding routes

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Volume of accrual
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What have we grown into?

• Comprehensive coverage of UK
• Tripled accrual to cancer studies
• Highest per capita accrual in the world
• Broad portfolio
• Treatment, screening, genetics, follow-up
• High accrual in a few cancers
• Modest accrual in most cancers

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Maturity

• Maturity is the art of living in peace with
  that which we cannot change, the courage to
  change that which should be changed -- and the
  wisdom to know the difference.

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NIHR

• National Institute for Health Research
• Best Research for Best Health
• providing the NHS with the support and facilities
  it needs for first class research
• Clinical research networks for England
• Research Centres
• Biomedical Research Units
• Experimental medicine facilities
• Technology platforms
• Research Design Centres

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NIHR Portfolio rules

• NIHR defined portfolio criteria
• Majority of from NIHR partners
• (National funders HTA, CRUK)
• CTAAC approved studies, even if not CTAAC funded

• Adopted Fully funded pharmaceutical studies
• Foreign government funded studies

• Peer reviewed Academic Pharma funding
• EORTC and other high quality studies

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Comprehensive networks

• Provide Service support costs for research in the
  NHS
• TCRNs, PCRN and all other diseases
• Unblocking research barriers
• Pharmacy, Radiology etc.
• Provide research governance
• RD/ Management approval
• Estimate that more money is spent on NHS cancer
  research costs outside NCRN than inside.all of
  this will come through Comprehensive networks..

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Challenges for us

• Networks are the new model
• Do we act like networks?
• NCRN review Jan 2009
• Much greater emphasis on speed of accrual
• Justification of a special Cancer Network.

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Pressures

• Slow recruiting trials
• Have to work together to solve what can be solved
• Cancer most mature network
• Often selected to try things out
• Mistakes very public!
• Industry..

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Speed

• Speed of opening
• CSP Comprehensive networks
• Do our bit efficiently
• Effective negotiation with Trusts Commissioners
• Speed of accrual
• Think how to do this most effectively
• Share best practise
• Identify barriers TELL US if outwith your
  control
• Share patients

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Networks

• Evidence of network benefits
• Working with service networks
• Impacting on local services
• Working with local researchers
• Cancer
• Non-Cancer
• Working with local consumers
• Working as a network
• Not just an administrative unit

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Pilot approach to slow recruiters

• Parallel the Industry trial ideas..
• Identify some key trials
• Identify potential solutions
• Collate information from PIs/RNMs/CLRs
• Meeting/TC
• Chief Investigator (- other TMG members)
• CTU
• CSG input
• Representative RNMs

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Targets v points?

• Improve patient outcome
• Speedy accrual to trials
• Increase RCT accrual
• Maintain non-RCT accrual

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What does this mean?

• Breast portfolio National priorities?
• Sofea ALTTO IBIS-II

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What does this mean?

• Breast portfolio National priorities?
• Sofea ALTTO IBIS-II
• All top priority studies
• All CTAAC approved RCTs in the NCRN portfolio
• Non-cancer patients cannot count in the 7.5 as
  they dont have cancer
• All patients count towards speed of accrual
  targets
• Local priorities will vary non-Stalinist.

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Summary

• Balance of the portfolio
• Diseases/ treatments/ genetics/ supportive
• Speed
• Open studies and get on with accrual.
• Overall recruitment
• More patients, more answers

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Summary

• Balance of the portfolio
• Diseases/ treatments/ genetics/ supportive
• Speed
• Open studies and get on with accrual.
• Overall recruitment
• More patients, more answers
• Industry is a core business

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Summary

• Balance of the portfolio
• Diseases/ treatments/ genetics/ supportive
• Speed
• Open studies and get on with accrual.
• Overall recruitment
• More patients, more answers
• Industry is a core business
• Work as networks

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• Delivering with the Pharmaceutical Industry