Randomized controlled trials (RCTs) are the gold standard for evaluating the efficacy of new cancer therapies. Since widespread adoption of the RCT in the 1970s, cancer clinical trials have evolved considerably. Work by our group and others have shown that RCTs have evolved over time to become larger, more likely to be industry-funded, with more multi-center and international involvement. There has also been a marked shift to the use of surrogate primary endpoints.

While the majority of North American research output is driven by the United States (US), Canada’s cancer research spending is comparable to that of other high-income countries across Europe and Asia. Like other parts of the world, most clinical research funding in Canada now comes from industry sources as it has become increasingly difficult for independent Canadian investigators to support the increasing costs of clinical trial infrastructure. Several groups have demonstrated that the volume of research output is associated with allocation of research funds rather than burden of disease.