Seven decades of chemotherapy clinical trials: a pan-cancer social network analysis
Clinical trials are crucial in establishing cancer care standards, but the social dynamics among researchers in this field have not been extensively studied. A social network analysis of authors involved in chemotherapy-based prospective trials from 1946 to 2018 reveals significant insights.
- The author network has grown exponentially, from fewer than 50 authors in 1946 to 29,197 in 2018.
- By 2018, 99.4% of authors were connected, either directly or indirectly.
- There is a tendency for authors to connect predominantly with those in the same or similar fields.
- An increasing disparity exists in author impact and the number of connections, with scale-free effects indicating that a small number of individuals have a disproportionate impact.
- Women are under-represented, often have lower impact, shorter productive periods (P < 0.001 for both comparisons), less centrality, and tend to have more co-authors within their subspecialty.
- The last 30 years show a trend towards increased authorship by women, with gender parity expected by 2032.
- The network of cancer clinical trialists exhibits strategic or mixed-motive characteristics, with both cooperative and competitive elements affecting its structure.
- Network effects such as low centrality may limit access to high-profile individuals, contributing to observed disparities.
The modern era of chemotherapy began in 1946, with publications describing therapeutic uses of nitrogen mustard. Over the next 70 years, the repertoire of available cancer treatments has expanded at an ever-increasing pace. Chemotherapeutics have a notably low therapeutic index, i.e., the difference between a harmful and beneficial dose or combination is often quite small. Consequently, a complex international clinical trial apparatus emerged in the 1970s to study chemotherapeutics in controlled settings, and prospective clinical trials remain the gold standard by which standard of care treatments are established. Discoveries made by successive generations have led to overall improvement in the prognosis of most cancers.
While social network analysis has been used to study patterns of co-authorship in scientific settings, the social component of clinical trial research is not well characterized. Little is known about how social factors have shaped the progress of the field, as cancer care has become increasingly sub-specialized, and how social network characteristics may reveal patterns of inclusiveness, exclusivity, and disparity. Prior literature has established that women in academic medicine are expected to perform to higher standards yet receive less financial and institutional support (e.g., grants, awards, salaries, opportunities for tenure) than men with the same qualifications do. Women must also contend with structural biases against them throughout their careers; this can manifest in gendered harassment and evaluations, questions of competence, lack of appropriate mentorship and peer support, and other inhospitable working conditions where they are undervalued, if not actively excluded. Past work on co-authorship networks indicates that men are over-represented in senior authorship roles, particularly in high-impact journals and in fields where research is more costly, and accrue more citations than their counterparts who are women.
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