Prime Location for Global Clinical Studies?

Canada is considered one of the most attractive places to live in the world, with a high quality of life, stable business environment, educated workforce, and diverse population. Because of these attractive “features”, it is also one of the best places in the world to conduct global studies. Over the past fifteen to twenty years, clinical trials in Canada have grown to contribute 4.1% of total clinical trial sites globally—this compares with 2^nd and 3^rd in the world Germany (5.7%), and France (4.3%).

Canada with world-class researchers & diverse patient population is one of the top 6 countries in the world for enrollment of clinical trial patients according to the FDA’s global clinical trial report. Considering Canada is a young country (only 153 years old) with a population of 37 million, these rankings indicate that this country has a disproportionately large number of sites and patients enrolled in global studies.

So, why and how do we do it?

#1: Top-Quality Data

While Canada isn’t the oldest or most populated country in the world, it is associated with the production of top-quality data in global studies. Canada’s success in this department can be attributed to the government’s ongoing financial support for over two decades, which has attracted many world-class researchers – did we mention Canada is a great place to live? The government’s financial support has helped staff Canada’s oncology clinical research centers, of which there are over 50, with top global talent that foster Canada’s solid reputation for research in clinical medicine, biomedicine, and science and technology.

#2: Consistent High Enrollment

In addition to the quality of data coming from Canada, we are also one of the most efficient countries at overcoming barriers to enrolling patients; Canada is among the top four countries in North America and Western Europe known to be the quickest to enroll patients following trial site initiation.

Canada’s success in patient recruitment is a result of a few key factors, including (1) universal, free access to healthcare; (2) a diverse patient population; (3) a positive public perception of clinical trials; and (4) a vast national network for disease treatment.

The first factor – access to healthcare – is due primarily to Canada’s publicly-funded healthcare system and the distribution of Canada’s population. In general, Canadian residents seek medical care more readily than their counterparts in privately-funded healthcare systems since they do not have to worry about cost or insurance restrictions to do so. Furthermore, Canada’s population tends to be clustered together. Nearly two thirds of Canadians (78%) live within 160 kilometers (about 100 miles) of the U.S. border. This makes it easy to access publicly-funded healthcare. As a result, Canadian PIs have access to a large patient population despite Canada having a relatively low population size.

Another factor that gives Canadian PIs an advantage with respect to patient enrollment is the diversity of the patient population. Canada is one of the most ethnically diverse countries in the world. This aids Canadian PIs to readily recruit a broad and diverse range of patients for global studies. Although this does not necessarily result in a higher absolute number of patients enrolled, it does provide diverse representation in global studies. A factor that usually results in improved safety profiles for potential drug candidates.

Public perception of clinical trials in Canada is the third factor that contributes to the success of Canadian PIs when it comes to patient enrollment. A survey conducted in 2018 showed that Canadians perceive clinical trials to be positive because of the societal and personal benefits they provide. In the survey, researchers found that most Canadians were somewhat (49%) or very willing (19%) to participate in clinical trials.

The final factor that contributes to Canadian PIs’ success in patient enrollment is the vast disease treatment networks that allow PIs to coordinate research across multiple centers of expertise. These networks use provincial and national patient databases maintained by government agencies such as Cancer Care Ontario in order to connect medical experts and patients to clinical trials; in turn, Canadian PIs are able to easily screen and find suitable patients for participation in their global studies.

#3: Proof in Numbers

After all this discussion of the reasons why Canada is a prime location for global studies, the proof is really in the numbers. Canada’s recruitment success rate in clinical trials is reported to be 98%, with sites in Canada that have as much as 22% of their total patient population participating in clinical trials.

That said, while the landscape in Canada is generally quite favorable to the success of global studies, this isn’t an exhaustive list of the factors that make Canadian PIs some of the top patient enrollers, nor does it always translate into enrollment success for every study.

Unsurprisingly, enrollment success can vary from study-to-study, which is why it is vital for Sponsors to be selective about who they partner with in order to recruit patients for their global studies. Specialized CROs with local expertise that can leverage the disease treatment networks effectively are often most successful at connecting Canadian PIs to the most relevant studies for the patient population they serve.

#4: Choose the Right Partner for Your Study in Canada

At Scimega, we are proud to say that the sites and Canadian PIs we work with are often top enrollers in the global oncology studies on which we collaborate with Sponsors.

As a niche Canadian CRO skilled in collaborative vendor teaming with a proven track record of 25 years unparalleled Canadian oncology experience Scimega guarantees sponsors the quickest site start-up and highest patient recruitment rate, without sacrificing premium quality data. With an optimal operations design robust enough to address an ever-changing clinical trial landscape, Scimega’s team of oncology experts go above-and-beyond for your study to provide:

• Identification and qualification of the right Canadian sites for your trial within just a few weeks thanks to our extensive network of Canadian Investigators. 

• Site activation 50% faster than the industry average. 

• In global oncology studies our Canadian sites frequently emerge among top enrollers. 

Like you, our clients develop cutting- edge oncology therapies – and they trust our results!

   Contributed by: Chantalle Willie, B.Sc., CCRP., Feasibility & Contracts Manager

Sources:

Nature Reviews Drug Discov 2008; [7]:13-4.

Government of Canada News Room: https://www.chairs-chaires.gc.ca/whats_new-quoi_de_neuf/2020/crc-2019-1-eng.aspx

IMS Enrollment Analytics Data from close of recruitment between 2016-2017

Canadian Clinical Trials Coordinating Centre. Clinical Trials: The Canadian Advantage Presentation, June 2018. https://www.cctcc.ca/wp-content/uploads/2018/02/CCTCC_CT-Investment-Case_June-2017_Final.pdf

James Fearon (2003). “Ethnic and Cultural Diversity by Country” (PDF). Journal of Economic Growth. 8: 195–222

Willison, D., et.al. Survey of Awareness and Perceptions of Canadians on the Benefits and Risks of Clinical Trials. TIRS. 2019; 53, 669-667.

Collier, R . Federal government unveils patient-oriented research strategy. CMAJ. 2011; 183: 1469. Leclerc, J.M., 2012

Princess Margaret Cancer Centre Annual Report 2019. https://www.uhn.ca/PrincessMargaret/Annual_Report