Conducting clinical trials in NZ has been challenging for many years, not least because clinical research was not considered part of the public health system, which was fragmented into 20 District Health Boards. As a consequence, there was little or no investment in clinical trial infrastructure (especially outside major centres) and all associated costs including staff salaries had to be fully covered. For collaborative trial groups including TROG, this resulted in fewer NZ sites recruiting fewer patients into clinical trials, because sites had to apply for grants to cover the shortfall between trial per patient payments and the costs charged by the hospitals. There was also little or no allowance made for oncologists spending time on clinical research as part of their employment.
In July 2022 the entire NZ public health system was integrated into a single entity called Health NZ (Te Whatu Ora), which theoretically removes the barriers to cooperation and collaboration between hospitals and regions. Importantly, clinical research is now explicitly considered an integral part of the activity of Te Whatu Ora, as part of a learning healthcare system. The Enhancing Aotearoa New Zealand Clinical Trials Project is intended to facilitate the conduct of clinical trials across NZ, and reduce the inequities of access to trials in regional and rural areas, by developing clinical trials infrastructure across NZ. While this is expected to take a few years to be in place, there is a current initiative to create a national cancer trials network to reduce barriers to site participation in collaborative group and investigator-initiated trials. This could be active much earlier than the national clinical trials infrastructure, but would align with its structure. It would require some investment in clinical trials staff at smaller sites in regional and rural areas, similar to that invested in the teletrials structure in Australia. There is, as yet, no funding available to support this in NZ, though SOPs for decentralised trials have been approved nationally. We anticipate that relatively modest investment and revision of costs charged for non-commercial clinical trials in public hospitals will substantially improve participation and recruitment of cancer patients from across NZ, especially from smaller sites.