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Original Investigation
October 2017

The Effect of Positive SWOG Treatment Trials on Survival of Patients With Cancer in the US Population

Author Affiliations
  • 1SWOG Statistical Center, Seattle, Washington
  • 2Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 3SWOG Group Chair’s Office, Knight Cancer Institute, Oregon Health & Science University, Portland
JAMA Oncol. 2017;3(10):1345-1351. doi:10.1001/jamaoncol.2017.0762
Key Points

Question  How have the National Cancer Institute–sponsored network cooperative cancer research groups benefited patients with cancer in the general population?

Findings  Using data from 23 positive SWOG treatment trials, this study estimated that 3.34 million life-years were gained in the population of US patients with cancer through 2015, at a cost of $125 per life-year gained.

Meaning  The National Cancer Institute’s investment in its cancer cooperative group research program has provided exceptional value and benefit to the American public through its research programs generating positive cancer treatment trials.

Abstract

Importance  Recently, tremendous prominence has been given to the investigation of the effect of different research processes as part of the Cancer Moonshot. More than half a century ago, the National Cancer Institute (NCI) established a network of publicly funded cancer cooperative research groups to systematically evaluate new treatments for efficacy and safety.

Objective  To examine the extent to which positive NCI-sponsored cancer treatment trials have benefited patients with cancer in the US population.

Design, Setting, and Participants  This investigation used study data from SWOG, an NCI-sponsored network cooperative research group. All treatment trials during SWOG’s 60-year history (1956-2016) were identified for which the new, experimental therapy provided a statistically significant improvement in overall survival. It was assumed that the new, proven treatments from these trials established new standards for cancer care in the treatment community. Twenty-three positive SWOG treatment trials were identified from a variety of different disease settings.

Main Outcomes and Measures  This study estimated population life-years gained from the 23 treatment trials through 2015 by mapping the effect of the new treatments onto the US cancer population using an area under the Kaplan-Meier survival curve approach that combined trial-specific hazard function and hazard ratio results, along with Surveillance, Epidemiology, and End Results program and life table data. Calculations were age adjusted. The US dollar return on investment was estimated as the ratio of the total investment by the NCI in the treatment trial program divided by the estimate of life-years gained.

Results  In total, 12 361 patients were enrolled to the 23 positive trials from 1965 to 2012. The study estimated that 3.34 million (95% confidence limit, 2.39-4.15 million) life-years were gained from these 23 trials through 2015. Estimates were greater than 2 million life-years gained under most model simulations. The US dollar return on investment was $125 per life-year gained.

Conclusions and Relevance  SWOG treatment trials have had a substantial impact on population survival for patients with cancer over 60 years. The NCI’s investment in its cancer cooperative group research program has provided exceptional value and benefit to the American public through its research programs generating positive cancer treatment trials.

Trial Registration  clinicaltrials.gov Identifiers: NCT00004001, NCT00075764, and NCT00644228

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