Graduate students across all educational programs at the School of Population and Public Health (SPPH) are working on diverse and important public health issues. In our new series, we will be hearing directly from current students and recent graduates about what they are working on, why it matters, and how their training at SPPH has prepared them to meet the research and professional challenges of tomorrow.

Kristina Jenei, MSc (2021)

Tell us about your recent publications.

KJ: Cancer clinical trials have been rapidly evolving. Contrary to what many people might believe, many clinical trials do not measure patient-centered outcomes. In two recent publications, we explored trends in Canadian cancer drug approvals – examining submissions to the pan-Canadian Oncology Drug Review – the agency tasked for making funding recommendations to Canadian provinces.

Our Pharmacoeconomics paper found an increasing trend of submissions based on ‘early phase designs’ which are not designed to answer questions about benefit but rather safety.  Many of these trials are non-comparative, meaning they don’t compare against current standard of care (or nothing) –  leaving us with questions about whether they are truly more efficacious than what is on the market.

Our JAMA Internal Medicine paper quantified the survival benefit of Canadian drugs and found that the median survival gain was only 3.7 months – a sobering statistic. However, we found Canada does a better job filtering higher value drugs into the system than the United States (FDA) who approved almost all drugs.

How would you like to see this work implemented? 

KJ: This trend introduces significant uncertainty into healthcare systems while undermining the goal for high-value patient care. These drugs are also associated with high costs (many greater than $100,000 per-patient) which create significant opportunity costs and can introduce additional risks to patients. There is an urgent need to better understand clinical trials, reconsider study designs, the use of real-world evidence, and implement mechanisms for reassessment.

How did your training at SPPH prepare you to conduct this research?

KJ: As a former RN in palliative care, I was no stranger to advocating for increased patient access to experimental and costly treatments. However, I lacked foundational knowledge to interpret scientific data from clinical trials (to determine efficacy) and contextual understanding of the health system. SPPH provided me with this foundation from rigorous courses in statistical methods, advanced epidemiology, and health economics. I am indebted to my wonderful supervisors Dr. Craig Mitton who provided me with opportunities to gain “real world” experience on his health-technology team and with CADTH. And to Drs. Michael Burgess and Stuart Peacock who gave me opportunities to facilitate public deliberations on costly cancer drugs to include patient and public voices into policy decisions.

You can follow Kristina on Twitter at @kjmeetswrld