# A statutory minimum share of public trial money for surgery and radiotherapy

Source: https://onco.cc/ideas/idea-fund-non-drug-trial-quota/  
OnCo record `idea-fund-non-drug-trial-quota` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Surgery and radiotherapy cure more people than drugs but get a fraction of trial funding because there is no company sponsor. A rule would guarantee them a fixed share of public trial money.

## Summary

Public trial funders (NCI's NCTN, NIHR, EU programmes) would set a floor, for example 25%, for trials whose primary intervention is surgical, radiotherapeutic, interventional or a care-pathway change. The floor is justified because private sponsors fund almost all drug phase 3s but essentially no non-drug ones, so public money should preferentially cover the market failure. The quota would be paired with core funding for surgical and radiotherapy trials units and quality assurance.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A 25% floor doubles the number of adequately powered randomised surgical and radiotherapy trials started per year within five years, without reducing the total number of practice-changing results per public dollar.
- Rationale: Published audits show surgery and radiotherapy receive a small single-digit share of cancer research funding despite delivering around half of cures; where dedicated infrastructure exists (UK CTRad, TROG, the German Hodgkin Study Group) these fields have produced practice-changing trials at low cost.
- Proposed test: Audit one funder's portfolio by intervention type, apply the floor for one funding cycle, and count trials started, completed and practice-changing five years later against the prior cycle.
- Maturity: speculative
- Actor: policy

## Sources

- Bottleneck evidence (Funding follows fashion, not burden): Carter & Nguyen, A comparison of cancer burden and research spending (BMC Cancer 2012): https://doi.org/10.1186/1471-2407-12-526

## Connected records

- ideas: [A permanently funded international network for randomised cancer surgery trials](https://onco.cc/ideas/idea-fund-surgical-trials-network/), [Core-funded radiotherapy trials infrastructure with central quality assurance](https://onco.cc/ideas/idea-fund-radiotherapy-trials-infrastructure/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- companies: [Alliance for Clinical Trials in Oncology](https://onco.cc/companies/alliance-oncology/), [NRG Oncology](https://onco.cc/companies/nrg-oncology/)
- institutions: [The Christie NHS Foundation Trust](https://onco.cc/institutions/the-christie/), [The Royal Marsden](https://onco.cc/institutions/royal-marsden/)
- bottlenecks: [Funding follows fashion, not burden](https://onco.cc/bottlenecks/b-funding-allocation/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)
- key papers: [Benefits of hyperthermic intraperitoneal chemotherapy for patients with serosal invasion in gastric cancer: a meta-analysis of the randomized controlled trials](https://onco.cc/key-papers/paper-sun-bmc-cancer/)

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