# Randomise inside the cancer registry: registry-based trials for everyday questions

Source: https://onco.cc/ideas/idea-tr1-registry-embedded-randomisation/  
OnCo record `idea-tr1-registry-embedded-randomisation` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

National cancer registries already collect the outcome data. Adding a randomisation button lets doctors compare two standard treatments across thousands of patients at a fraction of the usual cost.

## Summary

Registry-based randomised trials, pioneered in cardiology by Sweden's TASTE trial, embed randomisation in a clinical quality registry and use routinely collected outcomes (death, recurrence, hospitalisation) as endpoints. Oncology registries in the Nordic countries, the Netherlands, the UK and some US states could support comparisons of approved treatments, schedules and follow-up strategies at a marginal cost per patient of a few hundred dollars.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Registry-embedded randomised trials in oncology can enrol at least ten times more patients per year per dollar than conventional pragmatic trials and answer comparative questions (sequence, schedule, duration, surveillance) that industry will not fund.
- Rationale: TASTE randomised over 7,000 patients at low cost and produced a definitive answer. Oncology registries have the same coverage in several countries; the barriers are governance and consent design rather than technology.
- Proposed test: Run one registry-embedded trial of a surveillance or schedule question (e.g., follow-up imaging frequency after curative resection) in a national registry and report cost per patient, accrual rate and data completeness.
- Maturity: early-clinical
- Actor: research

## Sources

- TASTE registry-based randomised trial (NEJM 2013): https://www.nejm.org/doi/full/10.1056/NEJMoa1308789

## Connected records

- collections: [SEER (Surveillance, Epidemiology, and End Results)](https://onco.cc/collections/seer/)
- institutions: [Karolinska University Hospital](https://onco.cc/institutions/karolinska/), [Netherlands Cancer Institute (NKI-AvL)](https://onco.cc/institutions/nki/)
- terms: [Real-world evidence](https://onco.cc/terms/real-world-evidence/), [Standard of care](https://onco.cc/terms/standard-of-care/)
- bottlenecks: [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/), [Trials enrol too few, too slowly](https://onco.cc/bottlenecks/b-trial-enrolment/), [Weak real-world evidence and registries](https://onco.cc/bottlenecks/b-real-world-evidence/)
- roadmaps: [Trial modernisation roadmap: the randomised trial → platforms and adaptive designs → decentralised, pragmatic and always-on](https://onco.cc/roadmaps/trial-modernisation-roadmap/)

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