Toward an inclusive cancer clinical trial model: Health system geography and lessons from Australia for Saudi Arabia

Abstract

Background: This study reviews cancer clinical trials conducted in Saudi Arabia (KSA), focusing on how the spatial organization of health services and research institutions shapes access to experimental cancer therapies. The analysis highlights major trial sponsors, site distribution, and regional gaps in coverage. To interpret these patterns within a health-system context, KSA's clinical trial landscape is benchmarked against Australia between 2014 and August 2024, a country with a more geographically distributed oncology research infrastructure.

Methods: A total of 6381 clinical trial summaries were reviewed to identify studies primarily focused on cancer and classified by cancer type. Data were sourced from ClinicalTrials.gov and manually curated to distinguish trial-level activity from site-level geographic distribution. Comparative mapping was used to examine how institutional centralisation versus regional diffusion of trial sites reflects underlying health-system architecture.

Results: Marked disparities in cancer trial site distribution were observed in KSA, with activity overwhelmingly concentrated in Riyadh, leaving many regions without trial access. This pattern reflects the centralised development of tertiary cancer services in the Kingdom. In contrast, Australia demonstrated a geographically dispersed trial network across multiple states and cities, consistent with federated governance, public hospital-university integration, and cooperative trial structures. King Faisal Specialist Hospital and Research Centre (KFSHRC) emerged as the dominant Saudi trial site, serving as a national hub for international collaboration.

Conclusions: The current centralisation of cancer clinical trials in KSA is historically intelligible but increasingly limits equitable access and population-representative research. Adopting a networked, hub-and-spoke trial model drawing on Australian experience could expand regional participation while preserving the role of national centres of excellence. These findings offer policy-relevant guidance aligned with Saudi Arabia's Vision 2030 health transformation agenda.

Keywords: Australia; Cancer clinical trials; Cancer research landscape; ClinicalTrials.gov; KFSHRC; Regional disparities; Saudi Arabia; Site distribution.