Abstract
Clinical trials establish the standard of cancer care, yet the evolution and characteristics of the social dynamics between the people conducting this work remain understudied. We performed a social network analysis of authors publishing chemotherapy-based prospective trials from 1946 to 2018 to understand how social influences, including the role of gender, have influenced the growth and development of this network, which has expanded exponentially from fewer than 50 authors in 1946 to 29,197 in 2018. While 99.4% of authors were directly or indirectly connected by 2018, our results indicate a tendency to predominantly connect with others in the same or similar fields, as well as an increasing disparity in author impact and number of connections. Scale-free effects were evident, with small numbers of individuals having disproportionate impact. Women were under-represented and likelier to have lower impact, shorter productive periods (P < 0.001 for both comparisons), less centrality, and a greater proportion of co-authors in their same subspecialty. The past 30 years were characterized by a trend towards increased authorship by women, with new author parity anticipated in 2032. The network of cancer clinical trialists is best characterized as strategic or mixed-motive, with cooperative and competitive elements influencing its appearance. Network effects such as low centrality, which may limit access to high-profile individuals, likely contribute to the observed disparities.
Highlights
Clinical trials establish the standard of cancer care, yet the evolution and characteristics of the social dynamics between the people conducting this work remain understudied
We hypothesized that the social network of cancer clinical trialists would be a “strategic” aka “mixed motive” network, similar to those found in other areas of academic research displaying both collaborative and competitive elements reflective of the pressures faced by clinial trialists; this type of social network may be especially prone to preferential attachment, where authors with many co-authorship links are more likely to form new links or strengthen existing ones than authors with few existing links[20]
Co-authorship has changed in a non-linear fashion over time: the median number of authors per publication increased from n = 6 in 1946 to n = 20 (IQR 16–25) in 2018 (Figure S2)
Summary
Clinical trials establish the standard of cancer care, yet the evolution and characteristics of the social dynamics between the people conducting this work remain understudied. We hypothesized that the social network of cancer clinical trialists would be a “strategic” aka “mixed motive” network, similar to those found in other areas of academic research displaying both collaborative and competitive elements reflective of the pressures faced by clinial trialists; this type of social network may be especially prone to preferential attachment, where authors with many co-authorship links are more likely to form new links or strengthen existing ones than authors with few existing links[20] This could contribute to a widening disparity between authors with early access to resources through personal networks and authors in more socially disadvantageous positions, e.g., those who come from low-income backgrounds or were the first in their family to attend college[21,22]. These groups are more likely to include underrepresented minorities, e.g., women of color, who face a number of discriminatory barriers in pursuing careers in medicine and medical r esearch[11,23,24]
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