PERSPECTIVE OPEN Clinical Studies The National COVID Cancer Antibody Survey: a hyper- accelerated study proof of principle for cancer research Matthew Fittall 1 , Justin Liu 2 , James Platt 2 , Maria Ionescu 3 , Remarez Sheehan 4 , Sukhmunni Johal 4 , Rosie Mew 5 , James Clark 4 , Izzy Watts 6 , Arvind Tripathy 7 , Martin Little 4 , Grisma Patel 8 , Hari Panneerselvam 9 , Nathan Appanna 4 , Emma Burke 4 , Hayley McKenzie 10 , Michael Tilby 11 , Sam Khan 12 and Lennard Y. W. Lee 5 ✉ © The Author(s) 2023 The COVID-19 pandemic has led to a range of novel and adaptive research designs. In this perspective, we use our experience coordinating the National COVID Cancer Antibody Survey to demonstrate how a balance between speed and integrity can be achieved within a hyper-accelerated study design. Using the COVID-19 pandemic as an example, we show this approach is necessary in the face of uncertain and evolving situations wherein reliable information is needed in a timely fashion to guide policy. We identify streamlined participant involvement, healthcare systems integration, data architecture and real-world real-time analytics as key areas that differentiate this design from traditional cancer trials, and enable rapid results. Caution needs to be taken to avoid the exclusion of patient subgroups without digital access or literacy. We summarise the merits and defining features of hyper-accelerated cancer studies. British Journal of Cancer (2023) 128:1977–1980; https://doi.org/10.1038/s41416-023-02251-9 Cancer clinical trials have developed into a diverse and sophisticated array of designs suited to differing purposes. These trials aim to give robust insights into cancer biology, pathology, investigation and management. The heritage of these trials, developed prior to the utilisation of electronic health records and population-scale datasets, persists in modern clinical practice. The speed of the COVID-19 pandemic and its potential threat to society inspired a revolution in clinical trial design, achieved through collaboration and innovation between clinical specialties, research organisations, academic institutions and governments. A greater emphasis was placed on expedited and pragmatic studies, so termed hyper-accelerated trials. These novel approaches encom- passed clinical testing, risk stratification and the development of therapeutics: the RECOVERY programme rapidly established a coordinated national clinical trial assessing repurposed therapeutics in hospitalised patients [1], the FALCON Moonshot C-19 studies provided the validation for lateral flow tests in the UK [2] and the national coordination of testing, hospitalisation data and viral sequencing afforded rapid insights into viral evolution and clinical risk [3, 4]. The development of vaccines has been well described and rightly lauded [5]. The MHRA has accepted the findings from these new study designs, which has led to new diagnostics, therapeutics and vaccines being approved in record time. The COVID-19 pandemic has had a significant impact on cancer care, with delayed diagnoses and treatments, and disruption to research. Cancer patients have also been more directly impacted by COVID-19 than the general population [6, 7]. This risk was identified through the efforts of the UK Coronavirus Cancer Programme (UKCCP), one of the longest running cancer and COVID-19 research programmes globally [8]. A major clinical concern at the end of 2021, and the rationale for launching the National COVID Cancer Antibody Survey, was whether cancer patients received as much protection from COVID- 19 vaccination as the general population. The survey therefore aimed to appraise the utility of assessing immune responses in cancer patients post-vaccination through antibody testing. In 2021, pivotal immunology phenotyping studies were published from UK research consortiums such as CAPTURE [9] and SOAP [10]. Similar validation studies were also published in each cancer subtype, though with limitations. These studies used varying assays and meant there was no way to compare antibody responses across the cancer population. Most crucially, there was no known link between antibody response and COVID-19 protection. The National COVID Cancer Antibody Survey was an ambitious attempt to address these issues in a timely way to inform the ongoing vaccination programme. Received: 12 December 2022 Revised: 5 March 2023 Accepted: 20 March 2023 Published online: 20 April 2023 1 Cancer Institute, University College London, London WC1E 6DD, UK. 2 Leeds Institute of Medical Research, University of Leeds, Leeds LS9 7TF, UK. 3 UK Health Security Agency, Fleetbank House, London EC4Y 8AE, UK. 4 Oxford University Hospitals, Oxford OX3 9DU, UK. 5 Royal Devon University Healthcare NHS Foundation Trust, Exeter EX2 5DW, UK. 6 University College Hospitals NHS Foundation Trust, London NW1 2PG, UK. 7 University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK. 8 Maidstone and Tunbridge Wells NHS Trust, Kent TN2 4QJ, UK. 9 Wye Valley NHS Trust, Kent TN2 4QJ, UK. 10 University Hospital Southampton NHS Foundation Trust, Hampshire SO16 6YD, UK. 11 University Hospital Coventry, UHCW NHS Trust, Coventry CV2 2DX, UK. 12 University of Leicester, Leicester LE1 7RH, UK. ✉ email: Lennard.lee@nhs.net www.nature.com/bjc British Journal of Cancer 1234567890();,: