The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies

TLDR

Despite extensive study, cancer clinical trial enrollment remains low, with structural, clinical, and attitudinal barriers varying by demographics and a growing emphasis on patient‑centered decision making. The article aims to characterize cancer trial barriers and evaluate strategies to reduce them, including a focus on adolescents whose low enrollment correlates with poorer outcomes. The authors review and synthesize existing evidence on barriers and propose global and local strategies to improve enrollment. Higher enrollment accelerates treatment advances and improves population outcomes; low enrollment, especially among adolescents, limits progress and generalizability, and increased accrual benefits patients by providing access to new therapies.

Abstract

Fewer than one in 20 adult patients with cancer enroll in cancer clinical trials. Although barriers to trial participation have been the subject of frequent study, the rate of trial participation has not changed substantially over time. Barriers to trial participation are structural, clinical, and attitudinal, and they differ according to demographic and socioeconomic factors. In this article, we characterize the nature of cancer clinical trial barriers, and we consider global and local strategies for reducing barriers. We also consider the specific case of adolescents with cancer and show that the low rate of trial enrollment in this age group strongly correlates with limited improvements in cancer population outcomes compared with other age groups. Our analysis suggests that a clinical trial system that enrolls patients at a higher rate produces treatment advances at a faster rate and corresponding improvements in cancer population outcomes. Viewed in this light, the issue of clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor. Fewer barriers to trial participation would enable trials to be completed more quickly and would improve the generalizability of trial results. Moreover, increased accrual to trials is important for patients, because trials provide patients the opportunity to receive the newest treatments. In an era of increasing emphasis on a treatment decision-making process that incorporates the patient perspective, the opportunity for patients to choose trial participation for their care is vital.