Many obstacles to cancer clinical trial enrollment at community-based oncology settings were identified in a study published in JCO Oncology Practice.

Although the low enrollment of adult patients with cancer in US-based cancer clinical trials has been well documented, most studies evaluating the barriers and facilitators of clinical trial participation by this group of patients have not been made from the perspective of the community oncologist. Nevertheless, it has been estimated that community settings are the site of cancer care delivery for almost 80% of patients with cancer.

In this study, semistructured interviews were conducted either face-to-face or over the telephone from March to June 2018 with community medical oncologists practicing at 6 community-based sites affiliated with the City of Hope Cancer Center in southern California. One of the main aims of this study was to assess barriers to cancer clinical trial enrollment as perceived by community oncologists. Transcripts of the interviews were analyzed for thematic content.

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Of 23 community medical oncologists invited, 20 (87%) agreed to participate in the study. Consistent with previously observed findings, 16 (80%) study participants reported that fewer than 5% of their patients were enrolled in cancer clinical trials. Identified barriers to cancer clinical trial enrollment fell into 3 overall categories: system and protocol factors, physician factors, and patient-related factors.

System and protocol factors Study participants noted that the available clinical trials were frequently not meeting the needs of their patients. For example, most respondents stated that studies evaluating adjuvant therapy or treatments for first-line metastatic disease would be most appropriate for their patients, but many of the available clinical trials focused on higher-line therapy. Furthermore, a limited number of research staff dedicated to clinical trials, strict inclusion/exclusion criteria, and the lack of financial coverage for patients enrolled in clinical trials by common insurance plans were also identified as barriers to cancer clinical trial enrollment in the community.

Physician factors Barriers to cancer clinical trial enrollment included difficulties in staying up-to-date regarding available clinical trials and/or the details of specific clinical trials, particularly since many community oncologists treat a variety of cancers.  Time constraints were also noted as an impediment to enrolling patients in these studies.

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Patient-related factors Potential additional burdens imposed by the trial, such as the need for additional procedures or long-distance travel, as well as misperceptions on the part of some patients regarding the experimental nature of clinical studies were identified as barriers to trial participation.

The study authors noted that these results “highlight an enormous need for more research, policies, and strategies to remove known obstacles to patient participation in cancer therapeutic trials in the community setting.”


Wong AR, Sun V, George K, et al. Barriers to participation in therapeutic clinical trials as perceived by community oncologists [published online April 2, 2020]. JCO Oncol Pract. doi: 10.1200/JOP.19.00662