Expanding Clinical Trial Access Through Community Oncology

Clinical trials drive advancements in cancer care. Yet for decades, many oncology studies have not fully reflected the range of patients treated in everyday practice. Older adults, rural residents, patients with transportation challenges, and those who face language or communication barriers may have fewer opportunities to participate in research, even when a clinical trial could be an appropriate care option.^1,2

Geography, transportation, language, and other practical considerations can influence whether patients are able to explore clinical trial opportunities. When eligible patients cannot reasonably access clinical trials, it can limit the applicability of research findings and affect how advances in care reach local communities. Clinical trials help shape treatment decisions, and when study populations do not reflect the patients seen in real-world oncology settings, the research may garner less information to guide care for the full range of patients.

Expanding access requires a closer look at the practical barriers that keep patients from learning about, understanding, and participating in clinical trials. It also requires community-based strategies that bring appropriate research opportunities closer to where patients live and receive care. If we want clinical research to reflect real-world cancer care, research must increasingly be available where most patients receive treatment: in independent community oncology practices.³

What Barriers Limit Patient Participation in Clinical Trials?

A landmark 2024 study published in the Journal of Clinical Oncology estimated that approximately 7.1% of adult patients with cancer enrolled in clinical trials between 2013 and 2017.⁴ Although this estimate is higher than the frequently cited historical rate of less than 5%, it still shows that many eligible patients are not participating.⁵ When trials fail to meet enrollment targets, which happens approximately 20% to 40% of the time, studies may close early, slowing research progress and limiting patient access to investigational treatments.

Many patients are willing to consider a clinical trial, yet actual enrollment rates remain low.^4,6 This gap between willingness and participation points to several practical barriers that can prevent patients from joining studies.

• Geographic limitations: Clinical trials are often concentrated in large cities. This leaves rural residents with limited opportunities to participate. More than 50% of people with cancer in the United States cannot access a clinical study at their main treatment facility.⁵ Additionally, for those with metastatic cancer, roughly half must drive at least an hour each way to find a trial, which can be difficult for patients already managing fatigue, stress, cost concerns, and treatment demands.⁷
• Trust and awareness barriers: Some patients may be reluctant to participate in medical research. Building trust requires clear communication, transparency about study protections, and consistent engagement with community members before trial enrollment is ever discussed.
• Language and communication barriers: Trial materials are not always available in the languages that patients and families use most comfortably, which can make it harder to understand study requirements, risks, and potential benefits.

How Can Community Oncology Practices Broaden Clinical Trial Participation?

Community oncology practices are well positioned to help expand trial access because they care for many patients close to where they live. This work starts with practical, proactive steps: identifying relevant protocols, making trial awareness part of routine care discussions, and helping patients understand whether a study may be an option for them.

Clinical trial access also depends on whether patients can easily understand the information being shared. Study documents should use clear, conversational language and explain what the study aims to achieve, what participation involves, the trial’s potential risks and benefits, and what patients can expect throughout the process.

However, written materials are only part of the work. Practices also need to build relationships in the communities they serve. For instance, Texas Oncology works with grassroots networks to share information about clinical trials, including how studies are conducted, what safeguards are in place, and how patients may be able to access research opportunities. These groups understand local languages, cultures, and concerns, helping connect the practice with residents through churches, neighborhood clinics, and activity centers.^8,9

Additionally, effective outreach should extend beyond patients already connected to cancer care. Speaking with local organizations, faith communities, neighborhood groups, and other trusted networks can help oncology practices build awareness and trust before a patient is ever faced with a treatment decision.

How Can Clinical Trials Become Part of Everyday Cancer Care?

Community-based outreach is most effective when meaningful research opportunities are available close to home. For example, through The US Oncology Network and its collaboration with Sarah Cannon Research Institute, Texas Oncology can offer patients access to clinical trials within the communities where they already receive care. This community-based research infrastructure helps make participation more practical for eligible patients who may otherwise face geographic or logistical barriers.

Moreover, clinical trials should be integrated directly into the workflow of daily patient care. Research should not be treated as a secondary service or an afterthought. Instead, clinical trial awareness should be part of the way oncology teams evaluate care options for eligible patients.

Making research part of routine care requires visibility across the practice. Physicians and care teams need to know which studies are open, which patients may be eligible, and how to begin conversations about participation. When trial information is readily available during everyday clinical decision-making, patients are more likely to learn about research opportunities at the right time.

Maintaining research visibility across a practice requires ongoing engagement. For instance, Texas Oncology recognizes physicians and care teams who consistently identify appropriate trial opportunities and discuss them with eligible patients. These efforts help keep research top of mind during busy clinic days while preserving the physician-patient decision-making process.

What Real-World Progress Has Been Made to Expand Access to Cancer Clinical Trials?

During the 2026 American Society of Clinical Oncology Annual Meeting, investigators shared encouraging enrollment findings from the phase 3 evERA Breast Cancer study (NCT05306340).¹⁰ Texas Oncology was a key trial site for the protocol, which used community-based outreach and translated study materials, among other strategies, to help broaden participation. The study reported higher-than-average participation rates among several patient groups, including African American, Asian, and Hispanic patients.

These findings show that broader participation is achievable when research teams make trial access a practical, intentional part of care delivery. More importantly, the results reinforce a broader lesson: Participation becomes more representative when access is designed intentionally. Patients do not need to be persuaded to consider research; they need a meaningful opportunity to participate close to home.

What Can Community Oncology Practices Do to Expand Clinical Trial Access?

Progress requires practical changes: identifying relevant protocols for local patients, integrating trial discussions into everyday workflows, and making study information easier to understand across languages. Most importantly, practices must build relationships before patients are asked to consider a trial. That means engaging face-to-face with trusted local networks, answering questions clearly, and making trial participation feel understandable and accessible.

This work is not about meeting enrollment targets; it is about helping more eligible patients understand all care options available to them, including clinical trials close to home. Community oncology practices are uniquely positioned to bridge that gap. When community oncologists and care teams advocate for the health of the people and neighborhoods they serve, clinical trials can become a more accessible and trusted part of everyday cancer care.

References

1. Bibbins-Domingo K; Helman A, eds. Improving Representation in Clinical Trials and Research: Building Research Equity for Women and Underrepresented Groups. National Academies Press; 2022. Accessed July 15, 2026. https://www.ncbi.nlm.nih.gov/books/NBK584396/
2. Cancer and aging facts. Cancer and Aging Research Group. Updated April 27, 2020. Accessed November 5, 2026. https://mycarg.org/resources-activities/advocacy/cancer-and-aging-facts/
3. Nguyen CA, Beaulieu ND, Wright AA, Cutler DM, Keating NL, Landrum MB. Organization of cancer specialists in US physician practices and health systems. J Clin Oncol. 2023;41(26):4226-4235. doi:10.1200/JCO.23.00626
4. Unger JM, Shulman LN, Facktor MA, Nelson H, Fleury ME. National estimates of the participation of patients with cancer in clinical research studies based on commission on cancer accreditation data. J Clin Oncol. 2024;42(18):2139-2148. doi:10.1200/JCO.23.01030
5. Badhrinarayanan S. The challenge of patient enrollment in clinical trials. Network for Collaborative Oncology Development & Advancement. October 14, 2025. Accessed November 5, 2026. https://ncoda.org/news/the-challenge-of-patient-enrollment-in-clinical-trials/
6. Barriers to patient enrollment in therapeutic clinical trials for cancer. American Cancer Society Cancer Action Network. April 11, 2018. Accessed November 5, 2026. https://www.acscan.org/policy-resources/clinical-trial-barriers
7. Galsky MD, Stensland KD, McBride RB. et al. Geographic accessibility to clinical trials for advanced cancer in the United States. JAMA Intern Med. 2015;175(2):293-295. doi:10.1001/jamainternmed.2014.6300
8. Enhancing clinical trial awareness and outreach. J Oncol Pract. 2009;5(4):205-207. doi:10.1200/JOP.0944603
9. Garcia P, Kelly M. Promotoras helping to reduce the risk in El Paso County’s most isolated, vulnerable populations. Paso del Norte Health Foundation. February 17, 2021. Accessed July 7, 2026. https://pdnhf.org/news-and-media/health-news/promotoras-helping-to-reduce-the-risk-in-el-paso-county-s-most-isolated-vulnerable-populations
10. Vidal GA, Rugo HS, Fairley R, et al. Achieving epidemiologically representative enrollment and social determinants of health in the phase III evERA Breast Cancer study (NCT05306340). J Clin Oncol. 2026;44(suppl 16):1572. doi:10.1200/JCO.2026.44.16_suppl.1572