Advancing Cancer Health Equity Through Clinical Trials

Clinical trials are an important way to develop new and better treatments for cancer care. By participating in a clinical trial, patients can help advance research and potentially improve their own care, enhancing cancer health equity. According to the National Cancer Institute (NCI), approximately 9% of adult patients are invited to participate in clinical trials. The number of clinical trials for cancer comprises between 40 to 50% of all trials in the U.S. which dwarfs that of any other single disease. At the same time, 66% of oncology clinical trials close prematurely because they cannot fill their trials with patients. 

In April 2023, the U.S. Department of Health and Human Services released the National Cancer Plan which “supports strategies to increase the representation of all populations in cancer research and ensure that every person benefits equitably from cancer research and clinical advancements.” Increasing access and ensuring more underrepresented populations in clinical trials are strategic priorities for research institutions as a means of reducing health disparities in cancer treatment. At the same time, enhancing systems to ensure that trials are attended by patients seeking treatment moves the project of cancer treatment for the 21st Century forward.

Although clinical trial enrollment involves complex processes, research institutions can increase enrollment and patient diversity by identifying and resolving financial barriers, thus improving health equity for cancer patients. For example, the site of care impacts clinical trial opportunities and enrollment. 

While there are trials available at community hospitals, Academic Medical Centers and NCI Comprehensive Cancer Centers offer the majority of open clinical trials outside the immediate service area, which creates significant travel barriers, resulting in health disparities for cancer treatment. According to The Oncologist, the greatest travel burden is for patients enrolled in NCI-sponsored trials, Phase I studies, or those living in low-income areas. These factors must be reconciled to include patients experiencing financial barriers to treatment.

Clinical Trials and Financial Toxicity  

Financial toxicity encompasses the various hardships patients and families experience regarding treatment and care costs. This toxicity is at the heart of cancer health disparities. Most participants in clinical trials experience financial toxicity, but Cancer Clinical Trial (CCT) participants are at especially high risk. Harvard University published a study in the Journal of Clinical Oncology revealing that 57% of CCT patients reported associated financial burden and 41% reported having trial treatment cost concerns. 

Two recent studies showed that patients with household income of less than $50,000 per year were 27% less likely to participate in clinical trials. Patients with fewer financial resources may find the direct and indirect costs of clinical trial participation, such as travel, time off work, or childcare to be very prohibitive, precluding cancer health equity for these patients. Trial sponsors provide payment for specific elements of clinical trials and the Affordable Care Act requires coverage of routine costs, but many clinical trial participants still have associated medical costs billed to their health insurance. Leveraging patient assistance programs can help ensure patients stay in the clinical trial and avoid any associated financial toxicity, serving both the patient and the research.

In addition to cost and insurance obstacles, health disparities in cancer trial enrollment exist along age, ethnic, and sociodemographic lines, with younger, poorer, non-white, and underinsured patients — the exact population who may be at highest risk for financial toxicity — less likely to participate. To increase participation and health equity, research centers must identify and resolve all barriers to care and clinical cancer trial participation. This includes related needs such as financial burdens due to the cost of travel, food, housing, and childcare.  

How to Improve Cancer Clinical Trial Health Equity

Based on current statistics, research institutions have a significant opportunity to improve clinical trial participation and diversity to relieve cancer health disparities. Utilizing technology is one strategy to increase access to clinical trials and reduce financial toxicity for participating patients. 

Patient advocates can use technology to collaborate with charitable foundations to improve access to clinical trials by providing assistance to cover the incremental costs associated with participation. This technology enables advocates to efficiently and proactively address systemic barriers by identifying and enrolling patients in philanthropic aid programs. In doing so, patient advocates can increase patient access to financial support for costs associated with standard treatment and incremental costs of clinical trial participation. This strategy addresses needs like transportation, food, housing and/or childcare, considerably easing financial toxicity and concurrently, cancer health disparities.

With a coordinated approach centered on resolving disparities in the delivery of healthcare for cancer patients, patients with barriers to access can be supported in their journey toward effective treatment.