Financial barriers drive low participation in cancer clinical trials

A study by Case Western Reserve University and University Hospitals researchers has overturned long-held assumptions about why more cancer patients don't enroll in clinical trials that could potentially save their lives.

They found that financial factors-not race or demographics-are the strongest predictors of participation in cancer research studies.

Clinical trials save lives, but financial barriers prevent too many patients from participating. Addressing the real-world costs patients face, like transportation, childcare and lost wages, can make trials more equitable and ensure advances in cancer care benefit everyone."

Weichuan Dong, adjunct assistant professor at Case Western Reserve School of Medicine and assistant professor at Weill Cornell Medicine & Houston Methodist

The study, recently published in the Journal of the National Comprehensive Cancer Network, analyzed more than 12,000 cancer patients' electronic health records from University Hospitals in Northeast Ohio. The researchers learned that income, property ownership and financial stability were the most powerful factors determining enrollment in clinical trials.

Clinical trials are research studies involving people to test new ways to prevent, detect or treat diseases that, when successful, can be lifesaving. Yet only one in five cancer patients participate, according to the American Cancer Society Cancer Action Network. The low participation rate means breakthrough treatments take longer to reach patients, and underserved communities often miss out on cutting-edge care.

"Conversations about clinical trial enrollment often focus on education and trust, but in clinical practice, we see very practical barriers," said Richard Hoehn, co-author and assistant professor of Surgical Oncology at Case Western Reserve School of Medicine and University Hospitals Cleveland Medical Center. "For many patients, participation comes down to logistics and money. Addressing those challenges is one of the most direct ways to make trials more inclusive."

Instead of focusing solely on demographic factors, the researchers advocate for structural solutions that address the financial realities patients face: Reimbursement programs for travel and lodging expenses, compensation for lost wages during treatment, childcare assistance for parents in trials and transportation vouchers or services.

The team is now expanding the work, integrating clinical trial data from Cleveland Clinic, University Hospitals and MetroHealth with the Ohio Cancer Incidence Surveillance System, the state cancer registry.

"This larger study, expected to be published in early 2026, will provide the first comprehensive map of clinical trial enrollment among cancer patients-identifying where structural barriers prevent access to potentially life-saving treatments," Dong said. "We're working to map 'clinical trial deserts' and understand how geographic and structural barriers influence access across urban, suburban and rural communities."