Better reimbursement programs can improve access to cancer clinical trials

New research reveals that participating in cancer clinical trials can cause financial burdens that are shaped by both socioeconomic and logistical factors. The analysis published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, indicates the need for better reimbursement programs to improve equitable access to, and retention in, cancer clinical trials. 

For adults with cancer, participating in clinical trials can carry costs related to travel, lodging, meals, internet access, missed work, and greater need for childcare/eldercare. In the United States, federal legislation addressing financial support for clinical trial participants is currently under consideration. Recognizing the need for financial support for participation in trials, the Lazarex Cancer Foundation reimbursed out-of-pocket non-medical costs from 2006–2024 for patients enrolled in therapeutic cancer clinical trials across multiple US sites. 

When investigators examined the types and amounts of expenses faced by trial participants, they found that among 2,826 individuals who received at least one reimbursement, median total per-patient reimbursement was $2,128, median trial participation duration was 4.3 months, and monthly reimbursed amounts declined substantially throughout trial participation (with monthly reimbursements falling to 60% of initial levels by 3 months into trial participation). 

Importantly, the program reimbursed expenses only if there were no other sources of financial support from the trial sponsor or site. 

Types of reimbursement varied by patient income: internet, ground transportation, and childcare/eldercare were more common at lower income levels, while lodging and airfare were more common for higher income. After adjustments, monthly reimbursed amount was greater among middle-tier household income quartiles, greater distance to trial site, and phase 1 trials. 

When we consider the overall cost of running cancer clinical trials, covering patients' travel, lodging, and other non-medical expenses represents a relatively small investment. Our findings suggest that these costs are modest compared with what sponsors already spend per participant and decline substantially over time. Reimbursing patients for these expenses could be a practical and relatively inexpensive way to reduce financial barriers and make cancer clinical trials more accessible." 

Sukh Makhnoon, PhD, lead author, assistant professor, O'Donnell School of Public Health and Simmons Comprehensive Cancer Center, UT Southwestern Medical Center