Cancer clinical trials are supposed to reflect the patients they aim to help — but new research shows they still fall short. Two studies published in JAMA Network Open and JCO Oncology Advances reveal that sociodemographic disparities in oncology trial enrollment persist even within integrated health systems and NCI-designated cancer centers.

In the Kaiser Permanente Northern California (KPNC) study, only 1,341 of 97,764 invasive cancer patients enrolled in a clinical trial. Enrollees were more likely to be younger, wealthier, living in less deprived neighborhoods, treated at large urban centers, and English-speaking. A separate analysis across Yale, Vanderbilt, and UT Health San Antonio confirmed similar patterns — non-English speakers and Medicaid-insured patients were underrepresented at all three sites.

One bright spot: Yale's implementation of an automated trial prescreening tool boosted young adult consent rates from 1.2% to 5.2% and minority participation from 18.2% to 23.8% in solid tumor populations.

Key Takeaways:

• Non-English-speaking patients face the steepest enrollment barriers, largely due to limited trial materials in other languages
• Medicaid-insured patients are consistently underrepresented across cancer centers
• Automated prescreening tools can meaningfully improve diversity in trial enrollment

Why it matters: Clinical trial results only translate to real-world care when study populations mirror the patients being treated. Addressing these gaps isn't just an equity issue — it's a scientific one.