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Most advanced cancer patients never enroll in a clinical trial — and it's not mainly their fault. A large cohort study found that physician- and practice-level factors drive trial participation more than patient characteristics. In 2024, just 23% of physicians accounted for over 83% of all trial enrollments.
When it comes to clinical trial access for advanced cancer patients, the bottleneck may be in the clinic, not the waiting room. A new study published in JAMA Network Open, analyzing data from over 205,000 patients across 107 U.S. oncology practices, found that only 5.2% of advanced cancer patients participated in clinical trials — and that physician- and practice-level factors were bigger drivers of enrollment than patient characteristics.
The research revealed a striking concentration of trial activity: in 2024, just 23.4% of physicians were responsible for 83.6% of all enrollments, while nearly 30% of physicians enrolled zero patients. Subspecialized physicians and those with recent trial enrollment history were significantly more likely to enroll patients, as were practices with high research engagement.
By the Numbers:
Why it matters: Improving cancer trial access can't rely solely on patient outreach. Systemic changes targeting physician behavior, subspecialization, and institutional research culture are essential to broadening participation — especially for underserved populations.
