Bringing cancer trials closer to home — but it's complicated

Decentralized clinical trials (DCTs) promise to make cancer research more accessible — letting patients participate from their communities rather than traveling to major academic centers. But the road to widespread adoption is bumpy. The Association of Cancer Care Centers (ACCC), through its Community Oncology Research Institute (ACORI), convened three roundtables between November 2025 and April 2026, bringing together stakeholders from academic centers, community oncology programs, federal agencies, and advocacy groups to map out the barriers and find scalable solutions.

The discussions surfaced three core challenge areas: foundational regulatory hurdles, real-world implementation complexity, and equity and sustainability concerns. One concrete sticking point: the FDA's Form 1572 requires principal investigators to take full responsibility for all patient care — a tough ask when home-based or remote services are involved. Successful models from institutions like Sanford Health and HonorHealth Research Institute offered blueprints for what's possible.

Key Takeaways:

• Four pillars for DCT success were identified: aligned regulatory guidance, operational readiness, intentional workforce development, and equity-centered design
• ACORI is developing a site self-assessment tool and a DCT playbook — both to be published on its website
• Having a physician champion at the site was highlighted as a critical success factor
• The playbook will be tailored, not one-size-fits-all, to reflect each site's unique capacity

Why it matters: Millions of cancer patients — especially those in rural or underserved communities — can't easily access clinical trials. DCTs could change that, but only if sites have the tools and guidance to implement them safely and equitably. This initiative is a meaningful step toward closing that gap.