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What are the Most Common Barriers to Community Cancer Centers Engaging in Clinical Trials?

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An overwhelming amount of cancer patients express willingness to participate in clinical trials; however, only a small portion will actually end up enrolling in research protocols. Many of these patients rely on community centers for care, so it begs the question, why do so many of these centers struggle to enroll patients in clinical research?1

A study recently published on JAMA Network Open sought to answer this question through a thorough review of 58 cancer centers across 25 states. Its objective was to identify critical barriers to trial enrollment, translating findings into actionable changes that cancer centers can implement.

“This study of cancer treatment centers represents one of the most comprehensive national surveys of clinical trial activity and barriers faced by community cancer centers. Our findings reaffirm numerous long-standing difficulties: the scarcity of available trials, inadequate research-focused staffing, and prolonged intervals between referrals for clinical trials to external institutions,” the study authors wrote. “Additionally, we showed that the number of industry-sponsored trials available in community oncology centers and smaller practices were far below the offerings of academic and larger sites.”

According to the authors, the study included designated site contacts at oncology practices with teams who were highly involved with the Association of Community Cancer Centers (ACCC), Community Oncology Research Institute (ACORI), all American Society of Clinical Oncology (ASCO)–ACCC collaboration pilot sites, and/or sites providing care to a population comprised of at least 25% African American and Hispanic residents.

The survey—which included 34 questions and was designed in partnership with ACORI and City of Hope Comprehensive Cancer Center—was sent to 100 cancer centers, with completion by 58. Fifty-two centers (88%) reported that they conduct therapeutic clinical trials, of which 33 (63%) were from urban settings, 11 (21%) were from suburban settings, and eight (15%) were from rural settings. In terms of challenges, participants noted patient recruitment (27 respondents [52%]), limited staffing (27 [52%]), and nonrelevant trials for their patient population (25 [48%]). Finally, of the notable results, 79% of the centers referred patients to outside centers for enrollment.

“In this national survey study of barriers to clinical trial implementation, most sites offered therapeutic trials, but there were significant disparities in trial availability across care settings,” the authors said of the results. “Furthermore, fundamental deficiencies in trial support infrastructure limited research activity, including within programs currently conducting research as well as at sites interested in future clinical research opportunities. These results identify crucial unmet needs for oncology clinics to effectively offer clinical trials to patients seeking care.”

Looking forward to future research, the authors suggest focusing on practice sites which have never conducted any forms of studies. This would combat the current study’s limitation of only having a small number of practices report that they did not conduct research. According to the authors, there is an ongoing initiative by the ACCC dedicated to providing support to community practice sites having a limited number of studies at their facilities.

“Our findings informed a comprehensive platform to be developed by ACCC/ACORI that aims to improve community cancer center participation in clinical research for the benefit of patients with cancer from underrepresented geographic, socioeconomic, racial, and ethnic groups,” the authors concluded. “This encompasses the ongoing second phase of the initiative within ACCC/ACORI, aiming to provide exclusive assistance and guidance to community practices with restricted availability of trials for their patients.”


1. Ebrahimi H, Megally S, Plotkin E, et al. Barriers to Clinical Trial Implementation Among Community Care Centers. JAMA Netw Open. 2024;7(4):e248739. doi: 10.1001/jamanetworkopen.2024.8739