Changchuan Jiang, Assistant Professor medical oncologist at UT Southwestern Medical Center, shared on LinkedIn:
“New in JAMA Network Open today on clinical trial access!
When we talk about low cancer trial enrollment, we usually talk about patients: mistrust, travel, cost, eligibility. Those barriers are real. But we wanted to know how much depends on the doctor and the practice.
We studied 205,743 patients with 14 types of advanced cancer, treated by 1,664 oncologists at 107 US practices that had trials available (Flatiron Health, 2011 to 2024).
What we found: Only 5.2% of patients received a study drug. That rose from 3.9% in 2011 to 6.8% in 2024. 23% of physicians accounted for 84% of all enrollments, and 20% of practices accounted for 80%. 30% of physicians never enrolled a single patient.
Practice-level (15.1%) and physician-level (12.3%) factors explained more of the variation than patient-level factors (11.4%), and the practice share grew over time.
Oncologists who focused on fewer cancer types, and those who had enrolled patients recently, were far more likely to enroll again. Practices serving the most low-income patients had much lower odds of enrollment (OR 0.42).
The takeaway: trial access depends heavily on where you are treated and who treats you.
Fixing it means investing in research staff, screening support, and trials opened at the practices where underserved patients already get care.”
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