Many Older Americans Lack Local Access to Cancer Clinical Trials, Study Finds
Millions of older Americans live far from cancer clinical trial sites, limiting opportunities for participation in research that could shape future cancer care, according to a study published in JCO Clinical Practice.
“In this study, we leveraged ASCO's infrastructure and data available from ClinicalTrials.gov to describe the national landscape of cancer treatment trials and examine the demographic and social features of US geographies by trial availability,” explained M. Kelsey Kirkwood, MPH, American Society of Clinical Oncology, and coauthors.
The researchers aimed to evaluate the geographic distribution of active cancer treatment trials across the US and determine how well trial availability aligns with population needs, especially among adults aged 55 years and older, who account for 80% of cancer diagnoses.
In 2022, of 6710 active phase 1-3 oncology trials, nearly half of Americans aged 55 years or older (48%) lived in counties with a broad trial portfolio (≥100 active trials). However, 33% lived in counties with limited trial offerings (1–99 trials), 10% in counties with oncology care but no trials, and 9% in counties with neither. Notably, 70% of US counties had no active cancer trials, encompassing 74% of national land area and home to 19% of older adults.
Geographic disparities were most severe in nonmetropolitan and high-mortality counties. In fact, 85% of counties with the highest cancer death rates had no trials. Additionally, counties with overlapping vulnerabilities (rural location, high social vulnerability, high cancer burden) were far less likely to have trial access. Only 18% of these high-need counties had at least 1 trial site.
The drive-time analysis showed that while 94% of older adults live within 1 hour of some trial site, only 74% live within 1 hour of a site offering a broad range of trial options. Twelve states, including Mississippi, West Virginia, and New Mexico, had the majority of their older population residing more than 1 hour from such sites. “Altogether the oncology community should prioritize improving geographic access to research and ensuring all patients with cancer can participate in trials over the course of their care,” concluded the study authors.
Reference
Kirkwood MK, Schenkel C, Hinshaw DC, et al. State of geographic access to cancer treatment trials in the United States: Are studies located where patients live?. JCO Oncol Pract. 2025;21(3):427-437. doi:10.1200/OP.24.00261
