The frontier of oncology is moving at a breakneck pace. Every day, researchers are uncovering new ways to weaponize the immune system against tumors, engineer “smart” drugs that target specific genetic mutations, and refine therapies that were once considered science fiction. These cutting-edge cancer drugs are being tested in real-time, offering a glimmer of hope and potentially saving or extending the lives of patients who take part in clinical trials. For many, a trial isn’t just a contribution to science; it is a vital lifeline when standard treatments have failed.
Yet, despite the high stakes and the potential for medical breakthroughs, a persistent question haunts the medical community: Why don’t more cancer patients enroll in these trials? For decades, the conversation surrounding trial diversity and participation has focused heavily on cultural distrust or racial disparities. However, a landmark new study suggests we may have been looking at the wrong map. It turns out that the bridge between a patient and a potentially life-saving treatment isn’t built on background—it’s built on the ability to pay for the journey.
Financial factors — not race or background — most strongly predict who will participate in cancer research studies, researchers reported December 17 in the Journal of the National Comprehensive Cancer Network.
“Clinical trials save lives, but financial barriers prevent too many patients from participating,” said lead researcher Weichuan Dong, an assistant professor at Weill Cornell Medicine and Houston Methodist.
“Addressing the real-world costs patients face, like transportation, child care and lost wages, can make trials more equitable and ensure advances in cancer care benefit everyone,” Dong said in a news release.
About one in five cancer patients participates in clinical trials, researchers said in background notes.
This low participation rate not only means that many miss out on potentially lifesaving experimental treatments, but that treatments which prove to be breakthroughs take longer to receive U.S. Food and Drug Administration approval and reach patients.
RELATED: 5 Reasons to Enroll Yourself in Clinical Trials
For the new study, researchers analyzed the records of more than 12,000 patients receiving cancer care from University Hospitals in Northeast Ohio.
Of those patients, only five percent participated in a clinical trial for cancer treatment.
Results initially showed that Black patients were 30 percent less likely to enroll in clinical trials than white patients. But after researchers took income into account, that difference became no longer statistically significant.
Overall, higher income increased a person’s odds of joining a clinical trial up to 67 percent, researchers found.
Likewise, lower-income patients insured through Medicaid were 29 percent less likely to enroll in a clinical trial than those with private insurance.
Property ownership and financial stability were powerful factors influencing who joined a cancer trial, researchers said.
These results show that clinical trial participation could be boosted if researchers focused on addressing the financial realities of patients by:
“For many patients, participation comes down to logistics and money,” senior researcher Dr. Richard Hoehn, an assistant professor of surgical oncology at Case Western Reserve School of Medicine in Cleveland, said in a news release. “Addressing those challenges is one of the most direct ways to make trials more inclusive.”
The researchers aren’t stopping at these findings. They are currently expanding their study to include other Ohio medical centers, with a comprehensive report expected in early 2026. This follow-up aims to create a map of “clinical trial deserts”—areas where geographic and structural barriers intersect to cut off entire communities from the latest medical advances.
“This larger study will provide the first comprehensive map of clinical trial enrollment among cancer patients,” Dong said. The goal is to identify exactly where the system is failing so that resources can be diverted to urban and rural areas that are currently left behind.
If you or a loved one is facing a cancer diagnosis, do not let the fear of costs immediately take trials off the table. There are often resources available that are not widely advertised.
Ask for a Patient Navigator: Many large hospitals have navigators whose entire job is to help you find trials and secure the resources to attend them.
Inquire About “Trial-Related Costs”: Explicitly ask the research coordinator: “What costs are covered? Is there a stipend for travel, parking, or meals?”
Check with Non-Profits: Organizations like the American Cancer Society or Hope Lodge provide free or low-cost lodging for patients traveling for treatment.
Review Your Insurance: If you are on a private plan, call your provider to see if they cover the “routine costs” (like doctor visits and standard labs) associated with a trial.
Look for Local “Satellite” Trials: Some major trials allow you to do your routine blood work and check-ups at a local clinic, only requiring you to travel to the main hub for the actual treatment.
At the end of the day, a breakthrough drug is only a breakthrough if people can actually take it. When patients in a major health system are not participating in trials, the pace of medical progress slows down for everyone. It takes longer for the FDA to approve drugs, and it takes longer for those drugs to reach the general public.
By shifting the focus from “cultural outreach” to “financial support,” the medical community can ensure that the next generation of cancer treatments is accessible to everyone—regardless of the balance in their bank account.
What This Means For You: If you are interested in a clinical trial, don’t assume it’s out of reach. Start by visiting the National Cancer Institute’s trial search tool and speaking with your oncologist about financial assistance programs specifically designed to bridge the gap for participants.
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