Engagement in cancer clinical trials among a nationally representative cancer survivor sample: Motivators, barriers and opportunities for improvement

Most patients with cancer do not participate in a clinical trial. Understanding clinical participation rates, and the barriers and motivators that influence participation may help identify opportunities for improvement in accrual.

A cross-sectional analysis of cancer survivors was conducted using the Health Information National Trends Survey (HINTS) administered in 2020. Primary outcome was clinical trial participation amongst patients with cancer. Secondary outcomes were motivators and barriers to influence clinical trial participation. Logistic regression was employed to assess the association of clinical trials being discussed as a cancer treatment option with social determinants.

Six hundred and eighteen respondents (weighted population estimate 22,723,047) with a self-reported history of cancer were included. Overall, 15.7% reported an invitation to participate in a clinical trial, of which 37.8% participated. Clinical trials were discussed as a cancer treatment option amongst 13.5% of respondents. Knowledge of clinical trials was low (9.3%). Reported motivators included trying new care (72.3%), wanting to get better (88.9%), getting paid (40.1%), helping other people (73.0%), and encouragement from the doctor (73.7%) or family/friends (59.5%). Reported barriers included getting transportation, childcare or paid time off work (42.4%), and standard care not covered by insurance (69.6%). Race (Other, OR 3.84) and income (<$35k, OR 5.84) were associated with discussion of clinical trials as a cancer treatment option.

Clinical trial treatment discussion, invitation, and participation are low among patients with a history of cancer. Although the study identified multiple motivators and barriers to participation, improvement in the rates of discussion and invitation to participate in a clinical trial are required. Nevertheless, addressing the identified barriers and motivators that influence clinical trial participation may be a strategy to optimize patient enrollment.