What prevents more cancer patients from enrolling in potentially life-saving clinical trials?

CWRU Contact: Patty Zamora, patty.zamora@case.edu
UH Contact: Jeannine Denholm, Jeannine.denholm@uhhospitals.org

CLEVELAND—A study by Case Western Reserve University and University Hospitals researchers has overturned long-held assumptions about why more cancer patients don’t enroll in clinical trials that could potentially save their lives.

They found that financial factors—not race or demographics—are the strongest predictors of participation in cancer research studies.

“Clinical trials save lives, but financial barriers prevent too many patients from participating,” said Weichuan Dong, adjunct assistant professor at Case Western Reserve School of Medicine and assistant professor at Weill Cornell Medicine & Houston Methodist. “Addressing the real-world costs patients face, like transportation, childcare and lost wages, can make trials more equitable and ensure advances in cancer care benefit everyone.”

The study, recently published in the Journal of the National Comprehensive Cancer Network, analyzed more than 12,000 cancer patients’ electronic health records from University Hospitals in Northeast Ohio. The researchers learned that income, property ownership and financial stability were the most powerful factors determining enrollment in clinical trials.

Clinical trials are research studies involving people to test new ways to prevent, detect or treat diseases that, when successful, can be lifesaving. Yet only one in five cancer patients participate, according to the American Cancer Society Cancer Action Network. The low participation rate means breakthrough treatments take longer to reach patients, and underserved communities often miss out on cutting-edge care.

“Conversations about clinical trial enrollment often focus on education and trust, but in clinical practice, we see very practical barriers,” said Richard Hoehn, co-author and assistant professor of Surgical Oncology at Case Western Reserve School of Medicine and University Hospitals Cleveland Medical Center. “For many patients, participation comes down to logistics and money. Addressing those challenges is one of the most direct ways to make trials more inclusive.”

Instead of focusing solely on demographic factors, the researchers advocate for structural solutions that address the financial realities patients face: Reimbursement programs for travel and lodging expenses, compensation for lost wages during treatment, childcare assistance for parents in trials and transportation vouchers or services.

The team is now expanding the work, integrating clinical trial data from Cleveland Clinic, University Hospitals and MetroHealth with the Ohio Cancer Incidence Surveillance System, the state cancer registry.

“This larger study, expected to be published in early 2026, will provide the first comprehensive map of clinical trial enrollment among cancer patients—identifying where structural barriers prevent access to potentially life-saving treatments,” Dong said. “We’re working to map ‘clinical trial deserts’ and understand how geographic and structural barriers influence access across urban, suburban and rural communities.”

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About Case Western Reserve University

As one of the fastest-growing research universities in the United States, Case Western Reserve University is a force in career-defining education and life-changing research. Across our campus, more than 12,000 students from around the world converge to seek knowledge, find solutions and accelerate their impact. They learn from and collaborate with faculty members renowned for expertise in medicine, engineering, science, law, management, dental medicine, nursing, social work, and the arts. And with our location in Cleveland, Ohio—a hub of cultural, business and healthcare activity—our students gain unparalleled access to academic, research, clinical and entrepreneurial opportunities that prepare them to join our network of more than 125,000 alumni worldwide. Visit case.edu to see why Case Western Reserve University is built for those driven to be a force in the world.

About University Hospitals / Cleveland, Ohio
Founded in 1866, University Hospitals serves the needs of patients through an integrated network of more than 20 hospitals (including five joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship quaternary care, academic medical center, University Hospitals Cleveland Medical Center, is affiliated with Case Western Reserve University School of Medicine, Northeast Ohio Medical University, Oxford University, Taiwan National University College of Medicine and the Technion Israel Institute of Technology. The main campus also includes the UH Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, with more than 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to 19 Clinical Care Delivery and Research Institutes. UH is one of the largest employers in Northeast Ohio with more than 30,000 employees. Follow UH on LinkedIn, Facebook and Twitter. For more information, visit UHhospitals.org.