Cancer Breakthroughs for All: The Pursuit of Equitable Oncology Innovation

Innovation in cancer treatment and care is accelerating at an unprecedented pace. Scientific discovery, molecular profiling, and novel therapeutics are transforming oncology faster than ever before. Yet with this rapid pace comes a troubling reality: progress may be moving faster than the systems designed to deliver it.

According to McKesson’s 2025 Advancing Community Oncology Report, a vast majority of clinicians—78%—are finding it challenging to keep up with the pace in clinical innovation, and nearly 4 out of 5 community practices believe that accessing novel therapies is harder in the community compared with the academic setting.¹

When innovation outpaces adoption, some patients are left behind. The result is a growing disconnect between what is scientifically possible and what patients can realistically access: a “price” of progress that raises urgent questions about equity in clinical research and the broader health care delivery system.

At the center of this tension lies a fundamental question: who gets to reap the fruit of innovation, and who does not?

Clinical Trials: A Gateway to Progress—or a Gatekeeper?

Hailed as the gateway to progress, clinical trials are the cornerstone of cancer advancements, bridging discovery and patient care. Trials not only provide patients with the opportunity to access potentially life-saving therapies, but also generate the evidence needed to advance standards of care.

Ideally, trials should reflect the diversity of the patient population to ensure the findings are broadly applicable. But who actually gets through the gate?

For many patients, this gate is only partially open. Enrollment in trials is often riddled with hurdles that limit participation, potentially skewing generalizability.

A growing body of research is documenting stark disparities in clinical trial participation, driven largely by socioeconomic factors that keep cancer trials out of reach. Richard Hoehn, MD, assistant professor of Surgical Oncology at University Hospitals (UH) Cleveland Medical Center, along with researchers at Case Western Reserve University, recently explored these dynamics using patient-level data from their regional hospital system.² Their findings serve as a powerful reminder that access to trials is in part about circumstance.

“All of the variables that were important were financial in nature: income, resources, cost of the home, cost of homes in the neighborhood, resources of the family and associates... All of the most powerful characteristics, far and away, were finance related,” Hoehn told Targeted Oncology in a recent interview.

Notably, once financial characteristics were introduced into their model, race and ethnicity were no longer significant predictors of trial enrollment. “What that tells me is that just your race or ethnicity does not necessarily predict if you're going to enroll in a clinical trial…but it's your individual scenario,” Hoehn commented on this critical nuance. “Are you able to take the time off work, come to multiple appointments? Do you have the support to go to the extra treatments and scans and labs and travel across town and do all the things necessary to participate in a clinical trial?”

Meanwhile, other research has characterized the depth of these disparities among vulnerable populations—namely older adults, who face unique challenges like a compounded burden of comorbidities and functional limitations. Inna Gong, MD, PhD, hematologist at the Princess Margaret Cancer Centre in Toronto, Canada, and colleagues recently uncovered a concerning trend in trial participation among older patients with hematologic malignancies: between 2006 and 2018, under 5% had participated in a clinical trial.³

“What we found was that…trial participation among older adults was strikingly low, only 4.3% at 5 years, and that participation drops sharply with increasing age, Black race, female sex, lower income, greater distance from major [National Cancer Institute; NCI] centers,” Gong summarized to Targeted Oncology. To Gong, these findings are a red flag for underrepresentation, raising serious concerns about generalizability. When the gateway becomes a gatekeeper, the evidence guiding cancer care risks no longer reflecting the real-world patient population commonly seen in practice.

Beyond the Bench: Disparities in Access to Novel Therapies

Discovery and development represent only half the battle; similar disparities appear to extend beyond trials into the delivery of novel therapies themselves.

Research led by Joanna Rhodes, MD, MSCE, hematologist/oncologist at Rutgers Cancer Institute, probed factors that could be at play in driving these disparities. Rhodes and her group highlighted that racial residential segregation, along with lack of insurance, access to the internet, and vehicle ownership were all associated with whether patients were able to receive NCCN guideline-preferred frontline novel therapies for chronic lymphocytic leukemia (CLL), such as venetoclax (Venclexta)-based regimens or second-generation covalent Bruton tyrosine kinase (BTK) inhibitors like acalabrutinib (Calquence) or zanubrutinib (Brukinsa).⁴

Their analyses also demonstrated racial and ethnic disparities in receipt of these therapies. “There was a difference between White patients and Black patients in how many patients received ibrutinib [Imbruvica] in comparison to second-generation or other NCCN-recommended [BTK] inhibitors. Additionally, in Hispanic patients, there was a higher amount of chemoimmunotherapy that was prescribed in comparison to…NCCN-recommended treatment,” Rhodes noted.

Reflecting on these findings, Rhodes emphasized that these disparities run much deeper than clinical decision-making and guideline adherence: “What it really has highlighted to me is that there are things outside of just practice type and type of provider that are associated with patients not receiving what we would consider [standard of] care…there's probably more systemic things that we need to [address] in order to ensure that there aren't health inequities for our patients [with CLL], and not just saying, ‘These are the guidelines, and they're not being followed.’”

Confronting Where Inequities Begin: The System

The disparities observed across these studies are alarming within their own right, but as Rhodes suggested, they point to something much deeper, underscoring the important distinction between disparities and inequities.

Disparities describe measurable differences in health outcomes across populations. Inequities, however, refer to those differences that are avoidable and rooted in systemic disadvantage, such as insurance gaps, under-resourced health systems, and longstanding socioeconomic barriers, requiring multifaceted solutions.⁵ Hoehn advocates for evidence-based structural reform to mitigate socioeconomic barriers, beginning with insurance coverage.

“There are Medicaid, Medicare Advantage, certain health insurance plans and policies that do not support clinical trial enrollment, and that is criminal in this day and age. The data are very clear that participating in a clinical trial leads to better quality care and better survival for patients [with cancer],” Hoehn expressed. “As a payer, if your job is to provide the best care you can for your covered patients, you should support clinical trial enrollment.”

Equitable Innovation Starts in the Community

The development of many innovations, from novel treatments to advanced diagnostics, are still structured around academic hubs. Beyond payer reform, there is growing momentum to bring research to where the patients are: the community. Jason Hammonds, president of Oncology & Multispecialty at McKesson, anticipates a substantial rise in community oncology trials over the next few years, which will consequently bring increasing complexity. Therefore, the main challenge, he argues, lies not in science but rather operations.

“Community oncologists, you'll see in [McKesson’s] report… they're passionate about research. They're doing it today, but they also highlight that while they believe trials benefit the patients, at times, you have staffing shortages or protocols that may not be designed with the community in mind at the outset,” Hammonds explained. “So, how can we work together to help reduce that [burden]?”

The first ingredient, he says, is infrastructure and support to lighten administrative burden. One ongoing framework he referenced is Sarah Cannon Research Institute’s Accelero operations model,⁶ which aims to embed research infrastructure directly into routine care so community trials can launch faster and operate more seamlessly.

Next, Hammonds envisions a pivotal role for technology and artificial intelligence in streamlining more administrative processes, such as data entry and matching patients with cancer trials.

“Patient matching is always one of the challenges, and particularly as we see more trials—particularly trials that have smaller patient populations that they're trying to serve—we've invested in tools like Genospace, which help accelerate that matching. It will work with the physicians in their workflows to identify eligible patients based on clinical molecular data to support faster and more precise enrollment.”

Finally, Hammonds believes in the power of partnership with the biopharmaceutical industry, and in McKesson’s report, most community practices shared the same sentiment. Amid the prevalence of academic- or hospital-centric trial protocols, Hammonds believes that collaboration with community input would enable earlier, more intentional alignment of trial design with the operational realities of community practices.

“I think [a] consistent thing we hear from [community providers] is the need to have these protocols tailored for the community [on] day 1. And that's where partnership with biopharma can come in to help drive that.”

Closing the Distance: Navigation and Decentralization

Both Hoehn and Gong emphasize that trials must become more patient-friendly, acknowledging the geographic barriers and logistical requirements that might bar patients from participating.

“We make a lot of demands as far as scans, labs, and where you can have treatment. You often have to come to the main campus hospital to get treatment if you're going to enroll in a clinical trial, and all of these demands exclude patients,” Hoehn said.

Gong echoed that concern, pointing to the cumulative strain trials can place on patients’ daily lives. “We need to…think about the fact that the reality is that many patients do have to reorganize their lives around clinical trial participation just because of the number of visits and requirements to participate in trials.”

Furthermore, these burdens are not evenly distributed. Hoehn’s team is currently working on a follow-up study using geospatial analysis to map clinical trial “deserts,” or areas with disproportionately lower rates of trial participation.

“What we're seeing is that it follows the classic urban, suburban, rural ‘donut’ phenomenon, whereby patients in the more affluent suburbs that ring around the major city have the highest trial participation, and folks in the inner city and further out in the lower-income rural areas have lower trial participation,” he shared.

Two evidence-based strategies show promise in closing these gaps: patient navigator programs and decentralized trial designs.

Patient navigator programs help patients identify suitable trials and overcome logistical or insurance barriers. Gong cited the Blood Cancer United’s Clinical Trial Support Center—a free, nurse-led navigation service—as an exemplary model.

Decentralized trial designs offer another solution by harnessing the proximity and accessibility of community care. “These models leverage the partnership with community hospitals and treatment centers closer to patients’ homes. [Such designs] allow [for] sharing some of the logistics of enrollment and follow-up with centers that are closer for the patient,” Gong explained.

Hoehn agreed, emphasizing that decentralization must be paired with pragmatism. “If we want to be more equitable in who we enroll in clinical trials, I think clinical trial design has to be a little bit more open-minded and pragmatic in that patients can receive treatment throughout the region at multiple satellite locations. We allow monitoring, scans, labs…at a reasonable interval; we don't place undue demands on patients; and we don't make them go through a significant increase in testing compared [with] nontrial patients,” Hoehn said.

Rethinking Eligibility Criteria: Inclusion by Design

Both Hoehn and Gong pointed to another key barrier, embedded within trial design itself: restrictive eligibility criteria.

“Often, clinical trials in cancer are designed in a very rigorous way [for] these particular patients who we know [and] have confidence are going to tolerate treatment and jump through all of these hoops medically and physiologically to participate in the trial. We want to be very rigorous in who we study, but [that] excludes a lot of patients,” Hoehn said.

Gong’s research in older adults underscores that point. “We did find that certain comorbidities, specifically pulmonary and renal disease, were associated with lower participation, and there's literature to support that a [slight] loosening [of] the eligibility criteria for those comorbidities could be another evidence-based approach,” she added.

She referenced the FDA’s Project Optimus, geared toward optimizing dose selection for oncology therapies, as a promising initiative that could include older adults and patients with comorbidities without compromising safety.

Lessons from the Front Lines

As these voices in oncology remind us, scientific progress does not automatically translate into improved patient outcomes; it must be paired with systems that ensure access for all. And at the heart of every approach put forth—be it policy reform, community-based research, or inclusive trial design—is a shared principle: keeping the patient at the center.

As Gong reflects, this patient-centered focus is the guiding principle behind equitable innovation. “I think…the most important aspect that we need to consider for oncology trials is, if we want the trial population to reflect real-world patients, then we also need to design trials around the individual patients that we're treating and their lives.”

REFERENCES

1. Advancing Community Oncology Report. McKesson Corporation. 2025. Accessed January 28, 2026. https://tinyurl.com/ypkhy837

2. Dong W, Shoag J, Lal T, et al. A novel evaluation of patient socioeconomic characteristics that predict clinical trial enrollment. J Natl Compr Cancer Netw. 2026;24(1). doi:10.6004/jnccn.2025.7092

3. Gong IY, Soto MJ, Rafinejad‐Farahani B, et al. Disparities in clinical trial participation among older adult Medicare beneficiaries with hematologic malignancies from 2006 to 2019: A SEER–Medicare analysis. Cancer. 2025;131(24). doi:10.1002/cncr.70204

4. Rhodes J, Kittai A, Hampel P, et al. Mediators of racial and ethnic inequities in access to front-line therapies for chronic lymphocytic leukemia in the United States: A real-world evidence study. Blood. 2025;146(Supplement 1):2720-2720. doi:10.1182/blood-2025-2720

5. Braveman P. Health inequalities, disparities, equity: What's in a name?. Am J Public Health. 2025;115(7):996-1002. doi:10.2105/AJPH.2025.308062

6. Accelero. Sarah Cannon Research Institute. Updated 2026. Accessed February 9, 2026. https://tinyurl.com/3fkzyef8