LUNG cancer clinical trial participation remains markedly low and varies significantly according to care setting and patient-level factors.
Lung Cancer Trial Enrollment Trends
Using real-world cancer registry data, investigators analyzed more than 68,000 lung cancer cases over nearly two decades to assess which socioecological factors influence clinical trial participation. Only 0.88% of individuals in the cohort were enrolled in a trial, highlighting a substantial participation gap. Lung cancer clinical trial enrollment was strongly associated with where patients received care. Individuals treated at cancer-designated facilities were substantially more likely to participate in a clinical protocol, with odds exceeding fivefold compared with non-designated centers. This suggests that access to structured research infrastructure remains a primary determinant of participation.
Patient and Health System Influences
Comorbidity burden was a significant barrier to lung cancer trial enrollment. Increasing Charlson comorbidity categories were associated with steadily declining odds of participation, reflecting the persistent impact of eligibility restrictions on real-world access. The study also found that insurance type influenced enrollment among Black individuals, with Medicaid coverage associated with far lower odds of trial participation than Medicare. This pattern appeared across racial and ethnic groups, indicating systemic barriers embedded within coverage-based pathways to care.
Policy Context and Disparities
Although policy efforts have emphasized demographic transparency in trial reporting, findings indicate that operational factors within health systems remain central to improving representativeness. Expanding the number of cancer research facilities in underserved regions and broadening comorbidity criteria could help reduce racial and socioeconomic disparities in lung cancer clinical trial participation. The analysis underscores that structural access barriers continue to shape enrollment patterns more strongly than individual preferences alone.
Reference: Arizpe A et al. Socioecological Factors Associated With Lung Cancer Clinical Trial Participation: Real-world California Cancer Registry Data. Clin Lung Cancer. 2025;S1525-7304(25)00277-3.
