Study Identifies Unique Patient Concerns About Lymphoma Trial Access

A survey of patients with lymphoma found that concerns about structural barriers to clinical trial enrollment—including travel distance, study complexity, and financial concerns—vary significantly by race, ethnicity, and sex.¹

The survey, published in Cancer, enrolled 301 patients with non-Hodgkin lymphoma treated at UT MD Anderson, including 103 non-Hispanic White (NHW), 98 African American, and 100 Hispanic patients. Compared with NHW patients, Hispanic and African American patients reported significantly greater concern about clinic visit frequency, travel distance, taking time off work, and study complexity. African American patients specifically reported greater concern about out-of-pocket costs than NHW patients (43.6% vs 22.5%; P =.004).

In addition to racial/ethnic differences, sex-based differences were observed. Female patients were more likely than male patients to cite taking time off work as a concern (21% vs 13%; P =.024). When asked which interventions would be most helpful, female patients more often than male patients identified childcare services (23% vs 11%; P =.004), flexible appointment times (62% vs 43%; P =.015), and housing closer to the treatment center (55% vs 44%; P =.016).

Understanding of clinical trials also differed across groups. NHW patients reported understanding the term "clinical research study" very well more often than Hispanic patients (58% vs 40%; P =.015), and patients with an annual household income above $100,000 reported better understanding than those earning less than $50,000 (59.8% vs 38.8%; P =.012). NHW patients were also more likely than Hispanic or African American patients to report that a physician or member of their care team had discussed clinical trials with them (73% vs 51% and 54%, respectively; P =.002 and P =.007).

Across all groups, insurance or financial support was the intervention most frequently identified as helpful for improving enrollment, cited by 71% of patients, and 88% of patients said their physician's advice would most influence their decision to participate in a trial. Hispanic and African American patients were more likely than NHW patients to report agreement with statements reflecting past medical mistrust. Faith, community, and religious leaders were ranked as more influential sources of advice among African American patients compared with NHW patients.

Implications

The study authors proposed several strategies to address the barriers identified, several of which are already being tested in ongoing initiatives. Because NHW patients were more likely than Hispanic or African American patients to report that their care team had discussed trials with them, the authors pointed to universal screening and active prescreening—approaches that use limited eligibility criteria to identify potentially eligible patients before physician-level bias can influence referral—as ways to reduce this disparity. Automated screening using artificial intelligence algorithms was also cited as an emerging tool, though the authors cautioned that such systems should be designed to avoid replicating existing exclusion patterns.

Given that Hispanic and African American patients reported greater concern about study complexity, visit frequency, and travel distance, the authors highlighted decentralized trial elements—including remote consenting, virtual visits, local laboratory testing, and mobile phlebotomy—as strategies to reduce logistical burden.² They also noted that patients with lower education or income levels placed particular value on having a designated contact person on the research team, supporting a role for patient navigators to help identify barriers and connect patients with resources.

Finally, because insurance and financial support were identified as the most helpful facilitators across all groups, the authors suggested that trial budgets should account for reimbursement of childcare, transportation, and other participation-related costs, particularly for Hispanic, African American, female, and lower-education patients who ranked these services as most helpful.

“This study can serve as a source and priority list of evidence-based interventions that can be used in future implementation studies,” the authors wrote.

The authors noted that this particular study’s findings may be most applicable to populations treated at academic centers with established clinical trial infrastructure, as barriers identified in this cohort could be more pronounced among patients treated in community practice settings. They identified evaluation of patient perspectives in community-based practices as an area of future work.

REFERENCES

1. Akkad N, Chen M, Nguyen S, et al. Assessing patient perspectives on enrollment in lymphoma clinical trials. Cancer. 2026;132(8). doi:10.1002/cncr.70377

2. Nze C, Herrera AF. New strategies for enhancing enrollment of underrepresented minorities in lymphoma clinical trials. Blood Adv. 2025; 9(4): 774-782. doi:10.1182/bloodadvances.2024012981