Why 95% of Cancer Patients Never Get Into Clinical Trials (And What You Can Do About It)

The Truth About Clinical Trial Access

Picture someone sitting at their computer late at night, trying to make sense of clinical trials. This scene plays out in homes across the country every single day. Here's something that might surprise you: only about 5% of adult cancer patients ever enroll in a clinical trial. That number has barely budged in decades.

The reasons aren't what you'd expect. It's not that patients don't want to participate. Studies show that when patients are offered trials, most say yes. The problem is that most patients are never offered anything at all. The system is fragmented. Information doesn't flow the way it should. And there are financial incentives at play that nobody talks about openly.

The Gatekeeping Problem: Inclusion and Exclusion Criteria

Every clinical trial has a list of requirements called inclusion and exclusion criteria. These rules determine who can participate and who gets turned away at the door.

Inclusion criteria might say things like: must have a specific cancer type, must have failed at least one prior treatment, must be between 18 and 75 years old, must have adequate kidney function based on lab values.

Exclusion criteria screen people out. Common ones include: no brain metastases, no history of autoimmune disease, no current use of certain medications, no heart conditions, no second cancers within five years.

Here's what the drug companies won't say directly: these criteria exist to stack the deck. Pharmaceutical sponsors design trials to show their drug works. They want patients who are sick enough to potentially benefit but healthy enough not to die from other causes during the study. A patient who passes away from heart disease during a cancer trial muddies the data.

This creates a strange paradox. The patients who most desperately need new options are often the same patients excluded from trials. Too sick. Too many prior treatments. The wrong genetic markers. Wrong age. Wrong location.

Why Your Doctor Might Not Mention the Best Trial for You

Let's talk about something uncomfortable. An oncologist at a major academic medical center probably knows about the trials happening at their own institution. They may even be an investigator on some of those studies. But they may have limited knowledge of trials running at other hospitals, even excellent ones just a few hours away.

Part of this is simple logistics. There are thousands of active cancer trials at any given time. No doctor can track them all while also seeing patients, reviewing scans, and managing complex treatment regimens. The system doesn't provide good tools for cross-institutional trial matching.

But there's another factor that rarely gets discussed: money. When a patient enrolls in a clinical trial at a hospital, that institution receives payment from the trial sponsor. These payments cover the cost of administering the trial, but they also contribute to the hospital's research budget and reputation. A major cancer center running dozens of trials depends on that revenue stream.

This doesn't mean doctors are steering patients toward inferior options for financial gain. Most oncologists genuinely want what's best for their patients. But human nature creates subtle biases. When a doctor knows the investigator down the hall and has seen the trial data firsthand, that trial feels safer and more knowable than one across the country.

Meanwhile, sending a patient to a competitor hospital means losing them, at least temporarily. It means revenue walking out the door. Hospital administrators track these numbers even if individual doctors try to ignore them.

What the Sponsor Actually Wants

Here's where it gets complicated. The pharmaceutical company running a trial has different incentives than you might assume. They're not trying to help as many patients as possible. They're trying to prove their drug works so they can get FDA approval and bring it to market.

This means sponsors want to enroll patients who will make their drug look good. They want patients who are likely to respond. They want patients who won't drop out. They want patients who will complete the full treatment course and all the follow-up appointments.

A 45-year-old with good performance status, no major comorbidities, and stable disease after first-line treatment? Perfect candidate. A 72-year-old who has failed three prior regimens, has diabetes, and lives four hours from the trial site? The sponsor would rather pass, even if the trial is technically open to them.

Trial coordinators are under pressure to meet enrollment goals, but they're also under pressure to enroll the right patients. A trial that enrolls quickly but shows poor results helps no one. This creates an invisible filtering system where the patients who need options most are often deemed too risky to include.

The Distance Problem Is Real

For some patients, the best available trial might require traveling hundreds of miles. This is a genuine barrier, not something to dismiss.

Trial protocols often require weekly or biweekly visits for months. Blood draws, scans, physical exams, infusions. Flying across the country or driving six hours each way makes the logistical burden overwhelming. Hotels, meals, time off work, childcare. These costs add up fast, and most aren't covered by insurance or the trial sponsor.

Some trials offer travel stipends. Some have satellite sites for certain visits. But many don't. The result is that geography becomes another filter. Patients near major academic centers have access to trials that patients in rural areas will never hear about.

This is a real constraint, and only the patient can decide whether the potential benefit justifies the disruption to their life. But that decision should be made with full information, not because nobody mentioned the option existed.

Start Here: The Main Trial Databases

ClinicalTrials.gov is the official U.S. database. It lists every registered trial in the country. The interface isn't pretty, and yes, some listings are outdated. But it's still the best starting point. When searching, use the 'Recruitment' filter to see only open trials. Search by specific diagnosis, like 'Stage III breast cancer' rather than just 'cancer.' Check the 'Map' tab to find trials nearby, but also search without location restrictions to see what exists elsewhere.

The National Cancer Institute maintains a cleaner database at cancer.gov/clinicaltrials. Their search tool is easier to use, but it only includes NCI-supported cancer trials, which is a subset of everything available.

For trials outside the United States, check the WHO International Clinical Trials Registry Platform and the EU Clinical Trials Register.

Questions to Ask Before Applying

When potential trials surface, specific answers matter before moving forward. What are the exact eligibility requirements, including the lab values and timing? Where will visits need to happen and how often for the entire duration of the protocol? What costs will insurance cover and what falls on the patient? What happens after the trial ends if the drug is working? Can current medications continue or will some need to stop? Who can be contacted with questions at night or on weekends when something feels wrong?

Also ask: how many patients have enrolled so far, and how many slots remain? Has anyone dropped out, and why? What did the earlier phase trials show about side effects?

Watch Out for Red Flags

Most trials are legitimate, but staying alert for warning signs matters. Anyone asking for upfront payments to join a trial is almost certainly running a scam. Legitimate trials are funded by sponsors, not participants. Be wary of promises of guaranteed results or cures. No honest researcher would make such claims. If someone pressures for an immediate decision without time to review the protocol or discuss with a doctor, walk away.

Any legitimate trial should be listed on ClinicalTrials.gov. If it's not, ask why. Requirements to travel internationally without clear institutional support and documentation should raise concerns.

How Wondrlink Foundation Can Help

Wondrlink Foundation doesn't make medical decisions for patients. That's between them and their care team. What we do is help people understand what exists beyond what their current institution offers. Our volunteers can walk patients through trial searches, explain eligibility criteria in plain language, and help prepare questions for oncologists.

We believe what we offer to one, we should offer to all. Our support is free. Whether someone ultimately joins a trial or not, they deserve to know the full range of possibilities. The 95% of patients who never access trials aren't failing. The system is failing them. We're trying to change that, one patient at a time.

References and Resources

Clinical Trial Databases:

• ClinicalTrials.gov: https://clinicaltrials.gov

• NCI Cancer Trials: https://www.cancer.gov/about-cancer/treatment/clinical-trials/search

• WHO International Clinical Trials Registry: https://trialsearch.who.int

• EU Clinical Trials Register: https://www.clinicaltrialsregister.eu

Research on Clinical Trial Enrollment:

• Unger JM, et al. "Systematic Review and Meta-Analysis of the Magnitude of Structural, Clinical, and Physician and Patient Barriers to Cancer Clinical Trial Participation." Journal of the National Cancer Institute, 2019. https://doi.org/10.1093/jnci/djy221

• Murthy VH, Krumholz HM, Gross CP. "Participation in Cancer Clinical Trials: Race-, Sex-, and Age-Based Disparities." JAMA, 2004. https://jamanetwork.com/journals/jama/fullarticle/198817

Understanding Trial Design and Eligibility:

• FDA Guidance on Clinical Trial Eligibility Criteria: https://www.fda.gov/regulatory-information/search-fda-guidance-documents

• American Cancer Society - Clinical Trials Overview: https://www.cancer.org/cancer/managing-cancer/treatment-types/clinical-trials.html