Addressing Structural Challenges in Cancer Trial Participation

In a recent video interview with Applied Clinical Trials, Shanthi Sivendran, MD, MSCR, MBA, senior vice president for cancer care support at the American Cancer Society, discussed the national expansion of the organization’s Access to Clinical Trials and Support (ACTS) program and its implications for improving cancer trial access and equity. Sivendran explained how the program addresses persistent barriers to trial participation—including geography, transportation, lodging, financial burden, and limited awareness—through an end-to-end model that combines education, navigation, social support, and AI-enabled trial matching. She highlighted early utilization data from the program’s initial regional launch, underscoring the scale and complexity of patient-identified barriers, and emphasized the importance of integrating support services with precision trial matching. Sivendran also addressed broader industry challenges, including trial decentralization, narrative shifts around clinical research, and the need for more representative trial populations to ensure innovation reaches patients most affected by cancer.

The interview transcript was lightly edited for clarity.

ACT: Which barriers to cancer trial participation remain the hardest to solve, and what approaches are most promising for addressing them?

Sivendran: Yeah, great question. The barriers to clinical trials are multifactorial, right? So I’ve described a few that I think a nonprofit like ours, the American Cancer Society, can really be excellent at addressing. But this is a multi-industry, multi-stakeholder problem.

So when I think about it, one issue is geography. So I gave that example of where I live. Most cancer care—80% of cancer care—is done in the community and not necessarily in major academic hospitals and major cities. So we still have that problem where a lot of our clinical trials are concentrated in these really urban areas.

So there needs to be a move with our industry partners and through regulatory pathways to decentralized clinical trials.

So, I can have a patient who will travel for their appointment, for their blood work, and for their treatment. And that can be three separate appointments where they need to travel anywhere from an hour to three hours, depending on where they’re going, in a week or two. That’s just not sustainable, right? You’re not going to get patients on clinical trials that way.

So is there an opportunity where blood work can be done closer to home? Can telehealth be used for office visits? Can you get to a certain point where maybe those treatments can be given more locally where a few treatments are given in a central location?

So I think there are unique opportunities to think about that. And there are a lot of people involved to be able to do that.

And then I think we need to think about how we help patients change the narrative of clinical trials—that this is really about innovation. And this is one place where the American Cancer Society can help, because we’re right at the seat of where the healthcare team intersects with a patient or their loved one.

It’s changing the narrative around clinical trials to really be about innovation and not just something that’s brought up as a last resort. It should be brought up right at the beginning: this is standard of care. These are the clinical trials available. And really, at every time there is a treatment decision or treatment option being presented, clinical trials should be a natural part of that conversation.