Team Efforts Needed to Boost Veteran Cancer Clinical Trial Access and Participation

Clinical trials for cancer treatments are essential for advancing medical and scientific knowledge, improving treatment options, and ultimately enhancing patient care. Despite their critical role, participation in these clinical trials remains low.

Data indicate that only about 7% of patients with cancer enroll in clinical trials.¹ The participation rate among veterans receiving care within the Department of Veterans Affairs (VA) is estimated to be even lower, at approximately 2%. This discrepancy highlights the need for increased awareness and accessibility within the VA system, according to Daphne Friedman, MD, Deputy Director of the VA’s National Oncology Program.

Contrary to common misconceptions, clinical trials are not limited to patients without standard treatment options, and they offer significant benefits to patients, including high-quality care, close monitoring by clinical staff, and potential access to cutting-edge treatment options. The goal for clinical trials is to make them equitable and available to all eligible patients.

Barriers to Participation

Several barriers contribute to the low clinical trial participation rate among veterans. These barriers fall into 3 broad categories, according to Friedman, who outlined these barriers at the AMSUS 2025 meeting in National Harbor, MD²:

1. Patient-related barriers: Many veterans are unaware of clinical trial opportunities or do not know to inquire about them. A lack of knowledge often correlates with lower participation rates.
2. Provider-related barriers: VA oncologists may face challenges in identifying suitable clinical trials for their patients due to a lack of awareness or familiarity with trial options.
3. Systemic and institutional barriers: Veterans may have comorbidities that may exclude them from participation in certain studies, or their clinic or hospital may not be set up for the monitoring needed.

How VA Is Addressing Barriers Through the CCRS

The Cancer Clinical Research Service (CCRS), part of the National TeleOncology Service, has been instrumental in addressing barriers and expanding access to clinical trials for veterans. The CCRS is composed of 2 main components, focused on decentralized clinical trials (DCTs) and clinical trial navigation.

How VA Is Decentralizing Clinical Trials

The DCTs offer an innovative approach to overcoming traditional barriers by leveraging remote and digital healthcare technologies. DCTs in the VA fall into several categories, ranging from least to most complex:

• Observational studies: Fully remote, nontherapeutic studies that involve data collection via medical charts
• Remote treatment/pragmatic: Fully remote interventional studies, often comparing standard-of-care treatments
• Nontherapeutic interventional studies: Fully remote studies that involve text messaging, digital devices, or surveys
• Traditional therapeutic trials with decentralized components: Complex prospective interventional studies that allow participation from locations outside traditional research centers

DCTs involve collaboration among study sponsors, research teams, the National TeleOncology Service, and participant sites. This approach offers several advantages, including, but not limited to:

• Increased and faster participant recruitment due to a larger patient pool
• Improved participant retention, reducing dropout rates and missing data
• Shortened clinical trial timelines
• Greater convenience for participants by enabling treatment at home or at local VA facilities
• Reduced barriers to participation for rural and older veterans

Success of the VA’s DCT Portfolio

The VA has successfully implemented several decentralized cancer clinical trials, including:

• Quality of life, survivorship, and digital health studies: Pro-OP, BNT001, CASE, and POTENTIAL
• Blood cancer trials: HALO, RealMIND, and Selinexor studies
• Lung cancer trial: Krystal-1

Since October 1, 2019, the VA has enrolled 131 patients across various studies. The median participant age is 71 years, with representation from veterans across 36 states and the District of Columbia. These figures demonstrate the effectiveness of decentralized trials in improving access for rural and older veterans, Friedman said.

The CTN program provides education and guidance, ensuring that veterans are aware of available trials and the benefits of participation.

VA’s Cancer CTN Program

The Cancer Clinical Trial Navigation (CTN) program plays a critical role in assisting VA oncologists and veterans in identifying and enrolling in clinical trials. The CTN program provides education and guidance, ensuring that veterans are aware of available trials and the benefits of participation.

Steps to Referral

1. The referring provider educates the veteran about clinical trials as a potential treatment option and advises them about the CTN referral.
2. The provider contacts the CTN team via email.
3. The CTN navigation team reaches out to the veteran to assess their preferences and identify potential barriers to participation.
4. The CTN team performs a search to identify active and enrolling trials.
5. The search results are shared with the referring provider and veteran.
6. The CTN team facilitates the connection between the veteran and the appropriate clinical trial, providing ongoing support.

From June 2023 to February 2025, the CTN program processed 203 completed referrals, highlighting its effectiveness in increasing clinical trial participation among veterans.

Collaboration With Non-VA Partners

The VA has also established partnerships with several non-VA organizations to expand access to clinical trials. Notable collaborations include:

• National Cancer Institute (NCI): 96 veterans referred, 21 enrolled in NCI clinical trials
• Leukemia & Lymphoma Society (LLS): 25 veterans with blood cancers were referred to the LLS Clinical Trial Support Center, 15 completed a clinical trial search, and 3 enrolled in trials with LLS assistance

Patient Education and Resources

To ensure veterans have access to accurate and comprehensive information, Friedman encouraged those in attendance of her discussion to arm patients with educational resources, including:

• Cancer Clinical Trials at the NIH’s Center for Cancer Research
• Taking Part in Cancer Treatment Research Studies (National Cancer Institute)
• ASCO Pamphlet on Clinical Trials

Conclusion

Increasing participation in cancer clinical trials within the VA system is critical for advancing cancer treatment and ensuring equitable access to innovative therapies for veterans. By leveraging DCTs, the CCRS, and the Cancer CTN program, the VA is making significant strides in addressing barriers to participation, Friedman said. Continued expansion of decentralized trials and strengthened collaborations with non-VA partners will further enhance trial accessibility, ultimately improving cancer care for veterans nationwide.

References

1. Unger JM, Xiao H, Vaidya R, et al. Patient enrollment to industry-sponsored versus federally-sponsored cancer clinical trials. J Clin Oncol. 2024;42(33).
2. Friedman D. Expanding access and curing cancer every day at VA. Presented at: 2025 AMSUS Meeting. March 3-6, 2025; National Harbor, MD.