ACORI Research Review: January 2026

Cancer clinical research has led to sustained improvements in outcomes across cancer types. As Dr Buck observes, today’s treatments exist because of the clinical trials that established current standards of care. Framing trials as a fundamental part of evidence-based oncology practice, rather than as a last resort, can help patients view participation as an appropriate and informed option.

For Redmond, participating in a clinical trial is deeply personal and inherently forward-looking. By recognizing that the benefits of research extend beyond her own treatment to her children, grandchildren, and future generations, she describes her decision as “playing the long game.” This sense of leaving a legacy has shifted her perspective on clinical trial participation from a strictly medical decision to an act of stewardship. In aligning her participation with a desire to improve the health care experience for those who come after her, Redmond’s involvement is rooted in hope that endures beyond her own medical care.

Trust requires communication, shared decision-making, and respect for each patient’s individual story, not through a description of protocols alone. Redmond notes that as both a poet and a person living with multiple myeloma, she brings a perspective that weaves the emotional and existential dimensions of cancer into the same space as lab values and imaging results. While these experiences are not captured in medical reports, they can shape how patients understand and live with their disease. By bringing the patient’s story and voice into research, clinical trials can feel less like a procedure being imposed on patients and more like a collaborative process developed in partnership with them.

Shared decision-making is especially central to incorporating the patient’s voice in research. Carrington and Dr Buck both emphasize that clinical trials should be discussed in the context of a patient’s treatment goals, individual values, and life circumstances, rather than solely based on eligibility criteria. Care team members must engage in transparent conversations about risks, benefits, and the logistical considerations involved in trial participation. When presenting a clinical trial opportunity, providers should also outline alternative treatment options, supporting patients in making informed decisions that align with their priorities and reducing any perception of pressure to participate in research.

For many patients, but especially those from historically marginalized communities, trust is shaped by both past experiences and present interactions. Carrington emphasizes the importance of acknowledging the history of unethical experimentation and research as a necessary step toward moving forward. Avoiding these conversations can reinforce mistrust, whereas naming and addressing them can open the door to more honest, collaborative relationships between patients and their care teams.

Redmond, Carrington, and Dr Buck also highlighted the practical barriers that can prevent patients from participating in clinical trials, even when they are both interested and eligible. Transportation remains a significant obstacle, particularly for patients living in rural areas. Carrington describes the difficult trade-offs some patients face, such as choosing between money for gas, food, or housing, which can make trial participation feel nearly impossible. As a result, these barriers can exclude patients who may stand to benefit most from access to innovative therapies.

Ensuring that clinical trials reflect the diversity of the populations they aim to serve is both a moral and scientific necessity. The Association of Cancer Care Centers (ACCC) has long supported equitable access to trials and emphasizes that underrepresentation of racial, ethnic, rural, and lower-income populations undermines the relevance and generalizability of trial findings. When groups that carry a disproportionate cancer burden are missing from research, Ensuring that clinical trials reflect the diversity of the populations they aim to serve is both a moral and scientific necessity. The Association of Cancer Care Centers (ACCC) has long supported equitable access to trials and emphasizes that underrepresentation of racial, ethnic, rural, and lower-income populations undermines the relevance and generalizability of trial findings. When groups that carry a disproportionate cancer burden are missing from research, the evidence used to guide care may not fully apply to them.

To help address these gaps, ACCC offers tools such as the Just ASK™ Training Program and Site Self-Assessment free of charge to research sites. These resources are designed to help teams identify and reduce structural barriers to trial participation among various racial and ethnic populations, strengthen communication, and foster more inclusive trial cultures. When paired with local strategies, such tools can help research programs move from aspirational equity goals to concrete practice changes.
The conversation among Redmond, Carrington, and Dr Buck shows that trust in clinical trials is not a single intervention but an ongoing, relationship-driven process. It involves inviting patients to bring their full identities into discussions about research and responding with humility and openness. It also requires research programs to examine their own operations and ask hard questions about who is being left out and why.

For individuals diagnosed with cancer, the decision to explore a clinical trial can be both hopeful and simultaneously overwhelming. While trials may offer new treatment options, the process of identifying appropriate studies, understanding eligibility criteria, and navigating logistical requirements can present significant challenges. These barriers are exacerbated for patients who face socioeconomic challenges, have limited access to specialty care, reside in more rural areas, encounter language barriers, or have a history of mistrust in medical research. ACS ACTS aims to address these barriers by combining personalized trial-matching technology with human-centered navigation, education, and support..

At the core of ACS ACTS is a support model that serves people with cancer, caregivers, and health care professionals. Through the program, individuals can speak with ACS specialists who help them understand what clinical trials are, how they may fit into a treatment journey, and whether participation aligns with a patient’s goals and preferences. The program emphasizes education and shared decision-making, while providing clear, unbiased information so that patients feel informed rather than pressured or overwhelmed when considering research options.

In addition to education, ACS ACTS offers personalized clinical trial matching that uses clinical details such as cancer type, stage, and prior treatments, as well as geography and other factors, to identify potentially suitable trials. In collaboration with a technology partner, Massive Bio, ACS ACTS leverages artificial intelligence (AI) to generate tailored lists of trials from ClinicalTrials.gov, helping address one of the most common barriers to participation: finding an appropriate and accessible trial. For clinicians and care teams, this service can be particularly helpful when local research options are limited or when time and staffing constraints make in-depth trial searches challenging.

A significant feature of ACS ACTS is its focus on addressing barriers to participation, not just identifying available trials on paper. Many patients who express interest in clinical research are ultimately unable to enroll due to nonclinical obstacles such as social drivers of health or difficulty navigating complex health systems. Through ACS ACTS, individuals can connect with a broad range of ACS programs and resources, including transportation assistance, lodging support through services such as Hope Lodge, and other supportive care offerings designed to reduce the practical burdens associated with trial participation.

This integrated approach reflects growing recognition that equity in clinical trials requires more than recruitment messages alone. Clinical research has historically underrepresented racial and ethnic minorities, rural populations, older adults, and individuals with lower socioeconomic status, raising concerns that trial findings may not fully reflect the real-world populations most affected by cancer. By embedding navigation, education, technology-enabled trial matching, and wraparound support into the clinical trial process, ACS ACTS seeks to help close these gaps and foster more inclusive, representative research.

The nationwide expansion of ACS ACTS builds on earlier pilots and aligns with broader national priorities to improve diversity and representation in clinical research. As oncology care becomes increasingly personalized, driven by biomarkers, targeted therapies, and immunotherapies, the need for research participants that mirror the diversity of patients in routine practice becomes even more necessary. Ensuring that all patients have meaningful opportunities to participate in research is essential not only for equity in access but also for the scientific rigor and relevance of future cancer treatments.

For oncology care teams, ACS ACTS can serve as a valuable partner in supporting clinical trial conversations. Providers can refer patients and caregivers to the service to reinforce education, explore options beyond their own institution, and assist patients in navigating next steps when they express interest in research. The program also supports health care professionals by offering an additional resource when on-site clinical trial infrastructure or research staffing is limited, particularly in community-based settings where access to trials has historically lagged behind major academic centers.

As cancer care continues to evolve, programs such as ACS ACTS highlight the importance of meeting patients where they are and acknowledging the realities of their lives while offering pathways to innovation and hope. By combining personalized AI-enabled trial matching, expert navigation, and practical support services, the nationwide ACS ACTS program represents a meaningful step toward ensuring that clinical trials are accessible, inclusive, and patient-centered for all.

At the heart of the problem is the fact that CRPs—comprising dozens of distinct roles across regulatory, industry, clinical research site, data management, project management, sponsored programs, and compliance sectors—are often overlooked when it comes to clinical research matters. The conduct of modern clinical trials is a team-based effort, with principal investigators providing scientific and regulatory leadership and CRPs ensuring operational continuity and patient engagement. It is most often CRPs who meet with patients and work behind the scenes to take care of the bulk of research operations, despite not being fully recognized as a profession by the US Bureau of Labor Statistics. Without a standard occupational classification, it is difficult to capture data for these careers, leaving no way to obtain federal funding for critical workforce development initiatives.

Along with a lack of professional recognition, the industry has not yet arrived at a standard training path to become a CRP, and very little awareness is given toward this career path in higher education compared to other health care careers, such as nursing. Some institutions do have training programs for CRPs. Still, most of the time, they require previous work experience, which precludes early career professionals from entering the field straight out of high school or college. (One exception to this is the Clinical Research Apprenticeship Program at Duke University, which we featured in the October 2025 ACORI Research Review.)

These issues have created an urgent staffing crisis that needs to be resolved to advance cancer research. Tackling this crisis is a core mission of the Association of Clinical Research Professionals (ACRP), the nation’s only nonprofit organization dedicated to representing, supporting, and advocating for clinical research professionals. ACRP and the Society of Clinical Research Associates (SOCRA) provide two of the primary accredited certification programs for CRPs and help set professional training benchmarks, as the field lacks any overarching industry standards from regulators or government bodies.

To further enhance collaboration and impact, ACRP launched a multidisciplinary consortium called the ACRP Partners for Advancing the Clinical Research Workforce (PACRW) that includes sponsors, contract research organizations, investigator sites, academic institutions, regulatory agencies, and other research stakeholders. Earlier this year, the PACRW published a white paper focusing on solutions to the workforce crisis. The proposed solutions framework consists of 6 primary domains:

• Identity—create a strong identity for clinical research professionals and recognition of value within interprofessional teams
• Awareness—raise awareness of clinical research as a career and embed within schools and colleges
• Pathway—define entry level and map out a clear pathway into the career, with competency-based hiring
• Representation—ensure a diverse workforce through career access and training
• Standardization—standardize roles across the enterprise to support salary equity and career prospects
• Harmonization—harmonize training programs and employment requirements.

Most recently, ACRP has been awarded a 2-year R13 grant (NIH Research Conference Grant) to support their initiative in strengthening the US research workforce. This grant will fund a 2-part symposium that will bring together key stakeholders in clinical research to discuss 2 main themes: What does the future of the profession look like? What should be the pathway for this career field? The sessions will take place at ACRP’s Annual Conferences in 2026 and 2027.

ACRP is fiercely advocating for CRPs to receive more recognition and training, according to Susan Landis, chief executive officer of ACRP. Landis notes, “If every clinical research professional walked off the job tomorrow, drug development would stop.” While this may sound dramatic, the reality is that cancer clinical trials can only continue if there are skilled staff to run them.

Landis is proud of the advocacy work that ACRP has done thus far, but acknowledges that there is still a long way to go. For any ACCC members who are currently involved in workforce development programs at their institution, Landis encourages them to reach out to ACRP for further collaboration (Susan.Landis@acrpnet.org). Moreover, research clinicians or personnel interested in the ACRP Annual Conference can register at ACRP 2026.

Trial Library was founded in 2022 by Hala Borno, MD, a medical oncologist at the University of California San Francisco (UCSF), who wanted to build a platform that would help promote inclusivity in oncology clinical trials. Trial Library works by efficiently matching patients with trials, reimbursing providers for their pre-screening efforts, assisting patients in overcoming barriers to trial participation, and serving as the liaison between community practices and trial sites. Whether the program is a small independent practice with no research capability or a larger community network with ongoing trials, there is a role for Trial Library.

To use Lilly's Trial Finder, clinicians can enter the patient's zip code, search radius, and cancer type, at which point the platform will display a list of all actively recruiting trials in the database. Oncologists can narrow down the list of relevant trials by providing more information about the patient’s disease characteristics and biomarkers. For each trial, an overview of the study is presented along with inclusion and exclusion criteria.

If a trial is of interest, providers can select a site and refer a patient directly from the Trial Finder platform or contact the site’s principal investigator. Lilly notes that providers should hear back about the next steps within 7 days of the initial referral. Currently, the Trial Library is tailored to support phase 3 trials for bladder, breast, colorectal, gastroesophageal, gynecologic, lung, pancreatic, prostate, and sarcoma cancer types, with additional cancer types in the works.

The second part of Lilly’s TalkAboutTrials website features a resource on misconceptions surrounding clinical trials. Misconceptions can deter clinicians from recommending clinical trials and prevent patients from wanting to participate in trials. It is important that providers not only recognize misconceptions but also work to correct them so that they do not continue to be barriers to trial participation.

Some common misconceptions highlighted on TalkAboutTrials include the beliefs that “clinical trials are only for patients who have exhausted all treatment options”; “placebos are commonly used in oncology trials, and patients may receive no treatment”; “only large academic medical centers have access to clinical trials”; “clinical trials are too costly and often aren’t covered by insurance”; and “clinical trial participation can limit future treatment options.”

In reality, oncology clinical trials are available throughout a patient’s treatment journey—whether it be in the first- or last-line setting—and these trials typically compare a new intervention to the current standard of care, so a patient will receive, at a minimum, an already established treatment. Furthermore, phase 3 trials are increasingly being offered at community practice sites, and many insurance plans will cover the routine costs of care. Additionally, trial sponsors and other organizations continue to make efforts to alleviate the financial burden of trial participation for patients. These talking points can help providers address misconceptions with patients and pave the way for more conversations about clinical trials. In summary, Lilly’s TalkAboutTrials website equips community oncology providers with user-friendly resources to promote enrollment in phase 3 clinical trials.

Bradley Zebrack, PhD, MSW, MPH, research director of the Adolescent & Young Adult Cancer Research Working Group (AYA CARES) at the University of Michigan, currently runs an NCI-funded research study examining how social, environmental, and genetic factors impact the long-term health of AYA cancer survivors. “Stresses accumulate in the body and manifest as chronic disease, and nobody has really looked at that in cancer survivors,” Dr Zebrack explained. The study collects biospecimens and patient-reported outcome data from AYA survivors of Hodgkin lymphoma, non-Hodgkin lymphoma, or leukemia to evaluate associations among social and environmental stress exposures, alterations in gene expression and immune cell function, and health outcomes over time. The primary objective is to identify the genome-wide transcriptional impact of social-environmental risk and resilience factors, and to identify relationships between those genomic profiles with AYA survivor mortality, morbidity, and quality of life (QOL).

AYA cancer survivors often face unique stressors compared to their older counterparts. “The stage in life in which young people are diagnosed with cancer creates a very different set of experiences,” said Dr Zebrack. They may be focused on completing school, starting their careers, building a family, or navigating medical finances for the first time without parental support. These age-specific stressors interact with universal challenges, such as poverty, social isolation, and food insecurity, to create a complex landscape of risks that may affect health and QOL.

Dr Zebrack knew that if he wanted a study population that captured the full, diverse breadth of stressors faced by this age group, he would have to recruit beyond large academic cancer centers. This trial enrolled patients through ECOG-ACRIN and NCORP, reaching an extensive network of community cancer centers across the US. By the close of the recruitment period in December 2025, approximately 60 sites had enrolled patients. Although individual sites contributed varying numbers of AYA cancer survivors, ranging from a single participant to several, the collective effort resulted in a robust and diverse study cohort. 

“It was important to us to have accessibility to these community cancer programs because they’re more likely to see a much broader and more representative proportion of the US population,” said Dr Zebrack. Community clinical trial networks enabled a diverse cohort that reflects the challenges and needs of AYAs across the country. 

As AYA cancer research increasingly seeks to understand the long-term biological and psychosocial consequences of treatment, inclusive trial enrollment is essential. ECOG-ACRIN and NCORP provide a scalable pathway to reach AYAs across diverse geographic, socioeconomic, and clinical settings. Their success highlights the crucial role of community cancer centers in conducting equitable, generalizable research that can significantly enhance outcomes for the AYA population.

During the COVID-19 pandemic, remote care became a necessity, supported by local and national policy, but Huntsman Cancer Institute recognized it as an opportunity for sustainable innovations. As many cancer centers return to the pre-pandemic status quo, Huntsman Cancer Institute is advancing its decentralized clinical trials initiative to bridge the gap for patients with cancer who live far from a major medical center.   

Decentralized clinical trials at Huntsman Cancer Institute are thoughtfully designed to minimize the need for frequent, in-person visits by leveraging remote technologies and flexible protocols. Designing trials with a “hub-and-spoke model,” the institute anchors its research at a central site while prioritizing strategies that reduce travel burdens for patients across the West. While patients may still need to travel to Huntsman Cancer Institute for care, telehealth, self-administered medications shipped directly to their homes, and less frequent treatments all help to reduce the number of trips.  

For example, researchers at Huntsman Cancer Institute are evaluating the efficacy of a shorter course of radiation therapy. These studies work to understand if the same outcomes can be achieved through radiation administered in fewer doses, decreasing the amount of time a patient and their caregiver must spend away from home. Other planned trials will investigate therapeutic agents that are administered orally or via subcutaneous injections, which patients can self-administer at home (or with the help of a home health nurse). Huntsman Cancer Institute updated its pharmacy licensure to allow drugs to be shipped across state lines. This is one key way access to clinical trials can be extended to more patients. Now, patients across the region who qualify to participate in a trial can receive study medications shipped to their home rather than having to drive to Huntsman Cancer Institute’s Salt Lake City campus to access medications. The cancer center also partners with phlebotomy sites across the region, allowing patients to receive routine lab testing closer to their homes.

Jessica Moehle, CCRP, senior clinical research administrative director at Huntsman Cancer Institute, leads the decentralized clinical trials initiative. She has received positive feedback from participants who take advantage of these trials, including an individual who lives over 4 hours away in Wyoming. The combination of telehealth and local phlebotomy partnerships reduced the time this patient and their caregiver had to take off work and travel. “They were so grateful to not have to make this really long journey, saving themselves a full day of travel, especially in wintertime, when there are mountain passes and unpredictable weather,” Moehle said. 

Clinicians also see the benefits, including higher patient satisfaction, opportunity to participate in trials when living far away, and potentially lower dropout rates in clinical trials. Moehle works with a multidisciplinary team of leaders from across the cancer institute, along with outside advocacy groups, to continuously improve the program and share these successes with policymakers at local and national levels. They aim to keep and expand policies developed during the pandemic that support telehealth and pharmacy shipment directly to patients to ensure care across state borders. 

Looking ahead, Moehle’s team is designing new strategies to make clinical trials more accessible to patients. In February 2025, Huntsman Cancer Institute received an Advanced Research Projects Agency for Health (ARPA-H) grant to expand its care offerings in rural areas. Part of the funding is going toward the development of an electric vehicle equipped for infusions, laboratory services, and computed tomography (CT) scans that will travel to rural communities in several counties in Utah. In addition to providing cancer screenings and treatments, Huntsman Cancer Institute is designing clinical trials specifically tailored to the capabilities of this mobile unit. 

For patients who would otherwise face hours of travel, time away from work, and weather-related risks, decentralized trial models offer more than convenience; they offer access. Through telehealth, regional partnerships, and mobile clinical infrastructure, Huntsman Cancer Institute is reducing the structural barriers that have long limited trial participation for rural populations. As these efforts continue to evolve, decentralized clinical trials highlight how thoughtful trial design can enhance access to clinical trials for more patients.