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ACCCBuzz interviewed leadership from the National Association of Veterans’ Research and Education Foundations to better understand the current clinical and operational barriers Veterans face in accessing clinical trials and the progress being made to address them.
Clinical trials can offer patients cutting-edge therapies and an opportunity to contribute to research, but they are inaccessible or underutilized in many patient populations. One critical example is Veterans, who are underrepresented in research due to a complex set of clinical and operational barriers. Even within the US Department of Veterans Affairs (VA), lack of awareness and referral challenges limit trial enrollment.
The National Association of Veterans’ Research and Education Foundations (NAVREF) works to reduce these barriers by strengthening the VA-affiliated nonprofit research corporations (NPCs) that directly support VA health systems around the country. NPCs offer flexible funding and administrative support for research activities at their local VA sites. NAVREF’s role is to provide resources that help these groups streamline trial start-up, improve Veteran awareness and enrollment, elevate best practices, and advocate for policy change.
ACCCBuzz interviewed leadership from NAVREF to better understand the current barriers Veterans face in accessing clinical trials and the progress being made to address these hurdles. Rashi Romanoff, chief executive officer, and Hawk Tran, MPH, chief operating officer, shared how the VA, NPCs, and community cancer centers can all play a role in improving representation of Veterans in clinical research.
ACCCBuzz: Why are Veterans underrepresented in clinical trials?
NAVREF: Many Veterans receive care across both VA and community systems, which can fragment referral pathways and make it harder to identify eligible trials. Trial protocols can also unintentionally exclude Veterans due to higher rates of comorbidities, complex medical histories, or prior exposures. In addition, awareness remains a challenge—both among VA and non-VA providers—about the breadth of research opportunities available within the VA system. As a result, Veterans are often left out of studies for diseases that disproportionately affect them, including cancer.
ACCCBuzz: What unique strengths of the VA health system make it a good fit for clinical research?
NAVREF: The VA operates the largest integrated health care system in the country, with a unified electronic health record, long-term patient relationships, and deep expertise in Veteran-specific conditions. This integration supports longitudinal research, real-world evidence generation, and pragmatic clinical trials that reflect how care is actually delivered. The VA also serves a diverse patient population with high disease burden in areas like oncology, mental health, and chronic conditions, leaving it uniquely positioned to generate insights that improve care for Veterans and the broader US population.
ACCCBuzz: How do NPCs support VA research?
NAVREF: NPCs provide operational flexibility that the federal system cannot: managing grants, hiring research staff, supporting compliance, and handling contracts and partnerships with industry and academia. NPCs are uniquely equipped to bridge federal and nonfederal research environments, allowing VA investigators to participate in cutting-edge clinical trials while maintaining VA oversight and Veteran protections. Without NPCs, many VA clinical trials simply would not be feasible.
ACCCBuzz: Where are the biggest opportunities for growth in VA oncology clinical trials right now?
NAVREF: There is a significant opportunity to expand VA oncology trials in precision medicine, rare cancers, and real-world comparative effectiveness studies. Operationally, improving trial start-up timelines, expanding research staffing, and strengthening recruitment infrastructure are key areas for growth. There is also untapped potential to better integrate VA sites into multicenter trials and to increase awareness among community oncologists who treat Veterans but may not realize that VA trials are an option for their patients.
ACCCBuzz: How can community cancer centers collaborate with or support VA clinical trials?
NAVREF: Community cancer centers can play a critical role by partnering with VA sites on referral pathways and shared trial awareness. Simple steps, such as educating clinicians about VA trial availability, coordinating care transitions, or collaborating on outreach to Veteran patients, can significantly expand access. These partnerships help ensure Veterans are not excluded from innovative therapies simply because of where they receive care. If community oncologists are looking to connect their patients to VA trials, there’s a good chance that one of our research nonprofits is in their area. Public trial registries, such as ClinicalTrials.gov, are typically a good starting point for identifying VA study locations and eligibility criteria. From there, coordination with their local VA medical center research office or affiliated NPC can help determine site participation and next steps for Veteran enrollment.
ACCCBuzz: What are some of NAVREF’s advocacy priorities in 2026?
NAVREF: NAVREF’s 2026 advocacy priorities focus on strengthening the VA research workforce, stabilizing funding, and modernizing research operations. Legislators are especially engaged by issues tied to Veterans’ access to care, workforce shortages, research readiness, and return on federal investment, particularly when research is framed as a driver of both clinical quality and national biomedical leadership.
If you are interested in increasing enrollment of Veterans in your clinical trials, NAVREF and ACCC each provide tailored resources on collaborating with VA sites and improving equitable care for this patient population.
Decentralized clinical trial approaches, including remote consent, telehealth, local laboratory and imaging services, and more, can help reduce some of the many barriers that prevent eligible patients from participating in trials. But as the participants in ACCC’s Advancing Decentralized Clinical Trials in the Community Setting Roundtable Series emphasized, implementing DCT elements is not simply a matter of adopting new technology. Doing so successfully requires thoughtful workflows and oversight structures that consider equity, scalability, and sustainability.
