By Angi Fisher
Chair, WCRC’s Board of Directors

I started going to talks about cancer clinical trials because the science was remarkable. What I kept wanting to know was simpler than the science. Who actually gets to reach any of this?

The answer I kept hearing was that patients of color are hesitant to sign up. Given the history, who could blame them.

The history is real. The answer is wrong, and we’ve known it for five years.

Researchers pooled thirty-five studies covering nearly ten thousand cancer patients who were offered a spot in a trial. Black patients said yes 58 percent of the time. White patients said yes 55 percent of the time. Hispanic and Asian patients came out about even too.

Read that again. When someone is asked, the group we’ve spent a decade calling reluctant says yes slightly more often than everyone else.

So the problem isn’t the answer. It’s that most people never get the question.

Seventy percent of U.S. counties don’t have a single cancer trial running. Not one. And the trials that exist cluster at big academic cancer centers, where roughly one in five patients ends up in a treatment trial. At community cancer programs it’s about one in twenty-five. Community programs are where most low-income patients and most patients of color get their care. Add up the patients with no trial nearby and the ones ruled out by eligibility rules, and roughly three in four are gone before a doctor ever brings it up.

Those patients didn’t turn anything down. Nobody offered.

For the ones who do get in, there’s a bill nobody mentions. The drug is free. The trip isn’t.

Researchers at MD Anderson tracked what patients in early trials actually spend. The answer was about $985 a month on travel, gas and lodging, and that’s before a dollar of medical cost. Half their patients lived more than three hundred miles from the clinic. A third had to fly.

Now picture that as a schedule instead of a number. A two-hour drive there, two hours back, every other week, and you’re paid hourly with no time off. That’s not a hassle. That’s choosing between the treatment and the paycheck.

And here’s the finding that should have changed the conversation. When researchers went looking for what drives the racial gap in enrollment, one of the biggest single factors wasn’t fear or mistrust or awareness.

It was whether the patient owned a car.

We’ve spent years building campaigns to fix a trust problem, and a good share of the gap comes down to a ride.

For a long time, charities quietly covered that ride. The Lazarex Cancer Foundation paid travel costs for more than twelve thousand patients and caregivers over almost twenty years, people driving an average of 544 miles to reach treatment. Lazarex shut down for good at the end of 2025, squeezed by the same funding pressures hitting nonprofits across the field.

Patients didn’t stop needing gas money. The people paying for it just disappeared.

So, look at where this problem sits now. With patients, who get told to speak up for themselves. With charities, which are closing. With drug companies, who can address it or not, as they please. And when the numbers don’t budge, everyone concludes it’s just a hard problem.

To be fair, part of it is. Running a trial across a dozen scattered clinics is harder than running it down one hallway. The data is messier. Quality checks cost more. Home nursing visits and courier deliveries add real expense to budgets that are already tight. Anyone who’s run a study will tell you that, and they’re not making it up.

But hard is a reason to plan for something, not a reason to skip it. And it’s already been done.

Mayo Clinic rebuilt how its trials work. Nurses visit patients at home for blood draws. Labs get done locally. Check-ins happen by video. Medication ships instead of being picked up. Over fifteen months, patients living more than 120 miles away went from 19 percent of enrollment to 30. Rural patients climbed from 17 to 25. And enrollment among underserved racial and ethnic groups rose from 12.5 percent to 17.4.

That was across 765 trials. Not a pilot.

Nobody ran a trust campaign. Nobody asked those patients to believe in medicine more. One hospital system changed how it operates, and a gap researchers have chased for thirty years started to close.

Two things should follow from that. Put travel, lodging and childcare in the trial budget from the start, the way you’d budget for anything else you know is coming. And move the routine stuff to clinics near where patients already go. Blood draws, scans, follow-ups, none of it requires the academic center.

Slow enrollment costs money too. It just doesn’t show up on a line anyone reads.

I went looking for who has access to trials. What I found is that access gets decided long before any patient can say yes or no.

The patients said yes. We haven’t been asking.

Angi Fisher works on the governance and organizational side of healthcare nonprofits. She writes about health equity. Read more of her work on Substack:

The Invisible Gatekeepers: Why Diversity in Cancer Trials Is a Structural Failure, Not a Patient Problem
The Trial Travel Burden: Why Zip Code Dictates Cancer Outcomes
When Targeted Cancer Cures Leave People Behind
Is There a Blueprint for Health Equity?