Cancer is the second-leading cause of death in the U.S., but thanks in part to research, cancer mortality has dropped by more than a third over the past three decades. That research is founded on willing patients having access to research opportunities like clinical trials. One of the U.S. National Cancer Plan goals is that “Every person with cancer or at risk for cancer has an opportunity to participate in research or otherwise contribute to the collective knowledge base, and barriers to their participation are eliminated.”

Our previous work shows that the biggest barriers to expanding new clinical trial opportunities are having sufficient staff, money, and infrastructure to handle the burden of trial activations and operations. These barriers translate into differences in patient research opportunities between sites that are supported by U.S. National Cancer Institute (NCI) funding and those that are not, with our recent research showing that the percentage of patients enrolling in clinical trials is five times higher at NCI-designated cancer centers compared to community cancer programs (20.6% vs 4.1%).

With the understanding that research opportunities are not equal when comparing NCI-funded sites to non-funded sites, our current study sought to understand whether patients across the U.S. lived in proximity to an NCI-funded site. We found that large segments of the population do not have this access, especially in rural areas.  This means travel distance is a barrier to extending research opportunities to all. This study offers hope, however, showing that cancer care locations exist in areas distant from NCI funded sites.

Research capacity at these non-funded sites could be enhanced through more financial support from NCI in the form of new or expanded grant programs.  The NCI Community Oncology Research Program (NCORP) was created in 2014 to allow community settings to augment and complement the care offered at NCI cancer centers. However, our findings indicate that even with NCORP, 97% of NCI-funded sites are located in densely-populated urban areas. To address the lack of opportunities in rural areas, the NCI’s board of scientific advisors recently recommended an expansion of the NCORP program as well as potential new research infrastructure grant programs. The Fiscal Year 2026 professional budget proposal from NCI called for $196 million in new funds for training and infrastructure to realize these recommendations. While these recommendations were made during the last U.S. presidential administration, the current administration has likewise recognized the need to bolster federal support for clinical trial infrastructure, with a recommendation in the draft Make America Healthy Again (MAHA) report suggesting that the National Institutes of Health (NIH) will strengthen pre-existing clinical trial networks through engagement with large public and private hospital systems, including the Veterans Administration.

The evidence is clear that research opportunities for patients with cancer are not equally accessible to all, and multiple U.S. federal administrations have identified the same solution to this barrier. Public policy and public funding can expand research opportunities into more rural areas where cancer incidence and mortality are higher than in urban areas.  We hope that our study will help make the case with policymakers that now is the time for broadening the base of institutions receiving research infrastructure.

The paper “Assessing populations with access to National Cancer Institute-funded sites using local distance-based service areas“, published in Journal of Clinical and Translational Science, is freely available.