A comprehensive analysis of breast cancer clinical trial enrollment has revealed that patients living in food deserts face significant barriers to participating in potentially life-saving research, with the problem becoming even more pronounced when combined with geographic distance from trial sites.
The study, presented at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting by Dr. Mariam Eskander, surgical oncologist and assistant professor of Surgery at Rutgers Cancer Institute of New Jersey, analyzed data from over 1.3 million patients with breast cancer treated between January 2022 and June 2024.
Geographic and Socioeconomic Barriers Create Double Burden
Researchers found that patients in food deserts—areas with limited access to healthy food—had lower rates of clinical trial participation. The impact became more severe when patients also lived in "clinical trial deserts," defined as areas over 2 hours' drive from a trial-enrolling hospital.
"There's a compounding effect of living in a double desert environment," Eskander explained in an interview. The data showed that patients facing both challenges had a 27% lower likelihood of trial participation compared to a 19% reduction for food desert residents alone.
Multiple Factors Influence Trial Enrollment
The study identified several key factors independently associated with decreased odds of trial enrollment, including living in a food desert, residing in a clinical trial desert, and having limited access to transportation. Patients with Medicaid insurance also showed reduced odds of enrollment, while those treated at academic hospitals were more likely to participate.
Systemic Solutions Required
According to Eskander, addressing clinical trial accessibility requires tackling systemic issues at multiple levels. While some solutions lie at the policy level—such as improving transportation infrastructure and increasing access to healthy, affordable food—hospital administrators and clinicians also bear substantial responsibility for ensuring trials are accessible to underserved populations.
Local Interventions Show Promise
Eskander's research within her health care system's multiple satellite hospitals revealed that patients are reluctant to participate in restrictive studies requiring travel to the main cancer center for treatments or lab work. Patients with Medicaid insurance particularly desired the ability to receive care without traveling, strongly suggesting that travel requirements significantly influence clinical trial enrollment decisions.
A crucial intervention involves establishing clinical trial sites, telehealth options, or satellite facilities directly within underserved neighborhoods, as travel represents a significant barrier for many patients. The research suggests that interventions like patient navigation, local food banks, and expanding clinical trial access in underserved communities could help improve enrollment rates.
The findings underscore the complex, interconnected barriers faced by disadvantaged populations and highlight the need for comprehensive approaches to address both food insecurity and geographic access challenges in clinical trial participation.
