82 Facilitators and Barriers to Clinical Trial Participation in Metastatic Breast Cancer: Patient and Physician Perspectives to Advance Representation

Background

Despite ongoing diversity initiatives, racial and ethnic minorities remain under-represented in cancer clinical trials, creating challenges for real-world clinical decision-making because evidence from clinical trials may not reflect all patient populations. This survey, unlike previous single-institution/qualitative studies, employed a dual-perspective approach, gathering quantitative insights from both patients and physicians across multiple settings. It aimed to identify facilitators, barriers, and actionable strategies for improving trial participation among patients with metastatic breast cancer and explore differences in these factors across racial and ethnic minorities.

Methods

The surveys were conducted in the US between July 2025 and September 2025 to identify factors impacting a patient's decision to participate in a clinical trial. Patient survey assessed demographics, attitudes, beliefs, and trial awareness; physician survey examined perceived patient barriers and institutional challenges.

Results

Overall, 110 patients with metastatic breast cancer (mean age: 61 years; female: 97%) completed the survey and were categorized into the following racial/ethnic categories: non-Hispanic White (NHW; 35%), non-Hispanic Black (NHB; 30%), Hispanic (22%), and other (14%). Of 32 breast cancer physicians completing the survey, 72% had 5 to 15 years of clinical trial experience, 81% practiced at academic centers, 16% in private practice, and 3% in community settings. The strongest patient-reported facilitator to trial participation was treatment with fewer adverse effects, followed by life-saving treatments, trusted medical advice, and financial compensation. These factors ranked highest across all racial/ethnic groups. Key patient-reported barriers included concerns about treatment effectiveness, unknown adverse effects, insurance coverage, and financial burden (Table). For minority groups (Hispanic, NHB, other), additional significant barriers vs NHW included mistrust in pharmaceutical companies (52% to 73% vs 18%), fear of being experimented on (55% to 87% vs 29%), language barriers (36% to 63% vs 18%), digital access issues (30% to 54% vs 18%), and concerns about burdening others (64% to 79% vs 37%). When recommending trial participation, physicians prioritized efficacy of investigational treatment, patient's disease stage/severity, and expected trial burden. While generally comfortable discussing trial participation across racial/ethnic groups, many acknowledged potential implicit/unconscious biases and needing additional explanation time. For improving recruitment of racial/ethnic minorities, physicians strongly supported covering transportation costs (100%), addressing medical mistrust (94%), eliminating out-of-pocket expenses (94%), providing dedicated trial navigators (88%), up-front stipends to patients (88%), covering childcare/elder-care costs (81%), and translating study materials into patients' primary languages (81%).

Conclusions

This survey highlights key factors influencing clinical trials participation among patients with metastatic breast cancer and identifies additional barriers for minority groups related to trust, communication, and logistics. Key insights to improve trial enrollment include financial/logistical support for patients, and culturally and linguistically adapted services for racial and ethnic minorities, thus offering guidance for more inclusive clinical trial recruitment initiatives.