ArticleJAMA network open2026
Physician- and Practice-Level Variation in Clinical Trial Participation Among Patients With Advanced Cancer.
Article in JAMA network open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: Clinical trial enrollment is essential to advancing cancer care, yet participation among patients with advanced cancer remains low. While patient-level barriers are frequently cited, the role of health care delivery factors-specifically physician- and practice-level variation-has been poorly quantified. Objective: To quantify variation in clinical trial participation and identify associated delivery system factors among patients with advanced cancer. Design, Setting, and Participants: This cohort study included adults with advanced or metastatic cancers diagnosed and treated between January 1, 2011, and December 31, 2024, by 1664 physicians across 107 trial-available oncology practices across the US. Data were obtained from the Flatiron Health Research Database. Analyses were conducted between January and April 2025. Exposures: Patient-level (eg, demographic characteristics, cancer type, and performance status), physician-level (eg, patient volume, subspecialization, and prior trial enrollment activity), and practice-level (eg, size, research engagement, and patient composition) factors. Main Outcomes and Measures: The primary outcome was clinical trial participation, defined as receipt of a clinical study drug. Mixed-effects logistic regression models were used to decompose the proportion of variation attributable to patient-, physician-, and practice-level factors. Multivariable logistic regression was used to identify characteristics associated with trial participation. Results: Among the 205 743 patients with advanced or metastatic cancer (mean [SD] age at advanced cancer diagnosis, 67.5 [11.3]; 107 370 males [52.2%]), 10 785 (5.2%) participated in a clinical trial over the study period, increasing from 235 of 5964 (3.9%) in 2011 to 638 of 9336 (6.8%) in 2024. Participation remained highly concentrated: of 1664 physicians, 389 (23.4%) accounted for 9018 (83.6%) of all enrollments (10 785), while 21 of 107 practices (19.6%) accounted for 8686 (80.5%) of all enrolled patients. Additionally, 494 of 1664 physicians (29.7%) enrolled no patients. Physician-level (12.3%) and practice-level (15.1%) factors explained a greater share of variation in trial participation than observable patient-level characteristics (11.4%), with physician- and practice-level contributions increasing over time. Physician's subspecialization (treated 1-2 cancer groups: odds ratio [OR], 4.11 [95% CI, 2.53-6.68], P = .002; treated 3-4 cancer groups: OR, 2.38 [95% CI, 1.37-4.14], P < .001), physician's prior trial enrollment activity (enrolled patients in the 2 previous years: OR, 1.58; 95% CI, 1.43-1.76; P < .001), and practice's research engagement (OR, 2.68; 95% CI, 2.12-3.39; P < .001) were associated with higher odds of trial participation. Conclusions and Relevance: In this cohort study of patients with advanced cancer, clinical trial participation increased moderately but remained low over the study period, with physician- and practice-level factors consistently accounting for a substantial share of participation variation. Improving trial accrual requires interventions targeting structural factors in enrollment, including research infrastructure and physician engagement.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.