{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:56:43Z","timestamp":1791341803336,"version":"4.3.1"},"reference-count":52,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n 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\u2014specifically physician- and practice-level variation\u2014has been poorly quantified.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To quantify variation in clinical trial participation and identify associated delivery system factors among patients with advanced cancer.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 205\u202f743 patients with advanced or metastatic cancer (mean [SD] age at advanced cancer diagnosis, 67.5 [11.3]; 107\u202f370 males [52.2%]), 10\u202f785 (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\u2019s subspecialization (treated 1-2 cancer groups: odds ratio [OR], 4.11 [95% CI, 2.53-6.68],\n P<\/jats:italic>\n \u2009=\u2009.002; treated 3-4 cancer groups: OR, 2.38 [95% CI, 1.37-4.14],\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), physician\u2019s prior trial enrollment activity (enrolled patients in the 2 previous years: OR, 1.58; 95% CI, 1.43-1.76;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), and practice\u2019s research engagement (OR, 2.68; 95% CI, 2.12-3.39;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) were associated with higher odds of trial participation.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.33046","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T15:00:15Z","timestamp":1791298815000},"page":"e2633046","source":"Crossref","is-referenced-by-count":1,"title":["Physician- and Practice-Level Variation in Clinical Trial Participation Among Patients With Advanced Cancer"],"prefix":"10.1001","volume":"9","author":[{"given":"Changchuan","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas"},{"name":"Peter O\u2019Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas"},{"name":"Harold C. 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Robin","family":"Yabroff","sequence":"additional","affiliation":[{"name":"Surveillance, Prevention, and Health Services Research, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen H.","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Kaiser Permanente Southern California Permanente Medical Group, Riverside, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song","family":"Zhang","sequence":"additional","affiliation":[{"name":"Peter O\u2019Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas"},{"name":"Harold C. 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