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Out-of-pocket costs for clinical trial participants create barriers to enrollment and retention for patients and their families. Financial burdens associated with travel, lodging, meals, caregiving, and time away from work can cause patients and their doctors to decide against enrollment in a trial that otherwise might be their best treatment option.
Studies have shown that individuals enrolled in cancer clinical trials often travel more than twice as far for treatment as do patients receiving standard therapy, and trial-related travel burdens may be greatest for individuals living in low-income areas. In fact, according to the American Cancer Society Cancer Action Network, patients cite cost as a top reason for declining clinical trial participation. Financial considerations that may influence someone’s decision to join—or stay in—a study differ based on factors including geography, personal support networks, employment status, and government assistance.
Making Financial Support for Clinical Trial Participants the Norm
In 2022, LUNGevity Foundation launched and funded the Equitable Access to Clinical Trials
(EACT) initiative. Today EACT is hosted jointly by the Association of American Cancer Institutes (AACI) and the Multi-Regional Clinical Trials (MRCT) Center of Brigham and Women’s Hospital and Harvard.
EACT engages patients and patient advocacy organizations; industry; academia; clinical research organizations (CROs); institutional review boards (IRBs), vendors; and professional societies in a collaborative forum to advance financial neutrality for patients participating in clinical trials.
Since its founding, EACT has been working to mitigate non-medical, out-of-pocket financial burdens for clinical trial participants in the United States. While the issues addressed by EACT pertain to clinical trials broadly, its initial focus has been on oncology as a case study. EACT’s strategic goal is making financial neutrality and financial support for trial participants the norm in all oncology clinical trials.
Education, Outreach, and Events
Over the next several years, EACT will focus on accelerating the dissemination, implementation, and long-term adoption of strategies that reduce the financial burden associated with clinical trial participation. A central component of this work will be expanding education and awareness across the clinical research ecosystem.
To date, EACT has hosted—and co-hosted—four webinars with publicly available, evergreen content; the initiative has also developed an issue brief focused on the tax and legal considerations associated with financial compensation for trial participants, sponsors, and sites.
An EACT initiative update is scheduled for 8:00 am central time on Thursday, June 25, during the 18th Annual AACI Clinical Research Innovation (CRI) Meeting at the Loews Chicago O’Hare Hotel in Rosemont, IL.
Educational webinars and conference presentations will continue to ensure that sponsors, sites, CROs, and IRBs have access to practical guidance, emerging best practices, and tools for the consistent implementation of participant support programs. EACT will continue hosting its quarterly "all hands" virtual meetings to bring these stakeholders together with patients, advocacy organizations, and academic institutions to discuss emerging challenges and identify opportunities to advance financial neutrality for trial participants.
Developing Evidence-Based Guidance and Policy
In addition to education and outreach, EACT will prioritize validating the resources it has already developed. This includes pilot testing EACT site implementation tools with participating clinical trial sites to better understand how these resources function in real-world settings. EACT aims to identify operational barriers, gather user feedback, and refine scalable approaches, not only to create guidance, but also to ensure that sites and sponsors have feasible models that can be integrated into existing workflows and compliance structures.
Policy development is another important pillar of EACT’s future work. EACT plans to collaborate closely with IRB leaders and other regulatory stakeholders to explore standardized approaches to participant compensation and reimbursement, helping to reduce uncertainty among sponsors and sites while increasing consistency. EACT also intends to develop evidence-based policy recommendations that can inform future institutional practices, regulatory discussions, and broader industry standards related to participant financial support.
Generating new evidence to inform the field remains a critical priority. EACT plans to develop additional datasets evaluating current financial support practices across the clinical trial landscape, improving our understanding of how reimbursement and support programs are currently used. The initiative will also analyze the impact of participant support programs on key research outcomes, including enrollment, retention, and participant diversity. By building a stronger evidence base, EACT hopes to demonstrate the practical and ethical value of reducing financial barriers to participation and to encourage broader adoption of participant-centered support strategies.
Looking Ahead: Expanding Scope and Reach
As the initiative evolves, EACT plans to expand its scope and reach. One major area of focus will be the development of operational models that support financial neutrality in academic and investigator-initiated trials, where resources and infrastructure may differ substantially from large, industry-sponsored studies.
EACT also intends to extend its work beyond oncology into other therapeutic areas where financial barriers similarly limit equitable access to clinical research opportunities. Future efforts will additionally explore the broader issue of patient medical out-of-pocket costs associated with trial participation, further examining how both medical and non-medical expenses influence decision making and access. Looking ahead to 2027, EACT aims to develop a global framework to adapt and expand financial neutrality principles to international clinical research settings.
Collectively, these initiatives reflect EACT’s vision of creating a more equitable, patient-centered clinical trial ecosystem in which financial considerations no longer prevent individuals from accessing potentially beneficial research opportunities.
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