Cancer clinical trial recruitment for patients from rural areas: a scoping review

BACKGROUND: This work will explore the literature on recruiting patients from rural and remote areas to cancer clinical trials. By examining the definitions employed, identifying levers and barriers to recruitment, and describing initiatives to promote recruitment, we seek to inform the development of future trials with these populations. METHODS: A scoping review of primary research published since 2004 relating to the recruitment of patients from rural or remote areas to cancer clinical trials was conducted. The cancer could be of any type, haematological or solid tumour. A comprehensive literature search was conducted in CINAHL, PsycINFO, PubMed/MEDLINE, C2-SPECTR Campbell Systematic Reviews and Cochrane Library. All records were screened by two independent reviewers, and data on study characteristics and findings were extracted and analysed. RESULTS: A total of 29,160 papers were identified in the searches. After screening, 27 studies met our inclusion criteria. Twenty-three of those papers focused on the context of the United States of America, with an additional three looking at Australia and one at Canada. There was no uniformity in researchers' classification of rurality, despite the existence of agreed measures. Several common levers and barriers to engagement were identified, including the distances patients must travel to cancer centres. CONCLUSIONS: Rurality is a significant challenge to the recruitment of cancer patients to clinical trials. The potential solutions are multifaceted and span the major determinants of health. Focus on the development of collaborative research networks between major academic cancer centres and rural healthcare facilities may help improve access to trials.