Advancing Equity in Cancer Clinical Trials: Barriers, Evidence-Based Solutions, and an Integrated Multilevel Model for Underrepresented Populations

Diversity among clinical trial participants is essential to assessing the efficacy and toxicity of targeted cancer therapies, yet racial and ethnic minorities remain persistently underrepresented, limiting the generalizability of findings and perpetuating disparities in cancer outcomes.This review examines the multilevel barriers to equitable participation -lack of awareness, mistrust, insurance issues, immigration status, language, transportation, and limited access to culturally competent care.The review will also synthesize evidence-based solutions, including community-engaged research, patient navigation, culturally tailored education, workforce diversity, language access, financial reimbursement, decentralized trials, and improving community trial infrastructure.Using clonal hematopoiesis of indeterminate potential (CHIP) as a case study in inequitable access to precision prevention, we argue that no single intervention suffices and propose an integrated, sustained, multilevel model to advance equitable oncology research and care.Delivery 2026;678910111213141516171 from sponsors, health systems, policymakers, and communities with mandatory diversity reporting, expanded cost coverage, language access mandates, and policies addressing protected pathways for immigrant participants. binaytara.org/journal | Suresh et al.