Cancer Trial Participants Reimbursed a Median $2,128 for Nonmedical Costs

Patients with cancer who received help with the nonmedical costs of taking part in therapeutic clinical trials were reimbursed a median of $2,128 each over a median 4.3 months of trial participation, according to an 18-year multicenter analysis published in Cancer.¹ Monthly reimbursed amounts declined as participation went on, and the types of expenses reimbursed differed by household income, findings the investigators said show that these needs change over time and are tied to both socioeconomic status and travel burden.¹

Why do cancer clinical trials carry out-of-pocket costs for patients?

Clinical trials add to the financial burden of cancer care, the investigators wrote.¹ Beyond medical bills, participants can face costs for travel, lodging, meals, internet access, missed work, and a greater need for child care or elder care, according to a news release from Wiley, which publishes Cancer on behalf of the American Cancer Society.² Federal legislation addressing financial support for trial participants is under consideration in the United States, the release noted.²

How was the reimbursement program studied?

From 2006 to 2024, the Lazarex Cancer Foundation reimbursed nonmedical expenses related to participation in therapeutic cancer clinical trials at multiple US sites.^1,2 Eligible patients were enrolled in a cancer treatment trial and had a household income at or below 700% of the federal poverty level. Expenses were reimbursed at 50%, 75%, or 100%, depending on income level.¹ The program paid only when there were no other sources of financial support from the trial sponsor or site.²

The investigators analyzed the type, timing, and amount of reimbursed expenses, expressed in 2024 dollars. They used t tests, analysis of variance, and multivariate linear regression to evaluate associations among patient and trial characteristics, reimbursed amounts, and distance traveled.¹

The analysis included 2,826 individuals who received at least 1 reimbursement. Among them:¹

• 64% were non-Hispanic White
• 97% had health insurance
• Median household income was $50,948

How much were trial participants reimbursed over time?

Key reimbursement findings included:

• Median total per-patient reimbursement: $2,128¹
• Median duration of trial participation: 4.3 months¹
• Change over time: monthly reimbursed amounts declined substantially throughout participation, falling to 60% of initial levels by 3 months into trial participation^1,2

Which reimbursed expenses differed by patient income?

The types of reimbursement varied by income. Internet, ground transportation, and child care or elder care were more common at lower income levels, whereas lodging and airfare were more common among patients with higher incomes.¹

In multivariate analysis, monthly reimbursed amounts were greater for:¹

• Patients in middle-tier household income quartiles (P = .003)
• Patients with greater distance to the trial site (P < .001)
• Patients enrolled in phase 1 trials (P = .001)

The proportion of patients participating across income levels remained stable over the study period.¹

What did the study authors say about the cost of reimbursement?

Lead author Sukh Makhnoon, PhD, an assistant professor in the O'Donnell School of Public Health and Simmons Comprehensive Cancer Center at UT Southwestern Medical Center, said the expenses are small relative to the overall cost of conducting trials.

“When we consider the overall cost of running cancer clinical trials, covering patients' travel, lodging, and other non-medical expenses represents a relatively small investment. Our findings suggest that these costs are modest compared with what sponsors already spend per participant and decline substantially over time,” Makhnoon said in the release.² “Reimbursing patients for these expenses could be a practical and relatively inexpensive way to reduce financial barriers and make cancer clinical trials more accessible.”

In the study, the investigators concluded that reimbursement needs during trial participation “are dynamic and closely tied to both socioeconomic status and logistical burden,” particularly travel distance and trial intensity, and that financial support for these expenses may enhance trial accessibility and retention.¹

How does this fit with other efforts to ease trial-related financial burden?

Members of the study team previously published a protocol to evaluate the Lazarex reimbursement program as a means of enhancing access to and diversity in cancer clinical trials.⁴

Nurses are also testing ways to address cost concerns before enrollment. At Fox Chase Cancer Center, a nurse-led education session and animated video lowered concern about the cost and time of trial participation among 101 patients with kidney cancer, from 1.59 to 1.22 on a 0-to-4 scale (P = .03), although the change in insurance-related worries was not statistically significant.³ Separately, an interim analysis of the randomized AYA-NAV trial found that a tailored needs navigation intervention for adolescents and young adults with cancer facing financial hardship was largely delivered as designed; its effects on financial hardship and clinical outcomes have not yet been reported.⁵

The current analysis has limitations. It describes expenses only among patients who received at least 1 reimbursement from a single foundation program, and reimbursement was available only when sponsors or sites offered no other support.^1,2 Nearly all participants had health insurance, and the published abstract does not report enrollment or retention outcomes compared with patients who did not receive reimbursement.¹ Authors reported support for the manuscript from the Cancer Prevention and Research Institute of Texas and the Lazarex Cancer Foundation, among other disclosures.¹

What are the key takeaways for oncology nurses?

• Raise nonmedical costs early. Travel, lodging, meals, internet access, missed work, and caregiving can add up during trial participation; discussing them at enrollment supports informed consent.²
• Match referrals to the patient’s situation. Lower-income patients more often needed help with internet, ground transportation, and child or elder care, whereas higher-income patients more often needed lodging and airfare.¹
• Flag long-distance travelers and phase 1 enrollees. Greater distance to the trial site and phase 1 trials were each associated with higher monthly reimbursed amounts.¹
• Check in at the start of participation. Monthly reimbursed amounts fell to 60% of initial levels by 3 months, so cost conversations in the first weeks of a trial may be the most timely.²
• Confirm sponsor and site support first. The Lazarex program paid only when no sponsor or site support existed; nurses can verify what a trial offers and connect patients with social workers, financial navigators, or foundation programs.²

References

1. Makhnoon S, Gao A, Lee JL, et al. Patient reimbursement in therapeutic cancer clinical trials: an 18-year multicenter experience. Cancer. 2026;132(22):e70625. doi:10.1002/cncr.70625

2. How well are cancer clinical trial participants reimbursed for non-medical expenses? News release. Wiley. November 9, 2026. Accessed November 10, 2026. https://newsroom.wiley.com/press-releases/press-release-details/2026/How-well-are-cancer-clinical-trial-participants-reimbursed-for-non-medical-expenses/default.aspx

3. Biese A. Nurse-led education clears up clinical trial myths in kidney cancer. Oncology Nursing News. October 26, 2026. Accessed November 10, 2026. https://www.oncnursingnews.com/view/nurse-led-education-clears-up-clinical-trial-myths-in-kidney-cancer

4. Gerber DE, Tiro JA, McNeill LH, et al. Enhancing access to and diversity in cancer clinical trials through a financial reimbursement program: protocol to evaluate a novel program. Contemp Clin Trials. 2022;121:106922. doi:10.1016/j.cct.2022.106922

5. Beauchemin MP. AYA needs navigation trial meets most fidelity targets at interim look. Oncology Nursing News. November 3, 2026. Accessed November 10, 2026. https://www.oncnursingnews.com/view/aya-needs-navigation-trial-meets-most-fidelity-targets-at-interim-look