Broad inclusion leads to maximal value – examining travel costs associated with clinical trial participation

Acts of social good, like jury service and voting, lead to distributive societal benefits and often come with protections to ensure that everyone can participate. Clinical trial participation is an act of social good, yet it lacks protections or benefits and comes at great personal cost. In this current study, we assessed the indirect costs associated with cancer clinical trial participation among patients enrolled in therapeutic cancer clinical trials at two National Cancer Institute-Designated Comprehensive Cancer Centers as part of a multi-institutional IMPACT (Improving Patient Access to Cancer Clinical Trials) program from January 2018 to August 2020. A total of 258 patients received financial reimbursement during the IMPACT program period. The median (interquartile range, IQR) reimbursed total amount (including all cost categories possible) in US dollars is \$378 (1123); the median reimbursed amount for each category is \$0 (0) as patients typically do not request for reimbursement in all categories. The median amount of requested entries was \$713 (1,824) for lodging, \$248 (902) for ground transportation, \$208 (373) for gas/ parking/ tolls, \$1080 (2105) for patient flight, and \$1,001 (1793) for companion flight. Average cost per patient attributable to lodging was \$342 (standard deviation, SD=1081), ground transportation was \$277 (SD=843), gas/parking/tolls was \$410 (SD=634), companion flight was \$70 (SD=477), and patient flight was \$76 (SD=506). Our analysis of costs demonstrates that clinical trial participants incur indirect costs to engage in clinical trials, and these costs vary by institution. These data support the notion that clinical trial participants should receive the same protections and benefits that government and employers offer other social goods such as voting or jury service.