For decades, clinical trials have been the engine that has driven our field forward. At every phase, they have delivered incredible discoveries, changed our practice, opened new avenues of investigation, given patients the opportunity to access novel agents, and most importantly, brought hope to our patients and their loved ones.  

 

But even as they represent the gold standard of scientific research, we know that our current model of performing clinical trials has drawbacks. They can be slow and expensive to conduct. The logistical challenges involved can be a barrier for practices and settings without an existing research infrastructure, leading to geographic disparities in trial availability. And they can be exclusionary to patients who might benefit and are eager to contribute, either because of strict eligibility criteria or because of the associated costs and time involved in participating.  

 

If we want our clinical trial results to reflect the full population of the patients we care for, what does the future of clinical research look like?  

 

In this issue, our cover story explores the concept of pragmatic trials, with perspectives from experts in the U.S. Food and Drug Administration, National Cancer Institute, patient advocacy, health equity, and others. By design, these trials can accrue a truly diverse and representative patient population, broadening the applicability of the results and breaking down a critical barrier to health equity. At a time when we are being asked, in every aspect of our work, to do more with less, we can expect streamlined, efficient, pragmatically designed clinical trials to play an increasingly important role in our research enterprise.  

 

 

Similarly, Dr. Sabe Sabesan provides an overview of a national model of decentralized clinical trials in Australia, expanding access to patients and providers at rural and regional cancer centers across the country. “If we can provide chemotherapy services through a tele-chemotherapy model at smaller rural centers, why can’t we do the same for clinical trials?” Dr. Sabesan writes. “Ultimately, it is an unethical and non-compassionate health practice to disadvantage a group of vulnerable citizens based on geography.” 

 

What other areas of our field are ripe for innovation? Two contributors urge us to look with fresh eyes at oncology training. Dr. Inas Abuali pushes back against the “we’ve always done it this way” attitude and advocates for a better medical education system for future learners than the one we ourselves probably experienced. Dr. Matthew Kurian proposes a new structure for oncology and hematology training that is more aligned with today’s practice and can respond more nimbly to workforce deficits.  

 

Oncology has always been an exciting, exhilarating, and humbling field. I look forward to working with all of you to continue shaping it to best serve our patients, our profession, and our future workforce.