Abstract
The lack of treatments with durable response in neuro-oncology highlights the critical
need for clinical trials to advance patient care. The intersection of relatively low
incidence, evolving classification schema, and entrenched community, healthcare provider,
and organizational factors have been historic challenges against successful trial
enrollment and implementation. The additional need for multidisciplinary, often tertiary-level
care, further magnifies latent national and international health inequities with rural
and under-served populations. The COVID-19 pandemic both unveiled fundamental weaknesses
in historical approaches and prompted the necessity of new approaches and systems
for conducting clinical trials. Here, we provide an overview of traditional barriers
to clinical trial enrollment in neuro-oncology, the effect of COVID-19 on these barriers,
and the discovery of additional systemic weaknesses. Finally, we discuss future directions
by reflecting on lessons learned with strategies to broaden access of care and streamline
clinical trial integration into clinical practice.
Keywords
neuro-oncology - clinical trials - barriers - COVID-19 - inequities
