# At least a third of pivotal-trial sites in community and rural settings

Source: https://onco.cc/ideas/idea-tr1-community-site-quota/  
OnCo record `idea-tr1-community-site-quota` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Most cancer patients are treated outside big academic hospitals, but most trials are run inside them. Requiring a share of sites to be community practices would bring trials to where patients are.

## Summary

Regulators and public funders would expect registrational trials to open at least 30 percent of sites in community oncology practices and non-metropolitan hospitals, supported by hub-and-spoke oversight from an academic centre (the NCORP model). Sponsors report site mix in the application and diversity plan.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Trials meeting a community-site share will enrol a population closer to the disease's real-world age, race and rurality distribution, and will not have worse data quality by monitoring metrics.
- Rationale: NCORP trials enrol more rural and minority patients than academic-only trials; community practices treat the majority of US cancer patients but host a minority of industry trials.
- Proposed test: Compare demographic representativeness and query rates between industry trials above and below the community-site threshold, using FDA Drug Trials Snapshots and sponsor data.
- Maturity: speculative
- Actor: regulator

## Sources

- NCI Community Oncology Research Program: https://ncorp.cancer.gov/

## Connected records

- institutions: [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/)
- bottlenecks: [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/), [Trials enrol too few, too slowly](https://onco.cc/bottlenecks/b-trial-enrolment/)

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