{"entity":{"id":"idea-tr1-community-site-quota","kind":"idea","name":"At least a third of pivotal-trial sites in community and rural settings","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"NCI Community Oncology Research Program","url":"https://ncorp.cancer.gov/"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["nci"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-trial-enrolment","b-trial-diversity"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"small","horizonYears":3},"route":"/ideas/idea-tr1-community-site-quota/","neighbours":{"institution":[{"id":"nci","kind":"institution","name":"National Cancer Institute (NIH)","route":"/institutions/nci/"}],"bottleneck":[{"id":"b-trial-diversity","kind":"bottleneck","name":"Trials do not represent the people who get cancer","route":"/bottlenecks/b-trial-diversity/"},{"id":"b-trial-enrolment","kind":"bottleneck","name":"Trials enrol too few, too slowly","route":"/bottlenecks/b-trial-enrolment/"}]}}