Figure 1.

The barriers to older adult participation in cancer clinical trials are multifaceted and interrelated, with barriers existing at the system, clinician, patient, and caregiver levels. System-related barriers include trial design, overly stringent eligibility criteria, and lack of infrastructure support, appropriate and representative trials, and funding. Clinician-related barriers include concerns for side effects or toxicities, patient age, comorbid conditions, personal bias, costs to clinicians, and lack of time, support and staff, awareness of trials, and engagement amongst clinicians. Patient-related barriers include attitudes towards clinical trials, knowledge, side effects/toxicities, burden, and financial limitations. Caregiver-related barriers include caregiver burden and preference against participation.