Cross-sectional study of regional variation in bladder cancer clinical trial availability in the US

Geographic disparities in cancer clinical trial access are well described in the US, but patterns in bladder cancer remain poorly defined. A cross-sectional study evaluated availability of (completed, open, of active) bladder cancer trials across US counties from June 2019 to June 2025. The study identified 436 bladder cancer trials across 713 counties. Of 3145 counties, 713 (22.7%) had one or more trial sites, and 2432 (77.3%) had one. Trial availability was higher in coutnies with greater bladder cancer incidence and lower social vulnerability, but lower in counties with higher bladder cancer mortality. These differences were statistically significant. The authors conclude that these findings suggest that bladder cancer trial access is misaligned with disease burden, highlighting the need to expand trials into socially vulnerable regions and those with high mortality to improve equity.