The strong faith of late Sister Irene Kraus, former President of the Daughters of Charity National Health System, was placed on the notion of “No margin, no mission.” If the modern health care system loses money constantly, it will not serve for long. Crucial decisions need to be made due to unprecedented financial losses because of the COVID-19 pandemic to maintain the cancer center’s solvency.

The article surveyed the financial and performance metrics of cancer clinical trials at 79 major academic cancer centers in North America, three-quarters of which housed National Cancer Institute–designated cancer centers.

Facts suggest that there were 21 mid-size cancer centers with annual CTO budgets ranging between $8 to $12 million. A median of 245 clinical trials were working with a median of 498 patients enrolled. The median cost for each trial enrollee was $17,363, which was based on CTO employees’ salary support, as trial accrual averaged five patients for each full-time employee.

Adopting the electronic health record systems by the cancer centers will leverage the selection of feasible trials for patients. It will support the identification of eligible patients. The industry- and NCI-sponsored studies accounted for 39% and 19% of trial enrollees, respectively, highlighting the threat of not identifying new efficiencies within CTOs.

Moving forward, data-driven decisions will help enhance clinical trial efficiency and reserve the academic cancer center’s research mission. A change in late Sister Irene Kraus’s statement to “Respect the margin to preserve the mission.” is a required model.