The key drivers of progress in cancer care are unevenly distributed across the American landmass. This means that people affected by cancer in America have been unable to benefit equally from quite remarkable advancements in cancer care, namely the advent of personalized medicine and the rise of immunotherapy as the fourth pillar of available treatment. We in this article have described and discussed some of the geographical inequities by improving access to clinical trials in rural areas.Some of them are The Ohio State University Comprehensive Cancer Center, Center for Cancer Health Equity, Missouri Baptist Medical Center, Heartland Cancer Research, and the New Mexico Cancer Care Alliance. 

First, we must continue to address the economic barriers to trial access2: with no federal mandate for Medicaid to cover clinical trials, and with the Affordable Care Act under threat, a national bill such as the Clinical Treatment Act is of paramount importance.The National Institute of Health Revitalization Act of 1994 has been largely unsuccessful in reducing such disparities.

Despite recent successes in providing access to clinical trials in rural areas and some examples of better outreach to improve minority representation in trials, it is a shame that the responsibility to address inequity falls so heavily on individual institutions. The lack of a unified national approach inevitably leads to a system of cancer care that is entrenched in disunity. 

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