The Future is Local: the Role of Decentralised Clinical Trials in Patients with Advanced Cancer Receiving Palliative Care.

Trial participation is increasingly recognised as a crucial component of optimal cancer care, yet patients with advanced cancer receiving palliative care often face significant challenges in meeting the logistical demands of traditional clinical trials. Decentralised clinical trials (DCTs), including teletrials, which conduct study activities outside a central site - frequently in participant's homes or local communities - offer a promising model to overcome these barriers. By enabling remote participation, DCTs can overcome geographical and functional barriers, making trials more accessible to this often-frail population. However, there are important concerns that warrant careful consideration. DCTs may inadvertently fragment care, expose vulnerable patients to novel medications in an isolated setting, and exacerbate digital health inequities. In our experience these challenges can be mitigated through careful trial selection, as well as the implementation of rigorous screening and support systems to ensure both patient suitability and continuity of care. Key measures include close liaison with treating oncologists and palliative care teams, 24/7 clinical phone support, accessible IT assistance during working hours, and collaboration with local trial coordinators when available. This approach not only extends the geographical reach of clinical trial participation for patients with advanced cancer receiving palliative care, but also maintains trial rigour and patient safety.