Background: Low cancer clinical trial (CCT) enrollment may contribute to survival disparities affecting adolescents and young adults (AYAs, 15–39 years). This study evaluated whether differences in CCT availability related to treatment site could explain this low CCT enrollment. Methods: This prospective, observational cohort study was conducted at an academic children’s hospital and its affiliated but geographically separated adult cancer hospital within a National Cancer Institute-designated comprehensive cancer center. For consecutive, newly-diagnosed AYA patients, it was determined whether an appropriate CCT existed nationally, was available at the treatment site, and was utilized for enrollment. Proportions of AYAs in these categories were compared between sites using the χ2test. Results: One hundred fifty-two consecutive AYA patients were included from the children’s hospital (n=68, aged 15–20 years) and adult cancer hospital (n=84, aged 18–39 years). Although there was no difference in CCT existence for individual AYA patients by site (children’s hospital 36/68 [52.9%] versus adult cancer hospital 45/84 [53.6%], p=0.938), CCT availability was significantly lower at the adult cancer hospital (14/84 [16.7%] versus 30/68 [44.1%], p<0.001). The proportion of AYAs enrolled was low at both sites (8/68 [11.8%] versus 6/84 [7.1%], p=0.327). Fewer existing CCTs were available at the adult cancer hospital (4/27 [14.8%] versus 8/14 [57.1%], respectively), and those were directed toward solid tumors and new agents. Conclusions: Efforts to improve low CCT enrollment among AYAs should be differentiated by treatment site. In the adult setting, these should be aimed at improving CCT availability by overcoming site-level barriers to opening existing CCTs.

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