Oncology eligibility lives in reports and notes, not the problem list

How does eligibility work in oncology trials?

Oncology protocols define a patient in layers: confirmed histology, stage and measurable disease, line of therapy, biomarkers, performance status and organ function, plus washout windows and exclusions such as brain metastases. Each layer is a separate chance to screen out, and each tends to live in a different part of the chart.

The therapeutic areas pages map criteria to the chart the same way for other areas.

What drives screen failure in oncology trials?

Published screen failure data in oncology is thin, partly because many trials never report it. In a review of trials in advanced genitourinary cancers run from 1999 to 2016, ineligibility was the main reason given, with patient refusal also common in kidney and bladder trials.^⁠[2]

Radiology was the largest category, led by newly found brain metastases (27 patients) and disease that was not measurable (17 patients). The authors conclude that referring patients with a brain scan and laboratory results may help reduce screen failure.^⁠[3] A single-center review of 217 solid-tumor patients, which set aside biomarker, stage and prior-treatment failures, found the most common remaining reasons were rapid progression (16%), performance status of 2 or worse (12%) and abnormal liver tests (12%).^⁠[4]

Biomarker-selected trials fail patients at a different point. In phase 3 HER2-positive breast cancer trials at 14 sites in India, 56.1% of 727 screened patients failed screening, and most of those who missed the criteria were HER2 negative.^⁠[5] Where the biomarker result is already in the chart, that kind of failure can be caught before a screening visit is booked.

Performance status is the other common gate. Among 96 phase III and IV oncology trials listed on ClinicalTrials.gov from 2019 to 2023, 43.8% admitted only ECOG 0 or 1 (or Karnofsky 70 or higher), and 20% included patients with ECOG 2.^⁠[6] FDA's final guidance on performance status, issued in July 2026, says patients with ECOG 2 should be included unless established safety considerations justify excluding them.^⁠[7] Protocols written before it may still require ECOG 0 or 1, and a patient's ECOG is often recorded only in a clinic note. For site-level fixes, see how to reduce screen failure.

Why does structured EHR data miss oncology eligibility?

Structured fields hold diagnosis codes, medication orders and lab values. The facts that decide oncology eligibility are mostly written in text. In a 2014 study of trials in chronic lymphocytic leukemia and prostate cancer, unstructured data was essential to resolving 59% and 77% of the eligibility criteria, respectively.^⁠[8]

Stage is a clear example. At one academic cancer center, TNM stage was documented in the EHR on time for only 5.6% of new patients before a hospital-wide intervention raised it to 67.4%.^⁠[9] Progression and response are harder still: outside of trials they are not routinely encoded as structured data, and they live in radiology reports.^⁠[10] Molecular results add a further gap, since outside lab reports are often filed as documents rather than as discrete results.

How does Bond screen oncology charts?

Bond's Identify stage reads structured and unstructured records against each inclusion and exclusion criterion and ranks candidates.^⁠[13] It connects to all the major EHRs, including Epic, Oracle Health (Cerner), MEDITECH, athenahealth, eClinicalWorks, NextGen, Veradigm and OncoEMR, through FHIR or HL7 interfaces or through an aggregator.^⁠[13],[14]

1. 1

   Map each criterion to clinical concepts

   Concepts in a criterion link to Bond's terminology graph, built from 18 vocabularies including NCIt for cancer and HGNC for genes, so a finding can be matched under the different names reports and notes use.^⁠[15]

2. 2

   Read the documents that decide eligibility

   Imaging data, pathology, molecular and radiology reports, oncology notes and other unstructured documents are read alongside labs, medications and diagnosis codes, where the site's EHR connection makes them available.^⁠[14]

3. 3

   Check treatment history against the notes

   Line-of-therapy and washout criteria are checked against infusion and medication records, which give drugs and dates, and the notes, which often say why a regimen stopped.

4. 4

   Show the evidence for each criterion

   Each candidate's criteria are listed with a decision and the evidence behind it, so a coordinator checks the cited evidence instead of re-reading the chart.

5. 5

   Leave to people what the chart cannot settle

   Current performance status, ability to attend visits, and changes not yet documented go to the pre-screening call, handled by Bond's Engage agents or site staff.

Reduced our chart review time significantly while improving the quality of patients we bring in for screening.^⁠[13]

How many oncology trials are recruiting in the US?

As of September 21, 2026, 7,074 studies with a US site were recruiting under an oncology keyword search, about a third of the 22,041 recruiting US studies.^⁠[12] The search covers cancer, neoplasm, carcinoma, lymphoma or leukemia in the condition field, so it can miss tumor types named otherwise and includes some supportive care studies. Other areas use similar keyword sets (neurology covers only Alzheimer, dementia, Parkinson, multiple sclerosis, migraine and epilepsy), and a study can count in more than one area.

Many oncology trials target narrow groups: worldwide, 74% of oncology trials started in 2024 evaluated medicines for rare cancers.^⁠[11] In the pooled analysis cited above, the largest barrier was access: no trial was available at the patient's institution 55.6% of the time, and enrollment was 15.9% at academic sites against 7.0% at community sites.^⁠[1]

What do current oncology trials ask for?

These studies were recruiting at US sites in September 2026, per ClinicalTrials.gov.^⁠[12]

• Biomarker plus line of therapy. A Merck phase 3 study of calderasib in colorectal cancer (NCT06997497) requires a KRAS G12C mutation, unresectable stage III or IV disease and, in Part 2, no systemic therapy for advanced disease beyond a short allowed course of chemotherapy.
• Pathology-defined subgroup. An NCI phase 2 study in recurrent endometrial cancer (NCT05112601) requires mismatch repair deficiency by immunohistochemistry or microsatellite instability testing, documented in an institutional pathology report.
• Treatment-naive disease. An AstraZeneca phase 3 study in follicular lymphoma (NCT06549595) requires no prior systemic lymphoma therapy and ECOG 0 to 2, and excludes suspected transformation to aggressive lymphoma.
• Receptor status and stage. An NCI phase 3 study in breast cancer (NCT06058377) requires hormone receptor positive, HER2 negative, clinical stage II or III disease without metastases.
• Rare histologies. An NCI phase 2 study (NCT03866382) enrolls rare genitourinary cancers such as pure squamous cell carcinoma of the bladder, which only the pathology text tells apart from urothelial cancer with squamous features.
• Early-phase study. A phase 1/2 study in advanced colorectal cancer (NCT07693751) requires ECOG 0 or 1 (ECOG 2 only with the sponsor's agreement) and sets limits for neutrophils, platelets, creatinine clearance and liver enzymes.