I'm a Cancer Researcher – Ask Me Anything About Participating in Clinical Trials for Cancer

webmd · 2026-03-25T17:06:13+00:00

CAR T-cell therapy, and many newer cancer drugs in general, can be very expensive. The high cost reflects a few factors: these are complex therapies to manufacture, they require specialized centers to administer safely, etc.

Reducing costs is a major focus moving forward. Some of the ways this may happen include improving manufacturing processes, developing more “off-the-shelf” therapies, and creating policies that help with pricing and access.

There are ongoing efforts to expand insurance coverage and provide financial support programs, and I’m hopeful that in the near future this will make these treatments more accessible to patients.

- Marina Baretti. MD

webmd · 2026-03-25T17:03:53+00:00

I think there are a few common misconceptions. One is the fear of being placed on a placebo and not receiving an active treatment, but in oncology, placebos are almost never given instead of treatment when an effective standard option exists. They are usually added on top of standard care. Another common concern is the idea of being “used for testing.” In reality, clinical trials are very closely regulated, with strict safety monitoring, and patients can withdraw at any time.

People also often think trials are a “last resort,” but that’s not always the case: many trials are available earlier in the disease course and can be a very reasonable option.

Finally, there’s a perception that trials are inherently riskier than standard treatments. While there is uncertainty, standard therapies also have risks, and in trials patients are often monitored even more closely.

- Marina Baretti, MD

webmd · 2026-03-25T16:36:04+00:00

I hear your frustration, it’s a very real one. Sometimes very early data, especially from the laboratory or from small studies, gets a lot of attention. But even when results look promising at that stage, they don’t always translate into meaningful benefit once tested in larger human clinical trials, and many of these approaches don’t move forward. That said, there have absolutely been real advances. Immunotherapies and targeted therapies, for example, have significantly changed how we treat certain cancers and have had a very positive impact on outcomes for some patients.

The challenge is that this is not true for all cancers or all patients. Progress can feel uneven. But each of these steps, even when they don’t fully pan out, helps us learn and refine better strategies over time.

- Marina Baretti, MD

webmd · 2026-03-25T16:33:38+00:00

This is already an option for patients in many cases. Participating in a clinical trial can sometimes be considered even before, or instead of. standard FDA-approved treatments.

That said, it requires a thoughtful discussion with your physician/oncology team, weighing the known benefits of approved therapies against the potential risks and uncertainties of a trial. The right choice really depends on the specific situation, the type of cancer, and the available data.

– Marina Baretti, MD

webmd · 2026-03-25T16:30:00+00:00

I’m sorry to hear about your parents. Truth be told, every case is different. My goal is to take care of the patient as a whole, not just focus on the cancer. There’s a saying: “The good physician treats the disease; the great physician treats the patient who has the disease.” (This is a quote from Dr William Osler that I keep always in mind))

This means continuously weighing the risks and benefits: how much the treatment is actually helping the patient versus how much toxicity it may be causing. It’s not always easy, and these decisions often require open, shared discussions with the patient.

- Marina Baretti, MD

webmd · 2026-03-25T16:25:49+00:00

The reality is that many clinical trials have relatively strict eligibility criteria, and unfortunately, patients with significant comorbidities may not qualify. A big part of that is safety, especially in earlier-phase trials, where we are still learning about the drug’s side effect profile, we want to avoid exposing more frail patients to potentially serious toxicity.

At the same time, when we are trying to understand whether a drug is actually working, we try to limit other factors that could influence outcomes, like other medical conditions that might impact life expectancy independently of the cancer. It’s not a perfect system, but it’s designed to both protect patients and allow us to interpret the results as clearly as possible.

–Marina Baretti, MD

webmd · 2026-03-25T16:22:50+00:00

Immunotherapy has probably been one of the most exciting and impactful breakthroughs in oncology in recent years. It has really changed the trajectory of several cancers, especially those that are more “immune-responsive.”

That said, it doesn’t work for every patient or every type of cancer. A lot of current research is focused on understanding how to better harness the immune system, overcome resistance, and expand its benefit to more patients.

In terms of cancer rates, there are some signals that certain cancers (like colon cancer) are being diagnosed more frequently in younger individuals, and this is an area of very active research.

- Marina Baretti, MD

webmd · 2026-03-25T16:17:36+00:00

It varies quite a bit. It depends on what treatments are already available for that disease, how well they work, and how strong the data is for the new drug.

Some drugs, especially if they show very promising results in diseases with limited options, can receive accelerated approval and become available within a couple of years. Others require more time to go through all the necessary phases of testing to fully establish safety and effectiveness, which can take several years.

Overall, I would say the situation is encouraging. We are seeing faster development timelines for some therapies, especially with better trial designs and a deeper understanding of cancer biology but careful validation is still essential to make sure treatments are both safe and truly beneficial.

- Marina Baretti, MD

webmd · 2026-03-25T16:15:32+00:00

We absolutely take that into account when interpreting results. A drug showing activity in that setting can actually be very encouraging, because those cancers are often more resistant to treatment. That said, it’s not always as simple as “if it works there, it will work anywhere.” That’s why, as we start to see signals of benefit, drugs are then studied earlier in the disease course (in patients who are less heavily pretreated), where they may work even better.

Nowadays, trial design is evolving, and we are increasingly testing promising therapies earlier depending on the biology of the disease and the strength of the data.

So it’s a stepwise process, but yes, your intuition is right that we have to be very thoughtful about how we interpret results depending on the patient population being studied.

- Marina Baretti, MD

webmd · 2026-03-25T16:13:08+00:00

When we think about phase I trials in oncology, these are almost always conducted in patients who have cancer, not in healthy volunteers. There are very strict rules around dosing and scheduling to ensure safety. Typically, trials start at a lower dose and gradually escalate only after a period of observation, with very close monitoring (frequent blood work, visits, etc.). The goal is to find a safe and appropriate dose while minimizing the risk of significant toxicity.

Most early-phase oncology trials are what we call “single-arm,” meaning there is no placebo control, everyone receives the investigational drug.

For later-phase trials (like phase II or III), placebos may sometimes be used, but almost always on top of standard-of-care treatment rather than instead of it. And you’re right, side effects can sometimes make it obvious which treatment a patient is receiving, which is one of the challenges in trial design. That’s why we rely on objective endpoints (like imaging) to assess efficacy.

- Marina Baretti, MD

webmd · 2026-03-25T16:10:27+00:00

Navigating clinical trials can be very difficult for patients and caregivers. There are advocacy groups and foundations that do a great job keeping patients informed about trials, hosting webinars, and sharing updates—so I always encourage my patients to stay connected with those groups.

There are also ongoing efforts to create disease-specific consortia to help facilitate trial enrollment, but this process is still far from optimal.

A key part of trial eligibility is assessing what we call “performance status,” along with a full clinical evaluation, including a physical exam. Since we are often testing new drugs and trying to understand their safety, we need to ensure there are no obvious contraindications that would make participation unsafe.

For a physician seeing a patient for the first time, it can be difficult to fully appreciate some of these nuances, especially over video, which can also add to the complexity of trial enrollment.

- Marina Baretti, MD

webmd · 2026-03-25T16:08:09+00:00

There are many different types of cancer, as essentially every organ in our body can develop tumors. Each of them is characterized by different biology and different underlying risk factors. Some cancers are very common, while others are rare, which unfortunately can limit the amount of research and data available to fully study them.

This diversity influences how cancers respond to treatment and our ability to develop effective strategies. I think with newer technologies that allow us to better understand the characteristics of each cancer, and how it interacts with the immune system, we are increasingly able to identify more effective, tailored treatments.

So yes, the future is moving toward having more targeted therapies for different cancers (and even different subtypes within the same cancer), but there is definitely still a lot of work to do.

- Marina Baretti, MD

webmd · 2026-03-25T16:03:14+00:00

I think we are moving more and more toward personalized medicine, where we really try to match treatment with the underlying biology and molecular makeup of each tumor.

- Marina Baretti, MD

webmd · 2026-03-25T16:02:20+00:00

Even when a study looks promising, most trials are still steps along the way, and it takes time to know how effective a treatment truly is. That said, if a drug is showing strong results, there are sometimes ways to access it earlier, through clinical trials, expanded access/compassionate use programs, or occasionally early, accelerated FDA approvals.

For earlier-stage studies (often known as phase 1 or 2), access is usually only through the trial itself, and eligibility can be more limited.

In situations where the disease is progressing and options are limited, we do sometimes think more creatively. This can include early-phase trials, off-label treatments, or compassionate use. These are very individualized decisions, balancing potential benefit with risks.

- Marina Baretti, MD

webmd · 2026-03-25T15:57:16+00:00

AI is an important new tool, and we are still learning how to use it at its best. There are important efforts underway to integrate AI to facilitate drug discovery and to better match therapies with the right patients. It’s also being used to analyze large datasets (genomics, imaging, clinical data) in ways that would be very difficult for humans alone, which can help identify patterns and generate new hypotheses. That said, we are still early, and these tools need careful validation before they truly change clinical care.

- Marina Baretti, MD

webmd · 2026-02-12T19:06:44+00:00

Great questions. Electroconvulsive therapy was a mainstay for treating severe depression from the 1940s until the 1980s. It fell into a decline in the 1960s as there was a belief in the power of antidepressant drugs. We now know that antidepressant meds don’t help everyone, and sometimes if they do work, then well they work too slow. So there is fresh recognition that ECT still has a firm place in the treatment of depression, and there continues to be slow growth in the number of facilities that offer ECT. Fifty or sixty years ago it seems that many cases of depression could be reversed with 6 or so sessions of ECT. But now ECT is mostly reserved for people with treatment resistant depression, and these ‘harder to treat’ cases often require 8-12 sessions of ECT over a period of 3-4 weeks. Relapse is common after ECT if nothing is put into place to prevent relapse. The best strategies for preserving a good response to ECT is to consider the prescription of lithium after the acute course of ECT is over, and to give a few step-down, taper ECT sessions at the end of acute course of ECT, rather than just stopping it abruptly

Dr. Vaughn McCall

webmd · 2026-02-12T18:57:18+00:00

Before addressing weight lifting, let's talk in general about exercise. The verdict is in. Many studies, including randomized controlled trials, have shown an antidepressant effect of moderate aerobic-style exercise. I would add, though, that this approach when used alone without meds and without psychiatric oversight only makes sense for milder cases of depression. Severe cases of depression, such as those cases burdened with thoughts of suicide, need more care than just exercise, IMO. Apart from antidepressant effects, my research and that of others has shown that moderate aerobic exercise improves sleep, too - which is always good news for treating depression. I am ignorant about weight lifting specifically as a depression self-care, but if it gets your heart rate up for 20-30 minutes then that should qualify.

One last thought about self care maneuvers such as exercise. A common term used by all mental health disciplines is “locus of control.” Locus of control refers to the patient’s sense of where their help comes from. If a depressed person feels that they can contribute nothing to their own recovery, and counts on the doctor to carry that weight - then that patient has an “external locus of control.” If the patient believes that there is something they can do to help themselves (such as weight lifting), then that person has an “internal locus of control.” No surprise - having at least some degree of an internal locus of control tends to make everything go better.

Dr. Vaughn McCall

webmd · 2026-02-12T18:47:58+00:00

I am sorry that time was wasted in finding an answer to your problem. Getting basic lab work such as blood chemistries or B12 levels is not yet an absolute standard of care in depression care, although stories like yours remind us that psychiatrists are still medical doctors and function as such. Perhaps part of the answer is for psychiatry patients to be bold and advocate for themselves and ask their psychiatrist hard questions about the value of blood tests, etc.

Dr. Vaughn McCall

webmd · 2026-02-12T18:41:53+00:00

As one psychiatrist to another - thank you for your question. While I stated earlier that I have never been clinically depressed, I entered my training in psychiatry at a time (mid 1980s) and a place where it was expected that all trainees should be a patient in psychoanalysis as a matter of self discovery. So, I was in formal psychoanalysis as a patient, 4 times per week for 3 ½ years. Forty years later, I am still working through that experience and found it helpful. But now an immersion in psychotherapy principles is uncommon in many psychiatry training programs - which is sad.

My message, which is congruent with yours, is that we must preserve psychotherapy training in our training programs - otherwise our new doctors will not have the experience with anything other than prescribing.

Dr. Vaughn McCall

webmd · 2026-02-12T18:36:58+00:00

So for the audience as a whole, “executive function” describes a set of higher order mental functions such as the speed with which we process information, our ability to pay attention, our ability to make rational decisions when faced with problems, our ability to consider alternatives, our ability to “set shift” from one way of thinking to a new way of thinking. In other words executive functioning is a cognitive process but it is not memory processes. People with severe depression have problems with executive functioning, and this can be scary for both the doctor and the patient since suicidal depression can be associated with problems with executive functioning. I suppose some stimulant medications might help with some selective aspects of cognitive functioning such as attention, but not sure that it would help other aspects. There are hints that some brain stimulation treatments such as rTMS or ECT might help executive functioning. I mentioned earlier that I was a Sleep Medicine specialist, too…. And you have heard the expression that if you have a hammer then all you see is nails…. So here is my sleep-oriented answer to your question: There is no doubt that sleep disorders, especially insomnia, contribute to executive dysfunction. So, if had a depressed patient with insomnia who complained that their brain was not working properly - then I would pursue treatment of the insomnia

Dr. Vaughn McCall

webmd · 2026-02-12T18:28:16+00:00

No doubt about it. Using a depression diagnosis to explain away physical problems is just cutting corners. A physical complaint in a depressed patient ought to be handled with the same interest as in a person who is not depressed.

Dr. Vaughn McCall

webmd · 2026-02-12T18:26:27+00:00

Wow, that is a loaded question! While psychiatry and psychology can and should work hand-in-hand, occasionally one discipline will pursue a new idea in the mental health field that is not universally shared by the other discipline. As a psychiatrist, I became aware about 30 years ago of a psychological theory of depression called “depressive realism”. This theory posited that all the psychologically-well people were happy because they were oblivious to the hardships of this world, while the depressed folks actually saw the world for what it was - depressive realism. For folks who have always felt depressed, perhaps because they viewed the glass as always half empty, is to find a way to grapple with all the ugliness that does in fact exist, while maintaining a sense of hopefulness that each of us has a purpose that might make things just a little better - even if it's just a little better for one other person

Dr. Vaughn McCall

webmd · 2026-02-12T18:15:47+00:00

If by “cure” we mean to have a condition go away and not return, even after treatment is over…… well I guess that is what happens when we treat infections with antibiotics… but it does not happen often with mental illness. Certainly some depressive illnesses can be brought completely under control with medication or psychotherapy, but these illnesses often return when all treatment is withdrawn.

But I can imagine a few expectations where all treatment is withdrawn and a real “cure” continues. An example might be a milder form of depression in which a person has distorted view of themselves and of the world and with therapy comes to terms with the reality of things - that is, the distortion is eliminated. In this example, the patient makes a fundamental change in their own mental processes - of course with assistance from a therapist. But the key here is that the patient is ultimately making the change and is not eternally dependent on the therapist.

Dr. Vaughn McCall

webmd · 2026-02-12T18:07:55+00:00

Thank you for your question. I went to medical school thinking I wanted to work in primary care - internal medicine. But when I had my psychiatry rotation I was assigned a young woman who just wanted to talk to me. She was a patient in a state mental hospital. The weather was nice that time of year and we would go outside and sit on the lawn and she would talk about her life. I had no training at that point and so did not do much other than listen. Remarkably, she found that helpful! I thought, wow, while surgeons might use a scalpel to achieve results, a psychiatrist could use themselves as the instrument - no scalpel required. That was a profound realization, and I have never looked back. Oh, and somehow I have been spared from having depressive illness myself…. But I think I get a sense of what it feels like from what patients tell me.

Dr. Vaughn McCall

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