Trials avoid high risk patients and underestimate drug harms

A relative of mine was in the late-stages of cancer, and was not able to find ANY trials willing to accept them. The worst of those trials was out of Baltimore (MD USA), and they ghosted my relative after initial in-person consults that required by relative to drive out of state. Despite the patient's repeated and dogged outreach to the trial authors after that point, there was never an explicit "no" that would let the patient move on, just radio silence instead and that felt cruel to me.

This also comes up with rankings of cancer centers. As the rankings get based on metrics that include things like survival, taking on the hard patients can have a negative impact on their rank. I've seen this cause internal debates on how to handle.