Background: The COVID-19 pandemic significantly disrupted global access to cancer care. Patient access to early phase trials during COVID-19 was maintained at our major tertiary Phase 1 unit using split teams, remote monitoring, direct to patient drug delivery and telehealth¹. While there is substantial research focused on trial access, patient experiences of early phase treatment during the pandemic have not been documented. This research aims to identify early phase trial patients’ needs and provide insight into patients’ journey while receiving novel therapy in the midst of the Australian lockdown. Methods: This qualitative study recruited early phase trial participants with advanced /metastatic cancer treated at St Vincent’s Hospital, Sydney between 2020-2022 whilst the government-mandated lockdown was effective. Participants were audio/video recorded during their interview using a semi-structured approach. Thematic analysis was used to analyse patient stories and identify unmet needs. Analyses were performed using NVivo. Results: Nine clinical trial participants (five females, four males; five new trial participants, four known exceptional responders) consented and completed the in-depth interview (1-2.5 hours). Participants reported that COVID-19 created additional burden at a time of vulnerability, including challenging travel logistics, such as frequent travel exemption requests or need to relocate to access treatment, worsening anxiety and financial toxicity. COVID-19 lockdown induced separation from family abroad, touch deprivation and reduced psychological support for those with advanced cancer needing support, but provided more flexible work arrangements, allowing patients to work from home whilst on treatment. Conclusions: This study revealed unique social, psychological, logistical and financial challenges for cancer patients accessing early phase trials during the COVID-19 pandemic. Development of meaningful patient centred resources and supportive care interventions is needed to assist trial participants. ¹N Aggarwal et al (2022), Impact of COVID-19 on early phase clinical trials recruitment and treatment in a major metropolitan Phase 1 Unit, Poster Abstracts. Asia-Pac J Clin Oncol, 18: 33-51. https://doi.org/10.1111/ajco.13856.