BETHESDA, Md--Cancer patients may be more likely to enter treatment
trials if the medical centers are near their own homes. With this
in mind, the National Cancer Institute and the Division of Cancer
Prevention and Control developed the Community Clinical Oncology
Begun in 1983, the program's purpose is to bring the benefits
of clinical research to cancer patients in their own communities
by encouraging physicians to enter patients into treatment research
protocols (see table for other program goals).
The first requests for applications (RFAs) in 1983 led to funding
for 63 community programs in 34 states and brought 14,000 patients
into NCI-approved treatment clinical trials. The second RFA went
out in 1986, at which time CCOP expanded its focus to include
cancer prevention and control research.
By 1994 there were 50 programs in 29 states involving more than
300 hospitals and 3,000 physicians. In 1994, about 3,800 patients
were entered into treatment trials, and 5,000 subjects were entered
into cancer prevention and control trials. The most recent RFA
(June, 1995) resulted in three new programs.
Managed Care Brings Problems
In an interview with Oncology News International, David K. King,
MD, principal investigator of the Greater Phoenix CCOP, said that
"the concepts of the Community Clinical Oncology Program
are superb, and the impact on the community had been important.
We've been with CCOP ever since the beginning, and it's an extremely
The fly in the ointment, according to Dr. King, is a growing inability
to place patients in clinical trials because of the reimbursement
restrictions of managed care. "It is no secret that there
is a problem in the Phoenix area, that also has become mirrored
in other areas," he said. "It has had a tremendous negative
impact on the CCOP in Phoenix. Our managed care penetration is
extremely high and is still growing."
He noted that managed care organizations have become sophisticated
in determining whether a patient has been placed on a trial. "Trials
usually require frequent testing at intervals not approved by
the managed care provider--that's how they figure out that it's