SAN DIEGO--For community physicians who have an interest in clinical
research, "the line between community and academic centers
isnt so far apart anymore," said Andrew Pecora, MD,
chairman of the medical board of the newly created Affiliated
Physicians Network (APN), Fort Lee, NJ, which helps practitioners
participate in clinical trials.
Dr. Pecora, who turned down an opportunity to continue in academic
research after finishing a fellowship at Memorial Sloan-Kettering
Cancer Center in the 1980s, never lost his desire to pursue research.
He found a way to accomplish this, and "others can do the same
thing," he said at the Sixth International Symposium on Recent
Advances in Hematopoietic Stem Cell Transplantation, sponsored by the
University of California, San Diego, Medical Center.
Affiliated Physicians Network
This year, Dr. Andrew Pecora and a group of 100
The network provides practice management services, disease management
Within the clinical trial management arm, APN provides a drug company
Dr. Pecora said that the first step toward achieving his goal to do
research was to help establish the Northern New Jersey Cancer Center,
a limited liability partnership with eight other physicians. Many in
the group were trained at Memorial Sloan-Kettering, and the
partnership included three adult transplant physicians. Its principal
hospital affiliation is with Hackensack University Medical Center,
which, despite its name, is not an academic center.
"Collectively, we decided that if we pooled our energies and all
came under one roof and approached institutions together, we could do
more things that we wanted to do," Dr. Pecora said. "We
were all interested in doing clinical research, but, as a practical
matter, we knew we didnt have the time or manpower to do it on
Among the trials that the group is now participating in are four
active national clinical trials on the use of high-dose chemotherapy
with bone marrow or stem cell transplant in breast cancer. Dr. Pecora
was recently chosen by the Eastern Cooperative Oncology Group (ECOG)
to develop a metastatic breast cancer trial using high-dose
chemotherapy with stem cell support.
The group was also active in tamoxifen (Nolvadex) breast cancer
studies, as well as numerous trials in gastrointestinal and
The New Jersey group sees 2,500 new patients a year and conducts
19,000 follow-up visits. The transplant service had 380 consults and
performed 221 transplant procedures in 1997.
To get started in clinical research, he said, the physician group
needs a good patient volume, to provide a sufficient head count as
well as cash flow to make it work.
Also critical is hospital support. Dr. Pecora said that Hackensack
University Medical Center has committed some of its profits from its
transplant service and elsewhere to the groups research
endeavors. That money is set aside in a separate fund to pay for the
staff necessary to support the research, including six
administrators, 22 nurses, and three data managers. Their salaries
are completely paid by the hospital.
Finally, physicians who want to do research need to be part of an
academic institution, a cooperative group like ECOG or the Southwest
Oncology Group (SWOG), or a private business like Response Oncology,
Inc. or Affiliated Physicians Network that assists physicians in
Big Institutions Need Help
Dr. Pecora observed that even the biggest names in cancer research
cannot pull off major breakthroughs by themselves. "While a
single institution like Sloan-Kettering and Fred Hutchinson is
capable of doing large trials, most of the important questions in
medicine are, in fact, answered as the result of large cooperative
group trials," he said. "These trials have involved
multiple institutions not only in the United States but around the
world. Many of the physicians participating in these trials dont
necessarily work at academic centers."
As an added bonus, Dr. Pecora said, getting more private oncologists
involved in clinical trials can ultimately increase the number of
cancer patients who participate in clinical trials in the United States.
"Our center and our program have demonstrated clearly that there
is no group or individual practicing physician who is incapable of
participating in clinical trials," he said.