SAN DIEGO--Not wishing to be a self-contained island of clinical
research in a region with a wealth of private cancer specialists, the
Fred Hutchinson Cancer Research Center established a community
outreach program to involve more oncologists in clinical trials, a
program that now includes autologous transplants of peripheral blood
stem cells (PBSCs), Leona Holmberg, MD, an associate in the clinical
division at Hutch-inson, said at a conference sponsored by the
University of California, San Diego.
Founded in 1986, the initial mission of the Puget Sound Oncology
Consortium (PSOC) included encouraging and facilitating the entry of
patients into clinical trials by providing private physicians with
information and access to protocols; acting as a forum for the
development of pilot studies that might ultimately become national in
scope; and sponsoring educational meetings.
The mission expanded in 1994, Dr. Holmberg said, when the academic
physicians concluded that cancer specialists in the community would
be doing autologous transplants at their institutions. The PSOC
decided to provide guidance to these local physicians and offer
protocols to better ensure safe treatment.
The PSOC began enrolling patients in its autologous PBSC transplant
protocol in 1994. During that year, physicians affiliated with PSOC
did 23 autologous transplants. In 1995, this rose to 112, and in 1996
and 1997, to 127 and 126, respectively. To put these numbers in
perspective, Hutchinson physicians performed 148 such transplants in
There are 16 active PSOC transplant centers throughout the
northwestern United States, including Washington state, Oregon,
Montana, Idaho, and northern California, as well as Hawaii.
The arrangement offers benefits for both the cancer research center
and the community. At Hutchinson, for example, it has increased the
referral base for transplants as well as other oncology services. In
the community, the program allows physicians to expand their
treatment capabilities with quality protocols.
For patients, the arrangement provides continuity of care. In the
past, many patients had been hesitant to leave their homes to receive
transplants. Dr. Holmberg said that transplant candidates in Redding,
Calif, for example, in the past had been referred to Stanford
Universitys program, but patients often balked at making the
trip. Now Redding physicians affiliated with the PSOC can perform the
The data also indicate that patients need not worry that they are
sacrificing quality of care by not making the trek to Seattle or
elsewhere. "The toxicity rates in the community have been
identical to what we see at our center, so we are observing a high
quality of care," she said.
There are some negatives to this cooperative effort, she said.
Hutchinson loses some referrals each year for its phase I trials, as
patients opt to join the PSOC protocol closer to home. The
institution also incurs certain expenses. Hutchinson physicians
constantly monitor the community programs for quality of care and
toxicity, and all data submitted to PSOC are reviewed before being
coded. The center also spends money to train the community physicians
in blood banking, apheresis, and PBSC collection, and provides
on-site lectures on patient care.
To continue in the program, a group must perform a minimum of five
transplants a year, pay for a data manager, and submit data in a
timely fashion. On very rare occasions, she said, Hutchinson has had
to put a group on probation for failing to do so, but this action has
always resulted in quick compliance.