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 hematologists/oncologists, radiation oncologists, and OB/GYN oncologists started Affiliated Physicians Network (APN), which aims to help private physicians more easily participate in transplant clinical trials, as well as other trials in the oncology/hematology field. APN physicians practice in such states as New Jersey, Connecticut, Florida, and Ohio.
The network provides practice management services, disease management programs, clinical trial management, and a clinical information resource center.
Within the clinical trial management arm, APN provides a drug company liaison, clinical trial budget negotiations, central data collection for all the physicians participating, and a division that looks at pharmacoeconomic and outcomes studies.
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 our own."
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(Drug information on tamoxifen) (Nolvadex) breast cancer studies, as well as numerous trials in gastrointestinal and gynecologic cancer.
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 performing research.
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.