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 Program (CCOP).
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 worthwhile program."
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 a trial."