In an effort to consolidate the work of 2 different programs targeting community oncologists and hospitals, the National Cancer Institute (NCI) is merging its NCI Community Cancer Centers Program (NCCCP) and Community Clinical Oncology Program (CCOP) into a single program to be known as the NCI Community Oncology Research Program (N-CORP).
“The idea is to align these programs to address changes that are occurring in clinical oncology,” says Worta McCaskill-Stevens, MD, MS, who is currently acting chief of the CCOP and will head up the combined program. “Since the merger was announced in April, NCI has engaged key stakeholders, current participants, and those who work in the area of cancer care delivery research.”
The NCI will continue gathering input from stakeholders through the end of this year in terms of N-CORP's structure and goals. Peer review will begin in 2013, and the program ultimately will need to be presented for approval by the NCI Board of Scientific Advisors. A new request for applications (RFA) will be issued, and all existing applicants will need to reapply, whereas new research groups also will be encouraged to apply, Dr. McCaskill-Stevens says. She anticipates that the program will be launched in 2014.
The CCOP was founded in 1983 as a way for communitybased physicians to partner with academic researchers. Its main goal was to accelerate NCI clinical trials for cancer prevention, control, and treatment. The program has accomplished just that, contributing approximately 40% of the overall patient accruals on NCI clinical trials, says Dr. McCaskill-Stevens. In 1990, the Minority-Based CCOP was formed as a companion program to reach large minority populations. The CCOP is administered by the NCI's Division of Cancer Prevention.
Meanwhile, the NCCCP was launched in 2007 as a pilot program to develop a network to support basic, clinical, and population-based research on cancer prevention, screening, diagnosis, treatment, survivorship, and palliative care at community hospitals. It is funded by SAIC-Frederick, a wholly owned subsidiary of Science Applications International Corporation that operates under contract with the Frederick National Laboratory for Cancer Research, part of the National Institutes of Health.
The NCCCP was initiated in part because although 80% of oncology patients are cared for in the community setting, cancer research has historically been the purview of academic medical centers, says Lawrence Wagman, MD, executive medical director of the Center for Cancer Prevention and Treatment at St. Joseph Hospital in Orange, California, one of the original NCCCP-funded hospitals. “NCI realized these community hospitals could be resources for cancer research,” he says. Currently, the network includes 21 participating hospitals that, among other things, are studying ways to reduce cancer health disparities, increase the use of electronic health records, and promote the collection of high-quality biospecimens for personalized medicine research.
The new N-CORP will continue these efforts in addition to increasing focus on cancer care delivery research, which has not been a strong focus for either entity in the past. It involves examining organizational structures, health technology, and the behavior of physicians and patients, all of which are factors that influence access to care and health care cost and quality, says Dr. McCaskill-Stevens. “We're looking at the system that delivers research results from NCI-sponsored clinical trials and determining the uptake of those results,” she says. “The ultimate question is, having made these research advances, how do we best deliver them in the community setting?”
Dr. Wagman says that leaders at his hospital are hopeful that N-CORP will expand on the tactics that were developed by the NCCCP. Those tactics will be used to answer many more questions.
For example, in terms of recruiting minority patients onto clinical trials, clinicians at St. Joseph Hospital were able to develop methods of targeting Asian and Pacific Islander and Hispanic patients through trusted groups in those communities. They worked with these populations to reduce barriers to care and introduce them to the concept of appropriate medical care, screenings, and trials. Other sites did the same for their minority populations. Furthermore, the sites carefully recorded which approaches worked and which did not, says Dr. Wagman. “NCCCP allowed us to create an infrastructure that helped us accomplish our goals and vision,” he says. “The new model gives us something to move into as the next step.”
The blending of the 2 programs may require St. Joseph Hospital and other NCCCP sites to retool and potentially add a few programs and find new partners, Dr. Wagman says, noting that it likely will take his hospital a year or more to put the proper systems into place.
The sites have been given some direction in terms of how they might want to function and apply for the new RFA. Currently, the hospital contracts with the NCI, investing approximately $3 for every $1 spent by the government. The hospital invests an enormous amount in terms of personnel, space, and capital equipment, according to Dr. Wagman. He adds that he hopes the new structure will provide a more equal investment by both entities. “We've identified a significant number of additional opportunities that we might be able to get involved in,” he says. “It's never easy to take the next step, but it's doable.”
Michael Fisch, MD, medical director of the CCOP at The University of Texas MD Anderson Cancer Center (MDACC) in Houston, represents one of the academic research bases that partner with the CCOP community oncology programs. “The effort to start N-CORP is understandable in the face of restructuring the whole NCI clinical trials network,” Dr. Fisch says. “The previous system didn't work in an integrated and coordinated fashion.”
He adds that N-CORP may have different membership tiers to promote more robust types of research. As an example, a community site may be able to improve some of the research they do and move up to a new tier and engage the system at a higher level, he says.
The network has a lot of promise for the way people have been doing cooperative research. I think it will be inspiration to team science.—Michael Fisch, MD
At the same time, he envisions that sites will be able to interact with the full, expanded membership in the new network to ask and answer specific research questions that they have not been able to pursue under the current system, essentially opening the door to a broader menu of higher quality studies. “The network has a lot of promise for the way people have been doing cooperative research as well as for extramural investigators who have not engaged the network before,” Dr. Fisch says. “I think it will be inspiration to team science.”
Although it is unclear how many cancer center research bases will be funded for cancer control (currently there are 4, including MDACC), Dr. Fisch is optimistic that the number will remain at least 4. “The bottom line is that there just is not much money for cancer control research,” he adds. “There are lots of things you can dream up, but you're still dividing the same or smaller size pie.” Nevertheless, he is optimistic that MDACC will be well positioned to react to the change.