NCCCP Increases Patient Access to Quality Cancer Care

NCI has created an infrastructure of clinical cancer research and cancer care that is unmatched anywhere in the world. The foundation of this successful system is the 61 NCI-designated Cancer Centers, which have been the bedrock of the continual improvements made in prevention, screening, treatment, and palliative care. However, the fact still remains that 85 percent of cancer patients receive their care at the local community level. Given this, if we are to bring the latest scientific advances to the patient, we must continue to develop programs to reach them in the communities where they live.

Cancer is a disease of the aging. This rapidly growing patient population, as well as underserved or disadvantaged populations, need more support in order to access quality care. I agree with Dr. John Seffrin, CEO of the American Cancer Society, who has said that access by patients with cancer to state-of-the-art care - to the latest advances in genomics and proteomics - will be a bigger determinant to mortality than any risk factors identified today. It is for this reason that I believe NCI needs to create a new rim of clinical cancer research and care beyond the NCI-designated Cancer Centers Program to build on the superb efforts of these Centers. By virtue of their ability to directly address issues of delivery, many Centers have invested in creating networks of affiliated community cancer programs.

One of the missions of NCI, however, is to conduct research on how to meet the health care access crisis sitting on our doorstep, and to determine the best ways to bring prevention, early diagnosis, treatment, and new science to all of those affected with cancer. Therefore, NCI has launched a new initiative, the NCI Community Cancer Centers Program (NCCCP), which is being tested as a pilot project - not in competition with programs that do community outreach, but as a complementary program to the existing network of NCI-designated Cancer Centers, Community Clinical Oncology Program (CCOP) sites, and other academic medical center cancer programs.

NCCCP seeks to broaden and magnify the impact of our research advances and create a more comprehensive National Cancer Program that builds on our strengths. NCI's mission is to fund and perform research, not to deliver care. As a pilot, the program, which will cost $9 million over its 3-year span, is intended to help answer some of the most pressing clinical cancer-related issues, including one of the most serious problems - disparities in care.

When the NCI-designated Cancer Centers Program was being created during the 1970s, there was a need for special care units in large hospital settings to manage the side effects associated with highly toxic chemotherapeutic treatment regimens. Today, it is possible to propose this next sphere of clinical research and outreach because the new generation of drugs are targeted and less toxic, and will be able to be administered in early-phase clinical studies in a community practice setting.

To qualify for the NCCCP pilot, Centers will need to have established systems able to support clinical trials and a substantial patient base to be able to accrue patients to clinical trials, as well as effective means of serving the underinsured and uninsured. The Centers will also need to be able to apply resources effectively to build information technology capability, including electronic patient medical records, as well as support biospecimen collection. Sites must be unconditionally accredited by the American College of Surgeons Commission on Cancer, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the College of American Pathologists or JCAHO for laboratory services. There also is a preference for sites to be participating in national or state programs for screening and treatment to incorporate other efforts to improve cancer care.

A major goal of NCCCP will be to create a cohort of oncology patients linked through electronic records and common bioinformatic databases. If we hope to accelerate the timeline to drug approval, we need to establish linked multisite clinical trial networks. NCCCP offers the infrastructure that reaches deeper into the community to bring together these patient cohorts.

The interplay of the NCCCP pilot will be an important step in transferring the rigors of clinical cancer care to local hospitals and clinics. I believe that by introducing clinical research standards to the local setting, it will raise the quality of care and acquaint community physicians with state-of-the-art cancer care management.

Through this pilot, we hope to identify effective ways to increase accrual to clinical trials, assess programs to bridge the disparities gap, develop standardized tissue banks that will enable future research in carcinogenesis, and bring community-based oncology into the era of electronic medical record keeping and information technology networks.

Like any well-designed project of this nature, evaluation metrics will be established for NCCCP, and independent assessments will help us determine whether it is something that, approximately 3 years from now, we need to revisit, revise, or even expand.

With NCCCP, we are trying to answer some ambitious questions for which there are no easy answers. But I am a firm believer that if we make the effort to identify the parameters and imperatives behind delivering high-quality care to people in communities across the country, we will reap the benefits - as measured by many cancers prevented and lives saved.

Dr. John E. Niederhuber
Director, National Cancer Institute