 |  For More Than 20 Years, CCOPs Define Commitment, Success There are many examples of successful National Cancer Institute (NCI) programs that span every part of our research enterprise. With this special issue of the NCI Cancer Bulletin, we are honoring a program that has come to represent the very definition of success: the Community Clinical Oncology Program (CCOP). In 1982, a Request for Applications was issued soliciting participants for a unique program that would bring together community hospitals, the growing cadre of community oncologists, and other local health care providers into a nationwide network for conducting cancer clinical trials. Who could have imagined just how effective this program would become? But here we are, more than 20 years later, with CCOPs having enrolled more than 172,000 patients into cancer treatment and prevention trials. Read more
Minorities Gaining Access to Clinical Trials This past June, when the NCI Clinical Trials Working Group focused on the ongoing need to increase recruitment of minority populations to cancer clinical trials, a key element of their proposed solution was to fund more Minority-Based Community Clinical Oncology Programs (MB-CCOPs), and for good reason. Over the last decade, more than 5,500 minorities have enrolled in both treatment and prevention clinical trials sponsored by NCI through the MB-CCOP network. Read more
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For More Than 20 Years, CCOPs Define Commitment, Success There are many examples of successful National Cancer Institute (NCI) programs that span every part of our research enterprise. With this special issue of the NCI Cancer Bulletin, we are honoring a program that has come to represent the very definition of success: the Community Clinical Oncology Program (CCOP). In 1982, a Request for Applications was issued soliciting participants for a unique program that would bring together community hospitals, the growing cadre of community oncologists, and other local health care providers into a nationwide network for conducting cancer clinical trials. Who could have imagined just how effective this program would become? But here we are, more than 20 years later, with CCOPs having enrolled more than 172,000 patients into cancer treatment and prevention trials. From the beginning, there were those who doubted the program would work, who believed community providers could not stand up to the rigors of conducting large clinical trials. But time and again, these critics have been proven wrong. Analysis of CCOPs' performance over the years has consistently shown that they are not only skilled at recruiting patients, but also produce quality data and ensure the adoption of new standards of care by community providers. The CCOPs' role in treatment trials has been critical. But under the inspired, excellent leadership of Dr. Peter Greenwald and his staff in the Division of Cancer Prevention (DCP) - including the program's current head, Dr. Lori Minasian, and its previous leader of 10 years, Dr. Leslie Ford - the cancer prevention and control arena is where the CCOPs have helped stake new ground. Indeed, the first drug ever approved for cancer prevention, tamoxifen, might never have been if the CCOP network had not conducted the Breast Cancer Prevention Trial, on which the approval was based. From the beginning, the individuals and institutions participating in the CCOP network have had a remarkable commitment to its success. That commitment can be seen in the unselfish and cooperative manner in which they work with the NCI Cooperative Group and Cancer Centers, collectively known as the Research Bases. During a time when we are still working to more effectively integrate team science into cancer research, the CCOPs' collaboration with the Research Bases has been the epitome of teamwork. A perhaps underappreciated component of the CCOPs is their participation in symptom management trials. These trials may not garner as many headlines as treatment and prevention trials, but their importance in developing interventions to reduce side effects such as nausea and mucositis is undeniable. Finally, there is no greater indicator of success than imitation, which is why two institutes at the National Institutes of Health (NIH) have followed the CCOP model in developing community-based clinical trial networks to test new treatments for HIV and drug abuse. In many respects, the success of the CCOPs is not a surprise. The genesis of the term "cancer community" is rooted in the unwavering commitment displayed by so many individuals in this country to defeating this disease. So it should come as no shock that, more than 20 years ago, when NCI reached out to communities to play a new role in advancing cancer research, they exceeded every expectation - and continue to do so. Dr. Andrew C. von Eschenbach |
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This past June, when the NCI Clinical Trials Working Group focused on the ongoing need to increase recruitment of minority populations to cancer clinical trials, a key element of their proposed solution was to fund more Minority-Based Community Clinical Oncology Programs (MB-CCOPs), and for good reason. Over the last decade, more than 5,500 minorities have enrolled in both treatment and prevention clinical trials sponsored by NCI through the MB-CCOP network.
"Despite the recruitment challenges remaining, and any new barriers that may arise, the MB-CCOPs have shown that they can use their infrastructure to engage community health care providers and successfully recruit minorities into prevention trials," says Dr. Worta McCaskill-Stevens, the MB-CCOP program director in NCI's DCP.
"We address the issue of trust immediately, and we focus on educating people about the clinical trials that are available," says Dr. Lucile Adams-Campbell of the Howard University Cancer Center in Washington, D.C., who directs the District's MB-CCOP. MB-CCOPs also benefit the communities they serve. In Puerto Rico, for example, the program targets cancer patients who cannot afford the drugs and treatments being evaluated. This was the case in trials that recently led to the new standard of care for HER-2 positive breast cancer. "This program offers patients hope and state-of-the-art therapies in their own communities from people who know their language and their culture," says the director, Dr. Luis Baez of the University of San Juan. Dr. McCaskill-Stevens feels that MB-CCOPs also are in a unique position to address issues critical to minority populations and cancer, including mentoring investigators, sharing recruitment strategies with other institutions, identifying trends in cancer incidence in their local communities, and contributing to trial designs that account for competing minority health issues. Dr. McCaskill-Stevens is optimistic about the increasing access that minorities will have to cancer trials, whether for prevention or treatment. "The future of minority participation in cancer trials rests with the burgeoning potential of this network," she says. "Their early successes will continue to bring quality health care delivery to diverse groups for years to come." By Edward R. Winstead |
The MB-CCOPs were launched in 1990 as part of the efforts of the CCOPs to deliver the best cancer care to patients, wherever they live. At least 40 percent of the local populations served by MB-CCOPs are minorities and the programs have had a disproportionately positive effect: In 2003, for instance, the MB-CCOPs accounted for less than 20 percent of the CCOP network but enrolled half of the minority patients in the studies. (August 2 
Minority communities experience an unequal burden of cancer, and the professionals who work with them face challenges in recruiting for trials. In some African American communities, for example, earning the trust of patients and their families is essential. |
The most recent list of CCOPs can also be found at http://www3.cancer.gov/prevention/ccop/aboutccop.html.
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CCOPs (50)
Minority-based CCOPs (13) |
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1987 - First evaluation of CCOP finds the program effective in enrolling patients in clinical trials and getting physicians to adopt trial results as standards of care.
June 1993 - The Colorectal Adenoma Prevention Study (CAPS) is begun under the direction of the Cancer and Leukemia Group B, using the CCOP network. The trial evaluates whether aspirin will reduce the development of adenomas in people who have already had early-stage colorectal cancer.
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Dr. Minasian has been chief of the Community Oncology and Prevention Trials Research Group, which administers the CCOPs, since 1997.
Why are the CCOPs so successful at recruiting patients? CCOP physicians receive training and support from NCI. What have the CCOPs taught NCI about community oncology? |
What do you think are the CCOPs' most important contributions to cancer research and prevention? |
CCOPs initially arose as mechanisms that would enable community oncologists to participate in cooperative groups' cancer treatment studies. Often such protocols would include the investigation of a new drug. Some studies would redefine the standard of care for a particular disease. Although these programs focused on treatment trials have been quite successful, community oncologists have come to recognize that the greatest reduction in the cancer burden will only come from disease prevention. All of the advances in prolonging survival and reducing relapse pale in comparison to cancer prevention. CCOP investigators have learned this from their patients, their patients' families, and their communities. CCOPs now view themselves as the best medium for chemoprevention studies at the local level. Indeed, CCOPs are the ideal platform for such prevention studies because they align the principal investigator's recognition that chemoprevention holds great promise with his or her local community's desire to participate in the research process. The successes of such cancer awareness events as the "Race for the Cure" and the "Walk for Life" are clues to how important local communities feel about doing their part to help. CCOPs then take this local interest and desire to participate to a higher level by enrolling at-risk individuals into studies designed to reduce cancer incidence. The cooperative groups have a responsibility to harness their considerable expertise to design a national prevention program for all malignancies that are candidates for prevention strategies. When armed with good national large-scale prevention programs, the CCOPs can fulfill their initial promise of truly reducing the cancer burden. |
By Dr. James L. Wade III, Principal Investigator, |
Cancer treatment is an evolving process. The knowledge we gain from the results of clinical trials ultimately determines what the standard treatment for a particular type and stage of cancer will be. During our residencies at academic medical centers we learned the value of evidence-based medicine. We studied the landmark clinical trials that influenced our current recommendations and we participated in new trials destined to influence future standards. When we completed our residencies, we chose whether to stay in the academic world or to join the ranks of community physicians. Many of us struggled with this decision because we enjoyed the stimulation of the university setting, and felt the good that comes from working to advance the treatment. Those of us who go into private practice don't give up our intellectual curiosity or our desire to help advance the knowledge of cancer treatment. Participation in clinical trials through the CCOPs allows us to continue contributing to our profession and helping to improve the quality of patient care. For me, participation in the North Central Cancer Treatment Group, a CCOP Research Base, provides a framework for ongoing collaboration with my academic colleagues, an occasion to attend semiannual group meetings, and the opportunity to stay informed about new developments in oncology. Why do I participate?
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By Dr. Richard L. Deming, Medical Director, Mercy Therapeutic Radiology Associates, Des Moines, Iowa
