title: Clinical Trials: A Congressional Focus of Need.
abstract: Senator Specter, Honorable Members of the Committee, it is my high privilege to speak on behalf of a subject near and dear to my heart. I have been involved in the care of patients with cancer and in cancer clinical trials for the past 34 years. I chair the Southwest Oncology Group, the largest National Cancer Institute-supported cancer clinical research organization. In 1996, this Group enrolled 6,359 patients to therapeutic cancer clinical trials from all 50 states (Fig. 1), and completed the randomization of 18,867 normal, healthy men into the intergroup Prostate Cancer Prevention Trial. Cancer clinical trials are always designed to improve the outcomes of cancer patients. However, only 2%-3% of all eligible cancer patients in this country are treated on these cutting-edge trials. It is clear that this number must increase dramatically in order for us to be able to translate the monumental advances emanating from the basic cancer research laboratories into effective diagnosis, prevention and treatment strategies for patients with and at high risk for cancer. This low accrual is related to multiple factors: First, managed care has had a negative impact related to its refusal to reimburse for the clinical care aspects of patients on cancer clinical trials. During my presentation to the President's Cancer Panel in San Antonio in September, I shared three thoughts as to what the Panel should be asking as they pursue the question of "Managed Care's Role in the War on Cancer": &bul; "Should managed care bear a portion of the costs of clinical research as a form of R & D?" &bul; "What State or Federal legislation is needed to assure that managed care patients have access to cancer clinical research?" &bul; "Will there be any future for cancer clinical research when the managed care tidal wave finally reaches Chicago and New York?" The NCI-Department of Defense and the NCI-Department of Veterans Affairs Interagency Agreements are superb models of what needs to be done for the rest of managed care. Secondly, the Southwest Oncology Group is outstripping its financial support at its current rate of accrual. Even if the managed care problem was resolved, there must be more money to support clinical research to translate this plethora of science to patients with cancer. I am also Director of the San Antonio Cancer Institute, a National Cancer Institute-designated Comprehensive Cancer Center. A recent astonishingly productive Breast Cancer Program Project Grant received a priority score one point below the pay line. While this grant will undoubtedly be funded by exception, it is representative of a nationwide problem of insufficient funds to support truly outstanding research. The following quote is from another Cancer Center Director, who is also a Cooperative Group Chair: "We never know where the next breakthrough will come from. Every time we discover a new gene, we also have a new marker for early diagnosis, a new predictor of response to therapy, a new target for chemoprevention, as well as for cancer treatment. Every discovery in a Cancer Center provides fuel for the Cooperative Group program, and requires affirmation in large clinical trials. Thus, the universe of cancer research is a continuum, (where) improved funding for any of it, impacts all of it, and improved funding for all of it will hasten the pace of discovery throughout." (Richard L. Schilsky, M.D.) Finally, I would like to paraphrase a futurist that I recently heard: &bul; "The present is obsolete." &bul; "The future has already been discovered" in the laboratories of molecular biologists throughout this country! We must search among those discoveries for the keys to cancer cures. &bul; "We are confronted with insurmountable opportunities!" &bul; "These new tools will change the rules of the game!" &bul; "We should not manage change, we should love change and make change our best friend," as all those involved in cancer research and the Congress must do every day. (Don Burrus) Thank you for your attention.
authors.affiliation: Cancer Therapy and Research Foundation of South Texas; Southwest Oncology Group, San Antonio, Texas, 78229, USA.
authors.initials: CA
authors.lastname: Coltman