title: Sustainability and performance of the National Cancer Institute's Community Clinical Oncology Program.
abstract: BACKGROUND
  The National Cancer Institute's (NCI) Community Clinical Oncology Program (CCOP) contributes one third of NCI treatment trial enrollment ("accrual") and most cancer prevention and control (CP/C) trial enrollment. Prior research indicated that the local clinical environment influenced CCOP accrual performance during the 1990s. As the NCI seeks to improve the operations of the clinical trials system following critical reports by the Institute of Medicine and the NCI Operational Efficiency Working Group, the current relevance of the local environmental context on accrual performance is unknown.
  
  
  METHODS
  This longitudinal quasi-experimental study used panel data on 45 CCOPs nationally for years 2000-2007. Multivariable models examine organizational, research network, and environmental factors associated with accrual to treatment trials, CP/C trials, and trials overall.
  
  
  RESULTS
  For total trial accrual and treatment trial accrual, the number of active CCOP physicians and the number of trials were associated with CCOP performance. Factors differ for CP/C trials. CCOPs in areas with fewer medical school-affiliated hospitals had greater treatment trial accrual.
  
  
  CONCLUSIONS
  Findings suggest a shift in the relevance of the clinical environment since the 1990s, as well as changes in CCOP structure associated with accrual performance. Rather than a limited number of physicians being responsible for the preponderance of trial accrual, there is a trend toward accrual among a larger number of physicians each accruing relatively fewer patients to trial. Understanding this dynamic in the context of CCOP efficiency may inform and strengthen CCOP organization and physician practice.
authors: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Campus Box 7411, 1102A McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA. wrc4@email.unc.edu
authors: William R
authors: WR
authors: Carpenter
authors: Alice K
authors: AK
authors: Fortune-Greeley
authors: Leah L
authors: LL
authors: Zullig
authors: Shoou-Yih
authors: SY
authors: Lee
authors: Bryan J
authors: BJ
authors: Weiner
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D006801:Humans; D008495:Medical Oncology / Q000458:organization & administration*; D054547:National Cancer Institute (U.S.); D009313:National Health Programs / Q000458:organization & administration*; D009369:Neoplasms / Q000517:prevention & control*; D009935:Organizational Affiliation; D015397:Program Evaluation; D012107:Research Design; D014481:United States