139th National Cancer Advisory Board
NCI COMMUNITY-BASED CANCER CENTERS PILOT PROGRAM—DR. JOHN NIEDERHUBER
Dr. Niederhuber reminded members that the impetus for a community-based cancer centers program came from the concern that there is no way at present of delivering the science of today to people in the community where they live, as well as the belief that access to state-of-the-art care will be a greater determinant of cancer patient mortality than any other risk factor, including tobacco. He cited the success of the NCI-designated Cancer Centers in 61 major academic and research institutes in making significant contributions each day to advances in the understanding, prevention, and treatment of cancer. He pointed out that many geographical gaps exist, however, where the public is unable to receive the kind of care available in the Cancer Centers. Moreover, more than 80 percent of patients with cancer actually are cared for in their local communities.
Dr. Niederhuber reviewed current trends in community-based cancer care that make the NCI Community-based Cancer Centers Pilot (NCCCP) a viable option at this time, as well as the reasons why most cancer patients are treated in hospitals in their communities. The mission statement developed across the NCI over the past year for the NCCCP is to enable the provision of state-of-the-art multispecialty care and early-phase clinical trials in community-based locations to meet the needs of people. The goal of the pilot is to anticipate and sponsor multiple pilot sites for a 3-year period to identify critical factors that would be incorporated into a future Request for Applications (RFA), which would establish this initiative as a permanent program. Members were reminded of the House Appropriations Subcommittee FY 2007 report commending the development of a program to translate the most promising advances in cancer treatment to community hospitals around the country.
Dr. Niederhuber acknowledged and commended the work of the Guiding Coalition and the many Division and Office staff members who collaborated in the development of the NCCCP. Considerations in developing this pilot was to select from among community sites that have: (1) early-phase programs with significant outreach to racial and ethnic minorities and address health care disparities; (2) well- established programs with experience in clinical trials research and some infrastructure in place; (3) strong state-funded support indicating a relationship between the community effort and the regional or state health care structure; (4) hospital-based programs that reach large uninsured populations; or (5) programs that primarily address rural issues. Dr. Niederhuber noted that NCI-designated Cancer Centers that have community networks already in place have been consulted and have provided valuable advice. In addition, NCI program developers have talked with other national health systems to explore the possibility of utilizing their rapid knowledge transfer capabilities for replication of the program.
Baseline components that are considered important for sites selected in the NCCCP are: (1) evidence of a community cancer program, including a minimum of 1,000 new cases a year, cancer screening programs, accreditation, and appropriate staffing, technology, clinical programs, and expertise; (2) clinical trials experience; (3) disparities and community outreach capability; (4) information technology capacity that includes plans for electronic medical records (EMRs) and implementation of caBIGTM infrastructure and components; (5) commitment and capability to describe and assess implementation requirements for the First-Generation Guidelines for NCI-Supported Biorepositories; and (6) emphasis on hospice and palliative care. Dr. Niederhuber briefly reviewed areas that will be of special interest in implementing the pilot program, such as linkages with NCI-designated Cancer Centers and successful approaches to increase accruals to NCI-sponsored clinical trials.
Next, Dr. Niederhuber described the NCCCP assessment structure. An external and independent program evaluator will be employed for this demonstration project. Year 1 would be devoted to infrastructure development, refinement of the pilot program, and beginning to address the research