The NSABP Cancer Control Network (CGOP) Program proposed in this application will increase the number of patients receiving state of the art cancer care by extending clinical trial participation further into the community setting. The current proposal will continue and expand the ongoing program, which began in 1978, through twenty-five geographically dispersed networks, five of which are new to the program. The specific program objectives include: 1) introduce and promote patient protocol management in the community setting; 2) develop and maintain systems of support and education for the community physicians; 3) institute and maintain procedures that ensure the quality of care. The typical cancer control network consists of a major medical center and its cancer control satellites, which are either community hospitals or physician groups practicing in a community setting. The community physicians are invited to participate in NSABP protocols, provided that all institutional and physician eligibility criteria have been met. To be classified as a community physician, the physician's primary appointment must be at a satellite facility of the network institution and must have responsibility for at least one aspect of community patient care: surgery, treatment, or follow-up. The mechanism by which the community physician is recruited depends upon the organization of the particular cancer control network, but the physician's participation is facilitated through the provision of appropriate educational and support services. All components of the NSABP quality assurance program apply equally to community and non-community patients: pathology review, surgery review, radiation therapy review, toxicity monitoring, medical review for eligibility and treatment failure, quality control of estrogen and progesterone receptor assays, drug accountability, medical record audits, institutional evaluations, monitoring of forms submission, and quality control in data processing. These procedures assure high quality protocol participation while the Cancer Control Network activities facilitate the accrual of community patients into high quality NSABP breast and colorectal cancer protocols.
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