As the health care industry becomes more institutionalized and as major for profit corporations begin to increast their market share, there exists the real danger of isolating patients enrolled in Health Maintenance Organizations form high quality clinical cancer trials. This would represent a loss botyh for the individual patients as well as society. This application is designed to integrate clinical cancer trials within the largest HMO in California, Kaiser Permanente. The San Diego region of Kaiser Permanente provides total health care for 290,000 patients and Kaiser Permanents, state wide, cares for over 10% of the population. The San Diego Kaiser Permanents has for several years been quited active in national groups studying cancer treatment such as Cancer and Acute Leukemia Group B and National Surgical Adjuvant Project for Breast and Bowel Cancer. The added resources provided by a Community Clinical Oncology Program would enormously expand the capability to provide a wide variety of clinical cancer trials to our medical, pediatric and gynecologic cancer pateints. The centralized administration of cancer treatment would also enahcne physician education and improve the overall quality of cancer care delivered to all of our patients. In addition, the large volume of patients followed in our Health Appraisal Clinic constitutes an ideal population to evaluate for cancer control issues. By demonstrating that involvement in high quality cancer treatment and cancer control trials under the auspices of a CCOP both enhances patient care without added expense and improves physician competence and motivation, a role model may be established that can be expanded to involve other regions within our Health Maintenance Organization.
