Cancer clinical trials in the community setting: a 20 year retrospective.

During the past two decades clinical cancer research in the United States has grown dramatically and has been significantly enhanced by the participation of community hospitals, practicing oncologists, and the creation of community cancer clinical trials organizations. More than 102,000 patients have been enrolled by these community based groups to important clinical trials which have answered questions that have improved cancer treatment in this country and worldwide (Figure 3, Table 8). Practicing oncologists are now well trained in the practice of clinical research and efforts should be directed to ensure that their participation in clinical research continues to increase. There are many obstacles to performing clinical cancer research, but none is greater than the issue of cost. We are currently facing the daunting prospect that health care reform may dramatically curtail or bias future cancer clinical trials. Consumers, providers, politicians, and the general public must be educated to protect and expand the cancer clinical research structure so that we can continue the pursuit of optimal cancer management.