ASSURING ACCESS TO STATE-OF-THE-ART CARE FOR UNITED-STATES MINORITY POPULATIONS - THE 1ST 2 YEARS OF THE MINORITY-BASED COMMUNITY CLINICAL ONCOLOGY PROGRAM

Background: The Minority-Based Community Clinical Oncology Program (MB CCOP) was initiated in September 1990 to expand the National Cancer In stitute's (NCI's) clinical trials network to minority populations. Ins titutions, organizations, and/or physician groups that had more than 5 0% of new cancer patients from minority groups were eligible to partic ipate. There has been no previous evaluation of the MBCCOP. Purpose: T his study was designed to describe the early implementation of the MBC COP and identify the challenges that have emerged in developing a netw ork aimed at increasing the participation of minority populations in c linical trials. Methods: Data were taken from primary and secondary so urces, including site visits and patient log data, that described perf ormance of 12 MBCCOP centers initially funded in September 1990. Accru al was measured by the number of credits earned per MBCCOP for patient s enrolled in research protocols for cancer treatment or for preventio n and control, which includes activities such as early detection, pain control, and rehabilitation. These accrual credits, assigned by the N CI, were based on the complexity of the protocol and the amount of res ources expected to be required for accrual of patients by the MBCCOP. Results: Data for the first 2 years of the MBCCOP showed that 344 pati ents were accrued to trials of treatment protocols from June 1, 1990, to May 31, 1991, and this number increased to 470 during the second ac crual year, June 1, 1991, to May 31, 1992. Similarly, accrual of patie nts to cancer prevention and control studies increased from 256 in 199 0-1991 to 423 in 1991-1992. More than 70% of the MBCCOP patients enter ed in studies were from minority populations. The proportion of eligib le MBCCOP patients entered into treatment protocols was identical with that experienced by the initial Community Clinical Oncology Program ( CCOP). Results also demonstrated that MBCCOP centers operate in an env ironment characterized by socioeconomic decline and limited resources, both having substantial effects on the implementation of clinical tri als among minorities. While minority patients are willing to participa te in clinical trials, there are profound barriers involving language, logistics, and the appropriateness of available protocols. Participat ing physicians, nurses, and support personnel report a high level of a greement with program goals and have developed unique approaches to me eting the challenges faced in the implementation of this program. Conc lusions: The MBCCOPs have demonstrated their ability to participate in clinical trials. Evaluation reveals, however, that they are emerging organizations influenced by factors endemic to the community they serv e and their own structure. The MBCCOPs are confronting substantial cha llenges, yet they provide an important link to the overall NCI clinica l trials network.