I have never regretted my decision to move to a small rural cancer center. I do believe, however, that the experience could be more fulfilling for both myself and my patients if I were able to participate in a clinical trial network organized through a larger academic system. This would allow a small treatment facility such as the one where I practice to participate in clinical research and ensure that the fundamental values and principles of clinical research are upheld. Although large cooperative groups have outreach programs, they are often labor intensive and provide insufficient support for even the smallest cancer treatment facility to breakeven financially.

Despite being able to participate in clinical cancer research from a rural cancer center, the process was difficult without a cooperative group and I questioned our future ability to continue with clinical research. This decision would have been very unfortunate, as based on the historical rate of cancer patients being treated on clinical trials, the United States sorely needs more clinical trial participation.


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While there is some degree of altruism in providing innovative and otherwise unavailable treatments to patients in my community, the cancer center’s program also benefits from having a network that allows for consistent and continuous participation in clinical research. Our facility has the designation of being certified by the Commission on Cancer (CoC) through the American College of Surgeons. In the past, the CoC considered clinical trial participation a point of commendation. But recently, this was made a requirement, and therefore, clinical trial participation will be necessary to build if not maintain the number of CoC-certified cancer centers in our state.


Donald Fleming is an oncologist/hematologist at the Cancer Care Center, Davis Memorial Hospital, Elkins, West Virginia. 


REFERENCES

1. Fenton L, Rigney M, Herbst RS. Clinical trial awareness, attitudes, and participation among patients with cancer and oncologists. Commun Oncol. 2009;6:207-213.

2. National Cancer Institute. Cancer Clinical Trials: The Basic Workbook. Bethesda, MD: National Cancer Institute (NCI); 2002. NIH publication 02-5050. https://accrualnet.cancer.gov/sites/accrualnet.cancer.gov/files/BasicsWorkbook_m.pdf. Accessed October 22, 2014.

3. Baguet CR, Commiskey P, Daniel Mullins CD, Mishra SI. Recruitment and participation in clinical trials: socio-demographic, rural/urban, and health care access predictors. Cancer Detect Prev. 2006;30(1):24-33.

4. Peppercorn JM, Weeks JC, Cook EF, Joffe S. Comparison of outcomes in cancer patients treated within and outside clinical trials: conceptual framework and structured review. Lancet. 2004;363(9405):263-270.