The NCI Community Oncology Research Program (NCORP) is a national network that brings cancer clinical trials and care delivery studies to people in their own communities.
The NCORP network designs and conducts clinical trials in the following focus areas:
- cancer prevention;
- supportive care and symptom management;
- health-related quality of life; and
- cancer care delivery.
The NCORP network also participates in treatment and imaging clinical trials conducted by the NCI National Clinical Trials Network (NCTN). The NCORP network is the primary source of accrual to NCI cancer control symptom management trials and to health-related quality of life trials that are embedded into NCTN treatment trials. Health-related quality of life outcomes are incorporated into many treatment trials and aim to inform the primary endpoint, describe how patients will feel during treatment, and provide valuable data that can be used when patients and clinicians are discussing treatment options in the future.
As they do for the other types of trials in the portfolio, NCORP Research Bases provide scientific and statistical leadership for developing, implementing, and analyzing multi-institutional health-related quality of life studies embedded within treatment and imaging studies conducted under both the NCORP and the NCTN. The NCORP Community Sites participate in the integrated national network by increasing the involvement of community oncologists and other medical specialists and their patients.
A dedicated scientific Steering Committee for Symptom Management and Quality of Life is part of the NCORP network’s review process.
NCORP is committed to integrating health disparities research questions across all studies in the network. By bringing cancer clinical research studies to individuals in their own communities, the NCORP research reflects national diversity so the evidence generated contributes to improved patient outcomes and a reduction in cancer disparities for all people.
Research questions in this area address disparities in clinical trial outcomes and cancer care delivery related to the most serious, prevalent cancers and cancer-related problems which disproportionately affect racial/ethnic minorities and underserved populations. It includes studies to: enhance participation of racial/ethnic minorities and the underserved in clinical trials; address determinants of disparities (for example, social and health care system factors, co-morbidities, and genomics); and evaluate differential outcomes in minority/underserved populations.
The NCORP Community Sites accrue individuals to NCI-approved cancer clinical trials and research studies. The Sites are consortia of researchers, public hospitals, physician practices, academic medical centers, and other groups that provide healthcare services in communities across the U.S. NCORP MU Community Sites have a patient population comprised of at least 30% racial/ethnic minorities or rural residents.
The NCORP is housed in the NCI Division of Cancer Prevention, with collaboration by the NCI Division of Cancer Control and Population Sciences, NCI Division of Cancer Treatment and Diagnosis, and NCI Center to Reduce Cancer Health Disparities.
The NCORP network works closely with other NCI-supported programs, including:
- National Clinical Trials Network (NCTN) to provide treatment and imaging trial options and opportunities;
- Pediatric and adult Central Institutional Review Boards (CIRBs) to help reduce the burden on local IRBs while ensuring protection for human research participants;
- Center to Reduce Cancer Health Disparities to reduce the unequal burden of cancer and to train the next generation of researchers in cancer and health disparities;
- Advisory and scientific committees to ensure high-quality research studies through expert scientific review and oversight;
- Clinical trials tumor banks to provide researchers with high-quality biospecimens to inform future research;
- Imaging and Radiation Oncology Core (IROC) to provide integrated radiation oncology and diagnostic imaging quality control programs in support of the NCI's NCTN Network; and
- Cancer Trials Support Unit to support the management and conduct of those clinical trials.
NCI Supports Community-based Research
The NCI has supported cancer clinical research within community settings for over four decades. The participation of community oncologists, non-oncology specialists, and primary care physicians in cancer clinical trials has facilitated the introduction of research advances into practices throughout the country. The era of genomics and molecularly-targeted therapy necessitates shifts in the delivery of cancer-related care.
Although academic medical centers play a crucial role in cancer clinical research, the majority of cancer care takes place in the community setting. Expanding clinical research beyond the academic environment allows access to a larger and more diverse patient population treated in a variety of healthcare delivery settings, which can accelerate accrual to cancer clinical trials and other human subjects research and increase the generalizability and relevance of study findings. Research in community settings reflects the complexity of cancer care delivery and engages community oncologists in research to develop care delivery approaches that can be implemented within usual clinical workflow.
The foundation of NCORP is the conduct of multi-site cancer clinical trials and other human subjects research in the primary focus areas of cancer control, prevention and care delivery. NCORP plays an important role in the National Clinical Trials Network (NCTN), a major NCI-supported infrastructure for cancer clinical trials. Approximately 30% - 35% of the patients enrolled on NCTN clinical trials, including precision medicine studies, are from NCORP sites.
The NCORP Community Sites and Minority/Underserved Community Sites have responded to many of the challenges associated with implementation of precision medicine by providing quality specimens for genomic sequencing and establishing a multidisciplinary team to support the newer generations of clinical research. Recent advances in technology are providing new opportunities to characterize premalignancies in ways that will enhance the development of cancer prevention interventions, and biomarkers of response to those interventions, and biomarkers of risk.
The NCORP network's diversity in patient age, race/ethnicity, and geographic location as well as partnerships with non-oncology practices provides a natural laboratory for the development of strategies for precision prevention to improve efficiency of trial implementation and to balance the risks and benefits of interventions. At the same time, the role of the immune response is increasingly incorporated in cancer prevention research. Cancer screening research to reduce aggressive cancer incidence and to identify overdiagnosis is needed to reduce overall cancer mortality, both in therapy and for prevention. Community organizations have proven to be well positioned to advance the science of symptom management, cancer prevention, and surveillance, and to improve the diversity of participants in clinical research.