Clinical trials have revolutionized cancer care and remain critical to continuously advancing the care of the surgical patient. From breast conservation, to minimally invasive colorectal surgery, to selective lymphadenectomy in melanoma, large-scale multicenter clinical trials have shaped the way cancer care professionals deliver cancer care. The National Cancer Institute (NCI) supports cutting-edge clinical trials, some of which are conducted via their National Clinical Trial Network (NCTN).
From breast conservation, to minimally invasive colorectal surgery, to selective lymphadenectomy in melanoma, large-scale multicenter clinical trials have shaped the way cancer care professionals deliver cancer care.
The NCTN is a collection of more than 2,200 member institutions, allowing collaboration for large multi-institutional trials.* It is an organization that provides infrastructure to help streamline trial operations, improve accrual through its member organization participants, and reduce administrative burdens.
How is the NCTN organized?
The NCTN is composed of four adult cancer cooperative groups: SWOG (Southwest Oncology Group); the Alliance for Clinical Trials in Oncology (commonly known as the Alliance); ECOG-ACRIN (Eastern Cooperative Oncology Group and American College of Radiology Imaging Network) Cancer Research Group; NRG Oncology (National Surgical Adjuvant Breast and Bowel Project, Radiation Therapy Oncology Group, and Gynecologic Oncology Group); and the Children’s Oncology Group (COG).* The Canadian Cancer Trials Group also partners with these U.S. groups. Each cooperative group has its own operations center, tissue bank, statistical center, and a large group of member institutions. To encourage collaboration among the different NCTN cooperative groups, sites and institutions may become a member of more than one cooperative group, and membership in any cooperative group allows the institution to participate in any NCTN trial (see Figure 1).
Figure 1. NCI NCTN structure
Each cooperative group has various committees, ranging from disease site-specific committees to health services research committees. The Alliance also has some disease site-specific surgical working groups.
Within the Alliance, the Alliance/American College of Surgeons Clinical Research Program (ACS CRP), an ACS Cancer Program, includes the following committees: Education, Dissemination and Implementation, Cancer Care Standards Development, and Cancer Care Delivery Research.†
How does one get involved?
The first step to participating in clinical trials is to become credentialed by the NCI as an investigator. Requirements include the Good Clinical Practice (GCP) training at least every three years. A popular provider of GCP course content and certificates of completion is the Collaborative Institutional Training Initiative (CITI). More information about CITI can be found at https://about.citiprogram.org/en/courses/.
The three options for participating in NCTN clinical trials are as follows:
- Participate in the NCI Community Oncology Research Program (NCORP), either through receiving a grant as a main member or through affiliate membership status. For community hospital cancer programs, affiliation with an NCORP site is the most common approach. A total of 46 community sites are spread across more than 900 locations (both community hospitals and private practices). Individuals, organizations, group practices, and other cancer care providers that are interested in becoming affiliate members can contact the principal investigator or administrator of a community NCORP site or minority/underserved NCORP site. The listing of sites and more information can be found on the NCORP website.‡
- Access trials through the NCI’s Cancer Trials Support Unit website.
- Become a member through one of the cooperative groups. Membership and participation information can be found on the websites available in the sidebar, this page.
Participating in the NCTN, and specifically the Alliance and ACS CRP, allows surgeons at all phases of their career—including trainees, academic surgeons, and community practice surgeons—to become more involved with NCI-sponsored clinical trials.
Cooperative group meetings are open to anyone at a cancer care center that is affiliated with that particular NCTN group; for instance, if your institution is an Alliance member, attendance is free to any of the Alliance or ACS CRP committee meetings. It is a forum to learn the latest updates on enrolling clinical trials and to interact with national leaders regarding upcoming clinical trials, as audience feedback is actively sought when new study concepts are presented. In addition, the ACS CRP committees regularly work with programs that directly affect surgeons, such as by collaborating with the Commission on Cancer on operative standards for cancer surgery, developing cancer clinical trial-related content for the ACS Clinical Congress, and implementing programs to disseminate the latest trial data to practicing surgeons.
To register for an upcoming Alliance Group Meeting, which takes place in Chicago, IL, in May and November each year, you must create a Cancer Therapy Evaluation Program (CTEP) ID. Use the CTEP-Identity and Access Management application to obtain a user account, then complete the NCI registration through the NCI Registration and Credential Repository. If you cannot attend the biannual meetings, you can participate in monthly conference calls.
Participating in the NCTN, and specifically the Alliance and ACS CRP, allows surgeons at all phases of their career—including trainees, academic surgeons, and community practice surgeons—to become more involved with NCI-sponsored clinical trials. For more information, contact ACS CRP at firstname.lastname@example.org.
*NIH National Cancer Institute. NCTN: NCI’s National Clinical Trials Network. May 29, 2019. Available at: www.cancer.gov/research/areas/clinical-trials/nctn. Accessed December 30, 2019.
†American College of Surgeons. ACS Clinical Research Program Committees. Available at: facs.org/quality-programs/cancer/acs-crp/committees. Accessed December 30, 2019.
‡National Cancer Institute. NCI Community Oncology Research Program (NCORP) questions & answers. August 1, 2014. Available at: https://ncorp.cancer.gov/news/ncorp-qa.pdf. Accessed December 30, 2019.