The community physician's involvement in clinical trials and home treatment

The advances in outcome of children with cancer in the last four decades have been remarkable. The improvement, however, has not been uniform. It has recently been shown that the outcome of children with medulloblastoma treated at nonuniversity cancer centers has been less successful than those who were treated at the university cancer centers. Protocol treatment and location of treatment has been correlated with outcome in children with acute lymphocytic leukemia. Cooperative group protocols, used in the clinical setting of pediatric oncologists, with extensive resources and major referral center backup, have improved the prognosis of childhood ALL. Therefore, to improve outcome of pediatric cancer patients a multidisciplinary team at a center with partnership of community physician (CP) would be helpful. The CP can assume an extremely important role in shared management of children with cancer. Major involvement can be anticipated in areas including: chemotherapeutic treatment, immunization, infection surveillance and treatment, detection of disease recurrence, and late effects of cancer treatment. A CP could decrease the financial burden, and help alleviate the anxieties and emotional stresses placed upon the patients and parents. More importantly, the CP can facilitate home terminal care when necessary. These CP-referral center arrangements are of value to the CP, as well, through their educational and psychological benefits.