Ecological analysis of the first generation of community clinical oncology programs

An ecological framework is proposed for assessing factors important to consider in allocating funds to promote sound performance of interorganizational programs.

This framework is used to examine the first generation of Community Clinical Oncology Programs (CCOPs) funded by the National Cancer Institute (NCI) from 1983-1986 to coordinate clinical research activity at the local level. The research reported is based on secondary data collected for the Community Cancer Care Evaluation at the Fred Hutchinson Cancer Center.

A repeated measures design was used to analyze differences in the level and patterns of CCOP productivity, a measure of the number of patients enrolled on NCI-approved Phase III trials. The predictive dimensions include (1) measures of environmental inputs (population density, organizational dominance, professional support, NCI funding); (2) measures of organizational inputs (number of hospitals, number of staff, number of physicians, NCI experience, clinical research experience); and (3) structural measures (functional specialization, administrative concentration). Predicted relationships were assessed using general linear models procedures.

Data obtained from NCI files were supplemented by interviews with NCI personnel and published statistics.

Funding level, clinical research experience, and number of staff are the most important predictors of patient enrollment. Clinical research experience has a positive relationship with patient enrollment and a negative association with changes in enrollment. The reversal is explained by the influence of the CCOPs that had the greatest amount of clinical research experience at the beginning of the program.

The ecological approach provides a useful framework for understanding factors that should be considered in funding interorganizational programs and promoting their development. Most importantly, results suggest that a somewhat different approach is needed to initiate programs rather than to expand existing programs.