The majority of children with cancer (an estimated 70 percent), but only about 2 percent of adults, receive their care through a research protocol, most often sponsored by the National Cancer Institute (NCI, 1998a). There are 35 NCI-designated ''comprehensive cancer centers'' with extensive research portfolios covering basic science, epidemiology, medicine, and public health. Another 23 NCI-designated "basic" and "clinical" cancer centers have research programs with a narrower focus (Figure 2.3). In addition to conducting research, NCI-designated cancer centers also provide community outreach activities and public education (NCI, 1999).

NCI's Cooperative Group Program conducts and promotes multi-institutional clinical trials. Twelve cooperative groups involve 1,700 institutions and 6,000 investigators throughout the United States, Canada, Europe, and Australia. Each year, approximately 20,000 new patients participate in cooperative group clinical trails (NCI, 1999).

The Community Clinical Oncology Program (CCOP) links community cancer specialists and primary care physicians with clinical cooperative groups and cancer centers to conduct clinical trials. There are currently 48 CCOP offices in 30 states, with 330 participating hospitals at which some 2,300 physicians enter individuals into NCI-approved clinical trials. An additional seven minority-based CCOPs enhance the participation of minority populations in clinical trials. Altogether, more than 4,000 patients are entered into NCI-sponsored cancer treatment clinical trials each year through CCOPs and an additional 4,000 participants are entered into cancer prevention and control clinical trials (NCI, 1999).