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Harper-Grace Hospitals
Harper Hospital Division

March 23, 1981

Dr. Gale Katterhagen

Tacoma General Hospital

Director of Oncology, Consolidated Hospitals
P.0. Box 5277

South K Street

Tacoma, WA 98405

Dear Dr. kasrorhage

Your letter with regard to the opportunity and need to encompass a larger
group of patients into clinical trials in community cancer programs is
encouraging and important. As you recognize, the 40,000 patients now being
entered into clinical trials represent less than 5 percent of the patients
with newly diagnosed invasive cancer this year. We certainly should be
able to do better than that. Not only will the investigations themselves
be important for the knowledge they contribute, but the rigorous quality
assurance program inherent in clinical trials wil] probably improve care
while the information obtained about the history and characteristics of
disease through the data collection of these clinical trials will probably
be more valuable than the relatively scant data collected in the SEER
program.

I congratulate you and your colleagues for your forward-looking efforts
towards development of community cancer programs.

In taking a global look at the National Cancer Program, I feel a sense of
dismay that we do not have a universally agreed upon and effective method
of collecting data with regard to the impact of the National Cancer Program
on: a) the cost of cancer care or, b) the results of improvement in
cancer care. Thus, I feel that the National Cancer Institute would do well
to expand the support to programs such as the current contract with the
National Center for Health Statistics on the cost of cancer care (with
suitable modification of the study mechanism to include all of the costs,
including the cost of detection and definition of cancer and the rapidly
increasing cost of terminal care of patients dying of cancer). Further,
while the SEER program collects some useful information about the incidence
and end-results of cancer, the data are often incomplete and additional
resources will be required for analysis and evaluation. For example, I
would Tike to know the difference in the extent of cervical cancer when
first discovered in black women and white women in New Orleans, Detroit

and in the Seattle-Tacoma area. These areas are covered by SEER programs.
Further, I need to know the end-results of treatment of cancer of the
cervix in New Orleans, the Seattle-Tacoma area, Detroit and Connecticut.

In otherwords, I agree with you that we must give good care to the patient

throughout the entire community of the United States and add that we must

also know the cost of cancer care and the impact of our efforts.
Sincerely,

William E. Powers, M.D.
3990 John R., Detroit, Michigan 48204 Chairman, Dept. of Radiation Oncology