Background

Cancer has become the leading cause of death in Taiwan since 1982. Approximately 75 percent to 80 percent of cancer patients will succumb to their illness no matter how sophisticated the management provided. Several reasons are considered to explain why the cancer survival is unacceptably low in Taiwan:

1. Most cancer diagnosis was made at advanced stage.
2. Poor cooperation of patients for treatment.
3. Common types of cancer in Taiwan are apt to have intrinsic or acquired drug resistance.
4. Suboptimal and divergent management of cancer treatment between individual oncologists and leading medical centers.
5. Lack of adequate number (or critical mass) of qualified oncologists.

Therefore, training, education and reorganization of the oncologists to form a cooperative team for clinical research have become the critical steps to reduce cancer death.

Taking the Eastern Cooperative Oncology Group (ECOG) of the United States as an example, the Taiwan Cooperative Oncology Group (TCOG), established in 1989, is the first organization in Taiwan to conduct multi-center clinical trials for cancer treatment and is now the largest cooperative medical group in Taiwan. It can utilize the resources of patients effectively, ensure the safety and ethics of clinical trials, and establish therapies through a strict monitoring system for data gathering and patient-follow-up. By these, the integration of diagnostic technology and consensus of treatment for cancer in Taiwan are possible.

TCOG provides a research platform to push the investigator-initiated clinical researches of major cancers in Taiwan, participates in several international breast cancer trials by being the member of the Breast International Group (BIG), and also conducts transnational clinical trials cooperative with NHMRC Clinical Trials Centre, University of Sydney, Australasian Gastro-intestinal Trials Group (AGITG) and Japan National Cancer Center Hospital. Besides, TCOG invites oncologists to obtain their consensus on cancer therapy guidelines for improving clinical practice across the country. These clinical guidelines offer patients and their family a correct direction, and clinicians a reference of standard cancer managements as well.

TCOG has also involved and executed several special MOHW projects, such as “Accreditation of Cancer Care Program” and “Site Specific Clinical Reference groups – Develop and monitor Core Measurement Indicators for Cancer Screening and Treatment” to facilitate the quality of cancer patient care in Taiwan. The accreditation was carried out for hospitals with 500 or more new cancer patients per year since 2008. The results are post on web and are also included in accreditation of hospitals and medical center task indicator evaluation. Therefore, these conclusions will improve the quality of cancer treatment and patient care, and also provide cancer patients with the safe treatment environment. In addition, TCOG has involved in clinical investigator developing programs for junior medical faculty staffs to support domestic cancer research.

The aims of TCOG are:

• To promote high quality clinical research.
• To facilitate multi-center oncology trials.
• To develop new modalities of treatment, e.g. new drugs, immunotherapy, differentiation therapy, antiangiogenesis and gene therapy.
• To set up the guideline for diagnosis, prevention and treatment of cancer.
• To improve cancer treatment and care.