versity of Texas M. D. Anderson Cancer Center,. Houston, Texas. .... program is directed toward small business and pre- .... ipating in conference calls, delays in protocol devel- opment .... how best to combine them with state-of-the-art can-.
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Second International Conference on Cervical Cancer Supplement to Cancer
Grantsmanship and Career Development for Gynecologic Cancer Investigators Edward L. Trimble, M.D., Maria Bell, M.D.2 Judith Wolf, M.D.3 Ronald Alvarez, M.D.4
M.P.H.
1
1
Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland.
2
Department of Obstetrics and Gynecology, Sioux Valley University Hospital, Sioux Falls, South Dakota.
3
Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
4
Department of Gynecologic Oncology, The University of Alabama–Birmingham, Birmingham, Alabama.
The gynecologic cancer investigator faces many challenges. Successful career development requires choosing commitments wisely after completing clinical training, earning board certification, and completing a fellowship. Finding protected time for research requires cooperation from the department chair, and lining up funding for research begins with the researcher’s own institution and stretches as far away as European funding groups. State and federal agencies, particularly the National Cancer Institute, offer a wide range of opportunities to obtain funding and to seek information about how to shape research and applications. Professional societies and charities also fund initiatives. Advantages of working with a clinical trials cooperative group include large fund reserves, centralized data management, statistical support, the potential of rapid accrual from multiple sites, and an established infrastructure. Seeking multiple sources of funding probably is wise, and meeting grant deadlines requires organization and planning. Working with industry requires legal review; avoiding conflict of interest; working with appropriate federal agencies, such as the U.S. Food and Drug Administration; and careful review of contractual agreements. Today’s successful investigator who wants to reduce the burden of cervical cancer seeks funding from multiple sources, including industry; makes use of the consulting advice available from state and federal governments and nonprofit organizations; establishes clear channels of communication; and consults appropriate legal and scientific advisors in planning a trial. Developing a successful academic career with a focus on research in gynecologic cancer requires planning and a supportive environment. Cancer 2003;98(9 Suppl):2075– 81. © 2003 American Cancer Society.
KEYWORDS: grantsmanship, economics, health care economics and organizations, organized financing.
C Presented at the Second International Conference on Cervical Cancer, Houston, Texas, April 11–14, 2002. Address for reprints: Michele Follen, M.D., Ph.D., Center for Biomedical Engineering, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 193, Houston, TX 77030; Fax: (713) 792-4856; E-mail: mfollen@ mdanderson.org Received October 31, 2002; revision received February 13, 2003; accepted February 20, 2003. © 2003 American Cancer Society DOI 10.1002/cncr.11683
entral to effective research on gynecologic cancer is the academic investigator. The path to a successful academic career, including major contributions to the field, often is meandering, poorly lit, and blocked by obstacles. The purpose of this article is to illuminate the various potential paths, point out barriers to avoid, and help new investigators reach their goals as fast as possible.
Career Development After completing clinical training, new investigators must find a job, earn board certification, and work toward an independent research career. The last years of fellowship generally are hectic, taken up with completing research projects, conducting clinical care, seeking advice from peers and mentors, and interviewing for jobs. New investigators should look for a job with the possibility of adequate time for additional training if needed, time for research, and time for family life. Often, young faculty members are pressed to see patients and operate
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at least 4 days per week, with the possibility of 1 day per week devoted to research. This research day often may be eaten up with making rounds, seeing consultations, performing emergent operations, telephoning patients and referring physicians, dictating charts, attending department and divisional conferences, and completing paperwork. Such a schedule will generate adequate cases for board examinations in gynecologic oncology as well as billings for the department. However, such a schedule will not permit time to make major strides in cancer research. Institutional and/or grant support to buy research time is essential. Support and understanding from division chairs and department directors, translated into limited clinical responsibilities, adequate administrative support, and seed money to begin research projects, is critical. The young investigator must negotiate for adequate time and support for research when taking a new job. In addition, it is important to schedule regular reviews with division directors and departmental chairs, because they have been known to overlook previous commitments. New investigators also should avoid extensive time commitments to institutional committees. Participation in medical school admissions, pharmacy, credentials, and operating room committees often will take up valuable nonclinical time, which otherwise may go to research. Some committees, such as Institutional Review Boards (IRBs) and cancer research committees, may be helpful, because their work can provide a broad overview of clinical research and help new investigators meet potential collaborators and mentors within the institution. Suppose, for instance, that, as a new investigator, you have taken a job at a university hospital or cancer center with a commitment of time for research and seed money from the division director and department chair. Next, you should define a research program for the next 5 years and 10 years. This should take into account the criteria for promotion at your institution, obligations for clinical work, institutional commitments, requirements for board certification, and family imperatives. In addition, the research program should take into account your existing research skills, research interests, the available patient population, nearby resources, and potential mentors. There are many potential areas for research, including laboratory, clinical cancer treatment, health services delivery/outcomes, epidemiology, cancer prevention, and quality of life. To date, most gynecologic oncologists with an interest in research have focused on laboratory research or clinical cancer treatment, overlooking many opportunities in outcomes, epidemiology, cancer prevention, and quality of life. In many areas of cancer research, potential mentors may be in
other departments or institutions. You should explore the strengths of your medical school and nearby institutions, find out who is doing exciting work, and determine whether you might collaborate with them. Do you need additional training? You may decide you need a Ph.D. or a master’s degree in public health, epidemiology, or public administration.
Grantsmanship Next, you need to start lining up funding for what you want to do. You probably will need to line up funds to buy your research time, as discussed above. Begin with your own division, department, and institution. Often, there is seed money available for young investigators. Become familiar with the grants office at your institution. The staff there can give you leads on potential grants programs. Find out whether your institution has training grants. The National Cancer Institute (NCI) sponsors several institutional training grants to help develop clinical cancer researchers. In addition, the National Institute of Child Health and Human Development sponsors 20 Women’s Reproductive Health Research Career Development Centers in medical schools around the country. These centers are set up to help develop researchers in obstetrics and gynecology, including gynecologic cancer. The National Institutes of Health (NIH) also pays for General Clinical Research Centers in many university hospitals. These centers can help pay for the clinical care costs of patients on research protocols, including office visits, hospital stays, and laboratory tests. You also should explore grants offered by professional societies and charities. Gynecologic oncologists have won grants from the Gynecologic Cancer Foundation, the American College of Obstetrics and Gynecology, the American Gynecologic and Obstetric Society, the Berlex Foundation, the American Society of Clinical Oncology, the Society of Surgical Oncology, the American College of Surgeons, and the American Cancer Society. In addition, should use the grant search mechanisms available over the Internet, including the Community of Science, the Foundation Organization, the Grantsmanship Center, Grantsnet, and Sciencewise. Some of these require yearly subscriptions. Institutional grants offices often subscribe to these services. State governments are another potential source for grants. Some states, such as California and Pennsylvania, have small programs that support cancer research in their own states. In addition, many more states have earmarked some of the money they have received as tobacco restitutions funds for cancer research. The largest governmental source of grants, of
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course, is the federal government. Grant support for cancer research can come from many agencies in addition to the NCI. These include the Agency for Healthcare Research and Quality, which funds outcomes research, the Food and Drug Administration (FDA) (orphan drug development), the Center for Medicare and Medicaid (health care delivery), the Health Resources and Services Administration (also health care delivery), and the Indian Health Service. The Centers for Disease Control include the National Center for Chronic Disease Prevention and Health Promotion, which runs the National Breast and Cervical Screening Program and the National Center for Health Statistics. In addition, the U.S. Department of Defense Office of Congressionally Mandated Medical Research funds $10 million of research in ovarian cancer each year. Various institutes at the NIH fund cancer research. These include the National Human Genome Research Institute (genetics of cancer), the National Institute on Aging (cancer in older patients), the National Institute on Allergy and Infectious Diseases (sexually transmitted diseases, including human papillomavirus), and the National Institute for Child Health and Human Development (faculty development in obstetrics and gynecology; centers for multidisciplinary research in women’s health, ovarian, endometrial, and uterine biology). In addition, under the NIH umbrella and of interest here are the National Institute of Biomedical Imaging and Bioengineering and the National Institute for Nursing Research. The big gorilla in federally funded cancer research, of course, is the NCI. NCI funds training in Bethesda, training and research elsewhere in the United States, and research around the world. Training programs in Bethesda include the NCI Scholar’s Program, which was designed to help young investigators who have completed their clinical training get laboratory training and fellowships in cancer prevention. Beyond Bethesda, the NCI funds training in basic science (through the K08 mechanism), epidemiology and prevention (through the K07 mechanism), and clinical research (through the K23 mechanism). In addition, the NCI has a wide range of training programs for minorities under-represented in medical faculties, called the Continuing Umbrella of Research Experience program, which supports young investigators at every level from high school through postdoctoral positions. The NCI funds laboratory research through various grant mechanisms. On the smaller side would be an R03, for a correlative study linked to a clinical trial. A larger grant for one specific project would fall under the R01 mechanism. The program project, or P01, covers a series of related projects. The NCI currently
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funds two program projects in ovarian cancer (one at Memorial Sloan-Kettering Cancer Center and one at the University of California–San Francisco and The University of Texas M. D. Anderson Cancer Center jointly) and two program projects in cervical cancer (one at The University of Texas M. D. Anderson Cancer Center and one at the Johns Hopkins University School of Medicine). A more recent development is the Specialized Program of Research Excellence (SPORE), a center for translational research focused on one anatomic cancer site. The NCI currently funds four SPOREs in ovarian cancer, at the Fred Hutchinson Cancer Research Center, The University of Texas M. D. Anderson, the University of Alabama–Birmingham, and the Fox Chase Cancer Center. The NCI has two grant programs to help develop new products, one for academic researchers (the Small Business Technology Transfer [STTR] Program) and one for small businesses (the Small Business Innovation Research [SBIR] Program). The STTR Program is meant to stimulate innovation and produce advances that meet the nation’s scientific and technological challenges. This program is directed toward small business and premier nonprofit research institutions. The SBIR Program offers small businesses opportunities to develop technological know-how into products that can bring profit. Funds encourage research and development efforts in small businesses that, usually, only larger businesses can afford. Familiar to most researchers are extramural funding opportunities called Requests for Applications (RFAs) and Program Announcements (PAs and PARs), which offer funding to investigators in specific areas identified by the NCI. PAs and PARs for a recent year, for example, included small grants programs for cancer epidemiology and a mentored clinical scientist award for under-represented minorities. RFA topics have included chemoprevention trials and cancer disparities research. Gynecologic cancer investigators should find out which areas of cancer research have been highlighted by the NCI for special attention. Each year, the NCI publishes on its website and on paper a document called the Bypass Budget. This document describes the NCI’s priorities for cancer research (available from URL: http://plan.cancer.gov). For 2004, these include the following: building the nation’s cancer research capacity; enhancing investigator-initiated research; expanding the capacity of centers, networks, and consortia; national clinical trials program in treatment and prevention; developing bioinformatics for cancer research; advancing discovery and its application; genes and the environment; signatures of the cancer cell and its microenvironment; molecular targets of prevention and treatment; cancer imaging and molec-
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CANCER Supplement November 1, 2003 / Volume 98 / Number 9 TABLE 1 National Cancer Institute Supported Clinical Trials Cooperative Groups Conducting Research in Gynecologic Cancers Cooperative group Within the U.S. American College of Radiology Imaging Network Children’s Oncology Group Gynecologic Oncology Group Radiation Therapy Oncology Group Southwest Oncology Group Outside the U.S. National Cancer Institute of Canada Clinical Trials Group European Organization for Research and Treatment of Cancer Gynecologic Cancer Cooperative Group
ular sensing; cancer communications; addressing areas of public health emphasis; improving the quality of cancer care; reducing cancer-related health disparities; cancer survivorship—improving treatment outcomes and quality of life; and research on tobacco and tobacco-related cancers. In addition, from time to time, the NCI will advertise Initiatives in Extraordinary Opportunity Areas as well as disease specific research initiatives. Research recommendations arising from the Gynecologic Cancer Progress Review Group may be found on the same NCI website. Investigators also may wish to see what grants already are funded by the federal government in their area of interest. This data base, called CRISP, may be accessed through the main NIH grants website (available from URL: http://grants1.nih.gov/grants/ oer.htm; the counterpart website for the NCI may be found at http://researchportfolio.cancer.gov). The NCI also funds various tumor banks and tissue-acquisition programs to help support research in gynecologic cancer. These include the Cooperative Human Tissue Network (CHTN), the Gynecologic Oncology Group Tumor Bank, and the ovarian cancer SPORE grants. The CHTN can collect tissue prospectively to meet the needs of the requesting researcher. Only basic clinical information is linked to these specimens. The Gynecologic Oncology Group Tumor Bank, however, collects specimens from patients enrolled in cancer treatment trials and from patients who do not enter trials. These specimens are linked to more extensive clinical information. Finally, the four ovarian SPORE projects collect benign and malignant ovarian tissues. The NCI funds clinical research through SPORE grants, other grants, the cancer centers program, the Clinical Trials Cooperative Groups, and the Clinical Community Oncology Program. Individual trials may
Type of research
Cervical cancer Rhabdomyosarcoma, germ cell tumors All gynecologic malignancies, except rhabdomyosarcoma Cervical and endometrial cancers Ovarian, endometrial, and cervical cancers
All gynecologic malignancies except rhabdomyosarcoma
be supported by the quick trials mechanism (R21), R01 grants, and P01 grants. Cancer center core grants include funding for data management, statistics, and laboratories, all of which can be used to support clinical trials at each cancer center. The Clinical Community Oncology Program is a network of community hospitals and oncology practices that conduct cancer treatment and prevention trials. Clinical Trials Cooperative Groups that conduct studies in gynecologic cancers include the American College of Radiology Imaging Network, which conducts imaging studies in cancer patients (Table 1). The NCI also helps support the cost of data management and statistical operations for clinical trials conducted by the National Cancer Institute of Canada Clinical Trials Group and the European Organization for Research and Treatment of Cancer. Other NCI-funded multiinstitutional consortia conducting gynecologic cancer research include the Cancer Genetics Network and the Early Detection Research Network, both of which have initiated major projects in ovarian cancer. The clinical trials cooperative groups conduct Phase I, II, and III treatment trials; Phase II and III prevention trials and correlative laboratory studies; as well as collecting specimens for tumor banks. Advantages of working with a cooperative group include the presence of a large sum of money earmarked for clinical trials, centralized data management, statistical support, the potential of rapid accrual from multiple sites, and an established infrastructure for clinical trials. The disadvantages of working with a cooperative group include the potential of competing studies, the time commitment for attending meetings and participating in conference calls, delays in protocol development, and the inertia inherent in a large organization. The steps for developing a protocol through one
Grantsmanship and Career Development/Trimble et al.
FIGURE 1. Steps a cooperative group might follow in developing a clinical trial protocol. NCI: National Cancer Institute. of the NCI-sponsored cooperative groups are shown in Figure 1. Protocols originate with a one-page to two-page concept, which is reviewed at each cooperative group’s semiannual meeting. Each concept is assigned generally to a primary committee, and it also may be reviewed by a modality committee. If the concept meets with approval at these initial stages, then it is forwarded to the group’s main scientific review committee, which can approve, reject, or table it. If it is approved for further development, then the group’s scientific leadership will rank it against other approved concepts. The author of the concept will then need to work closely with the assigned statistician, protocol development staff, and cochairs from other modalities to draft a complete protocol. In general, the group’s scientific review committee reviews the protocol before forwarding it to the NCI for additional review. The NCI must approve all protocols that involve more than 100 patients as part of the cooperative agreement between the NCI and each cooperative group. At maximum efficiency, this process may take 6 months; if it is held up for a variety of reasons, it may take as long as 3 years. In general, we recommend that you seek multiple sources of support for the same project. For example, your salary support may come from a K23 grant, funds to run the clinical trial from a cooperative group or R21 grant, and funds for the translational research component from a SPORE, R03, or foundation grant. NCI project officers, program staff assigned to work with grant applicants and investigators, can advise you on the various potential mechanisms to support your research. Once you decide which grant mechanisms may help support your research, you need to concentrate
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on drafting competitive grant applications. Talk to previously successful applicants for advice. If possible, get copies of successful applications. Make sure you keep track of deadlines for grant submissions. Find out what application forms are required. Most NIH and NCI grants require one specific form called a Public Health Service (PHS) 398 form. Some nonprofit foundations use this form as well. Others may have less complex forms. Line up your mentors and collaborators. Do you need the help of other clinicians for access to patients and specimens? Do you need laboratory scientists, epidemiologists, or social scientists? Who will help you with biostatistics? Treat all of your collaborators as colleagues, not hired help. Get supporting information from your mentors and collaborators, including their previous grant applications, other sources of funding, relevant publications, and the NIH two-page biographic sketch. Line up your research team. You may need research nurses, laboratory technicians, data managers, and secretarial help. Make a checklist and time line. In most cases, your grant will need to be signed off by the department chair, department administrator, and the institutional office of research administration. The office of research administration often takes 1–2 weeks to review grant applications before approving them. You also will need to develop a budget with your department administrator. Do you need letters of support and commitment from your division director and department chair? You may have to draft those letters yourself and hand-carry them to your division director and department chair to get them signed on time. Do you need IRB approval of the proposed research? This may take 2– 6 months, depending on your institution. Find out whether electronic submission of your application is available. The PHS 398 form can be downloaded as a PDF file. Grant-writing software for the PHS 398 form also is available. Review the NCI advice on completing the PHS 398 form (available on the NCI website under Resources for Scientists). Give yourself enough time to write the grant. You will need a minimum of 50 productive hours, not including evenings and weekends, when you are brain dead from clinical work. Ask your division director and colleagues for protected time. Cancel clinics and the operating room if possible. You also should clear your schedule the week before the due date for last-minute crises. The key elements of the PHS 398 form are as follows: Description, Budget, Resources, Research Plan, Introduction, Specific Aims, Background and Significance, Preliminary studies, and Research Design and Methods. The Description section should give
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the big picture. Why is this issue important? What do you propose to do? What are your endpoints? The Budget should include salary support, consultants, equipment, supplies, travel, patient care costs not covered by third-party payers or the institutional general clinical research center. Be realistic about costs. Reviewers may be put off if you ask for too much or little time. Under Resources, you should list what is already in place to help you do the proposed work. The Research Plan generally takes the most time. Get preliminary reviews from friends and colleagues. Ask your collaborators to review it and make sure it is complete. If you have time, ask NCI program staff to review a draft. Do not forget the section on gender and minority inclusion, human subjects, and vertebrate animals. Even though gynecologic cancers do not occur in men, you need to state that fact in the grant. Check the grant deadline 2 weeks ahead of time to make sure that you have the correct date and time. Send it by overnight express mail or hand deliver it. If submitting electronically, make sure you get a confirmation that it was received. Use mail only as a last resort. If delays are unavoidable, due to fire, floor, earthquake, blizzard, death in the family, then call the program officer and ask for an exception. Send copies of the grant to all collaborators and mentors. After you submit the grant application, do not forget to follow up on it. Some grant mechanisms allow you to submit additional information just in time for the grant review. This can include new publications and new data. Find out from the project officer when the grant will be reviewed and whether the project officer will be at the review. When you receive your grant review, call your project officer and the Scientific Review Administrator who ran the review and ask for feedback. Often, they can indicate changes that would strengthen the application. Do not get discouraged easily. Very few people get their first grant funded. Revised resubmissions of grants have better success rates than initial grant applications. In addition, you should be ready to cut and paste one grant application to make it fit another application from a different funding source.
Working with Industry Although the NCI is the big gorilla of cancer research dollars coming from the federal government, NCI research monies are dwarfed by those from industry. In 2000, the pharmaceutical companies in the United States estimated that their combined budgets for research and development totaled $6 billion. Academic investigators should know how to interact with industry. Historically, academia and industry had different
primary goals and different perceptions of primary success. It was believed that the academic investigator cared about expanding the understanding of science to benefit the public, whereas industry was interested in developing a successful commercial product. The academic investigator wanted publications, grants, and promotion; industry was interested in revenue and profits. These old stereotypes are not particularly helpful today, however. Both academic investigators and industry want to accelerate the development of new interventions to prevent and cure cancer. To make progress, academia and industry need to cooperate with one another. Industry needs the expertise of academia in designing and conducting clinical trials. Academia needs to evaluate the new products emerging from industry to determine whether they work and how best to combine them with state-of-the-art cancer care. Both sides need to avoid conflicts of interest and understand the limitations inherent in developing new therapies. Out of 5000 good ideas, for example, only 5 ideas may end in human clinical trials. Of these 5 ideas, on average, only 1 idea wins approval from the FDA. The average cost to bring a new pharmaceutical agent to market is $800 million. We do not know whether the development of new targeted therapies for a smaller patient population will prove more or less expensive. Currently, 300 new cancer agents are in development, yet only 2–3% of all cancer patients enroll in clinical trials. Let us explore various examples of how an investigator may work with industry. Suppose that, as a gynecologic investigator, you develop a new treatment for cervical cancer. It could be a silver bullet. It works in cell culture and mice. You present the results at the annual meeting of the American Association for Cancer Research and publish your article in Nature or Cancer Research. Now, a small biotechnology company wants to buy the rights to your treatment. What do you do? First, contact your institution’s legal department and intellectual property representative. Have you patented your new treatment? Do not sign anything without legal review. Let us say that you end up signing a contract that allows the small biotechnology company to develop your new therapy, with royalties from any profits going to you and your institution. Next, the small biotechnology company will need to conduct animal toxicity studies and Phase I trials in adults. Once a safe dose, schedule, and route of administration have been identified, they are ready to start clinical trials. Should you conduct the trials? Probably not, because there would be an apparent conflict of interest. You want the drug to work in humans. After all, you developed it. You cured mice
Grantsmanship and Career Development/Trimble et al.
with it. In addition, if it works, then it may make you rich and famous. So, let someone independent conduct the clinical trials. That way, there will be no doubt about the results. However, you certainly may advise on the design of the trials. If the initial trials confirm activity against cancer, then you and the biotechnology company will need to go to the FDA and ask for advice on the design of a definitive clinical trial or trials. The biotechnology company also can get the help of the NCI in developing clinical trials for the drug and working with the FDA. Let us say that the key licensing trial or pivotal study demonstrates efficacy. Then, the biotechnology company may sign a deal with one of the big drug companies to help bring the drug to market. You become rich and famous. Now, what if the company has developed the drug and you would like to study it? You will need to contact the company and express your interest in their new agent. You also should talk to other physicians who have collaborated with the company to ask their advice. Is the company already conducting a trial similar to the one you are proposing? Is this company an easy one with which to work? Sometimes, the company designs a trial and needs help accruing patients. It may want you to act as the local principal investigator and recruit patients to the study at your institution. They will pay you a set amount of money for each patient. You have to get the trial approved by your local IRB. Generally, you cannot make any changes to the protocol. Conversely, you can design the study and present it to the company. Their medical board will then review your proposal. If they approve the study, then you will need to negotiate with the company about various aspects of the trial. Here, you need to get your institutional lawyer involved early. The contract between the company, you, and your institution should cover details for the protocol, responsibility of each party, ownership of the results, confidentiality, and compensation. In general, as the principal investigator, you are responsible for getting approval from your local IRB, recruiting patients, getting informed consent, treating patients on the protocol, and maintaining meticulous study records. The company or sponsor of the trial is responsible for providing the experimental agent, monitoring the study, supporting data analysis, and complying with the regulatory requirements of the
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TABLE 2 Federal Web Sites Useful for Grants Organization
Web site URL
National Cancer Institute National Cancer Institute Plans and Priorities National Cancer Institute currently funded research projects National Institutes of Health Office of Extramural Research
http://www.cancer.gov http://plan.cancer.gov http://researchportfolio.cancer.gov http://grants1.nih.gov/grants/cer.htm
FDA. You should ask the company for per capita reimbursement. This may need to be prorated by treatment cycle or visit. In addition, you should ask for financial support for your time as well the time of nurses and data managers who will be working on trial. Let us say that you, your lawyers, the company, and their lawyers finally reach an agreement. You will need to have a face-to-face meeting with all the involved parties to go over the details of the trial. This should include you, any other physicians at your institutions who will have major involvement with the trial, the research nurse, the study coordinator, the data manager, the medical expert from the company, and the company contact person. You will need to review every detail of the protocol, the case report forms, and the plan for reporting toxicity. You also should establish clear channels of communication. You need to be able to contact the appropriate people at the company quickly (say, within 1 working day), and they need to be able to contact you equally quickly. Without this communication, you will not be able to conduct a good trial, and no one benefits: not you, the company, or the patients who agree to try this new experimental agent.
Conclusions Developing a successful academic career focused on research in gynecologic cancer requires planning and a supportive environment. A variety of funding sources, including federal, state, nonprofit, and corporate sources, are available to investigators. See Table 2 for particularly useful federal websites. Investigators should be prepared to use all of these resources to help reach their goal of reducing the burden of gynecologic cancer.
