The Jefferson Cancer Network (JCN) is a mutually beneficial association of an academic cancer center, the Kimmel Cancer Center (KCC) of Thomas Jefferson University, with twelve community hospitals in the Philadelphia metropolitan area. One of the primary goals of the JCN is to extend the option of cancer clinical trial treatment to patients of the community hospitals. The KCC benefits by gaining a wider pool of patients for accrual on clinical trials, while the other member institutions benefit by being able to offer the best treatment options to their patients, in their own community.

The World Wide Web (WWW) is being used to communicate information on available cancer clinical trials to the JCN members (http://www.jci.tju.edu). This information consists of the type of cancer being investigated, the overall schema for the treatment, and the criteria for patient eligibility for participation in the trial. There are about 200 cancer protocols active at the KCC. These are cooperative group studies, as well as institutional investigations. Every month, about twenty cancer clinical trials either open or close, or undergo modifications in their specifications. The clinical trials information is therefore both voluminous and frequently changing. The traditional means of disseminating trials information is by mailing paper documents. The receiving institutions then must update existing paper documents, and provide local storage and retrieval systems. By using the WWW, clinicians at any institution can access the most recent data from any desktop workstation with Internet access. Institutions which generate protocol data, such as KCC, can update the WWW information and have the modifications instantaneously available, without the delays and burden of mailing paper documents.

A physician at a JCN hospital who is presented with a cancer patient can search the KCC WWW site for potential clinical trials. Telemedicine is then employed to provide for efficient consultation between the community physicians and the cancer center specialists as to a patient's diagnosis and treatment options. These consultations utilize desktop video conferencing over ISDN lines. Intel Corporation's personal computer (PC) based video conferencing product, ProShare, is used. PC's were chosen for the video conferencing platform because of their low cost and familiarity to community hospital data processing staffs. ISDN was selected for the communications mode also because of its low costs, and since it requires only copper wire, no infrastructure modifications such as fiber optic cabling were necessary at the remote hospitals. Four video conferencing PC's have been installed on the Thomas Jefferson University campus, and five additional units at three other JCN hospitals.

Clinical trial accrual has increased from 4 patients the previous year to 14 patients at the two JCN community hospitals which have had these PC's for a full year. There is no formal evidence to suggest that the increase in accrual rate was a function of the WWW page and the dozen telemedicine conferences held, but anecdotally physicians have expressed that they found the video conferences to be a very efficient and comprehensive mode of consultation, definitely superior to the traditional telephone consult. The ability to view and annotate radiographic and pathology images on the video conference "whiteboard" was cited as the primary beneficial feature of the form of consultation. The collegial atmosphere promoted by both participants being able to see each other during the conference was also seen as a major advantage of this method of consulting over the simple telephone call. From a technical standpoint, mid-bandwidth ISDN has proved suitable for this "talking heads"!video application, and PC SVGA graphics image displays are more than adequate for consultation reviews. The server statistics for the KCC WWW page show several accesses a week from JCN hospitals, which implies that it is a suitable means of obtaining clinical trials information.