The Essentia Health Community Cancer Research Program (EHCCRP) was originally funded by the National Cancer Institute in 1984 under the former name Duluth CCOP. EHCCRP brings the benefits of clinical research to patients in regions that would be without access to clinical trials due to the distance from the nearest comprehensive cancer center. With successful competitive CCOP grant renewals in 1987, 1990, 1995, 2000, 2005 and 2010, as well as a successful NCORP grant in 2014, EHCCRP has proven to be a sustainable and successful community oncology research program over the span of 34 years. Since the NCORP grant inception in 2014, the EHCCRP has continued its expansion in rural communities by adding additional affiliates and sub-affiliates. The EHCCRP catchment area now covers portions of five states (MN, WI, MI, ND, SD). This large geographic area is predominantly rural and includes a number of American Indian tribal communities. The strategy of the EHCCRP NCORP is to continue to offer patients in the region access to state-of-the-art cancer care through participation in NCI supported treatment, cancer control/prevention, screening, post treatment-surveillance, and imaging protocols. The NCORP grant will support the infrastructure and personnel necessary to fulfill our proposed research strategy in our catchment area. In addition, the EHCCRP NCORP will continue to develop a robust Cancer Care Delivery Research (CCDR) program; to participate in NCI supported CCDR protocols. The Alliance for Clinical Trials in Oncology will function as the primary research base for the EHCCRP and secondary research bases will include the NRG, ECOG-ACRIN, SWOG, and Wake Forest. The EHCCRP NCORP will continue to open trials through the Clinical Trials Support Unit of the NCI with full utilization of the central IRB. The goal of the EHCCRP is to accrue 350 patients annually to treatment, cancer control, prevention, screening, imaging and post-treatment surveillance protocols. EHCCRP CCDR infrastructure will grow over the coming NCORP grant period to support 6 open CCDR protocols annually. A robust culture of cancer care that supports multi-disciplinary treatments allows us to deliver the best possible therapy while maintaining a high level of accrual to clinical trials. .