The Sanford Community Cancer Program (SCCP) remains committed to its original goals and aims as stated in our 2013 application. The SCCP continues to increase patient participation in cancer control, prevention, care delivery, treatment, and imaging studies across its expanding network. The rural communities of the upper Midwest and Central Plains represent a large underserved population for cancer treatment, care delivery and clinical trials (PMID:24097196 PMID:22046848 PMID:19621978). The reasons for this disparity are multifactorial but a main obstacle is access to services in rural regional areas. Sanford Health has developed a network of hospitals, cancer centers and clinics to provide high-quality, multi-disciplinary cancer treatment, clinical trials, and cancer care delivery to this underserved area. Sanford Health has designated cancer care as a Center of Excellence; elevating cancer care as a top priority to the patients it serves. The SCCP has expanded from five to seven components in the past five years, adding two new components to improve trial access in rural and underserved areas. It is hypothesized that this disparity in care for this rural population can be improved by utilizing the organized SCCP network community. This proposal describes how the NCI Community Oncology Research Program (NCORP) partnership will help deliver clinical care and offer clinical trials across the rural area served by the SCCP. This will be accomplished through the following aims: 1. Maintain and enhance robust accrual to NCI Division of Cancer Prevention (DCP) supported clinical trials through seven components. 2. Address disparities in clinical trial accrual in underserved and underrepresented populations to increase participation. 3. Cultivate innovative access points to address barriers to clinical trial accrual through outreach and telemedicine. 4. Expand Cancer Care Delivery Research infrastructure. Through these four aims the Sanford Community Cancer Program will continue to offer NCI clinical trials and provide state-of-the-art cancer treatment and cancer care delivery to millions of people across six states in rural America. The SCCP's ability to provide clinical trials through outreach and telemedicine to this underserved rural population of patients increases their opportunity for participation in a trial as a treatment option. Telemedicine services are currently provided in existing Sanford Clinics in rural communities to deliver oncology consultations, surveillance exams and chemotherapy oversight. As a community based health care organization, the SCCP will participate in the development and implementation of cancer care delivery research to better understand and improve patient outcomes. The SCCP will design and develop additional community based investigator-initiated Cancer Care Delivery pilot projects with the goal to collaborate with the SCCP's primary Research Bases.