Background: Within past decade NCI has implemented two major initiatives to improve CT participation and quality of cancer care in the community setting. Catholic Health Initiatives (CHI) St. Francis Cancer Treatment Center in Grand Island Nebraska was one of the privileged community cancer centers to participate in both programs. Methods: During the last 3 years of NCCCP and first 3 years of NCORP, data on CT activities including number/percent of patients, underserved populations on CTs, number/type of CTs, staffing, organizational infrastructure/linkage to National Clinical Trials Network (NCTN), and access to cancer treatment (CRx), cancer control/prevention (CC/P), cancer care delivery (CCDR) trials were gathered and compared. Results: CT enrollment increased from 512 (30%) during NCCCP to 518 (36%) during NCORP (P = 0.0005). All patients were rural Nebraskans, 70% older than 60. Total CTs increased from 45 during NCCCP to 125 during NCORP. Major increases in NCTN trials/accruals were seen during NCORP. Staffing increased by two. Organizational infrastructure/linkage to cooperative group (CG) trials was with CALGB through an academic affiliation and academic IRB during NCCCP and with ECOG-ACRIN, SWOG, NRG, ALLIANCE through CHI-NCORP and central IRB of NCI and/or CHI during NCORP. Conclusions: Participation in both NCI programs positively impacted CT related activities and expanded research with enhanced access to quality cancer care. NCORP provided a robust NCTN linkage resulting in a record high CT portfolio. This preliminary comparison between two strong NCI initiatives may help for design of future programs.