Moderator: Welcome to Viewpoint with our guest, Lance Armstrong. Lance, thank you for joining us. Please get us started by explaining why you are promoting cancer clinical trials.

Lance Armstrong: Thanks for having me. Quite simply, I'm alive today due to the fact that someone long before me participated in a clinical trial; research which is conducted to study treatments.

Rockville, Md.: A lot has been written about your success on the Tour being attributed to your new "redefined body" as a result of your chemotherapy. How has being a cancer survivor helped make you a better racer and person? What do you attribute your success to?

Lance Armstrong: I don't think that chemotherapy necessarily changed my body type completely, while I do think the entire process did. Taking 18 months off the circuit changed me physically and that was the biggest impact, as I lost a lot of muscle which ended up being a good thing.

Ketchum, Idaho: What kind of thoughts did you have when you first learned that you had cancer and what gave you the strength to not only learn about cancer and get so involved with your treatment, but to then also get "back in the saddle" so to speak and keep pursuing your dreams?

Lance Armstrong: I've always preferred to be involved as much as possible in anything I do. So when you talk about an illness like cancer in a life or death situation, then obviously I was extra-motivated to learn and to hopefully become empowered. Oncology 101 ...

Bethesda, Md.: Lance -- as a testicular cancer survivor, I know all too well about the highs and lows associated with this disease. Share with us how you view life differently today than before your diagnosis.

Lance Armstrong: That's a big question with a big answer. Basically, my passion for life, family, and my sport are very different. I try not to take many things for granted, especially my health and the health of my family.

Moderator: Dr. Paul Bunn has joined us. Dr. Bunn, welcome.

Toledo, Ohio: How difficult is it to get access to Phase I trials when you live in a small healthcare market? Do you have any advice to make the process go faster?

Lance Armstrong: Dr. Paul Bunn: Thank you very much. I am honored to be here to answer this and other questions. Clinical trials in general and Phase I in particular are available throughout the U.S., especially in major cancer centers. Available clinical trials can be accessed through several Web sites including www.CancerTrialsHelp.org and www.cancer.gov or ask your local oncologist.

Arlington, Va.: Do feel that the cancer message is starting to get lost amid the cycling publicity? If so, how would you like to change that?

Lance Armstrong: Absolutely. As I said back in 1999, I thought that this message/story would become old hat and that is unfortunate. I try to remind people and tell my story as a cancer survivor as often as possible. Hopefully, in 20 years I'll be remembered as much for being a cancer survivor as a cyclist.

Los Angeles, Calif.: Could you explain the treatment that you recieved for your cancer? Was there surgery? What was the nature of the medication you took? Do you continue to take medication? If so, what kind and how much, and is it in any way regulated by the governing body of cycling?

Lance Armstrong: Basically, I had two surgeries and four cycles of chemotherapy. I started with a protocol called BEP then switched after one cycle to another protocol called VIP which is three different chemotherapy drugs and because of cancer clinical trials both of these were available. I now only take multi-vitamins like everybody else and they are not governed by the UCI.

Columbus, Ohio: Why aren't doctors actively pursing clinical trials for their patients? It appears the patients have to be their own advocates for their care.

Lance Armstrong: Dr. Paul Bunn: I believe patients should always be advocates for their own care and can receive support from support groups and foundations such as The Lance Armstrong Foundation to help in this regard. With respect to clinical trials, there are several obstacles including regulations, lack of infrastructure in the practice setting and lack of education. Several organizations such as ASCO and the Coalition of National Cancer Cooperative Groups are working on reducing the obstacles.

Silver Spring, Md.: Mr. Armstrong, I begin chemotherapy on Monday for adjuvant treatment of testicular cancer. How bad is it? I understand from your book that you went through many more cycles and a much nastier mix of chemotherapy.

Lance Armstrong: How bad is it? It gets worse as you go along. I remember being "disappointed" with not being very sick after cycle one but I quickly realized that the effects compounded. Cycles three and four were very difficult for me. The tricky part for me was that with the VIP 3-drug combination chemotherapy regimen it meant that I had to be an in-patient which was tough.

Arlington, Va.: Lance -- congratulations on your 4th Tour victory!! We hope to follow you next year and cheer you on and USPS in the mountains. My question is this -- do you think the cancer patient's mind/thoughts, or the "will to live," is just as important as the best medicine? Or is it irrelevant? Is there any research into this field? You are such an inspiration to the world, thank you.

Lance Armstrong: It is my opinion that when patients are confident they're getting the best care available then their attitude can greatly improve. When I found Drs. Einhorn and Nichols I was convinced this was my best chance and that led to a positive attitude.

Greenbelt, Md.: When you are attacking for a big win, do you think about or use your cancer experiences as a motivator? Can you describe some of your thought processes if this is true?

Lance Armstrong: Yes, in the sense that I consider those days to be much more difficult than any mountain pass in Europe or any competitor in cycling. Basically, it's a question of perspective and how I now view the competition.

Denver, Colo.: Lance, Dr. Bunn, are there any clincial trials going on for some of the rarer forms of testicular cancer (e.g. extra-gonadal, chlorio, etc.) that don't respond well to BEP or VIP protocols?

Lance Armstrong: Dr. Paul Bunn: Obviously, there are more studies of more common cancers but there are some trials for extra-gonadal testicular cancer and for choriocarcinomas. Many phase I trials are available to patients irrespective of their cancer type.

Research Triangle Park, N.C.: Lance, as a cancer survivor and avid cyclist myself, you've provided inspiration to me and thousands of others. During my treatment I found that finding a single focus was what enabled me to do my part in my recovery. Who or what was your primary focus during that time, and how has this experience changed you?

Lance Armstrong: Easy. I was only focused on living. I was obsessed with everything from tumor markers to chest x-rays and I hung onto those results and was encouraged by their progress.

Bethesda, Md.: Your successes as a cancer survivor and cyclist have brought you to Washington several times. You were here most recently to lobby for increased cancer research funding on Capitol Hill with Senators Frist and Kennedy, and at the White House with your friend, President Bush. Do you foresee an active political future beyond your cycling career -- either cancer related or more generally?

Lance Armstrong: I'm thinking about running for president. JUST KIDDING!!! I can imagine I'll be involved on the Hill and in the Capital relating to cancer for as long as they will listen which may not be forever.

San Francisco, Calif.: How long did it take for you to return to cycling after your treatment was complete? Or did you ever stop?

Lance Armstrong: I actually tried to ride throughout treatment, but returned to serious training about a year later.

Washington, D.C.: Lance, I am an oncology clinical research coordinator. Many people who consider clinical trials as a treatment option become skeptical when we express to them that the trial is not guaranteed to help them, but will definitely provide information to help people with a similar diagnosis in the future. What would you say to these patients?

Lance Armstrong: Dr. Paul Bunn: Before starting any cancer treatment, whether standard or on a clinical trial, it is impossible to guarantee whether or not the treatment will work. The role of the oncologist is to explain the options and then determine whether the treatment worked or not as soon as possible. Clinical trials are unlikely to be worse than standard treatment in part because they are reviewed by many experts and lay individuals before they start.

Springfield, Va.: As a big fan of yours, can you put to rest the rumors about you possibly using performance enhancing drugs during the Tour de France?

Lance Armstrong: No, I've decided that I can't put those rumors to rest. I've tried everything, was drug controlled more than 30 times this year, both in competition and out of competition. Probably more than any professional athlete in the world and I still can't convince them. I give up ...

Arlington, Va.: Both of my parents are cancer survivors, and fortunately both were able to be treated with relatively "standard" methods. When should a patient consider clinical trials? What factors are involved in the decision-making process?

Lance Armstrong: Dr. Paul Bunn: Certainly patients should consider a clinical trial when there are no known effective therapies. For patients who would like to have results better than those available with a standard treatment, a clinical trial should be considered.

Toledo, Ohio: Lance, we were proud to see you included in the September 11th tribute on television. You certainly are an American hero. Thanks for speaking out for the rest of us. All of my friends, as well as my family, have read your book several times and we learn something different each time. Please keep your profile high not only for you and your beautiful family, but also for the sake of all cancer survivors and their families.

Lance Armstrong: Thank you. I will do my best.

Redmond, Wash.: Do you feel pain while you're really pushing yourself in a race, or would you describe it more as suffering?

Lance Armstrong: How about painful suffering? Seriously, I normally refer to it as suffering. I think all humans should suffer a little every day in the exercise sense.

Allen, Texas: You have inspired many people, both in cycling and out of cyling, cancer patients and families. Was there anyone, along with your mother, that inspired you as a cyclist and anyone that inspired you as you went through your a cancer treatment? Who did you look up to?

Lance Armstrong: I had a great swim coach in Plano named Chris MacCurdy who was inspiring to me after we stopped working together. He was tough, disciplined, and focused but I didn't understand that when I was 16. My friends, my family, and my doctors were my heroes while I was sick.

Duluth, Minn.: There has been a lot of bad press lately about people who should not have gone onto clinical trials. Please reinforce that the majority of physicians and research staff are highly ethical, caring people! We won't learn without clinical trials. Thank you for your help.

Lance Armstrong: Dr. Paul Bunn: I would like to strongly reinforce that not only the majority but the overwhelming majority of physcians and research staff are ethical, caring people. The government has increased the number of regulations relating to clinical trials to ensure they are conducted in the most ethical way possible. I agree that the only way to improve the outcome for cancer patients is improvements through research and clinical trials.

San Francisco, Calif.: Dr. Bunn, how do you propose to increase the number of community oncologists who offer clinical trials in their practices, and therefore increase availability of trials for cancer patients?

Lance Armstrong: Dr. Paul Bunn: Many community oncologists already offer clinical trials in their practice. However, about 80 percent of patients entered from community practices come from 20 percent of the practices. ASCO and other organizations such as the Coalition of National Cancer Cooperative Groups are working to provide education and infrastructure to expand the number of clinical trials in the community.

Bound Brook, N.J.: Lance: I, like you, am a cancer survivor (melonoma). I was lucky to catch it early. You were very close to dying from your cancer; do you attribute your success to the doctors and the medication or to your great physical conditioning or both? How much did your being a professional athlete play into your recovery and now thriving? I am a big fan from your triathlete days. You're a great role model for all people who have beat this disease.

Lance Armstrong: Primarily I give credit to the doctors, nurses, and the medicine. I think coming into the illness as a fit person made it easier for me and I think my doctors would agree.

Washington, D.C.: I loved you book "It's Not About the Bike." Will you be writing another in the near future?

Lance Armstrong: Yes, in fact we have started writing the second book with The Washington Post's very own Sally Jenkins. I suspect it will be released next summer.

Denver, Colo.: What are the issues with clinical trials and insurance coverage? Will most people's health insurance cover experimental treatments?

Lance Armstrong: Dr. Paul Bunn: Fortunately, essentially all government and private insurers have now agreed to pay for coverage of patients on cancer clinical trials. The costs of the experimental treatments are covered by the sponsor of the clinical trial.

Los Angeles, Calif.: Are enough people participating in these research studies?

Lance Armstrong: Probably not. It is roughly 3 percent of adults that participate in clinical trials while 80 percent of children do. And we cure 80 to 90 percent of all childhood cancers.

Dr. Paul Bunn: No, we have a long way to go to cure more patients with cancer. The faster the clinical trials are completed the sooner improved treatments will be available. Due to the nation's investment in cancer research we now have more new agents to test than patients to be enrolled on the clinical trials. Thus, the low percentage of patients on trials is slowing research advances.

Lance Armstrong: Thank you for logging on. Clinical trials really do offer hope and pave the way for many more cancer survivors in the future.

Moderator: Our thanks to Lance Armstrong, Dr. Paul Bunn, the Coalition for Cancer Cooperative Groups, Inc., and all who participated.