In my experience at Sloan Kettering we have encountered as many have mentioned advantages and disadvantages to using CROs. At Sloan we have an efficient and accomplished clinical department which includes management of clinical trials, contracts, etc and we have established relationships with CROs. However sometimes a sponsor wants to select the CRO and in that case we are basically forced to work with whichever CRO is selected, in these cases, it can sometimes take more time and delays are caused with putting contracts in place, protocols, etc because they are not familiar with Sloan standards and procedures and unfortunately having delays with clinical trials can be costly because especially in the field of oncology where patients need to get onto these clinical trials quickly in order to receive the appropriate treatment. Overall, I think most large institutions with a great clinical management team have existing relationships with CROs, but working with new CROs can prove challenging and can sometimes cause costly delays.