Cancer is by nature unfair, capriciously stalking children and grandparents, corporate presidents and clerks, super athletes and shut-ins. Still, there is a sense that this most feared of afflictions is an act of fate, rather than anyone's fault.

The same cannot be said, however, for the access to cancer treatment. Too often, patients are left to their own devices in the search for the best possible medical care, cancer experts and patient advocates say.

Forced to make their way through a morass of options, patients find themselves physically and emotionally exhausted by the very search for cancer treatment. And this, some say, has nothing to do with fate, but is the sad consequence of a disjointed, unwieldy treatment system unable to keep pace with almost continuous research advances.

"Technology and the ability to access technology are miles apart, particularly if you're not well-endowed with good health insurance," says Selma Schimmel, founder and director of Vital Options, a Studio City-based support organization for young adults with cancer.

Dr. Bruce Chabner, director of the National Cancer Institute's division of cancer treatment, acknowledges that many advances that spring from government-funded research do not become available to everyone who could benefit from them.

"People hear about all the wonderful things scientists are finding out and doing and they say: 'Where are the applications?' There is a large amount of our population that doesn't have access to these things," he says.

The problem is documented in a disturbing 1988 report by the U.S. General Accounting Office showing that many cancer patients do not receive up-to-date treatments.

The study showed that 37% of women with premenopausal breast cancer, 25% of patients with small-cell lung cancer and 60% of patients with rectal cancer did not receive the best possible treatment. Fully half of the breast cancer patients who should have received adjuvant therapy (combinations of surgery, chemotherapy and radiation) did not get it.

Age and economics have put the elderly and minority groups at a particular disadvantage, says Dr. Martin Abeloff, president of the American Society of Clinical Oncology.

For example, the five-year cancer survival rate for blacks stands at 38.2%, well below the 52% rate for whites.