The National Cancer Legislation Advisory Committee released in September its report, "Conquering Cancer: A National Battle Plan to Eradicate Cancer in Our Lifetime." Providing a blueprint for eliminating cancer as a major health problem, the document describes priorities and recommendations for updating the National Cancer Act of 1971.
The cancer burden can be reducedand ultimately conqueredthe report states, through a comprehensive strategy that not only provides greater funding for research and translation of new treatments, but also removes barriers to access and delivery of quality care so that all people may benefit equally from current and future preventive measures, medicines, and technologies.
What makes the NCLAC report unique compared to prior reports, say many experts, is its breadth. "I dont think any report in the pastincluding the original one that came out of the Cancer Acthas ever been as comprehensive," remarked NCLAC co-chair, Vincent T. DeVita Jr., M.D., director of the Yale Comprehensive Cancer Center, New Haven, Conn. (See box on p. 1594 for the full list of the committees goals.)
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The idea of modernizing the National Cancer Act captured the interest of U.S. Senator Dianne Feinstein (D-Calif.) at a 1998 meeting of the National Dialogue on Cancer, an independent forum of cancer experts from several key national organizations.
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The concrete steps outlined in the report were built on existing cancer legislation, past cancer reports, and cancer action plans. Successes and failures were examined to find ways to streamline and improve efforts to combat cancer.
The process of evaluating what the report should include began by simply gathering information, said DeVita. Broad-based input was obtained from the public, private, and nonprofit sectors through more than 250 interviews with cancer experts, advocates, survivors, and others.
Various U.S. government agencies, including the National Cancer Institute, Centers for Disease Control and Prevention, the Presidents Cancer Panel, Health Resources and Services Administration, and the Agency for Healthcare Research and Quality, presented their cancer action plans in a series of hearings.
In addition several roundtable discussions of invited participants headed by NCLAC members were held to discuss areas such as cancer research and clinical trials; quality of life and symptom management; elimination of disparities in health care; cancer prevention and control; data collection and surveillance; collaboration between government and the private sector; and quality cancer care in detection, diagnosis, and treatment.
"By the time we were through," said DeVita, "wed reached virtually all the components of the cancer community and received their input."
Challenges and Recommendations
Priorities include erasing disparities in cancer rates that exist for minorities, the medically underserved, and other populations and improving access to prevention, early detection, and treatment for all Americans, including the millions without health insurance.
The report begins by emphasizing the integral role research has played in the achievements made so far against cancer. The first and perhaps most fundamental of the goals is full funding for NCIs bypass budgetNCIs budget request that is sent directly to the president instead of through NIH channelsas well as other important cancer projects this year and in future years. As NCLAC committee member George Vande Woude, Ph.D., director of the Van Andel Research Institute, Grand Rapids, Mich., pointed out, "we wouldnt be talking about whats going on in cancer today if it werent for the funding of basic science."
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Paul Calabresi, M.D., professor of medicine at Rhode Island Hospital and a NCLAC committee member, is enthusiastic about this idea. While cancer centers have been a very successful enterprise, he pointed out that many states lack these institutions that provide a bridge from research to clinical application.
"There are huge segments of the population that need to have the discoveries being made in cancer centers translated to them," said Calabresi. "If we had a network of multidisciplinary translational cancer centers working hand in hand with the major comprehensive cancer centers, we could expand the potential of delivering the best kind of care to all communities."
But what really sets the NCLAC report apart from other cancer reports, said many experts, are the sections that address how to improve access to quality care and to deliver cancer prevention and care through a coordinated health care system.
As NCIs Rimer commented, "We were pleased to see the focus on quality care. This complements our initiatives in this absolutely vital area."
Rimer added that one of the most important messages in the report is the need for the cancer community to coordinate its approaches and messages. "There have been far too many shotgun approaches in these areas where everybody is doing their own thing, preventing the synergy that would come from a coordinated effort."
Voicing a similar opinion, John Mendelsohn, M.D., president of the University of Texas M. D. Anderson Cancer Center, Houston, said "Im hoping this will catalyze the resources and maybe change the way people collaborate so that we can move even faster."
Follow-through with this report should be ensured, said DeVita, because it originated in Congress. In the past, "finished reports are all too often relegated to a file drawer," he said, "but this one has a Congressional arm to it."
However, when the report was presented to Feinstein in an October hearing, she asked the committee to set priorities among its 12 recommended goals and to highlight a few major priorities. She also asked that the committee come up with a cost analysis for these goals.
Referring to recent national events, DeVita said, "The first responsibility of government is to defend the nation, but I think right behind that is the defense of the health of the nation. Of course, that involves preventing bioterrorism, but it also involves dealing with the terror of things like cancer."
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