In his recent State of the Union address, President Obama declared a new initiative called Cancer MoonShot 2020, which is aimed at accelerating progress against cancer. As chairman of one of the largest cancer centers in the world, the Taussig Cancer Institute at Cleveland Clinic, I strongly applaud this initiative.
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The timing is ideal for renewed attention in our quest to eradicate cancer. Our knowledge of the genomics of cancer has dramatically grown over the past decade, resulting in new forms of targeted therapies that have led to very real clinical progress for thousands of patients with cancer.
Additionally, our knowledge of immunology, and the immunology of cancer, has also dramatically increased, and new immunological therapies for cancer are generating surprisingly strong results for many patients. As we continue to expand our knowledge, the opportunities swell for translating research into cancer practice and doing more and clinical research as well. Yet the resources to execute on these opportunities are limited. I strongly believe that more resources will lead to new scientific knowledge, which will lead to very real treatment advances for cancer patients worldwide.
So what should we do to carry out the president’s initiative?
1. Increase federal funding for cancer laboratory research
Fifteen years ago, 25 percent to 30 percent of medical investigator-generated grant applications were funded; today that number is less than 10 percent. Too many outstanding projects go unfunded. The opportunity for more robust scientific discovery is very real, and simply funding more grants makes sense. Additionally, a renewed emphasis on funding for comprehensive cancer centers is appropriate. Not only does much of the research occur in comprehensive cancer centers, a great deal of population-based medicine and community outreach occur through this network of cancer centers.
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2. Fund basic cancer screening for early cancer detection
Resources should be added to insure that all Americans receive appropriate cancer screening. Far too many people, frequently of lower socio-economic status, do not receive basic cancer screening. Early detection is key to improving cure rates.
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3. Improve access to state-of-the-art cancer care
We must give patients better and more access to clinical care and to clinical research. Only 5 percent of cancer patients are treated in clinical trials. This rate clearly needs to rise.
All cancer patients should have sophisticated genomic sequencing of tumor tissue, and it should be covered by the insurance industry. At present, only a small number of patients have their tumors tested with advanced genomic sequencing techniques. This is of critical importance because many of the new targeted clinical research trials rely on such sophisticated genomic information.
Additionally, we must increase funding to generate clinical trials, such as the NCI Match Trial, in which genomic abnormalities of tumors are matched with specific drugs that target such abnormalities. The pharmaceutical industry should be encouraged to foster more cooperation on clinical research involving multiple targeted treatment agents that may have been developed at different companies.
Finally, the entire process of clinical research is cumbersome; there are many ways to streamline the entire delivery of clinical research to patients, and these opportunities should be developed and funded.
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4. Rationalize the cost of cancer drugs
One of the biggest challenges in clinical cancer care is the cost of new drugs to fight cancer. Over the past 10 years, the cost for a course of cancer therapy has risen from approximately $10,000 per patient to more than $100,000 per patient. This rate of price acceleration means that 10 years from now, it may cost more than $1 million per patient to receive new precision-based therapy. This is not economically sustainable. The cost of prescription drugs, especially for cancer patients, needs to become more rational. Patients should not be faced with the impossible decision of whether to receive new cancer therapy or declare bankruptcy. The federal government needs to lead this effort.
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5. Develop a better coordinated care system
Additionally, care coordination and multidisciplinary care needs to be supported and funded. Too often, patients, already filled with fear and anxiety, are rendered confused by the complexity of the healthcare system. We need to encourage and fund more coordinated care, patient-centered medical homes and other multidisciplinary care models for cancer patients. This will lead to better care, decreased rates of complications and generate more value for the patient and the system.
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6. Speed up the sharing of electronic medical records
The president correctly identified the challenge of information-sharing. The electronic medical record (EMR) is rarely in a shareable database. We should encourage the development of resources to accelerate efforts to translate clinical data from the EMR to scientific registries and databases — to be shared by clinicians and researchers.
As a leader in the cancer community, I again applaud the effort announced by President Obama. Appropriate resources, directed at the right targets, can — and will — generate very real advances that will benefit patients with cancer in the United States and worldwide.
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Read more expert advice from Brian Bolwell, MD, on his blog.
This editorial was originally published on Everyday Health.