I was honored to represent Baystate Health at a recent gathering at the Edward M. Kennedy Center for the United States Senate in Boston last month, where Vice President Joe Biden addressed the administration’s Cancer Moonshot initiative announced by President Obama in his State of the Union Address in January.
Since then, the vice president has led a task force that delivered a report to the president just a few days prior to his address, and Biden used the occasion to describe some of its findings and proposals.
One of those attending was Boston Mayor Marty Walsh, who survived childhood cancer, as did one of Kennedy’s sons. Biden lost his own son to an aggressive brain tumor — glioblastoma — in May of last year, and I could not help reflecting on the number of people and families affected by cancer and the deeply felt need to make further strides.
The vice president is nothing if not a superbly skilled orator; it took only a few minutes before he captured the audience with his message and his passion, occasional tears reinforcing his authenticity.
Biden recognized that this effort will have its share of skeptics. I confess that I am one of those skeptics.
Since the War on Cancer initiated by President Nixon in 1971 — an effort that did put in place successful research structures that yielded significant care refinements — many administrations have suggested an effort to cure cancer, with little follow through. However, reading the report and hearing the vice president’s take on what he has learned in the past few months, I am more hopeful than ever that significant changes will come.
Predictably, there were the usual cancer-fighting approaches, such as:
More sensitive screening measures to pick up cancer even earlier.
Oncologists have known for years that such efforts lead to dramatic increases in over-diagnosis such as finding cancers that would not affect a patient’s longevity, and false positives, such as abnormalities that are not cancer, but require still more testing. I believe what we need is more compliance by people with current recommendations, which would be more effective in reducing cancer mortality.
Better prevention efforts.
We know that smoking plays a role in developing cancer. But, reducing tobacco use has been frustratingly slow. What we need to develop are better cancer-prevention efforts and ways to draw attention to them. More importantly, a greater emphasis needs to be place on developing effective cancer prevention medications that improve survival.
I was less enthusiastic about other approaches mentioned such as using “big data” — the collection and collation of patient clinical, treatment and outcome information from electronic medical records and other sources to guide individual patient management. There is no empirical evidence that says we will improve a patient’s care with this approach. Another was the development of cutting-edge technology. Certainly technological advances have enhanced care over the past three decades, but major breakthroughs in cure rates will not emerge, either, from this approach over the next decade.
On the plus side of the equation was the emphasis on reform of our cancer research enterprise. Built on the chassis of the 1971 War on Cancer, this previously successful national research effort is inefficient, generating complicated clinical trials that do not answer large cancer-care questions and in which patients do not agree to participate.
Over the past 20 years, we have seen cancer advancements arising from clinical studies emerge increasingly from Europe where large studies asking important questions with mechanisms to encourage patient participation have been mounted. American cancer clinical trial output has languished, and the overhaul proposed by Biden’s moonshot is long overdue. It should go a long way to achieving enhancements in cancer care for the next 30 years, comparable to the War on Cancer’s achievements of the 1970s, ’80s, and ’90s.
It is no secret that health care costs in the United States are extremely high – about twice as much as in any other developed country. And, that goes for cancer, too.
Sadly, a study last year revealed that between 1982 and 2010, the U.S. spent $1.6 trillion more than the European Union on care for four leading cancers, but had 729 more deaths. The cost of drugs also needs serious urgent attention.
Evidence is mounting that patients are not receiving or taking effective treatments due to cost. Few patients will benefit from newly discovered treatments or newly described practice recommendations if they are not delivered in a rigorous and reproducible fashion, or are not available affordably, either for our society or for the individual patient.
A moonshot that addresses these concerns would be a launch truly worthy of national support and pride.
Dr. Wilson Mertens is vice president and medical director of cancer services for the Baystate Regional Cancer Program in Springfield. He is one of several heath care professions from Baystate who alternate contributing columns focused on cancer to this space each month.