WASHINGTON--Calling "The March" the first truly large-scale
grass roots demonstrative effort to focus attention on cancer, Allen
S. Lichter, MD, president of the American Society of Clinical
Oncology, used the event as a backdrop to discuss the Societys
three key policy recommendations for accelerating advances in cancer
research and treatment.
The recommendations are "to fund the clinical trials mechanism
adequately so that we can speed the pace of discovery; to ensure that
insurance is not a barrier to a patient entering a well-designed,
important research study; and to ensure that all patients have access
to the highest quality cancer care, which is cancer care given by
Dr. Lichter, professor of radiation oncology, University of Michigan,
described the cancer research world as being shaped like a funnel.
"Into the funnel come all the terrific research ideas from
laboratories and the pharmaceutical industry. We put these ideas
through the stem of the funnel, and out the other end come the things
that work. We discard the things that dont work, and feed back
to the laboratory questions and biologic concepts that help focus the
next generation of basic research studies."
However, he said, if the size of the funnel opening is small, "as
we think it is right now," the research comes dripping out.
"Its good research, but if we could increase the diameter
of that opening, if we could have it come out in a stream and maybe
even someday a torrent, we could greatly increase the pace at which
we bring discoveries to the bedside."
Right now, Dr. Lichter said, only 2% to 3% of all cancer patients are
enrolled in clinical trials, due in part to under-funding of clinical
research. For years, he said, the national cooperative cancer groups
have been getting about 50% of the recommended funding level,
"and we think the recommended levels are inadequate, so 50% of
that is truly just choking off this process. There is no way to
increase the number of patients on trials substantially without
ASCO has long advocated that the routine patient care costs
associated with clinical trials be borne by insurers, but currently,
he said, virtually no insurance policy, HMO, or managed care group
provides coverage for clinical trials as a basic benefit. "This
is not to say that insurers do not pay for the health care costs of
patients on clinical trials. Most often they do, but it is not a
covered benefit, and companies can and sometimes do deny these
payments," Dr. Lichter said. "This is a chiller to patients
who may want to join a trial but are faced with the possibility of
exposing themselves to thousands of dollars in medical bills."
He said that the insurance industry assumes that clinical care as
part of a study is more expensive than care outside a study, "but
there is no credible evidence that that is true." A study
currently nearing completion, he said, is expected to show that the
cost of care in clinical trials is virtually identical to that of
patients receiving standard care. He added that ASCO supports the Rocke-feller-Mack
legislation to create a demonstration project in which Medicare
would pay for routine care in trials.
Finally, he said, "cancer care is complex, and patients should
have access to specialists in all the fields of oncology from the
earliest point in their diagnosis or suspected diagnosis." ASCO
believes that access to specialists in oncology should be woven into
the fabric of insurance coverage and included in a patient rights
package. "Patients with a cancer diagnosis or suspected
diagnosis should not have to compromise their care by going through
levels and levels of gate-keepers before receiving this care,"
Dr. Lichter concluded.