Forty years of research have had a tremendous impact on the treatment
of leukemia in both children and adult's, according to a panel
of experts appearing before the President's Cancer Panel in Chicago
this summer. But those experts also reported their fears that
new ideas no longer will enter the medical marketplace as quickly
as they have in the past. The panel is a three member, Presidentially
appointed advisory committee that meets regularly to assess the
efficacy of the National Cancer Program.
"Since the 1950s, research has steadily improved the outlook
for patients with leukemia, and that progress continues,"
said Harold P. Freeman, MD, chairman of the President's Cancer
Panel and director of surgery at Harlem Hospital Center in New
York City. "In just the past several years, scientists have
found a new drug, all-trans retinoic acid, that induces remissions
in adults with a rare leukemia called acute promyelocytic leukemia
In addition to Dr. Freeman, the other members of the panel are
Frances M. Visco, JD, of the National Breast Cancer Coalition,
and Paul Calabresi, MD, of Brown University/Rhode Island Hospital;
the executive secretary is Maureen Wilson, PhD, of the National
A committee advisory to the Food and Drug Administration recently
recommended that the agency approve use of this drug for relapsed
patients. In 5 years, research spearheaded by the National Cancer
Institute (NCI) has brought this highly active drug into the clinical
arena, thus providing a new means of achieving remission in this
type of leukemia.
"Managed care squeezes payers, providers, and ultimately
the recipients of care," Dr. Freeman said. "Federal
funding constraints and the impact of managed care on drug development,
translational research, and clinical research threaten to stymie
the kind of medical progress Americans have enjoyed for decades."
The President's Cancer Panel is concerned that cancer treatment
options that are suboptimal but less expensive will be reimbursable,
while innovative and improved therapies will not be testable due
to lack of funds. "This is one of the greatest threats to
the mission of the National Cancer Program since its founding
in 1971," Dr. Freeman said.
The Panel recommended that the cancer research community review
how it communicates the results of clinical trial outcomes and
with whom; that the efforts of professional societies, academic
organizations, and Federal policy makers be coordinated to provide
consistent, rigorously reviewed, medically and scientifically
sound, minimum guidelines for insurance support of health care-including
clinical trials; and that a public-private partnership be
established to forge incentives for providers, payers, and recipients
of clinical care to participate in clinical trials, the benefits
of which can be assessed through health outcomes analysis.
"Studies in leukemia have shown that patients who participate
in clinical studies have higher rates of remission and longer
responses to treatment than patients who do not," said Freeman.
"Access to clinical trials must be maintained and expanded
for those patients who desire that treatment option. The Federal
Government has played and must continue to play a unique role
in funding and review of high risk or long-term research; otherwise
we face the demise of medical progress as we know it. Privatization
will not address this need and managed care with its cost containment
focus cannot accomplish it."