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 (APL)."

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 Cancer Institute.

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.

Recommendations

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."