WASHINGTON--At its first public meeting, the new National Cancer Policy
Board (NCPB) heard from a number of groups about the topics they believe
should shape its early agenda. Not surprisingly, access to care proved
a recurring theme, in one form or another.
"All Americans should have access to optimal cancer care,"
said Kathi H. Mooney, RN, president, Oncology Nursing Society. "We
believe this is an important avenue for study and policy."
Role of the NCPB
The NCPB was formed under the auspices of the Institute of Medicine,
Most third-party insurers refuse to cover even the ordinary costs of
care for patients participating in clinical trials, said Jill Rathbun,
director of government relations, Society of Gynecologic Oncologists. She
urged the panel to examine how a lack of such coverage "affects whether
an individual will enroll in a clinical trial."
Noting that only about 3% of patients eligible for clinical trials actually
enroll, Ms. Rathbun asked the NCPB to study what other barriers might exist
and "propose solutions that could be adopted and implemented."
Ms. Rathbun also sought a study of the direct and indirect costs of
denying cancer patients access to specialists. Such data would enable the
NCPB to "make recommendations to the managed care industry regarding
their policies and procedures regarding specialists."
Ms. Mooney said that the current health care restructuring addresses
cost containment but not access to care. Particularly affected are the
indigent, unin-sured, underinsured, and those who face barriers because
of race, culture, or geographic factors, she noted, and these are often
the people at highest risk of cancer.
Three speakers specifically addressed minority issues. Lovell Allan
Jones, PhD, codirector of the Intercultural Cancer Council, noted that
NCI had stated in the 1980s that with "equal access to all of the
knowledge we know today, we could reduce the cancer rates by 50%."
Such access does not exist today, and Dr. Jones urged the panel to consider
a number of minority issues, including:
- Providing a major role for minorities in developing health policies
and programs aimed at their communities.
- Giving priority to research and control programs for cancers that disproportionately
- Providing for full representation of minorities in clinical studies.
- Training health care providers to be more sensitive to the needs of
minorities and socioeconomically disadvantaged Americans.
Cultural differences that affect winning acceptance of greater access
by both African-Americans and Hispanics deserve special attention, said
Terry Mason, MD, of the University of Illinois, Chicago, representing the
National Black Leadership Initiative on Cancer, and Henry Stevenson-Perez,
of the Department of Health and Human Services Hispanic Employees' Organization.
Speakers also urged the NCPB to consider the issues of nutrition and
smoking. Ritva Butrum, PhD, vice president for research, American Institute
for Cancer Research, cited estimates "that between 30% and 40% of
all cancers may be preventable by diet and closely related factors."
Dr. Butrum urged the board to encourage increased funding for research
on such issues as how dietary patterns during life affect cancer risk;
the mechanism of actions of individual food constituents at the genetic
and cellular level as they relate to cancer; and how exercise and obesity
affect the potential for cancer. She also sought support for "research
into novel and effective means of communicating messages about nutrition
for cancer prevention."
Michael Jacobson, PhD, executive director of the Center for Science
in the Public Interest, urged the NCPB to look at how effective antismoking
campaigns might be applied to healthy eating issues.
And Helene Brown, of the UCLA Jonsson Comprehensive Cancer Center, urged
the board to put its prestige behind expanding ASSIST (American Stop Smoking
Intervention Study for Cancer Prevention) to all 50 states and the District
The joint federal-state partnership currently operates in 17 states.
Ms. Brown said that consumption of cigarettes in ASSIST state is now 10%
lower than in the other 33 states. "You have the only proven deterrent
to cigarette smoking ready to go," she said.
Several groups urged the NCPB to focus on early detection and prevention
issues. "A truly comprehensive approach to cancer control is necessary,"
said Myles P. Cunningham, MD, president of the American Cancer Society.
And the Oncology Nursing Society asked the panel to inform the country
"what constitutes quality cancer care."
Some health care plans are reducing quality and going to extreme ends
to disguise the fact, Ms. Mooney said, including removing the credentials
from name tags of health care personnel, such as RN and OCN, so that patients
don't know if they are being cared for by a registered nurse or a practical
The NCPB plans to use the testimony and input from other groups in fashioning
its mission agenda and plans.