WASHINGTON--Two pediatric oncologists brought a plea to Capitol Hill
that Congress pay greater attention to childhood cancers, both in
terms of research funding and guaranteeing access to quality care.
"From time to time, and for many reasons, we have declared war
on cancer--breast, prostate, colon. Its time to declare war on
childhood cancer," said G. Denman Hammond, MD, associate vice
president for health affairs, University of Southern California, and
president of the National Childhood Cancer Foundation.
One in every 333 persons in the United States develops cancer before
age 20, he said. Childhood cancers have been increasing at about 1%
per year for the last quarter century, although the mortality rate
has steadily declined. Nonetheless, Dr. Hammond said, "cancer
still kills more children than any other disease."
Nearly 11,000 US children and teens will be diagnosed with cancer
this year (Figure 1), added Gregory
H. Reaman, MD, chairman of hematology and oncology, Childrens
National Medical Center, and professor of pediatrics, George
Washington University School of Medicine and Health Sciences. The
fact that fewer than 3,000 will die is a tribute to the
"coordinated research efforts over the past several
decades," he said.
Three decades ago, less than 20% of children and adolescents
diagnosed with acute lymphoblastic leukemia (ALL) and treated in
leading pediatric cancer centers survived 5 years. Today, more than
80% of these patients are cured (Figure 2).
However, he said, this record of success, coupled with the
relatively low incidence of cancer in children (about 3%), has
yielded an unfortunate downside.
"There has been somewhat of a political and social de-emphasis
on childhood cancer that has plagued pediatric cancer specialists and
investigators for years," said Dr. Reaman, who also serves as
vice chair of the Childrens Cancer Group, one of the two
collaborative research efforts in childhood cancers.
He and Dr. Hammond spoke at a congressional briefing sponsored by the
National Coalition for Cancer Research. It drew several members of
Congress who have had a child treated for cancer, as well as key
House and Senate staff working on cancer issues. "We are
emphasizing two things," Dr. Hammond said. "More research
funding is needed, and access to quality care must be preserved and
insured. Researchers right now are working in this battle against
cancer with one arm tied behind their backs."
Extraordinary opportunities exist for advances in childhood cancers
in cancer genetics, genetic epidemiology, development of animal
models, imaging technologies and diagnostics, and in developing new
anticancer agents, Dr. Reaman said. "These occur at a time when
the stability of our pediatric cancer research enterprise is
threatened by federal funding cutbacks; by diminished private sector
foundation grant support; and by changes in payment, philosophies,
and systems in the health care industry."
He noted that only about 2% of the total National Cancer Program
funds are devoted to battling childhood cancers. Moreover, in the
last two competitive grant applications, budgets awarded the
Childrens Cancer Group for each of these 5-year periods was
less than half that recommended by an NCI peer review panel.
Both physicians warned that policies of many managed care
organizations threaten both research and care. Previously, academic
medical centers provided pediatric cancer researchers and treatment
programs with support to cover the research personnel,
administrative, and regulatory costs associated with clinical
research. But this support has been seriously eroded by significant
reductions in reimbursement imposed by managed care plans, Dr. Reaman said.
Dr. Hammond stressed that the remarkable successes in treating
childhood cancers have occurred at specialized centers, and are not
matched in children treated in community hospitals. "Children
with cancer require treatment by specialists in the management of
cancer in children," he said.
But managed care, as it is now administered, threatens the progress
made in both research and treating children with cancer, Dr. Hammond
warned. "Children are not always referred to these institutions
where they can be cured," he said. "They are being referred
to institutions that have not developed multidisciplinary teams."