During this election year, approximately 1.4 million U.S. residents will be diagnosed with cancer. For U.S. presidential hopefuls Sen. Barack Obama and Sen. John McCain, cancer has hit close to home. Sen. McCain, 72, has been treated several times for squamous cell carcinoma and malignant melanoma. Sen. Obama lost his grandfather to prostate cancer and his mother to ovarian cancer.
Both candidates recently released high-level cancer plans in conjunction with the September 5 “Stand Up To Cancer” televised fundraising event. Sen. Obama pledged $10 billion in funding for the National Cancer Institutes (NCI) and other research organizations, while Sen. McCain promised that “our researchers will have have necessary funding to defeat cancer once and for all.”
Despite the hopeful talk at a celebrity-filled telethon, neither Sen. Obama nor Sen. McCain has included cancer—which is overtaking heart disease as the nation’s number one killer—in his healthcare reform stump speeches. Oncology News International spoke with cancer care specialists who outlined what the community needs from a new administration.
During the two terms of President George W. Bush, cancer research funding flat-lined for the first time since 1971, when President Richard Nixon signed the 1971 National Cancer Act. “The total amount currently being spent on cancer research is less than the tobacco companies spend on advertising,” commented Jay S. Cooper, MD, director of the Maimonides Cancer Center (the tobacco industry spent at least $15.5 billion on U.S. promotion campaigns in the new century; the current budget for the NCI is about $10 billion).
Dr. Cooper expressed concern that much of the political rhetoric has centered solely on the “absolute number of Americans who are uninsured, without talking about what it means to be insured. What good is insurance if the amount the insurance company pays is so little that it prevents oncologists from using the full range of treatment options?”
Matthew Farber, manager of provider economics and public policy for the Association of Community Cancer Centers (ACCC), added that the “issue of underinsured or uninsured patients, whose life-saving chemotherapy may be at risk” is the foremost issue with his organization. In that respect, Sen. Obama’s plan toward universal healthcare coverage might trump Sen. McCain’s plan, which is more of a market-based approach (see sidebars),
Carolyn R. “Bo” Aldigé, president and founder of the Prevent Cancer Foundation in Alexandria, VA, said that she had recently been told that for the first time in the history of the NCI, the number of grant applications declined. This reflects the general discouragement of researchers, many of whom are losing faith in the system, pursuing their scientific investigations outside academia or moving abroad in order to escape the current environment.
According to Sen. McCain, his administration would work to better coordinate the efforts of NCI and (National Institutes of Health) in furthering bench-to-bedside translational research. In addition to doubling federal funding for research within 5 years, Sen. Obama has vowed to increase spending to shore up the FDA’s cancer treatment analyses efforts and to address healthcare disparities among financially challenged groups.
Workforce shortage
While the candidates’ promises to cancer research are laudable, again, they have yet to address nuts and bolts issues in cancer, most notably the impending shortage of oncologists. Sen. Obama has acknowledged that without intervention, the growing demand for cancer care will outstrip the number of oncology specialists. Sen. Obama’s plan will expand funding for loan repayment, increase grants and funds to support cancer research specialists, and invest in infrastructure to improve working conditions.
But experts agree that funding and grants won’t be enough to entice the best and brightest into the long hours and stress of oncology practice. According to Dr. Cooper, the key is fair salaries.
“What would be fair compensation for oncologists under a one-payer system? In other words, who would you use as benchmarks? I would like to hear what plan either candidate has to encourage our best and brightest young people to seek careers in oncology,” Dr. Cooper said.
According to Joseph S. Bailes, MD, chair of the ASCO Foundation board of directors, a long-term fix to the sustainable growth rate (SGR) is needed in order to make sure oncologists are properly reimbursed (see “Are rebates for ca drugs a good deal?” September, page 24).
Originally intended to check physician spending, the SGR has drastically cut Medicare reimbursement. “The time physicians spend administering chemotherapy and providing many other patient services is not fully covered, creating economic strain on many community practices. This is a major issue in the cancer community,” Dr. Bailes said.
Moreover, many physicians are now finding that reimbursement for some cancer drugs is less than their actual cost, he added. This downward financial trend, unless corrected, will discourage young medical students from specializing in oncology, hastening the shortage of cancer care providers.
Mr. Farber also expressed concern about the SGR formula. “If providers are not properly reimbursed for the services they provide, they may not continue to deliver the quality cancer care patients deserve. Hopefully, the issue of adequate healthcare and health insurance for all will be discussed during the debates,” he said.
Personal responsibility and prevention
Asked what cancer issue should be addressed in the 2 months prior to the election, Ms. Aldigé responded, “We look forward to working with the winner of the election to develop a more comprehensive plan that addresses the needs of the community. Number one on that list is equal access to preventive services and treatment.”
To that end, Sen. Obama’s plan seems more in line with the advocacy community than his opponent’s, although it comes at a steeper cost. Sen. Obama proposes that all U.S. residents have access to federally supported preventive healthcare; he would also expand the CDC’s biomonitoring programs to identify environmental causes of cancer.
Sen. McCain’s take on cancer prevention stresses personal responsibility and what he calls “commonsense approaches to encourage smoking cessation programs, healthier eating habits, and more active lifestyles.” In the past, Sen. McCain sponsored several cancer bills but spent more of his political capital in areas other than healthcare.
The presidental candidates have no shortage of advice when it comes to campaign strategies and running mates. Regardless of which candidate wins, cancer specialists said they hope the next president will continue to seek expert advice when the time comes to put speech into practice. “Many groups, such as ACCC and ASCO, offer their assistance on all issues affecting oncology care. Hopefully, Congress and CMS will take us up on our offers,” Mr. Farber said.
