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, a part of the National Academy of Sciences, at the request of NCI director Richard D. Klausner, MD. It is intended to provide an independent voice on policy matters and strategic planning issues, primarily those outside of cancer research. Peter M. Howley, MD, of the Harvard Medical School, chairs the 20-member panel.
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 affect minorities.
- 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 of Columbia.
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 nurse.
The NCPB plans to use the testimony and input from other groups in fashioning its mission agenda and plans.