WASHINGTON--Calling "The March" the first truly large-scale grass roots demonstrative effort to focus attention on cancer, Allen S. Lichter, MD, president of the American Society of Clinical Oncology, used the event as a backdrop to discuss the Society’s three key policy recommendations for accelerating advances in cancer research and treatment.
The recommendations are "to fund the clinical trials mechanism adequately so that we can speed the pace of discovery; to ensure that insurance is not a barrier to a patient entering a well-designed, important research study; and to ensure that all patients have access to the highest quality cancer care, which is cancer care given by oncology specialists."
Dr. Lichter, professor of radiation oncology, University of Michigan, described the cancer research world as being shaped like a funnel. "Into the funnel come all the terrific research ideas from laboratories and the pharmaceutical industry. We put these ideas through the stem of the funnel, and out the other end come the things that work. We discard the things that don’t work, and feed back to the laboratory questions and biologic concepts that help focus the next generation of basic research studies."
However, he said, if the size of the funnel opening is small, "as we think it is right now," the research comes dripping out. "It’s good research, but if we could increase the diameter of that opening, if we could have it come out in a stream and maybe even someday a torrent, we could greatly increase the pace at which we bring discoveries to the bedside."
Right now, Dr. Lichter said, only 2% to 3% of all cancer patients are enrolled in clinical trials, due in part to under-funding of clinical research. For years, he said, the national cooperative cancer groups have been getting about 50% of the recommended funding level, "and we think the recommended levels are inadequate, so 50% of that is truly just choking off this process. There is no way to increase the number of patients on trials substantially without greater resources."
ASCO has long advocated that the routine patient care costs associated with clinical trials be borne by insurers, but currently, he said, virtually no insurance policy, HMO, or managed care group provides coverage for clinical trials as a basic benefit. "This is not to say that insurers do not pay for the health care costs of patients on clinical trials. Most often they do, but it is not a covered benefit, and companies can and sometimes do deny these payments," Dr. Lichter said. "This is a chiller to patients who may want to join a trial but are faced with the possibility of exposing themselves to thousands of dollars in medical bills."
He said that the insurance industry assumes that clinical care as part of a study is more expensive than care outside a study, "but there is no credible evidence that that is true." A study currently nearing completion, he said, is expected to show that the cost of care in clinical trials is virtually identical to that of patients receiving standard care. He added that ASCO supports the Rocke-feller-Mack legislation to create a demonstration project in which Medicare would pay for routine care in trials.
Finally, he said, "cancer care is complex, and patients should have access to specialists in all the fields of oncology from the earliest point in their diagnosis or suspected diagnosis." ASCO believes that access to specialists in oncology should be woven into the fabric of insurance coverage and included in a patient rights package. "Patients with a cancer diagnosis or suspected diagnosis should not have to compromise their care by going through levels and levels of gate-keepers before receiving this care," Dr. Lichter concluded.
