It’s time to trade the moonshot mentality for a new National Cancer Plan
Fifty years ago this month, President Richard Nixon, flush from the success of the Apollo Program, launched a so-called “moonshot” to find a cure for cancer.
There was no doubt as to the singular focus of the National Cancer Act: a cure. The act stipulated that no more than 5 percent of the $1.6 billion of funding injected into cancer research allocated would be devoted to cancer prevention and control.
The moonshot metaphor took hold, with leaders from Al Gore to Presidents Bush, Obama and Biden proclaiming similarly lofty goals.
To be sure, this “cure mindset” has brought our understanding to new heights. Our fundamental knowledge of cancer biology has been transformed. Childhood leukemia is routinely curable; we now have “targeted therapies,” immunotherapies and gene therapies that have prolonged survival in several cancer types — the stuff of daydreams when I was a medical student.
Yet the hard truth is that the moonshot mentality also causes harm. It not only shapes the national research agenda but has also molded our $200 billion cancer care system of hospitals, insurers, doctors, scientists and industry into a behemoth that supports just about every stakeholder, except patients.
That’s why the National Academy of Medicine, an organization of top physicians and scientists, has characterized the American approach to cancer care as a “system in crisis.” Research shows 40 percent of patients deplete their savings within two years of a cancer diagnosis. Others turn to GoFundMe campaigns or forego treatment altogether.
And those new treatments? In one analysis, only one in five new cancer therapies approved by the Food and Drug Administration meet the American Society of Clinical Oncology’s definition of a “clinically meaningful survival benefit.”
Simply put, the fixation on finding a cure for cancer — a moonshot — is diverting our attention, energy and resources from the broader picture. At the 50th anniversary of the National Cancer Act, people are still getting cancers that should be preventable. And profound inequities in cancer burden persist across racial and ethnic groups and social classes. We need a new National Cancer Plan.
Let’s consider a messier approach inspired by a different moonshot — one that didn’t reach its goal, but still saved lives: the Apollo 13 mission. After an oxygen tank exploded two days after liftoff, the lunar landing was canceled and emergency mid-flight repairs were needed. In a scene memorialized in the 1995 film, a pile of assorted tools and gadgets was dumped onto a table at Mission Control. NASA scientists and engineers were told that these were the same items the astronauts had to work with, and they needed to devise a plan to get them home. We likewise have the tools to restructure our system of cancer research and care.
Here are four that should serve as a starting point:
Prioritizing and coordinating prevention efforts. We know what works to prevent cancer; we’re not doing enough of it. For example, we’ve made tremendous strides in decreasing tobacco use. Yet cigarettes still account for almost 30 percent of cancer deaths. Similarly, only half of all eligible teens have received the HPV vaccine, which dramatically reduces the risk of cervical and other cancers. Highly effective strategies abound. What is lacking is funding, coordination and a sense of urgency. States, health systems and insurance providers must be incentivized to ramp up their cancer prevention efforts.
Revamping our approach to evaluating, approving and paying for new cancer drugs. Over the past decade, Congress has progressively required less and less rigorous FDA evaluation of the new treatments in terms of survival rate or quality of life — precisely what matters to individual patients. Congress mandates that Medicare pay for virtually any cancer drug that is FDA-approved — without negotiation. As a result, new cancer treatments are exorbitantly priced (averaging well over $100,000 for a course of therapy, translating into substantial revenues for those who produce, prescribe and administer them. The status quo is clearly unsustainable, and drug pricing has captured the attention of policymakers for years. Yet the current system persists. A new National Cancer Plan could incorporate policy recommendations that — given the substantial support for anti-cancer efforts on both sides of the aisle — can help guide legislative action and ensure fair reimbursement for effective treatments. We can no longer afford to consider the financial and regulatory aspects of cancer care as only tangentially related to public health and scientific endeavors.
Addressing racial and socioeconomic disparities. Eliminating disparities will require clear objectives, sustained investment and political will. A National Cancer Plan 2.0 can galvanize our efforts, and identify leverage points such as health insurance reform, bolstering the primary care workforce, evolving models of telemedicine and novel approaches to addressing cancer risk.
Rebalancing our approach to clinical cancer research. By some estimates, industry funds over 90 percent of clinical cancer research. We should substantially bolster investments in the types of research less likely to be funded by industry. This includes developing new approaches to prevention, improving the quality of care, optimizing treatments in an aging population and decreasing toxicity after treatment. Allocating to research even one percent of the $200 billion spent each year on treating cancer could have a dramatic impact on the burden of cancer.
After 50 years, we are long overdue for a National Cancer Plan 2.0 that is comprehensive, bold and prioritizes patients with cancer and their families. It’s a golden opportunity.
Cary P. Gross is a professor of medicine at the Yale School of Medicine and founder and director of the Yale Cancer Outcomes Program. Gross is a contributing author of the book, “A New Deal for Cancer.” Twitter: @cpgYale