NCPB Hears From Several Cancer Groups on Policy Issues

WASHINGTON--At its first public meeting, the new National Cancer PolicyBoard (NCPB) heard from a number of groups about the topics they believeshould shape its early agenda. Not surprisingly, access to care proveda 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. "Webelieve 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 directorRichard D. Klausner, MD. It is intended to provide an independent voiceon policy matters and strategic planning issues, primarily those outsideof 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 ofcare for patients participating in clinical trials, said Jill Rathbun,director of government relations, Society of Gynecologic Oncologists. Sheurged the panel to examine how a lack of such coverage "affects whetheran individual will enroll in a clinical trial."

Noting that only about 3% of patients eligible for clinical trials actuallyenroll, Ms. Rathbun asked the NCPB to study what other barriers might existand "propose solutions that could be adopted and implemented."

Ms. Rathbun also sought a study of the direct and indirect costs ofdenying cancer patients access to specialists. Such data would enable theNCPB to "make recommendations to the managed care industry regardingtheir policies and procedures regarding specialists."

Ms. Mooney said that the current health care restructuring addressescost containment but not access to care. Particularly affected are theindigent, unin-sured, underinsured, and those who face barriers becauseof race, culture, or geographic factors, she noted, and these are oftenthe people at highest risk of cancer.

Minority Issues

Three speakers specifically addressed minority issues. Lovell AllanJones, PhD, codirector of the Intercultural Cancer Council, noted thatNCI had stated in the 1980s that with "equal access to all of theknowledge we know today, we could reduce the cancer rates by 50%."Such access does not exist today, and Dr. Jones urged the panel to considera number of minority issues, including:

• Providing a major role for minorities in developing health policiesand programs aimed at their communities.
• Giving priority to research and control programs for cancers that disproportionatelyaffect minorities.
• Providing for full representation of minorities in clinical studies.
• Training health care providers to be more sensitive to the needs ofminorities and socioeconomically disadvantaged Americans.

Cultural differences that affect winning acceptance of greater accessby both African-Americans and Hispanics deserve special attention, saidTerry Mason, MD, of the University of Illinois, Chicago, representing theNational 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 andsmoking. Ritva Butrum, PhD, vice president for research, American Institutefor Cancer Research, cited estimates "that between 30% and 40% ofall cancers may be preventable by diet and closely related factors."

Dr. Butrum urged the board to encourage increased funding for researchon such issues as how dietary patterns during life affect cancer risk;the mechanism of actions of individual food constituents at the geneticand cellular level as they relate to cancer; and how exercise and obesityaffect the potential for cancer. She also sought support for "researchinto novel and effective means of communicating messages about nutritionfor cancer prevention."

Michael Jacobson, PhD, executive director of the Center for Sciencein the Public Interest, urged the NCPB to look at how effective antismokingcampaigns might be applied to healthy eating issues.

And Helene Brown, of the UCLA Jonsson Comprehensive Cancer Center, urgedthe board to put its prestige behind expanding ASSIST (American Stop SmokingIntervention Study for Cancer Prevention) to all 50 states and the Districtof 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 deterrentto cigarette smoking ready to go," she said.

Several groups urged the NCPB to focus on early detection and preventionissues. "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 endsto disguise the fact, Ms. Mooney said, including removing the credentialsfrom name tags of health care personnel, such as RN and OCN, so that patientsdon't know if they are being cared for by a registered nurse or a practicalnurse.

The NCPB plans to use the testimony and input from other groups in fashioningits mission agenda and plans.