Oncologists Warn of Threats to Progress in Childhood Cancer

WASHINGTON--Two pediatric oncologists brought a plea to Capitol Hill that Congress pay greater attention to childhood cancers, both in terms of research funding and guaranteeing access to quality care.

"From time to time, and for many reasons, we have declared war on cancer--breast, prostate, colon. It’s time to declare war on childhood cancer," said G. Denman Hammond, MD, associate vice president for health affairs, University of Southern California, and president of the National Childhood Cancer Foundation.

One in every 333 persons in the United States develops cancer before age 20, he said. Childhood cancers have been increasing at about 1% per year for the last quarter century, although the mortality rate has steadily declined. Nonetheless, Dr. Hammond said, "cancer still kills more children than any other disease."

Nearly 11,000 US children and teens will be diagnosed with cancer this year (Figure 1), added Gregory H. Reaman, MD, chairman of hematology and oncology, Children’s National Medical Center, and professor of pediatrics, George Washington University School of Medicine and Health Sciences. The fact that fewer than 3,000 will die is a tribute to the "coordinated research efforts over the past several decades," he said.

Three decades ago, less than 20% of children and adolescents diagnosed with acute lymphoblastic leukemia (ALL) and treated in leading pediatric cancer centers survived 5 years. Today, more than 80% of these patients are cured (Figure 2). However, he said, this record of success, coupled with the relatively low incidence of cancer in children (about 3%), has yielded an unfortunate downside.

"There has been somewhat of a political and social de-emphasis on childhood cancer that has plagued pediatric cancer specialists and investigators for years," said Dr. Reaman, who also serves as vice chair of the Children’s Cancer Group, one of the two collaborative research efforts in childhood cancers.

He and Dr. Hammond spoke at a congressional briefing sponsored by the National Coalition for Cancer Research. It drew several members of Congress who have had a child treated for cancer, as well as key House and Senate staff working on cancer issues. "We are emphasizing two things," Dr. Hammond said. "More research funding is needed, and access to quality care must be preserved and insured. Researchers right now are working in this battle against cancer with one arm tied behind their backs."

Extraordinary opportunities exist for advances in childhood cancers in cancer genetics, genetic epidemiology, development of animal models, imaging technologies and diagnostics, and in developing new anticancer agents, Dr. Reaman said. "These occur at a time when the stability of our pediatric cancer research enterprise is threatened by federal funding cutbacks; by diminished private sector foundation grant support; and by changes in payment, philosophies, and systems in the health care industry."

He noted that only about 2% of the total National Cancer Program funds are devoted to battling childhood cancers. Moreover, in the last two competitive grant applications, budgets awarded the Children’s Cancer Group for each of these 5-year periods was less than half that recommended by an NCI peer review panel.

Both physicians warned that policies of many managed care organizations threaten both research and care. Previously, academic medical centers provided pediatric cancer researchers and treatment programs with support to cover the research personnel, administrative, and regulatory costs associated with clinical research. But this support has been seriously eroded by significant reductions in reimbursement imposed by managed care plans, Dr. Reaman said.

Dr. Hammond stressed that the remarkable successes in treating childhood cancers have occurred at specialized centers, and are not matched in children treated in community hospitals. "Children with cancer require treatment by specialists in the management of cancer in children," he said.

But managed care, as it is now administered, threatens the progress made in both research and treating children with cancer, Dr. Hammond warned. "Children are not always referred to these institutions where they can be cured," he said. "They are being referred to institutions that have not developed multidisciplinary teams."