Panel to Recommend Changes to Cancer Act

BETHESDA, Md—An independent committee studying the status of the National Cancer Program plans to release its report in January, the month that a new Congress and a new President take office. It will likely recommend legislative changes to revise the National Cancer Act of 1971 and restructure parts of the program.

“In 1971, it was thought that we had reached critical mass and that the Cancer Act would take us over the top. That was wrong,” said Vincent T. DeVita, Jr., MD, co-chair of the National Cancer Legislative Advisory Committee (NCLAC). “I think we have critical mass now. The investment in basic research has created critical mass.” [See the box at right for a further discussion of the idea of critical mass.]

Dr. DeVita, director of the Yale Comprehensive Cancer Center and a former director of the National Cancer Institute, described the committee’s activities and process at a meeting of the National Cancer Advisory Board (NCAB).

A common question directed at the committee is: “If it ain’t broke, why fix it?” Dr. DeVita said, calling the National Cancer Act “one of the most successful experiments in biomedical research by the federal government.” Nonetheless, “it is quite obvious that while ‘it ain’t broke,’ there are many people who are not benefiting from the research effort of the National Cancer Program.”

NCLAC emerged from the National Dialogue on Cancer, a forum for cancer advocacy groups. The National Dialogue is co-chaired by Sen. Dianne Feinstein (D-Calif) and LaSalle D. Leffall, Jr., MD, professor of surgery, Howard University College of Medicine. “Sen. Feinstein, after a few meetings, came to the conclusion that the time had come to take another look at the entire cancer program,” Dr. DeVita said.

She asked Dr. DeVita and John R. Seffrin, PhD, chief executive officer of the American Cancer Society, to form a committee to gather information from people with an interest in the National Cancer Program, prepare a white paper, and make recommendations for improving the program.

“We’re in a position a little different from other committees, in that we can deal with what you would like to have in the ideal and put something together that ignores the conventional,” Dr. DeVita said.

The NCLAC staff began by reviewing several recent reports assessing the National Cancer Program and problems in cancer care. It also conducted extensive interviews with researchers, oncologists, advocacy groups, policy makers, and industry leaders involved in supporting cancer research. The committee is now winding up eight public hearings.

“One of the issues in 1971 was: Money doesn’t buy ideas,” Dr. DeVita said. “Money does buy ideas by putting bright scientists to work who have new ideas. The question now is, Can we use the money for appropriate advice and more ideas?”

One area the committee will address is whether organizational changes are necessary “that would allow all the federal cancer programs to be put together in some sort of management scheme that would allow us to accelerate the war on cancer,” he said.

Dr. DeVita noted the decline in cancer incidence and mortality, which began in 1990. He attributed this to the fact that from the beginning of the National Cancer Program, 80% to 85% of its research budget has gone to basic research, which has generated a wealth of molecular information about the disease.

“The cancer rates have declined very dramatically,” he said. “And in fact, I think that when you see the mortality data for the year 2000, you will be even more surprised how much death rates are down.”

The declining rates are due in large part to the 15% of research funds that went into clinical application of the results of basic research, Dr. DeVita said.

NCLAC’s work is funded mostly by the American Cancer Society, with some money coming from industry sources. Despite the concern of some advocates that its report would reflect the Society’s agenda, NCLAC is a totally independent organization, Dr. DeVita said.

“The American Cancer Society cannot tell me what to do, and they have been very good about that,” he said. “I have not been told to do anything specific that would favor the Society.”

NCLAC will not draft any proposed legislation and will leave that to Sen. Feinstein and other members of Congress, he added.

Once the NCLAC members deliver their assessment of the National Cancer Program and their recommendations, “we will fold our tents and go home,” Dr. DeVita said.