President's Cancer Panel Assesses Progress in Two Areas

BETHESDA, Maryland—In its 2005-2006 annual report, the President's Cancer Panel (PCP) departed from its norm of examining a specific cancer-related issue and instead looked at what has emerged from the recommendations made in its two previous reports. The panel found some progress but much left undone, and it warned of "disturbingly diminished expectations for change related to specific survivorship and research translation concerns."

The new report, Assessing Progress, Advancing Change, focused on a few key recommendations contained in Living Beyond Cancer: Finding a New Balance, the panel's 2003-2004 report on survivorship issues, and Translating Research into Cancer Care: Delivering on the Promise, its 2004-2005 report. While recognizing the short time span that has passed since it issued the two reports, the panel said it selected them for review because it "believes them significantly critical to NCP [the National Cancer Program] to require follow-up at this time."

PCP was created under the National Cancer Act of 1971 and charged with monitoring and evaluating all aspects of the NCP and reporting at least once annually to the President on barriers to the most effective development and execution of the program.

The current membership consists of chair LaSalle D. Leffall, Jr., MD, Charles R. Drew Professor of Surgery at Howard University College of Medicine; cancer survivor Lance Armstrong, founder of the Lance Armstrong Foundation; and Margaret L. Kripke, PhD, executive vice president and chief academic officer of M.D. Anderson Cancer Center. In compiling its report, the PCP conducted four meetings, two focused on each report, at which it heard testimony from experts, patients, and advocates.

Survivorship Issues

The panel expressed satisfaction with the progress in some areas of survivorship, "most notably partnerships and programmatic initiatives to increase public and health provider awareness of survivor issues." But it declared progress in several other areas less encouraging.

• It found that the lack of a strong knowledge base needed to develop guidelines for follow-up care for many cancers and individual patients' circumstances remains a continuing problem. "However, meeting participants agreed that even while this evidence base is being strengthened, follow-up care plans must nonetheless be provided, based on best practices and the best available expert opinion," the report said.

• Research on some survival issues appears on the increase, but work lags on the problems that adolescents and young adults confront. "This dearth of knowledge is particularly alarming given that cancer survival rates for this population have not improved appreciably for more than 2 decades," the panel said.

• A large majority of survivors have limited access to the medical, psychosocial, and supportive care they need following cancer therapy, including some who would benefit from prosthetic and fertility-related services. "For many survivors, needed services simply are not available where they live and they cannot travel to reach them," the report noted. "For even more survivors, available services remain out of reach due to lack of insurance coverage for needed care and/or inability to pay for care out-of-pocket."

Translational Research

Although the PCP expected little progress so soon in implementing its recommendations from last year's report on translational research, it found evidence of new initiatives and partnerships that could eventually influence researchers to more readily embrace team science and other types of collaborative efforts. These include the revision of grant criteria by federal and other research supporters to place a higher priority on team science. The report warned, however, that without a large and well-trained pool of translational and clinical researchers, the discoveries of basic researchers will never fully benefit patients.

The panel found encouragement in the National Institutes of Health's commitment to increasing support for young investigators despite its decreasing budget, and efforts by professional societies and foundations to provide more career development and new investigator awards. Although research on disseminating information about new cancer discoveries and interventions remains in its infancy, PCP found the work's importance gaining recognition. Nonetheless, such research is almost entirely unfunded.

Members acknowledged that several pervasive and well-known issues prevent full implementation of previous recommendations. The reported cited fiscal constraints, such as declining federal research budgets; the limited or lack of health care coverage of many Americans; the short shrift and small budgets accorded education and communications activities; and an inadequate coordination of the National Cancer Program.