Cancer Moonshot Misses the Target

Hospitals don't have much to gain from the moonshot, at least in the short run. There are lot of other pressing, fixable problems with cancer care that the Obama administration's effort won't address.

I'm not excited about recent developments in the world of cancer research.

For starters, the American Society of Clinical Oncology (ASCO) has declared immunotherapy "the top cancer advance of the year" and everyone seems to think it is a big deal. But, I've been here for the inflated promises of interleukin, gene therapy, immunotherapy, the human genome, personalized medicine and angiogenesis. Now we're back to immunotherapy. I'm sure it's better than before, but I'm not excited.  

A lot of people are also excited about the so-called Cancer Moonshot. In his State of the Union speech, President Barak Obama promised to boost the search for cancer cures the way President John F. Kennedy boosted support for the space program.

The Cancer Moonshot Task Force met last week for the first time and filled in some details. It basically gives $1 billion to the National Cancer Institute over two years.

Twitter was abuzz with cheers for the space age push for better cures. But, I'm not excited.

The National Cancer Institute budget was $5 billion last year. What's another $500,000 million going to do? More of the same: slow, incremental progress through basic research findings. There's nothing wrong with that; science works that way.

It just doesn't feel like more NIH money will rocket us toward better cures any faster.

Let's assume billions for research are well spent. Everyone is happy when we fund cancer research. Why be a buzz kill? Because, in reality, there are a whole lot of other problems with the way we develop and deliver the treatments we already have.

Prevention and Care Delivery
The Cancer Moonshot might do a lot more to improve the prospects for cancer patients by looking beyond cures and paying attention to problems with cancer care delivery, costs, access and prevention. With hospitals' fortunes now tied to outcomes and population health, they should be looking for breakthroughs in those areas, not toward another marginally effective $100,000 drug.

Diana Zuckerman is a former Congressional aide and long-time DC-based women's health advocate. She is one of the founders of the Cancer Prevention and Treatment Fund, a non-profit group that promotes cancer risk reduction and helps patients "in choosing the safest and most effective" treatments.

Zuckerman supports additional research funding. She's just not sure the moonshot will change much.

"This administration has a year left," she said "What are they going to accomplish? It takes more than a year. We've had so many wars on cancer and we've had a lot of progress. But if you want to make meaningful progress, you don't [just] throw money at a problem for a year."

Her wish list: Zuckerman would like to see more FDA scrutiny, both before and after approval, of marginally effective cancer drugs. Costs are another issue and one way to keep them down would be to prevent drug makers from charging so much for treatments made possible by publically funded NIH research. Like the moonshot.

So, what else needs to be fixed? A lot, according to a 2013 committee convened by the Institute of Medicine. It issued a report entitled "Delivering High Quality Cancer care: Charting a New Course for a System in Crisis."

The Cost Problem
"Our current cancer care delivery system falls short in terms of consistency in the delivery of care that is patient-centered, evidence-based, and coordinated. We are at an inflection point in terms of repairing the cancer care delivery system. If we ignore the signs of crisis around us, we will be forced to deal with an increasingly chaotic and costly care system, with exacerbation of existing disparities in the quality of cancer care."

The signs of a crisis are indeed many, including costs. The rise of the $100,00-plus per year cancer drug had triggered a wave of outrage from Congress to medical journals and to healthcare leadership.

Even doctors are speaking out. In 2013 more than 100 doctors treating patients with chronic myeloid leukemia made the unusual move of signing on to a statement in the journal Blood protesting high drug prices. In July, another 100-plus oncologists singed on to a statement in Mayo Clinic Proceedings supporting a petition protesting the high drug prices. It starts out: "The high prices of cancer drugs are affecting the care of patients with cancer and our health care system."

At least one hospital refused to pay the high prices for new drugs unless they offer any new benefit.

On February 4, not far from the White House, breast cancer survivor Zahara Heckscher (who prefers to call herself a "cancer thriver") took action she thinks will help keep the cost of cancer drugs down.

She was arrested during a civil disobedience protest at the offices of PhRMA, the drug industry trade group. Backed by the consumer advocacy group Public Citizen and Doctors without Borders, she's part of an effort to block new pharmaceutical industry intellectual property rules in the pending Trans Pacific Partnership trade agreement.

Critics say the patent, marketing, and data provisions could boost the cost of biologics worldwide. PhARMA says weak intellectual property rules in the pact "could be highly detrimental to the future of innovation in the U.S."

Heckscher said that, on one hand, she was "really excited" to hear about the moonshot, because she supports efforts to put more money into cancer research.

Care 'Doesn't Seem Coordinated'
"All that is fantastic," she said from her home in Washington D.C. "However, I am highly aware that the proposed actions in the moonshot leave out many of the existing problems with access to cancer medicine and treatment. I would like it if it could be expanded to take these other issues into consideration. "

Heckscher, who said her early stage breast cancer came back as late stage breast cancer, has spent a lot of time in different hospitals, for both first and second opinions. She has been happy with the care she's received. She feels, however, that providers could all do a lot better job coordinating the non-clinical services she finds important, such as financial counseling, support groups, and art therapy.

"The effort felt really piecemeal and I had to scramble around to find the schedules, "she said. "It doesn't seem coordinated."

And it doesn't seem that complicated or costly to fix.

The list could go on. Let's look at disparities. African American women have a higher incidence of the aggressive triple-negative subtype breast cancer than other groups. African American men have higher rates of prostate cancer incidence and death. Prevention: Lung cancer kills 150,000 people in the US, more than breast, prostate and colon cancer combined. Environmental causes: It's barely a blip on anyone's research agenda.

So, hospitals, like the rest of us, may not have much to gain from the moonshot, at least in the short run. In terms of all these other problems in the way we deliver care—we'll just have to keep looking for solutions here on planet earth.