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The National Dialogue on Cancer Responds to 'Voices of a Broken System'
December 7, 2002

The President's Cancer Panel (PCP)( and the National Dialogue on Cancer ( met together on December 7, 2002 in Washington DC. PCP members-Dr. LaSalle D. Leffall, Jr., Chair; Dr. Harold Freeman; and Mr. Lance Armstrong-welcomed input from Dialogue working group representatives on recommendations issued in the Panel's published report, Voices of a Broken System: Real People, Real Problems. The Voices report summarizes findings from testimony of more than 400 "real people"-cancer patients, survivors, physicians, and caregivers-about barriers that prevent all Americans from receiving timely and effective cancer care services.

In addition to responding to recommendations in the Voices report, Dialogue partners discussed how the identified barriers to cancer care might be addressed. The meeting served to initiate collaboration between these two advisory bodies, to further the goals of the National Cancer Program.

Related efforts underway by the Dialogue and affiliated partners address specific Panel recommendations. Access to clinical trials is an issue embraced by the Dialogue, which has developed a report on barriers to clinical trial participation. Partners are working to quantify dollar losses experienced by physicians enrolling patients in trials so that the impact of this system issue, currently supported only by anecdotal data, can be better assessed. Surveys in various treatment-settings are collecting information on attitudes towards clinical trials among underserved populations, and may provide useful data to integrate into state cancer control plans and improve access to cancer care.

The Dialogue state-level cancer plan team has focused on access issues similar to the Panel. Galvanizing cancer control support at the state level has helped generate change at the national level, and serves as a useful implementation model. The cancer plan team is seeking ways its members can be active partners in state-level planning efforts to further public information efforts and access to cancer care services. The issue of training health professionals is being addressed by the Dialogue's workforce team. Disparity in resources for training nurses and physicians is a significant issue and contributes to persistent shortages in qualified nursing professionals. Such shortages have a documented impact on quality of cancer care. Challenges in coordinating cancer care, navigating insurance/reimbursement systems, and paying medical costs was recognized. Issues surrounding adoption of standard cancer care benefit packages have been raised by the Dialogue and were briefly discussed.

A novel initiative is being undertaken by the CEO Roundtable of the Dialogue, which has developed a Gold Standard Task Force, to determine how corporations can impact the problem of cancer care. Based on new data supporting cost benefits of prevention and early detection, this group has developed a "gold standard" cancer care plan that, once endorsed, may serve as a model for other corporate health plans around the country. The plan would foster health promotion, tobacco cessation, onsite cancer control services, no cost coverage for prevention and early detection services, and cancer patient counseling and caseworker support.

The Dialogue has the ability to bring together many constituencies and resources to transform the health care system. The Voices report, noted one member, allowed Dialogue partners to walk in the shoes of others and reenergize their commitment to solving these problems. Increased collaboration between the President's Cancer Panel and contributing partners of the National Dialogue on Cancer will serve to better address issues of cancer care delivery in America.

The President's Cancer Panel, an advisory group established by Congress to monitor the Nation's efforts to reduce the burden of cancer, reports directly to the President on delays or blockages in that effort. For more information, visit the Panel's web site at, call 301-496-1148, or e-mail to


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