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Biomarkers and Quality of Care, Key Presentations at BSA Meeting
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NCI Board of Scientific Advisors November, 2004 |
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Dr. Robert C. Young, BSA Chair, President, Fox Chase Cancer Center
Dr. Kirby I. Bland, Fay Fletcher Kerner Professor and Chair, Department of Surgery; Deputy Director, Comprehensive Cancer Center, University of Alabama at Birmingham
Dr. Kathleen M. Foley, Director, Pain and Palliative Care Service, Department of Neurology, Memorial Sloan Kettering Cancer Center
Dr. Sanjiv S. Gambhir, Professor, Department of Radiology and Bio-X Program; Director, Molecular Imaging Program, Stanford University
Dr. Joe W. Gray, Director, Division of Life Sciences; Associate Director, Biosciences, Lawrence Berkeley National Laboratory
Dr. Mary J. Hendrix, President and Scientific Director, Children's Memorial Research Center; Professor of Pediatrics, Feinberg School of Medicine, Northwestern University
Dr. Leroy E. Hood, President and Founder, Institute for Systems Biology
Dr. Stanley J. Korsmeyer, Professor, Department of Pathology, Dana-Farber Cancer Institute
Dr. Christopher J. Logothetis, Chair and Professor of Medicine, Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center
Dr. Edith A. Perez, Professor of Medicine, Division of Hematology/Oncology, Mayo Medical School; Director, Breast Cancer Program, Mayo Clinic
Dr. John D. Potter, Senior Vice President and Division Director, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center
Dr. Ellen V. Sigal,* Chair, Friends of Cancer Research
Dr. Jane C. Weeks, Assistant Professor, Department of Medical Oncology, Dana-Farber Cancer Institute
* Reappointed |
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At the NCI Board of Scientific Advisors (BSA) meeting on November 8 and 9, the
board discussed a proposed initiative to accelerate the identification of
cancer biomarkers, as well as ways in which the quality of health care practice
can be improved.Dr. Leland Hartwell, Nobel laureate and director of the Fred
Hutchinson Cancer Research Center in Seattle, began his presentation by noting
that the case for early detection through biomarkers is founded in both
economics and patient outcomes. He said that a more organized and systematic
approach for discovering biomarkers for cancer exists than that which is
currently available, and stated that even with existing technology, "If we take
a divide-and-conquer strategy" beginning with 1,000 biomarker candidates and
splitting the work among different laboratories, "we could end up with
something in the order of 30 to 40 good things in the end." The principle
obstacles in this process, he noted, are a lack of reagents and a lack of
standards within this research field. He called on NCI to lead and oversee a
new biomarker initiative, and proposed a structure whereby centers are funded
for focused work on reagents, technology, and informatics, with smaller pilot
projects led by individual researchers. BSA members were largely supportive of
Dr. Hartwell's proposal, but identified key concerns that should be reviewed,
including legal issues surrounding the collection of samples for biomarker
testing; the size and nature of the patient population for this research; the
ultimate cost during clinical trials of biomarker candidates; and the other
programs and initiatives, such as the NIH Roadmap and the Early Detection
Research Network, that should dovetail with this new effort. Dr. Mark Clanton,
NCI's deputy director of Cancer Care Delivery Systems, followed with an
overview of health care quality assessment as context for future discussion.
"The public health impact of cancer can really only change if we can increase
and enhance the performance of the health care system," he said. Staff from
NCI's Outcomes Research Branch in the Division of Cancer Control and Population
Sciences then presented a summary of the research dissemination tools that NCI
makes available to the health care community, the challenges in translating
research into practice, and two programs to improve palliative health care in
specific populations, with following discussion of the appropriate role for NCI
in provider training and in evidence synthesis and dissemination. BSA members
had many suggestions for how to address these issues, including a report-card
system in which clinicians have incentives to comply with standards of
practice, NCI-funded "leverage research" that would be adopted by health care
practitioners, and identification of interventions that have been effective in
systems similar to that of health care in this country.
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