108th Congress

National Cancer Act of 2003

S. 1101/H.R. 2741, S. 1899

Background

Cancer, a group of diseases characterized by the uncontrolled growth and spread of abnormal cells, is the second leading cause of death in the United States, exceeded only by heart disease. In the United States, one of every four deaths is from cancer.

The first comprehensive cancer legislation, the National Cancer Act of 1937 (P.L. 92-218), was introduced as part of a “war on cancer” initiated by President Richard Nixon. During the 107th Congress, bills were introduced in an attempt by Members to reinvigorate those early efforts to defeat cancer by updating the 1971 legislation. Senator Dianne Feinstein (D-CA) and Senators Sam Brownback (R-KS) and Judd Gregg (R-NH) introduced separate bills with the same name, the National Cancer Act of 2002. Representative Lois Capps (D-CA) introduced the companion measure to Senator Feinstein’s bill.

In the 108th Congress, similar bills were reintroduced in both the Senate and House. The two Senate bills had the same name, the National Cancer Act of 2003. Senator Feinstein, Vice Chair of C-Change: Collaborating to Conquer Cancer and Cochair of the Senate Cancer Coalition, reintroduced S. 1101 on May 21, 2003. Representative Capps reintroduced the companion measure, H.R. 2741, on July 15, 2003. Senators Brownback and Gregg reintroduced S. 1899 on November 20, 2003.

Provisions of the Legislation/Impact on NIH

S. 1101/H.R. 2741

This legislation contained provisions for several agencies within the U.S. Department of Health and Human Services. Because of the size of the legislation, the following summary describes only the provisions that would have directly applied to the National Institutes of Health (NIH).

• Sense of the Senate Resolutions: Two Sense of the Senate resolutions were included, the first of which addressed maintaining adequate funding for NCI and the second of which encouraged investment in therapies that target only cancer cells, which would lessen the severity of the side effects of treatment.
• Strategic Plans: By July 1, 2006, NCI would have been required to prepare one or more strategic plans to identify unmet needs and inadequate funding levels in the areas of prevention, treatment, early detection, and quality of life and to expand and intensify cancer research and cancer-related research. The bill identified nine research areas: behavior, prevention, reduction of health disparities, palliative care, quality of life, environmental risk factors, symptom management, early detection, and cancer survivorship.
• Scientific Priorities: To determine priorities based on scientific opportunities, NCI would have been required to consult with medical, scientific, patient, and provider representatives and prepare one or more strategic plans by July 1, 2005.
• Translational Cancer Research: A translational cancer research center grant program would have been established. NCI would have been required to award grants to plan and operate a national network of at least 20 existing or new translational cancer research centers that would have been tasked with developing new approaches and products to prevent, detect, control, diagnose, and treat cancer and to improve quality of life and ultimately cure cancer.
• Targeted Cancer Drugs: NCI would have been directed to award grants for the development of treatments that target only cancer cells, lessening the negative side effects of treatment. By July 1, 2005, NCI would have been required to develop and implement a strategic plan for intensifying and expanding research to increase the number of targeted cancer treatments. Twenty million dollars would have been authorized for each of the fiscal years (FYs) 2004 through 2008 to implement this section of the legislation.
• Clinical Trials: The bill would have required NCI to establish a program to increase patient and provider participation in clinical trials. The program would have been required to include outreach, diversity assurance, culturally appropriate materials, and an assistance program. The legislation also contained language that would have required health plans to allow patients to participate in clinical trials and would have required plans to pay for routine patient costs for items and services associated with the trials.
• Incentives To Increase the Number of Cancer Researchers: NCI would have been required to 1) increase the number and amount of training grants to institutions supporting cancer research, 2) increase the number of career development awards for health professionals, particularly minorities, 3) establish a loan repayment program for qualified health professionals who agree to conduct cancer research, and 4) develop a stipend schedule for postdoctoral trainees and fellows. For the postdoctoral stipends, the bill would have authorized $79 million for FY 2004, $86 million for FY 2005, $95 million for FY 2006, $105 million for FY 2007, and $115 million for FY 2008. For the other programs, $10.5 million would have been authorized for each of the FYs 2004 through 2008.
• Cancer Survivorship: NCI’s existing Office of Cancer Survivorship would have been codified, with specific requirements to collaborate with other NIH Institutes, Centers, and Offices and to submit a report within 1 year of enactment that described the Office’s survivorship activities and future strategies. Such sums as may be necessary would have been authorized for FYs 2004 through 2008. The bill would have also amended NCI’s cancer control program to include cancer survivorship. The Centers for Disease Control and Prevention would have also been required to address cancer survivorship by studying the health challenges confronted by cancer survivors and carrying out projects and interventions to improve their long-term health status.
• Model Community Cancer and Chronic Disease Care and Prevention, and Patient Navigators for Health Disparity Populations: NCI would have been authorized to award grants for the development and operation of model programs that would have provided culturally competent prevention, detection, treatment, and followup care services for health disparity populations with cancer and chronic diseases. NCI would have also been required to award grants for the development and operation of programs to develop model practices and training for patient navigators, who would have assisted and guided patients throughout their treatment for cancer or other chronic diseases. Health disparity populations were defined as populations (including medically underserved groups such as rural and low-income individuals and individuals with low levels of literacy) in which there exists a significant disparity in the overall rate of disease incidence, morbidity, mortality, or survival rates as compared with the health status of the general population. The term specifically included American Indians, Asian Americans, Native Hawaiians and other Pacific Islanders, Blacks, and Hispanics (with origins from Mexico, Puerto Rico, Cuba, Central or South America, or any other Spanish-speaking country). NCI would have been required to develop a peer-reviewed model of both programs within 5 years of enactment. To carry out these programs, such sums as may be necessary would have been authorized for FYs 2004 through 2008. The Indian Health Service and the Health Resources and Services Administration would have also been required to develop model programs.
• Strategic Plan for Research on Environmental Risk Factors for Cancer: The National Institute of Environmental Health Sciences, in coordination with NCI, would have been required to prepare and submit to the Secretary of Health and Human Services (HHS) a plan that identified the unmet research needs related to environmental risk factors for cancer and gene-environment interactions. The report would have been required to include a description of how to increase the amount of this type of research and resources. Such sums as may be necessary would have been authorized to carry out this section of the legislation.

S. 1899

Title I—Public Health Provisions of Interest to NIH

This legislation would have:

• Required the Secretary of HHS to develop a plan and submit a report to Congress that outlined strategies by which State cancer registries funded by NCI’s Surveillance, Epidemiology, and End Results Program and other State cancer registries could develop standardized data and share information
• Created a new Patient Education Program that would have provided grants to help educate patients and their families on pain management, healthy lifestyles, physical activities, and support programs
• Revised various NCI authorities with an emphasis on pain and symptom management
• Established the existing NCI Office of Cancer Survivorship in statute. The legislation would have required the Office to collaborate with other appropriate NIH entities and submit a report to Congress describing survivorship activities and strategies for future activities.

Title II—Research Provisions of Interest to NIH

This legislation would have:

• Allowed NCI to cofund grant projects with private entities for any purpose described in NCI’s authorizing statute
• Included a Sense of the Senate resolution that 1) the current procedure of sending a research protocol through multiple local institutional review boards (IRBs) may not be the most efficient method of protecting patients, 2) NCI should be commended for its work in centralizing the IRB process, and 3) the research community should continue to streamline the IRB process in order to bring life-saving treatments to patients as quickly as possible
• Required NCI to 1) integrate trials conducted by private manufacturers into the NCI clinical trials online database and 2) establish an education program to provide patients and providers with information about how to access the NCI clinical trials online database and the Food and Drug Administration’s process for approving the use of drugs and biologicals for a single patient

Status and Outlook

S. 1101 was introduced by Senator Feinstein on May 21, 2003, and was referred to the Senate Committee on Health, Education, Labor and Pensions (HELP). No further action occurred on this legislation during the 108th Congress.

H.R. 2741 was introduced by Representative Capps on July 15, 2003, and was referred to the House Committees on Energy and Commerce, on Education and the Workforce, and on Ways and Means for consideration of the provisions within the jurisdiction of the respective committees. No further action occurred on this legislation during the 108th Congress.

S. 1899 was introduced by Senators Brownback and Gregg on November 20, 2003, and was referred to the Senate HELP Committee. No further action occurred on this legislation during the 108th Congress.