110th Congress

Cancer Survivorship

S. 1056, S. 1415/H.R. 2353, H.R. 4450/S.2877

Background

There are more than 10 million cancer survivors in the United States. Recognizing that large numbers of individuals are surviving cancer for longer periods of time, the National Cancer Institute (NCI) administratively established the Office of Cancer Survivorship (OCS) in 1996. OCS supports and promotes research that examines and addresses the long- and short-term effects of cancer and its treatment; provides information to cancer patients and their families, health care providers, advocates, and the research community; conducts meetings with researchers, health professionals, advocacy groups, and the public to build common research agendas and ensure the dissemination of research findings; and conducts an annual analysis of the National Institutes of Health (NIH)/U.S. Department of Defense grants pertaining to cancer survivorship.

During the 107th Congress, cancer survivorship was included in four broad cancer bills, and Representative Steny H. Hoyer (D-MD) introduced a freestanding bill dedicated solely to the issue. Legislation introduced in the 108th Congress was similar to Representative Hoyer’s legislation, the most significant difference being that the amount that NCI would have been required to spend on cancer survivorship research was no longer specified. Other legislation introduced in the 108th Congress that contained survivorship language included S. 2771, the Quality of Care for Individuals With Cancer Act, and S. 1101/H.R. 2741 and S. 1899, each entitled the National Cancer Act. In addition, during the 108th and 109th Congresses, Representative Roger Wicker (R-MS) introduced freestanding legislation (H.R. 2896 and H.R. 5390, respectively) that would have required the Director of NCI to establish and support demonstration, education, and other programs for cancer survivorship. Thus far in the 110th Congress, four bills have been introduced that contain cancer survivorship provisions that would affect NIH: S. 1056, the National Cancer Act; S. 1415/H.R. 2353, the Cancer Screening, Treatment, and Survivorship Act; and H.R. 4450, the Pediatric, Adolescent, and Young Adult Cancer Survivorship Research and Quality of Life Act.

Provisions of the Legislation/Impact on NIH

Cancer survivorship provisions in S. 1056 include amending the Public Health Service Act to require NCI to conduct a study of the unique health challenges associated with cancer survivorship and, through grants or contracts, carry out projects and interventions to improve the long-term health status of cancer survivors. Authorized activities for these provisions would include 1) the coordination of a partnership between NCI and the Centers for Disease Control and Prevention (CDC) to assess the unique challenges associated with cancer survivorship and the enhancement of cancer-related surveillance systems to track the status of cancer survivors and determine whether cancer survivors are at risk for other chronic and disabling conditions and 2) the development of a national cancer survivorship action plan, in partnership with health organizations focused on cancer survivorship and including further support for the Childhood Cancer Survivors Study, to be carried out in coordination with CDC’s State-based comprehensive cancer control program. The Secretary of Health and Human Services (HHS) would be required to submit a report to Congress describing the results of the study.

The bill would also require NCI to award grants to enable eligible entities to develop, monitor, and evaluate information concerning quality cancer care in cancer survivorship. In order to be eligible, the entity must operate a statewide cancer registry funded by CDC’s National Program of Cancer Registries or have the capacity for such a system and the ability to link data on phases of cancer care that go beyond medical record data (on initial course of cancer diagnosis and treatment) to longer-term care and to also allow for determining patients’ needs and perspectives.

The bill would authorize such sums as may be necessary for each of the fiscal years 2008 through 2011 to carry out these provisions.

S. 1415/H.R. 2353 contains provisions that would establish programs within the U.S. Department of Health and Human Services for the detection and control of cancer. Specific to NIH, the legislation would amend Title IV of the Public Health Service Act to require the following:

• The Director of NIH, acting through NCI and other appropriate agencies, would be required to expand, intensify, and coordinate research programs to identify and improve cancer screening and testing protocols.
• The Secretary of HHS would be required to award grants for a public awareness campaign addressing cancer screening, early detection, and available treatments and research.
• The Director of NIH would be required to provide assistance to NCI-designated cancer centers to enable them to serve as comprehensive cancer survivorship centers and evaluate models of survivorship care.

The legislation would authorize such sums as may be necessary for each of the fiscal years 2008 through 2012 to carry out these provisions.

H.R. 4450/S. 2877 contains NIH-related provisions that would amend Title IV of the Public Health Service Act to require the following:

• The Director of NCI would be required to coordinate NIH activities with respect to cancer survivorship, including childhood cancer survivorship.
• The Director of NCI would be required to give priority to the comprehensive assessment of the prevalence and etiology of late effects of cancer and its treatment, identification of risk and protective factors related to the development of late effects of cancer, identification of predictors of neurocognitive and psychosocial outcomes, and development and implementation of intervention studies for patients and families.
• The Director of NIH, acting through the Director of NCI, would be required to award grants for research on the causes of health disparities in childhood cancer.
• The Director of NIH would be required to conduct research to evaluate follow-up care for childhood cancer survivors.
• The Secretary of HHS, in consultation with the Director of NIH, would be required to award grants to establish or improve training programs for health care professionals to improve the quality of immediate and long-term follow-up care for survivors and to ensure that such care is linguistically and culturally competent. The legislation would authorize $5 million for each of the fiscal years 2009 through 2013 to carry out this provision.
• The Director of NIH, in consultation with the Administrator of the Health Resources and Services Administration, would be required to award grants to establish pilot programs to explore model systems of care. The legislation would authorize $8 million for each of the fiscal years 2009 through 2013 to carry out this provision.

Status and Outlook

S. 1056 was introduced by Senator Dianne Feinstein (D-CA) on March 29, 2007, and was referred to the Senate Committee on Health, Education, Labor and Pensions. No further action has occurred on this legislation.

S. 1415 was introduced by Senator Tom Harkin (D-IA) on May 16, 2007, and was referred to the Senate Committee on Finance. No further action has occurred on this legislation.

H.R. 2353 was introduced by Representative Janice D. Schakowsky (D-IL) on May 16, 2007, and was referred to the House Committee on Energy and Commerce. No further action has occurred on this legislation.

H.R. 4450 was introduced by Representative Hilda L. Solis (D-CA) on December 11, 2007, and was referred to the House Committee on Energy and Commerce. No further action has occurred on this legislation.

S. 2877 was introduced by Senator Harry Reid (D-NV) [for Senator Hillary Clinton (D-NY)] on April 17, 2008, and was referred to the Senate Committee on Health, Education, Labor and Pensions.  No further action has occurred on this legislation.

June 2008