Prelude to a New Chapter in the National Cancer Program
Dr. John E. Niederhuber
One week ago today the country inaugurated Barack Obama as our new president, an occasion accompanied by the excitement associated with such a historic election. This election and this transition in government will one day generate many books, in part because of the economic crisis that in many ways rivals that of the 1930s and the fighting of two wars. With the election of the first African American president, it’s impossible not to draw the connection between President Lincoln’s second inauguration and this inauguration and the tremendous progress our democracy has made possible. For many of us, there were certainly memories of the 1961 inauguration of the young and energetic President Kennedy, as well.
There are great expectations that the new president will make significant changes—changes that will touch nearly every aspect of our daily lives, patient care and cancer research included. As a citizen and as NCI director, I share those expectations, the anticipation, and excitement of hope. The hope for an adjustment to our country’s compass toward a renewed investment in science, in the creation of new knowledge, and in the education of our talented young people. This, I believe, is about our future—our future as world leaders.
The inauguration of President Barack Obama at the U.S. Capitol on Tuesday, January 20, 2009
NCI’s leadership has been eagerly anticipating this administration change and actively planning and providing input and new ideas about the unique features of the cancer research enterprise as a model of how to leverage changes in policy, research funding, and science infrastructure to maximize the impact of discovery on health care. And we are carefully considering how to narrow the formidable gap between the rapid pace of innovation in biomedicine and our ability to harness it to improve not only the health of individuals but the need to manage cost. Today and tomorrow, in fact, the NCI Executive Committee—along with some of our country’s top scientific minds—is holding a retreat to discuss the next frontiers of cancer research.
Clearly, President Obama has the future of biomedical research on his mind. In his inauguration speech, one line in particular stood out to me: “We will restore science to its rightful place,” he said, “and wield technology’s wonders to raise health care’s quality and lower its cost.”
The Administration's Cancer Agenda
That one line in an 18-minute speech encapsulates just what cancer research has accomplished and can continue to do, even more productively, if we pursue the most worthy science and use our resources wisely. By investing in discovery and creating knowledge, we can dramatically minimize the cancer burden and do it more cheaply than is possible today. Creating the ability to match the right patient with the right therapeutic solution means we will not be wasting treatment dollars.
Examples of this potential already exist. In particular is the wealth of data now showing that cetuximab (Erbitux) only benefits colorectal cancer patients who have normal forms of the KRAS gene. As the Featured Article in this week’s issue of the NCI Cancer Bulletin details, the annual cost savings to be reaped from the more tailored use of this targeted agent may be substantial. In a similar vein, the initial results from The Cancer Genome Atlas (TCGA) revealed valuable new information about one of the most intractable tumor types, glioblastoma multiforme (GBM), by identifying what appears to be a mechanism of resistance to a chemotherapy drug commonly used to treat it.
Clinical practice is already changing based on the KRAS data, and the TCGA results have similar potential to help optimize available therapies, sparing patients unnecessary toxicities and, in the process, leading to more cost-effective treatment.
It’s important to stress, however, that optimally employing already existing knowledge and systems can lead to substantial gains against cancer. In a commentary in the January 2009 The Oncologist, NCI Division of Cancer Treatment and Diagnosis Director Dr. James Doroshow, NCI Division of Cancer Control and Population Sciences Director Dr. Robert Croyle, and I recommend five areas where modest investments can build upon existing programs and partnerships to achieve important research ends and yield dramatic improvements in the prevention and treatment of cancer.
One such action involves expanded tobacco control efforts. In California, for example, 5 years after implementing its state-wide, comprehensive tobacco control program, not only did smoking rates drop dramatically, but there was an estimated $86 billion in health care cost savings. Instituting such comprehensive tobacco control programs more broadly would prevent many cancers, and the cost of that investment would easily be offset by the savings of a downturn in tobacco-related diseases.
NCI leadership recognizes that advances in informatics will also play a critical role in this regard and has launched the BIG Health initiative to bring together, in a novel organizational framework, a continuum of information management aimed at empowering personalized medicine through the use of electronic medical records and a community of users including consumers, payers, and local physicians.
The realities on the ground have changed dramatically over the past 6 months. But, as others have said, crisis is often accompanied by great opportunity. With the incoming administration, NCI and the cancer community have an opportunity to demonstrate that we are amply prepared to wield science and technology to tackle one of the most difficult challenges facing our country’s people. In doing so, we can provide idea models and evidence-based programs for testing proposed changes in health care that will universally raise the quality of our nation’s well-being. The investment in the science and in care of patients with cancer remains the best model for understanding the genetics and biology of diseases in general, as well as the social and economic issues of delivering affordable health care to everyone.
Dr. John E. Niederhuber
Director, National Cancer Institute