Without any proposed new funding for his initiative “to end cancer as we know it,” President Biden walked into the White House’s East Room on Feb. 2 to inaugurate what his former science adviser, Eric Lander, called an “audacious” effort to reduce the death rate from cancer by at least 50 percent within 25 years. While there are many admirable ideas in the president’s proposed plan, his reignited “moonshot” — downsized from an earlier campaign promise to “cure” cancer — was greeted with skepticism. With no new investment, critics noted, the moonshot is not ready for liftoff.
That is especially unfortunate because had the president wanted to improve the lives of cancer patients in, say, the next three years, when he would still be accountable, he could have done so. While it is important to pursue long-term goals, it is also critical to ensure that cancer patients today benefit from programs, tools and therapies that have already been developed.
As the president noted, increased investments in research over the years have led to enormous progress in treating cancer. This investment can and must continue. Notably since the mapping of the human genome at the beginning of the century, new targeted treatments for multiple types of cancer, as the president noted, have helped lead to a 25 percent age-adjusted decline in the cancer death rate in two decades.
But, according to Otis Brawley, former chief medical officer of the American Cancer Society, 130,000 Americans die annually from cancer because they do not benefit from known science. There are, for example, more than 90 cancer therapies on the market that are linked to identifiable biological markers. However, studies show that as many as 40 percent of patients who test positive for actionable genetic mutations never receive the therapies that are indicated by those tests.
This “practice gap” largely results from limited access to the latest developments in science and technology. Eighty-five percent of cancer patients get treated in community health systems, which often do not have the resources to implement the latest advances in cancer care. In addition, some health insurance plans do not want to reimburse for new diagnostic tests because their clinical utility has not been confirmed by time-consuming — and expensive — controlled, randomized clinical trials.
What can be done to get us closer to the goal of improving the lives of cancer patients — not a quarter-century from now but, say, before the next election?
First, we know that in the 12 states that have rejected Medicaid expansion, millions of low-income Americans do not have access to any health care at all, including cancer care. Extending access, as the American Cancer Society has argued, is paramount, and a political goal that needs to be addressed with congressional assistance.
Second, we need to do a better job making sure that the technologies of the future will be accessible. Just this month, we learned that a decade after the first leukemia patients were infused with their own reengineered blood cells, at least two were still alive — suggesting, in the words of Carl June, the University of Pennsylvania immunologist whose research led to the development of this breakthrough technology, that we “can actually cure patients.”
But because new treatments are developed for individual patients, the most advanced and promising cancer therapies are very expensive.
Working with the private sector, as it did when faced with the need to quickly develop vaccines to combat the covid-19 epidemic, the government can and should invest in or incentivize the development of the necessary infrastructure to scale the production of cell-based therapies for cancer, and thereby lower their costs.
And third, the government should support the clinical trials to provide the necessary evidence for health insurers to pay for early diagnosis. In development today are potentially paradigm-changing new technologies that can find evidence of cancer wherever it occurs in the body from a simple blood draw before a patient experiences any symptoms. But these new tests will not be widely available until they demonstrate their clinical utility — that is, that they save lives and money. Recognizing the enormous potential of multi-cancer early-detection tests, the National Cancer Institute is already exploring such a trial.
While President Biden’s 25-year goals are commendable, improving the lives of cancer patients is within our reach today. Given the enormous progress that has occurred and is likely to take place well before the middle of the century, it behooves us to work now to remove the impediments that are leaving too many cancer patients behind.
