WASHINGTON—Speaking here at the Association of American Cancer Institutes (AACI)/Cancer Center Administrators Forum Annual Meeting, U.S. Health and Human Services Secretary Kathleen Sebelius, MPA, said that she will do everything in her power to keep funding for cancer research strong, despite the many current obstacles, including budget cuts imposed by sequestration. Ironically, Sebelius spoke just a few hours before the government shutdown, and one day before the health exchanges of the Affordable Care Act (ACA), which she is implementing, were slated to begin.
“The progress that you all are making means everything ... It's significant and tangible,” said Sebelius, a former governor of Kansas. “I want you to understand that President Obama does get this.”
Sebelius said she and the President are well aware that advances in cancer research “are not free,” and come at a cost. But she said, when it comes to cancer research, “Neglecting to invest has a cost.”
In terms of specific advances made possible by research, Sebelius cited progress in childhood cancer, noting that today there are some 300,000 childhood cancer survivors, and progress in targeted, precision therapies. She praised the selectivity of targeted therapies for cancer cells while sparing normal cells, and said this approach is far more effective than the “carpet bomb” treatments used before advances in molecular biology made precision medicine possible.
She also praised the new “breakthrough therapy” designation of the U.S. Food and Drug Administration, and said the FDA is committed to getting effective new cancer drugs to patients faster.
Forty percent of the HHS budget, she said, goes to the National Institutes of Health, which includes the National Cancer Institute. She referred to her visit to NIH this past Aug. 1, where she presided at a town hall meeting. Before that meeting, she toured NIH's Children's Inn and the NIH Clinical Center's Laboratory of Molecular Biology of Lymphoid Malignancies, and met with the senior leadership at NIH. At the town hall meeting, she said (as quoted in NIH's Clinical Center News), “Everyone agrees funding science at this moment in time is one of the single best investments the country could make; and cutting back on scientific research and funding is idiotic in a global economy.”
But at the AACI meeting Sebelius addressed the realities of a government shutdown, which at that point had not yet occurred, noting that “if the federal government does shut down, entrance into clinical trials at NIH will shut down—thus slowing the engine that powers advances in clinical cancer research.”
She also addressed the harms of Congressionally imposed sequestration, which has caused deep budget cuts for federal agencies. “For sequester, we had no choice; $1.5 billion had to come off the top,” she said. That cut occurred last March. “If we fail to restore sequestration cuts, we will lose $19 billion in NIH funding over the next decade.”
Sebelius added, “I wish I had a crystal ball and could tell you when sequester will end,” noting that President Obama and his administration are committed to ending sequestration. But, she said, some members of Congress, primarily those in the Republican-dominated House of Representatives, are “holding the Obama administration hostage” and blocking its efforts to end sequestration.
She praised the benefits of the ACA, the controversial health-reform centerpiece of the Obama administration. She referred to comments on the effects of being an uninsured cancer patient by Roy A. Jensen, MD, who introduced her at the AACI meeting. Jensen, Director of the University of Kansas Cancer Center and Director of the Kansas Masonic Cancer Research Institute, noted in his introductory remarks that an uninsured cancer patient has just half the five-year survival of a cancer patient who does have insurance.
Talking about the ACA, Sebelius emphasized that this law cannot be stopped by the federal government shutdown. She noted that (beginning in 2014) the 85 percent of Americans who already have health insurance will find their coverage improved. For example, preventive services such as mammograms will be covered, as will genetic testing and counseling for women with BRCA1 and BRCA2 mutations and a family history who are at high risk of breast and ovarian cancer.
The ACA also bans lifetime dollar limits on coverage for diseases such as cancer, prevents insurance companies from dropping the coverage of sick policy holders, restricts annual dollar coverage limits, and bans insurance companies from denying coverage to a person with a pre-existing condition such as cancer. And, noted Sebelius, the ACA will allow young adults to stay on their parents' health insurance plan until they are 26.
Remarks by AACI President Michelle LeBeau
Regarding the promise of precision oncology, AACI President Michelle M. LeBeau, PhD, Director of the University of Chicago Comprehensive Cancer Center, has made precision oncology the focus of her presidential initiative. “The research that is done in academic centers is what establishes the standard of care,” she told OT.
LeBeau and her team are currently in the process of choosing precision oncology topics of significant interest to AACI members, and she said she plans to assemble a panel of her cancer center colleagues to discuss best practices in implementing precision oncology in U.S. cancer centers. Topics under consideration include establishing a precision medicine tumor board; genetic counseling; start-up costs; tissue collection; biobanking; incorporating molecular diagnostics into clinical trial design; and communicating the results of genetic testing to patients, oncologists, and providers of cancer care.
In an AACI commentary, LeBeau wrote, “Clinical oncology is transitioning from a treatment paradigm based on the anatomic site of tumor origin to one in which the molecular characteristics of the tumor guide selection.”
As a result of that transition, she said, cancer centers are facing a new day. “Numerous challenges impede the implementation of comprehensive molecular diagnostics within cancer centers, including the acquisition of appropriate tissues, development of mutation panels, selection of technology platforms, and regulatory reimbursement policies.”
Thus, she said, her AACI initiative hopes to help cancer centers during this major paradigm shift in oncology.