Guiding Cancer Control A Path to Transformation (2019) / Chapter Skim
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4 A Path to Transformation
4 A Path to Transformation
Pages 127-146
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From page 127... ...
ederal agencies, state legislatures, and local governments F provided plans and regulations intended to direct cancer control efforts. Advocacy groups and professional associations added their voices, driving certain policies and approaches to help individuals with cancer or at risk of cancer.
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From page 128... ...
More generally, it would be desirable to have an established method for studying the various trade-offs that exist in cancer control, to help decide which trade-offs are in the best interests of population health. Another major shortcoming of the current cancer control efforts is the presence and possible perpetuation of wide disparities across populations.
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From page 129... ...
Conclusion 5: Cancer control has typically been pursued as a "war," "con quest," or "moon shot," but instead it needs to be recognized and approached in practice as a complex adaptive system whose elements are interactive and influential at multiple levels of society, starting with the individual. This change in mind-set is essential to recognize, reduce, and mitigate risks and make significant progress in diminishing the cancer burden in the United States, a situation challenged by population aging and other demographic factors with no apparent blunting of costs across cancer control activities.
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From page 130... ...
The contrast with cancer control lies in the pragmatic reality that these other sectors have long recognized the need to adopt principles of complex adaptive systems to better understand and respond to multiple constituencies, demands, and time scales. Conclusion 8: The current processes and systems of cancer control are at best reactive to circumstances.
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From page 131... ...
While a multi-agency approach may necessarily take some time to come to fruition or may not be seen as a possibility depending on the political circumstances, such an effort would be central to ultimately make significant progress in achieving national goals for cancer control. Coming up with a list of action items for each participant or sponsor -- with variable criteria -- would have been counterproductive both for this report and the national strategic vision based on a complex adaptive systems engineering approach.
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From page 132... ...
3. Integrate the use of social, behavioral, and other information made possible by the convergence of communication, social media, cognitive, financial, and sensor technologies as well as electronic health records, cancer registries, and insurance claims to establish large-scale interoperable data sources.
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From page 133... ...
Coordinating a wide range of federal agencies active in cancer control efforts could require congressional action if the participating agencies lack a legislative authority, in which case it is urged that the U.S. Congress provide the direction to implement the following recommendations.
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From page 134... ...
Another example is the NextGen air control system, discussed in Chapter 3, which requires integrative work and ongoing coordination and diligent performance review across many different agencies, particularly involving industrial partnership. And, indeed, the original Apollo "moon shot" that has inspired much of the recent activities in cancer control was a working demonstration of synergy among more than 20 different government agencies operating under a congressional mandate.
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From page 135... ...
would necessarily include all the cancer-related variables that might be of value to policy makers, including cancer incidence rates and mortality rates, quality-of-life indicators or proxies, the cost of a policy and its effects on the nation's gross domestic product, workforce productivity gains, and so on. It will be crucial that the inputs to the simulation package of the tool include the various policy actions that are possible to guide the cancer control system, from spending levels on various research and prevention
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From page 136... ...
Another potential use could be to look for the policies that would have the greatest effect on reducing disparities in cancer burden. With a simulated output that included details about various cancer-related differences among socioeconomic groups, such as behavioral differences (alcohol consumption, as an instance)
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From page 137... ...
efforts to control cancer. It supports research on a number of cancer-related topics, including studies on cancer incidence and mortality, examinations of the effectiveness of various cancer control efforts, and studies of public knowledge and attitudes about different types of cancer.
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From page 138... ...
It funds and provides guidance and technical assistance to states, territories, and other entities for developing their individual comprehensive cancer control plans. NCCCP emphasizes a multi-pronged approach to cancer control, with a focus on primary prevention, early detection and treatment, and supporting cancer survivors and caregivers, and it supports these focus areas through what it terms "cross-cutting priorities." These priorities include supporting changes in policies, systems, and environments to make communities healthier;3 achieving health equity; and using evaluations to ssess a and demonstrate outcomes, and these priorities can be multi-pronged in n ature as well.
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From page 139... ...
CDC could, for example, test a prototype of the interactive planning and monitoring tool described in recommendation C by making it available to the states and other entities for use in developing their comprehensive plans. Such a tool could be less complex and less layered because it may not include various options at the national level, such as federal funding for cancer research or national policies that affect medical care, drug prices or advanced technologies.
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From page 140... ...
Thus, one valuable service that NCI can provide would be to also carry out rigorous comparisons of effectiveness across interventions, looking at the outcomes of different approaches in varying circumstances -- ncluding conducting i financial analyses of research dollars spent on prevention strategies versus treatment, for instance, or of research funding for developing novel pharmaceuticals versus improved techniques for early detection and establishing robust reproducibility standards for research supported or conducted by NCI as well as different units of NIH involved in cancer research. One goal of the proposed tool is to allow policy makers to compare the likely outcomes of different strategies, but the tool will be only as good as the data informing it.
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From page 141... ...
Thus, one way these organizations could help move cancer control forward toward the future strategic vision of this report would be to make stronger connections among themselves and help the system become more integrated. The first step would be simply to encourage a greater awareness of the entire cancer control system and its nature, with individual components interacting to achieve the overarching goals, and the necessity for a planning and monitoring tool to organize and integrate the planning efforts necessary for national cancer control.
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From page 142... ...
At the present time, most of those in the various cancer control communities -- from oncologists to biomedical researchers in laboratories across universities and companies, and from public health practitioners to those involved in palliative care and end-of-life care -- are focused mainly on their own specialties. They may communicate and cooperate with those in other areas when necessary, but most of the time, that is not the case.
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From page 143... ...
The first is the development and dissemination of the cancer control planning and monitoring tool. Those who learn about how the tool is used -- and, ideally, get the chance to work with the tool themselves, at least to a limited degree -- will naturally begin to think of the nation's cancer control efforts as all part of one large, sprawling, loosely connected system.
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From page 144... ...
One of the advantages of the type of planning and monitoring tool that has been discussed here is that it encourages a decision process that is open and accountable. As was the case with the multi-criteria systems analytic approaches described in Chapter 3, a cancer control model and simulation of the sort under discussion would produce rankings of various options according to explicit inclusion and weightings of various factors.
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From page 145... ...
There is no way to do this with today's cancer control system; a complex systems engineering approach guided by a multi-level, multi-criteria model of the cancer control system could be an effective way to make progress. SETTING A PRECEDENT National cancer control efforts require something unprecedented: a collaborative initiative among multiple participants to develop a joint ability with joint accountability to understand and guide in productive ways a complex adaptive system.
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