Guiding Cancer Control A Path to Transformation (2019) / Chapter Skim
Currently Skimming:
2 The Current "System" of Cancer Control
2 The Current "System" of Cancer Control
Pages 63-100
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From page 63... ...
The system is the product of hundreds of independent or near-autonomous cancer control efforts -- research into the biology and epidemiology of cancer, improvements in surgery or radiation therapy, diagnostic and other product engineering, drug development and testing, hospice care, payment and reimbursement policies, and on and on. On various occasions, some organization, usually a government agency or professional group, has attempted to impose some sort of post hoc structure and direction on this system -- such as by developing a "national cancer plan" -- and to increase collaboration and coordination among the system's various components.
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From page 64... ...
Canada's recent plan has set milestones for cancer control subject to routine evaluations for a 30-year period. Peru's cancer control plan has focused on expanding national funding within its public health system and providing universal health coverage for cancer care to the most vulnerable populations.
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8/61 (13%) implementation strategy 65 continued
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From page 66... ...
2/27 (7%) implementation strategy NOTES: NA = not applicable; NCCP = national cancer control plan; NCD = noncommunicable disease; Data for two countries that had plans other than NCD plans or NCCPs are not shown here; *
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From page 67... ...
CMS manages the federally funded health insurance programs 1 A section of the National Cancer Act of 1971 authorized NCI to establish a national cancer program in cooperation with states and health agencies. The NCI director was to coordinate not only the cancer research programs within NCI but also all cancer control efforts related to other federal and nonfederal programs.
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From page 68... ...
. The Office of Population Affairs administers the Title X program on population health, including a program for breast and cervical cancer screening and prevention (HHS, 2018)
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. In 1992, with congressional funds, DoD started a breast cancer research program, followed 5 years later by a prostate cancer research program.
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From page 70... ...
Within the Department of the Treasury, the Alcohol and Tobacco Tax and Trade Bureau regulates the production, importation, distribution, labeling, and advertising of tobacco and alcohol -- both of which are known risk factors for several malignancies. To limit the consumption of these significant cancer risk factors, the agency levies and collects excise taxes on them; however, the full effects of these tax policies on tobacco and alcohol use across the United States remain to be well characterized.
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From page 71... ...
The agency enforces laws that make it illegal for private companies and federal, state, and local governments to deny a qualified job applicant a position because of a disability. Cancer patients and cancer survivors are more likely to report disputes related to job termination, terms and conditions of employment, and benefits than individuals without cancer (McKeanna et al., 2007)
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From page 72... ...
. The National Cancer Act of 1971 also empowered states to establish cancer control programs in collaboration with NCI (NCI, 2018b)
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From page 73... ...
• Increase the proportion of women who receive a breast screening and cervi cal cancer screening or were counseled by their clinicians based on the most recent guidelines. • Increase the proportion of men who have discussed the advantages and dis advantages of the prostate-specific antigen test to screen for prostate cancer with their clinician.
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From page 74... ...
. What is unknown is how many more unwritten, unpublished, and informal plans or guidance documents exist.8 CDC has determined that these plans should focus on encouraging people to make healthy choices, educating people about cancer screening tests, increasing access to high-quality cancer care, and reducing health disparities.
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From page 75... ...
Maryland's targets are based on information from the Healthy People Initiative along with the Maryland BRFSS and the Youth Tobacco and Risk Behavior Survey. PERFORMANCE EVALUATION A foundational hurdle affecting the progress of state and local cancer control programs is that currently there are no agreed-upon or declared national9 standards or methods (including for data analyses)
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From page 76... ...
. To date, no professional organization has conducted or commissioned an objective, neutral performance analysis of all the goals proposed and implemented by state cancer control plans.
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From page 77... ...
There are multiple nonprofits focused on breast cancer, prostate cancer, lung cancer, and hospice care. Not all these "cancer" organizations have a background in medicine or population health, nor do they approach cancer control efforts through those lenses; many of them focus on socioeconomic and ocial justice issues or on political activism, while others are s
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From page 78... ...
. GAO found that only about 15 percent of eligible women in the United States received breast cancer screening through the program in 2005 and 2006.
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From page 79... ...
Additionally, GAO concluded that the activities employed by HHS leveraged existing resources and did not duplicate other federal breast cancer education efforts. a The National Breast and Cervical Cancer Early Detection Program was authorized by the passage of the Breast and Cervical Cancer Mortality Prevention Act of 1990.
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From page 80... ...
Google has been investing in drug development startups (Reuters, 2018) , Intel has invested in predictive analytics companies working on noninvasive colon cancer screening (CB Insights, 2018)
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From page 81... ...
. A 2015 survey of 120 U.S.-based companies offering or planning to offer onsite health clinics reported that 86 percent offered new services that included lifestyle and wellness programs, while nearly all offered immunizations and acute care services (Towers Watson, 2015)
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From page 82... ...
The differences arise because of differences in how the various organizations weigh the potential benefits of screening versus the potential harms, such as un necessary biopsies and treatments, but it can be very difficult for patients to see the disagreements as anything less than contradictory and confusing. A similar situation exists with the guidelines for prostate cancer screening.
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From page 83... ...
This statement recommended baseline PSA measurement for men in their 40s and stated that PSA testing does reduce the incidence of metastatic prostate cancer as well as prostate cancer–specific mortality rates for men aged 50–69 (Murphy et al., 2014)
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From page 84... ...
Drawing on previous publications of the National Academies, six of those common themes are summarized in this section. The first theme is the very "fragmented" nature of cancer control efforts -- one that affects patients in significant ways and makes it logistically challenging to coordinate actions across the cancer control continuum, including prevention, screening and early detection, diagnosis,
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From page 85... ...
The third theme is the availability and use of a "data infrastructure" -- an issue that routinely comes up not only in discussions on how to understand and improve cancer control efforts but also in more general discussions about overall medical care and health policy. "There is no national cancer care data system in the United States," concluded an Institute of Medicine report issued in 2000 (IOM, 2000a)
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From page 86... ...
, identifying effective ways to communicate accurate cancer risk information and statistics to patients and other stakeholders (IOM, 2012) , and enabling the broader enrollment of patients in clinical trials (IOM, 2010c)
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From page 87... ...
. This issue of reproducibility further complicates the clinical guidelines debate and raises concerns about whether the right kinds of investments are being made in research and whether research is accountable and responsive to such investments, often coming from taxpayers (An, 2018)
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From page 88... ...
Challenges with the reproducibility of study findings also arise in fields that rely on the mining of large, observational data sets. For example, nutritional epidemiology studies often make the headlines for identifying associations between dietary intake and cancer risk, but the results from different studies may be contradictory.
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From page 89... ...
Moreover, recent media headlines highlight three new developments in cancer care and research that also have the potential to influence public trust. First is the increased and questionable promotion of services directly to patients by some medical centers and the rapidly growing marketing expenditures of drugs by biopharmaceutical companies (see Box 2-6 for additional discussion on promotion of cancer services and products)
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From page 90... ...
Doing so will require a completely different approach to better understanding and shaping a system using the approaches and tools of systems engineering. FINDINGS Finding 2-1: Historically, national strategic plans have been successfully established and refined to meet the prioritized needs of population health, national security, transportation, and economic development over the past century.
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From page 91... ...
Finding 2-2: In the United States, various initiatives pertaining to cancer control involve the leadership of at least a dozen federal government agencies in addition to those principally focused on health promotion, disease control, and medical benefits. Finding 2-3: Cancer control activities in the United States involve hundreds of participant groups with diverse interests.
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From page 92... ...
However, it is crucial that research results and publications in biomedical, public health, social and behavioral sciences, and related areas meet the central scientific standards of reproducibility and replicability required to maintain the public confidence and support, all essential for effective cancer control. Finding 2-10: Clinical guidelines currently issued by numerous advisory and professional organizations for cancer screening and care in the United States widely diverge from one another even for a specific cancer type.
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From page 93... ...
http://www.cancerindex.org/clinks5n.htm (accessed February 15, 2019)
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From page 94... ...
https://www.cdc.gov/workplacehealthpromotion/ model/index.html (accessed February 15, 2019)
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https://www. hhs.gov/opa/reproductive-health/index.html (accessed February 15, 2019)
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From page 96... ...
https://www.kff.org/report-section/ ehbs-2017-summary-of-findings (accessed February 15, 2019)
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From page 97... ...
2014. Guideline of guidelines: Prostate cancer screening.
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From page 98... ...
https://www.cancer.gov/about-nci/legislative/ history/national-cancer-act-1971 (accessed February 15, 2019)
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From page 99... ...
2018. Disability evaluation under social security https://www.ssa.gov/disability/professionals/bluebook/13.00-NeoplasticDiseases Malignant-Adult.htm (accessed February 15, 2019)
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From page 100... ...
Program. https://www.fns.usda.gov/nslp/national school-lunch-program-nslp (accessed February 15, 2019)
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