139th National Cancer Advisory Board
research also can help accelerate progress in the short term. Longer term approaches involve the implementation of the extensive CTWG recommendations on collaboration, coordination, standardization, and infrastructure support in clinical research; the creation of a unified, standardized national Web-based clinical trials information system; and the investigation of new technologies and targeted therapies with the goal of achieving personalized treatments for cancer. Other considerations that are important are the ideas that: (1) continued and enhanced support for fundamental research, particularly on the genetics and biology of cancer, is necessary to accelerate the pace of treatment advances; and (2) the regulatory environment and inadequate health care system threaten the translation of science to clinical innovation, particularly in underserved populations.
Survivorship is an area that needs a comprehensive approach. In particular, the increasing mobility of the U.S. population has created a need for uniform guidelines and electronic summaries of patient records, and longitudinal research is needed to better serve cancer survivors. To address this in the short term, Cancer Centers should collaborate with NCI’s Office of Cancer Survivorship on the data warehouse and with the American Society of Clinical Oncology (ASCO) in developing clinical practice guidelines; moreover, they should broaden already established educational and support programs for patients and families. Key issues to be dealt with over the long term include: Cancer Centers working more closely and effectively with the community providers in terms of followup care and their leadership role in developing a clinical research focused on understanding, detecting, avoiding, and treating late complications of cancer and its treatment. The appendix of the full report contains material on current survivorship activities of the Cancer Centers, as well as reports to the President’s Cancer Panel and some very good reports by the Institute of Medicine’s (IOM) Survivorship Report.
Key ideas about collaboration are that optimizing collaboration is essential to accelerating successes against cancer, and collaborations involving individuals (micro-scale) within or outside a Cancer Center are frequent and productive. Moreover, there is a great need to enhance institution to institution collaboration (macro-scale), and true translational science is, by its nature, a much larger undertaking than discovery science. The Working Group suggested five immediate strategies for Cancer Centers: (1) form a collaborative chemoprevention trial consortium of Cancer Centers and academic medical centers; (2) expedite research on biomarkers by multiplexing hundreds of candidates; (3) facilitate collaboration in therapeutics between industry and academia by developing shared licensing agreements; (4) develop and implement standardized databases for Cancer Centers’ collection and analyses of survivorship information; and (5) take the lead in disseminating cancer care guidelines in collaboration with state health departments and cancer plans. Longer term efforts should engage the interest and involvement of pharmaceutical and biotechnology companies in chemoprevention and engage health economics experts to overcome barriers to development of translational discoveries. Moreover, a commercial consortium (similar to the SNP consortium) could be formed to invest jointly in the discovery of new technologies in proteomics. Research strategies could be implemented to identify problems experienced by a large cohort of cancer survivors and to explore interventions and treatments. Finally, the Cancer Centers could bring together fragmented efforts of the NCI, Centers for Disease Control and Prevention (CDC), CMS, and other DHHS agencies to coordinate funding and dissemination of cancer control efforts. Other considerations for collaboration are that a more effective use of shared resources in Cancer Centers could be fostered throughout the country, and that cultural changes across academia, industry, government, and the financial community are required to achieve the level of collaboration noted in the report.
Regarding dissemination, there is striking heterogeneity in the U.S. population in knowledge of best practices and evidence-based approaches to cancer interventions. Furthermore, the disparities are greatest in communities not directly proximal to or traditionally linked with Cancer Centers. A major barrier is the limited CMS and private payor reimbursement for cancer prevention, screening, early