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139th National Cancer Advisory Board

detection, or survivorship issues. The immediate strategies recommend the development of an infrastructure to link Cancer Center expertise with community hospitals, clinical oncologists, and primary care physicians to utilize electronic technology to provide information for Cancer Centers to the diverse communities. Better use of the state cancer registries, Surveillance, Epidemiology, and End Results (SEER) data, and geographic information systems (GIS) mapping could help identify areas and populations of disproportionate need. An additional approach is to supplement Cancer Center Support Grants (CCSG) to link Cancer Centers in a regional network with community hospitals, clinical oncologists, and primary care physicians. Longer term strategies in dissemination involve: CMS support for demonstration projects, led by Cancer Centers, to test implementation strategies for population-based cancer control efforts; the development of metrics to continuously monitor effectiveness of efforts; and the planning and support of national outcomes studies through a national cancer data system working in connection with SEER and the National Cancer Data Base (NCDB).

Questions and Answers

Dr. Niederhuber expressed his appreciation for Dr. Mendelsohn’s leadership, as well as Drs. Abeloff’s and Johnson’s work, in fostering good dialogue among the leadership of the cancer community. He requested that Dr. Mendelsohn continue as a point person in the effort to extend the recommendations in the NCI Cancer Centers Directors’ Report through the American Association of Cancer Institutes (AACI) to non-NCI-affiliated cancer institutions. Dr. Coffey affirmed the importance of the Cancer Centers. He offered several ways to affect prevention, treatment, and the other areas discussed by the report; these included adding cancer preventive agents to food and water, and considering the development and use of cancer vaccines.

Ms. Giusti raised the issue of NCI funding and wondered what NCI’s message to decision makers should be about its funding, and what the NCI should do to make the message consistent and uniform; she also suggested that the NCI should consider how to take advantage of the industry’s support of oncology, and she described issues involving philanthrophy and cancer. She commented on the critical importance of collaboration across the cancer centers, especially in the uncommon cancers. Ms. Giusti noted that the patients and advocacy groups are willing to help the NCI in any way possible.

Dr. Chen requested further information about the role of disparities in Cancer Centers. Dr. Mendelsohn said that the NCI could assume a greater role in pulling together advocacy groups and reminding the American people that cancer is the most common cause of death in the United States for those under age 85. Dr. Abeloff pointed out that the accrual of minorities into clinical trials is one of the rigorous parameters set up for a center to become an NCI-designated Cancer Center or to retain its current Cancer Center status.

Dr. Chabner observed that two things will make a difference in terms of overcoming cancer: early detection with prevention, and treatment; but there is a serious national problem regarding the time that it takes for a protocol to be reviewed and activated in the Cancer Centers. Dr. Mendelsohn suggested that the agencies which impose the regulations should meet and discuss what each is doing. He noted that about every 6 months to 1 year, a major regulatory policy is adopted that disrupts everything that has been done in the past years; Medicare’s reimbursement for patient care costs in clinical trials is a recent example. Dr. Chabner recommended that the NCI coordinate a common policy among the Cancer Centers, the clinical trials, and industry about how trials should be reviewed and activated. Dr. Doroshow said that the NCI has control over the Cancer Center Support Grant (CCSG) guidelines, but not other things. Regarding the time process, Dr. Doroshow mentioned that the NCI funded a review at Cancer and Leukemia Group B (CALGB), which revealed that it takes 384 steps from the inception of a trial concept for it to be approved by the CALGB; no patient is enrolled during those steps. These steps relate to


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