# Presentation: 490589

## Accelerating Successes Against Cancer: Recommendations from the NCI – Designated Cancer Center Directors

August 2006

Presentation to the National Cancer Advisory Board September 7, 2006

**August 2006**
**Presentation to the ****National Cancer Advisory Board ****September 7, 2006**

## Why this report?

- Confusion over goals and expectations with regard to the 2015 target.
- Blueprint for achieving what is possible.
- Frustration over reduction in NCI funding at a time of great opportunity for increased successes.
- Recognition by NCI-Designated Cancer Center directors of the advantages of increased collaboration and joint activities.

## OUTLINE OF REPORT

- Statement of Purpose	  J. Mendelsohn, MD
- Executive Summary		  J. Mendelsohn, MD
- Prevention				  	D.  Alberts, MD
- Early Detection			          S. Gerson, MD
- Treatment				           M.Abeloff, MD
- Survivorship			       	  W. Dalton, MD, PhD
- Collaborations			         L. Hartwell, PhD
- Dissemination			    R. Herberman, MD
- Coordinator: Maureen Johnson, PhD, NCI

## STATEMENT OF PURPOSE (1)

- _Keypoints:_
- NCI-designated Cancer Centers have implemented programs that lead the way in each of the three initiatives of the NIH Roadmap.
- Cancer Centers, unlike the NCI, have dual missions: research and dissemination of improved care to patients.
- We can substantially reduce deaths from cancer just by broadening the application of knowledge we have today.  Cancer Centers can lead the way.
- The promise of “personalized” medicine is achievable.

## STATEMENT OF PURPOSE (2)

- _Goals of Cancer Center Directors’ Working Group:_
- Reduce the burden of cancer through research in the areas of _prevention_, _detection_, _treatment_, and _survivorship_, and create a strategy for success.
- Identify ways in which NCI-designated Cancer Centers can enhance _collaboration_ with each other and with other stakeholders in the pursuit of our shared mission.
- Suggest initiatives that will enable the Cancer Centers to extend their research beyond their local communities and to provide leadership in the wide _dissemination_ of best practices in cancer and prevention.
- Create a realistic vision of the potential for future successes and identify the roadblocks that must be dealt with.

## STATEMENT OF PURPOSE (3)

- _Progress:_
- ACS has performed a midpoint analysis of goal of 50% reduction in deaths 1990-2015: projected success is 23%. *
- Projected decrease in breast, male lung and colon cancers is tracking at 50%!
- Prevention and early detection more important than treatment in these successes.
- More can be achieved by increased participation.
- * Byers et al, Cancer 107(2):396-405, 2006.

## STATEMENT OF PURPOSE (4)

- _Collaboration and synchronization:_
- With other Cancer Centers
- With care providers in the state
- With professional organizations
- With governmental agencies and the U.S. Congress
- With pharmaceutical and biotech companies
- With patient advocacy groups

## STATEMENT OF PURPOSE (5)

- This exercise has succeeded in energizing the
- directors of NCI-designated Cancer Centers to
- collaborate in research and dissemination of
- best practices, and to advocate aggressively
- for increased public awareness and
- governmental funding.

## PREVENTION (1)

- Need for uniform dissemination
- 41 million uninsured Americans
- Uneven access
- Need for an educated and motivated public.
- Because cancer is a disease that starts as a premalignant clone of cells and progresses, early interventions should be effective.
- Endorsement of the recommendations of the National Cancer Policy Board.

## PREVENTION (2)

- _Immediate strategies:_
- Importance of acting on risk factors that reflect life style:
- Tobacco use
- Obesity
- Physical inactivity
- Diet

## PREVENTION (3)

- _Immediate Strategies:_
- Importance of intervention by health care providers
- Colon endoscopy, mammography, PSA, Pap smear
- Vaccination (HPV)
- Chemoprevention (breast cancer)
- Smoking abatement: counseling and nicotine replacement

## PREVENTION (4)

- _Long Term Strategies:_
- Clinical trials to discover molecular targets for early detection of high-risk and precancerous lesions and identification of targets for chemopreventive therapy.
- Chemoprevention clinical trials: risk based interventions.
- Clinical research in behavioral sciences.
- Need for databases and powerful informatics to establish risk profiles for individuals and for high-risk populations.

## PREVENTION (5)

- _Other considerations:_
- Clinical studies are long in duration and very expensive.  Any side effects are objectionable.  These issues deter faculty, pharma, and governmental sources of funding.
- Epidemic of childhood obesity – a cross-NIH issue.
- Disparities in provision of and payment for healthcare.
- Scientific knowledge does not guarantee clinical implementation!

## EARLY DETECTION (1)

- Early cancer is far more curable.
- Research results will come faster if focus is on high risk populations: cancer survivors, genetic predisposition, environmental exposure, family history.

## EARLY DETECTION (2)

- _Technology:_
- Genomics, proteomics, immunohistochemistry
- X-ray and MRI imaging
- Molecular imaging
- Informatics and computational biology

## EARLY DETECTION (3)

- _Immediate Strategies for Cancer Centers:_
- Partner with governmental agencies and health care providers to expand clinical use of validated screening methods.
- Partner with advocacy groups to pursue payment from CMS, insurance and health plans (and dealing with the uninsured).
- Partner with state public health departments and health care providers to disseminate information on health benefits and points of access.
- Partner with other Cancer Centers to share tissue resources and advanced technology platforms.

## EARLY DETECTION (4)

- _Long-term Strategies for Cancer Centers:_
- Collaborate in large-scale clinical trials to discover and validate biomarkers.
- Expand application of new technologies: genomics, proteomics, immunohistochemistry, molecular imaging.
- Continue fundamental, basic research on genetic and molecular abnormalities in cancer.
- Through NCI and governmental agencies, create a standardized electronic database of medical and scientific information and patient medical records.