Treatment of cancer is highly individualized. Cancer is not one but more than a hundred different diseases. Even among very specific cancer types, there may be great heterogeneity in different patients. Cellular characteristics of each patient's cancer may vary significantly, and treatment may correspondingly vary. In such circumstances, formulaic approaches to coverage determinations should be suspect to the extent that such determinations limit the treatment options available to individual patients with their potentially very different diseases.
Cancer research is well organized and integrated into standard patient care.
Cancer is unique among diseases in that it alone benefits from an extensive government-sponsored research network that provides patients, even in remote locations, access to new therapies through clinical trial participation. The research structures in cancer, under the auspices of the National Cancer Institute and otherwise, provide monitoring, evaluation and eventual publication of clinical trials results, ensuring a degree of oversight and quality perhaps not so consistently found elsewhere. The research orientation of cancer care helps to drive cancer therapies toward gradual improvements in morbidity and mortality rates, as recent national statistics have shown, and cancer advocates do not favor relinquishing decisionmaking to entities that are not involved in the cancer research enterprise. Progress in cancer is incremental but relentless. One seldom sees dramatic or immediate improvements in cancer therapy, but progress occurs nevertheless, as the data show.