A bill to improve data collection and dissemination, treatment, and research relating to cancer, and for other purposes.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``National Cancer Act of 2003''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) In 2003, an estimated 1,334,100 Americans will be 
        diagnosed with some form of cancer.
            (2) In 2003, an estimated 556,500 Americans will die of 
        cancer. In the United States, 1 in every 4 deaths results from 
        cancer.
            (3) In 2002, the National Institutes of Health estimated 
        the overall cost of cancer at $171,600,000,000.
            (4) In 2003, an estimated 211,300 American women and 1,300 
        men will be diagnosed with breast cancer, and 40,200 will die 
        of the disease. A mammogram every 1-2 years can reduce the risk 
        of dying by about 16 percent for women 40 years of age and 
        older.
            (5) In 2003, an estimated 40,100 women will be newly 
        diagnosed with cancer of the uterine corpus and 6,800 women 
        will die of the disease.
            (6) In 2003, an estimated 147,500 Americans will be 
        diagnosed with colorectal cancer and 57,100 will die of the 
        disease.
            (7) Incidence rates of colorectal cancer stabilized between 
        1995 and 1999. Research suggests that declines may be in part 
        due to increased screening and polyp removal.
            (8) The Chronic Disease Prevention Department found that 
        screening for colorectal cancer can reduce the number of deaths 
        by at least 30 percent.
            (9) Regular screening examinations by a health care 
        professional can result in early detection of cancers of the 
        breast, colon, rectum, prostate, testis, oral cavity, and skin. 
        If all these cancers were diagnosed at a localized stage 
        through regular examinations, the 5-year survival rate would 
        increase from 82 percent to 95 percent.
            (10) Cancers of the lung, mouth, larynx, bladder, kidney, 
        cervix, esophagus, and pancreas are related to tobacco use. The 
        American Cancer Society estimates that in 2003 more than 
        180,000 cancer deaths will be caused by tobacco use. Smoking 
        alone causes \1/3\ of all cancer deaths.
            (11) More than 1,000,000 skin cancers expected to be 
        diagnosed in 2003 could have been prevented by protection from 
        the sun's rays.
            (12) An estimated 9,000 new cases of childhood cancer are 
        expected to occur in 2003.
            (13) Cancer is the chief cause of death by disease in 
        children between the ages of 1 and 14.
            (14) The American Cancer Society estimates that 
        approximately \1/3\ of the 556,500 cancer deaths expected in 
        2003 will be related to nutrition, physical inactivity, 
        obesity, and other lifestyle factors that could be prevented.
            (15) About 77 percent of all cancers are diagnosed at age 
        55 and older. In order to ensure high quality cancer care for 
        American seniors, medicare reimbursements must reflect the true 
        cost of treatment in every treatment setting and medicare 
        payments should accurately reflect the cost of drug and 
        biologics as well as the cost of administering drugs and 
        supportive care therapies.
            (16) Despite an aging population, death rates for the most 
        common cancers, lung, colorectal, breast, and prostate continue 
        to drop at an average of 1.7 percent per year.
            (17) In May 2001, Gleevec, the first in what is expected to 
        be a number of cancer treatments, was approved for use by the 
        Food and Drug Administration as it appeared to be effective in 
        stopping the growth of deadly Chronic Myeloid Leukemia cells 
        within 3 months of use. In 2002, Gleevec showed ability to stop 
        growth of gastrointestinal stromal tumors.
            (18) In early 2003, researchers used gene chips to 
        accurately predict whether or not breast cancer tumors would 
        spread in the future. If the findings are validated, doctors 
        will be able to determine which patients are likely to relapse 
        and need chemotherapy, while sparing those with a favorable 
        prognosis from additional treatment.
            (19) The Lance Armstrong Foundation, a leading national 
        organization providing services and support for cancer 
        survivors, defines cancer survivorship as living with, through, 
        and beyond cancer.
            (20) In 2001, there were 9,600,000 cancer survivors in the 
        United States.
            (21) Sixty percent of adults diagnosed with cancer survive 
        at least 5 years.
            (22) While nearly every childhood cancer diagnosis 20 years 
        ago was fatal, today more than 80 percent of children diagnosed 
        with cancer survive at least 5 years.

SEC. 3. SENSE OF THE SENATE.

    It is the sense of the Senate that the United States is at a point 
in history in which we must take the proper steps to reach the goal of 
making cancer survivorship the rule and cancer deaths rare by the year 
2015.

                   TITLE I--PUBLIC HEALTH PROVISIONS

SEC. 101. NATIONAL PROGRAM OF CANCER REGISTRIES.

    Part M of title III of the Public Health Service Act (42 U.S.C. 
280e et seq.) is amended by inserting after section 399B the following:

``SEC. 399B-1. ENHANCING CANCER REGISTRIES AND PREPARING FOR THE 
              FUTURE.

    ``(a) Strategic Plan.--Not later than 1 year after the date of 
enactment of the National Cancer Act of 2003 the Secretary shall 
develop a plan and submit a report to Congress that outlines strategies 
by which the State cancer registries funded with grants under section 
399B and the Surveillance, Epidemiology, and End Results program of the 
National Cancer Institute (in this section referred to as the `SEER 
program') can share information to ensure more comprehensive cancer 
data. The report shall include ways in which the Secretary will--
            ``(1) standardize data between State cancer registries and 
        the SEER program;
            ``(2) increase the portability and usability of data files 
        from each registry for researchers and public health planners;
            ``(3) ensure data collection from the greatest number of 
        health care facilities possible;
            ``(4) maximize the use of State registry data and data from 
        the SEER program in State and regional public health planning 
        processes; and
            ``(5) promote the use of data to--
                    ``(A) improve the health status of cancer 
                survivors; and
                    ``(B) research quality of cancer care and access to 
                that care.''.

SEC. 102. ENHANCING EXISTING SCREENING EFFORTS.

    (a) Grant and Contract Authority of States.--Section 1501(b)(2) of 
the Public Health Service Act (42 U.S.C. 300k(b)(2)) is amended to read 
as follows:
            ``(2) Certain applications.--
                    ``(A) Strategies for colorectal cancer screening.--
                If any entity submits an application to a State to 
                receive an award of a grant or contract pursuant to 
                paragraph (1) that includes strategies for colorectal 
                cancer screening and outreach, the State may give 
                priority to the application submitted by that entity in 
                any case in which the State determines that the quality 
                of such application is equivalent to the quality of the 
                application submitted by the other entities.
                    ``(B) Women diagnosed with cancer.--If any entity 
                submits an application to a State to receive an award 
                of a grant or contract pursuant to paragraph (1) that 
                includes strategies for the provision of treatment for 
                uninsured women diagnosed with cancer discovered in the 
                course of the screening, the State may give priority to 
                the application submitted by that entity in any case in 
                which the State determines that the quality of such 
                application is equivalent to the quality of the 
                application submitted by the other entities.''.
    (b) Requirements With Respect to Type and Quality of Services.--
Section 1503 of the Public Health Service Act (42 U.S.C. 300m) is 
amended by adding at the end the following:
    ``(d) Waiver of Direct Services Requirement.--The Secretary may 
waive the requirement under subsection (a)(1) if--
            ``(1) the State involved will use the grant under this 
        section for a demonstration project that will leverage private 
        funds to supplement program efforts; or
            ``(2) such requirement would cause a barrier to the 
        enrollment of qualifying women.''.
    (c) Authorization of Appropriations.--Section 1510(a) of the Public 
Health Service Act (42 U.S.C. 300n-5(a)) is amended by striking 
``$50,000,000'' and all that follows and inserting ``such sums as may 
be necessary for each of fiscal years 2004 through 2008.''.
    (d) Report on the Comprehensive Colorectal Cancer Initiative.--Not 
later than 6 months after the date of enactment of this Act, the 
Director of the Centers for Disease Control and Prevention shall submit 
to the appropriate committees of Congress a report containing an 
assessment of the success of the Comprehensive Colorectal Cancer 
Initiative (within the Centers for Disease Control and Prevention) in--
            (1) increasing public awareness of colorectal cancer;
            (2) increasing awareness of screening guidelines among 
        health care providers;
            (3) monitoring national colorectal cancer screening rates;
            (4) promoting increased patient-provider communication 
        about colorectal cancer screening;
            (5) supporting quantitative and qualitative research 
        efforts; and
            (6) providing funding to State programs to implement 
        colorectal cancer priorities.

SEC. 103. ENHANCED PATIENT EDUCATION.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.) is amended by adding at the end the following:

``SEC. 399O. ENHANCED PATIENT EDUCATION.

    ``(a) Grants Authorized.--The Secretary is authorized to award 
grants to eligible entities to implement programs to educate patients 
and their families about--
            ``(1) the availability and options of effective medical 
        techniques and pain management technology therapies to reduce 
        and prevent pain and suffering for those with cancer upon 
        diagnosis;
            ``(2) the unique health challenges associated with cancer 
        survivorship, including--
                    ``(A) the role of followup care and monitoring to 
                support and improve the long-term quality of life for 
                cancer survivors;
                    ``(B) physical activity and healthy lifestyles; and
                    ``(C) the availability of peer and mentor support 
                programs; and
            ``(3) community resources available to increase access to 
        quality cancer care.
    ``(b) Application.--An eligible entity desiring a grant under this 
section shall submit to the Secretary an application at such time, in 
such manner, and containing such information as the Secretary may 
require.
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be 
necessary.''.

SEC. 104. PRACTITIONER EDUCATION PROGRAM.

    Section 414 of the Public Health Service Act (42 U.S.C. 285a-3) is 
amended by adding at the end the following:
    ``(d) In order to receive funding under this section, a center 
described under subsection (a) shall maintain a program for 
disseminating to patients and research participants, as well as their 
caregivers, the latest information about--
            ``(1) pain and symptom management and palliative care; and
            ``(2) the unique clinical and research challenges 
        associated with cancer survivorship.
    ``(e) The Secretary may provide additional amounts to fund centers 
under subsection (a) that develop innovative relationships with 
community cancer centers, community health centers, rural hospitals, 
and other community-based health care providers who target medically 
underserved populations for the purpose of increasing access to quality 
cancer care.''.

SEC. 105. ELEVATING THE IMPORTANCE OF PAIN MANAGEMENT AND CANCER 
              SURVIVORSHIP THROUGHOUT THE NATION'S CANCER PROGRAMS.

    (a) National Cancer Program.--Section 411 of the Public Health 
Service Act (42 U.S.C. 285a) is amended to read as follows:
    ``Sec. 411. The National Cancer Program shall consist of--
            ``(1) an expanded, intensified, and coordinated cancer 
        research program encompassing the research programs conducted 
        and supported by the Institute and the related research 
        programs of the other national research institutes, including 
        research programs for--
                    ``(A) pain and symptom management;
                    ``(B) survivorship; and
                    ``(C) the prevention of cancer caused by 
                occupational or environmental exposure to carcinogens; 
                and
            ``(2) the other programs and activities of the Institute, 
        including research on populations with both uniquely diverse 
        genetic variation and geographic isolation.''.
    (b) Cancer Control Programs.--Section 412(2) of the Public Health 
Service Act (42 U.S.C. 285a-1(2)) is amended--
            (1) in subparagraph (A), by striking ``, and'' and 
        inserting a semicolon; and
            (2) by adding at the end the following:
                    ``(C) appropriate methods of pain and symptom 
                management for individuals with cancer, including end-
                of-life care and cancer survivorship; and''.
    (c) Special Authorities of the Director.--Section 413(a)(2) of the 
Public Health Service Act (42 U.S.C. 285a-2(a)(2)) is amended--
            (1) in subparagraph (D), by striking ``and'' at the end;
            (2) in subparagraph (E), by striking the period and 
        inserting ``; and''; and
            (3) by adding at the end the following:
            ``(F) assess and improve pain and symptom management of 
        cancer throughout the course of treatment and cancer 
        survivorship.''.
    (d) Breast and Gynecological Cancers.--Section 417 of the Public 
Health Service Act (42 U.S.C. 285a-6) is amended--
            (1) in subsection (c)(1)--
                    (A) in subparagraph (D), by striking ``and'' at the 
                end;
                    (B) in subparagraph (E), by striking the period and 
                inserting ``; and''; and
                    (C) by inserting after subparagraph (E) the 
                following:
                    ``(F) basic, clinical, and applied research 
                concerning pain and symptom management and cancer 
                survivorship.''; and
            (2) in subsection (d)--
                    (A) in paragraph (4), by striking ``and'' at the 
                end;
                    (B) in paragraph (5), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(6) basic, clinical, and applied research concerning pain 
        and symptom management and cancer survivorship.''.
    (e) Prostate Cancer.--Section 417A(c)(1) of the Public Health 
Service Act (42 U.S.C. 285a-7(c)(1)) is amended--
            (1) in subparagraph (F), by striking ``and'' at the end;
            (2) in subparagraph (G), by striking the period and 
        inserting ``; and''; and
            (3) by inserting after subparagraph (G) the following:
                    ``(H) basic and clinical research concerning pain 
                and symptom management and cancer survivorship.''.

SEC. 106. SURVIVORSHIP RESEARCH PROGRAM.

    Subpart 1 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285 et seq.) is amended by adding at the end the following:

``SEC. 417D. SURVIVORSHIP RESEARCH PROGRAM.

    ``(a) Establishment.--There is established, within the Institute, 
an Office on Cancer Survivorship (in this section referred to as the 
`Office'), which may be headed by an Associate Director, to implement 
and direct the expansion and coordination of the activities of the 
Institute with respect to cancer survivorship research.
    ``(b) Collaboration Among Agencies.--In carrying out the activities 
described in subsection (a), the Office shall collaborate with other 
institutes, centers, and offices within the National Institutes of 
Health that are determined appropriate by the Office.
    ``(c) Report.--Not later than 1 year after the date of enactment of 
this section, the Secretary shall prepare and submit to the appropriate 
committees of Congress a report providing a description of the 
survivorship activities of the Office and strategies for future 
activities.''.

                     TITLE II--RESEARCH PROVISIONS

SEC. 201. NATIONAL CANCER INSTITUTE.

    (a) Other Transactions Authority.--Subpart 1 of part C of title IV 
of the Public Health Service Act (42 U.S.C. 285 et seq.), as amended by 
section 106, is further amended by adding at the end the following:

``SEC. 417E. OTHER TRANSACTIONS AUTHORITY.

    ``Notwithstanding any other provision of this subpart, the Director 
of the National Cancer Institute may cofund grant projects with private 
entities for any purpose described in this subpart.''.
    (b) Sense of the Senate on a Central Institutional Review Board.--
It is the sense of the Senate that--
            (1) the current procedure of sending 1 clinical trial 
        through multiple local institutional review boards may not be 
        the most efficient method for the protection of patients 
        enrolled in the trial and may delay the process of bringing 
        lifesaving treatment to cancer patients;
            (2) the National Cancer Institute should be commended for 
        its work in centralizing the institutional review board 
        process; and
            (3) the research community should continue to streamline 
        the institutional review board process in order to bring 
        lifesaving treatments to patients as quickly as possible.
    (c) Patient and Provider Outreach Opportunities With Experimental 
Therapies.--For the purpose of enhancing patient access to experimental 
therapies, the National Cancer Institute shall conduct the following 
activities:
            (1) Integrate, to the maximum extent practicable, trials 
        being conducted by private manufacturers into the National 
        Cancer Institute's clinical trials online database. Such 
        integration may require specific awareness-raising and outreach 
        activities by the National Cancer Institute to private 
        industry.
            (2) Establish an education program which provides patients 
        and providers with--
                    (A) information about how to access and use the 
                National Cancer Institute clinical trials database 
                online; and
                    (B) information about the Food and Drug 
                Administration process for approving the use of drugs 
                and biologics for a single patient.

Summary: National Cancer Act of 2003 - Amends the Public Health Service Act to direct the Secretary of Health and Human Services to develop an information-sharing plan for State cancer registries.

Modifies provisions concerning preventive health measures with respect to breast and cervical cancers to permit priority to be given to certain projects involving: (1) colorectal cancer screening and outreach; and (2) treating uninsured women diagnosed with cancer during such screening.

Authorizes specified waivers of the direct services requirement for breast and cervical cancer screening grants.

Authorizes the Secretary to award grants to eligible entities to educate cancer patients and their families about medical techniques to reduce and prevent pain, survivorship care and support programs, and related community resources.

Requires a national cancer research center to have a practitioner education program that includes pain and symptom management and survivorship care.

Amends various provisions of the Act to emphasize the importance of pain and symptom management throughout the nation's cancer programs.

Establishes within the National Cancer Institute (the NCI) an Office on Cancer Survivorship.

Authorizes the Director of NCI to co-fund grant projects for various cancer programs.

Expresses the sense of the Senate with respect to: (1) cancer survivorship; and (2) institutional review board procedures.