The Future of Cancer Research: Accelerating Scientific Innovation

196 Pages·2012·5.47 MB·English

by  National Cancer Institute

The Future Of Cancer Research:
ACCELERATING SCIENTIFIC
INNOVATION
President’s Cancer Panel Annual Report 2010-2011
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
National Cancer Institute
The President’s Cancer Panel
LaSalle D. Leffall, Jr., M.D., F.A.C.S., Chair
(through 12/31/11)
Charles R. Drew Professor of Surgery
Howard University College of Medicine
Washington, DC 20059
Margaret L. Kripke, Ph.D.
(through 12/31/11)
Vivian L. Smith Chair and
This report is submitted to the President of the United States Professor Emerita
in fulfillment of the obligations of the President’s Cancer Panel The University of Texas
to appraise the National Cancer Program as established in MD Anderson Cancer Center
accordance with the National Cancer Act of 1971 (P.L. 92-218), Houston, TX 77030
the Health Research Extension Act of 1987 (P.L. 99-158), the
National Institutes of Health Revitalization Act of 1993
(P.L. 103-43), and Title V, Part A, Public Health Service Act
(42 U.S.C. 281 et seq.).
Printed November 2012
For further information on
the President’s Cancer Panel or
additional copies of this report, please contact:
Abby B. Sandler, Ph.D.
Executive Secretary
President’s Cancer Panel
9000 Rockville Pike
Bld. 31/Rm B2B37 MSC 2590
Bethesda, MD 20892
301-451-9399
[email protected]
http://pcp.cancer.gov
The Future Of Cancer Research::
ACCELERATING SCIENTIFIC
INNOVATION
President’s Cancer Panel Annual Report 2010-2011
Suzanne H. Reuben
Erin L. Milliken
Lisa J. Paradis
for
The President’s Cancer Panel
November 2012
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
National Cancer Institute

The President
The White House
Washington, DC 20500
Dear Mr. President:
Passage of the National Cancer Act more than 40 years ago marked the start of our nation’s war on cancer.
In the decades since, important strides in preventing, detecting, and treating cancer have been made possible
by our national investment in cancer research. Major contributors to this progress include the sharp overall
decline in tobacco use among Americans, better cancer screening and early detection methods, and improved
and targeted cancer therapies. As a result, more Americans are surviving longer following a cancer diagnosis
than ever before. Moreover, mortality from some cancers has decreased markedly.
Despite these achievements, the incidence of some cancers is increasing for unknown reasons and the
decline in the nation’s overall cancer death rate has been slower than anticipated. Of additional concern, the
number of cancer diagnoses is expected to increase sharply over the coming years as the U.S. population ages,
overwhelming much of the progress that has been made. Indeed, cancer is projected to become the nation’s
leading cause of death over the next decade, surpassing heart disease.
Cancer is the disease most feared by Americans, and a majority of the population believes that accelerating
research to improve health is a top or high priority. Yet the impediments resulting from fluctuations in funding
and the current focus, priorities, and processes of cancer research have inhibited widespread reductions in
incidence and mortality and limited quality of life improvements for cancer survivors. These elements of the
National Cancer Program need to be examined, reimagined, and reorganized to better support innovative
research with the potential to transform cancer prevention and care.
With these concerns in mind, the President’s Cancer Panel (the Panel) devoted its activities in 2010-
2011 to exploring opportunities to significantly improve cancer patient outcomes by fostering innovative
research approaches and intensifying cancer prevention research efforts. The attached report provides the
Panel’s recommendations for policies and related actions to accelerate scientific innovation and achieve the
transformative advances needed to dramatically decrease cancer deaths.
Mr. President, your administration has amply demonstrated its commitment to health care reform and the goal
of a healthier nation. Similarly, the Panel believes that your administration now has an opportunity to lead
the nation into the next era of cancer research—one that holds more potential than at any time in history for
improving our understanding of cancer and learning to prevent it, find it early when it does occur, and treat
all forms of the disease effectively without harmful side effects. Without your crucial support for a refocused
vision for cancer research, progress toward the goal of preventing, controlling, and curing cancer will continue
to proceed incrementally instead of accelerating to meet the needs of the American people.
Sincerely,
LaSalle D. Leffall, Jr., M.D., F.A.C.S. Margaret L. Kripke, Ph.D.
Past Chairman Past Member

Table of Contents
Executive Summary and Recommendations ................................................................................i
Preface
Acknowledgements
PART I

THE NATIONAL CANCER PROGRAM: OVERVIEW .......................................................................1
Chapter 1: Scope and Leadership of the National Cancer Program
A Brief History of the National Cancer Act .......................................................................................... 3
Participants in the National Cancer Program ...................................................................................... 5
Perceptions of Cancer Risk, Cancer Research, and the National Cancer Program ......................... 5
Chapter 2: Our National Cancer Burden
Incidence ..................................................................................................................................................10
Mortality ...................................................................................................................................................12
Survival .....................................................................................................................................................12
Continuing Disparities ...........................................................................................................................13
Chapter 3: Highlights of Cancer Research Progress
Basic Research ..........................................................................................................................................15
Translational Research ............................................................................................................................16
Clinical Research .....................................................................................................................................18
Surveillance, Epidemiology, and Population Research ......................................................................19
Screening and Early Detection Research ............................................................................................ 21
• Breast Cancer Screening ................................................................................................................ 21
• Cervical Cancer Screening ............................................................................................................ 23
• Colorectal Cancer Screening ........................................................................................................ 24
• Prostate Cancer Screening ............................................................................................................ 25
• Lung Cancer Screening .................................................................................................................. 27
Prevention Research ............................................................................................................................... 28
• Preventing Cancer through Modifiable Lifestyle Behaviors ..................................................... 28
• Chemopreventive Interventions ................................................................................................... 28
• Addressing Cancer-Linked Infections ......................................................................................... 29
PART II
MOVING FROM INCREMENTAL ADVANCES TO TRANSFORMATIVE INNOVATION ................... 33
Chapter 4: Modifying the Focus and Priorities of the National Cancer
Program to Accelerate Innovation and Progress
Cancer Research Funding Trends ........................................................................................................ 35
• Federal Government ....................................................................................................................... 35
• Voluntary Sector.............................................................................................................................. 38
• Industry ........................................................................................................................................... 39
Variations in Research Emphases of Federal, Voluntary, and Private Sector Funders .................. 39
• Federal Government ...................................................................................................................... 39
• Voluntary Sector ............................................................................................................................ 40
• Industry ........................................................................................................................................... 41
Research Areas with Limited Emphasis .............................................................................................. 41
Making Prevention a Research Priority............................................................................................... 42
Changing the Focus of Biomarker Research ....................................................................................... 43
Managing Cancer as a Chronic Disease .............................................................................................. 45
Taking a Systems Approach to Cancer Treatment ............................................................................. 46
Chapter 5: Rethinking Research Processes to Accelerate Progress
and Encourage Innovation
Adopting Grant Application, Peer Review, and Funding Models that Encourage Innovation .... 49
• NIH Investigator-Initiated Grant Applications, Peer Review, and Funding ........................... 49
• Other Grant Application, Review, and Funding Models ........................................................... 50
Ensuring Publication of Study Results ................................................................................................. 51
Bolstering Drug Development .............................................................................................................. 53
Reimagining the Clinical Trials System—Need for a New Paradigm .............................................. 55
Addressing Organizational and Operational Issues ............................................................................ 56
• NCI Clinical Trials Cooperative Group Program ...................................................................... 56
• NCI Operational Efficiency Working Group .............................................................................. 57
Designing Effective Trials ...................................................................................................................... 58
• Reconsidering Endpoints .............................................................................................................. 58
• New Approaches to Trial Design .................................................................................................. 60
• Patient Selection ............................................................................................................................ 62
• Community Involvement .............................................................................................................. 63
Addressing Challenges Related to Institutional Review Boards and Other Regulators ................ 64
Promoting Productive Team Science, Multi-Institutional Collaborations,
Consortia, and Partnerships ................................................................................................................ 66
• Federal Coordination of Team Science ...................................................................................... 66
• Voluntary Sector Participation ..................................................................................................... 67
• Managing and Evaluating Collaborative Science ....................................................................... 68
Chapter 6: Fortifying the Research Infrastructure to Support Transformative Innovation
Upgrading Research Facilities .............................................................................................................. 71
Using Technology Infrastructure to Facilitate Innovation ................................................................ 71
• Imaging ............................................................................................................................................ 71
• Data Systems and Data Sharing .................................................................................................... 72
Expanding and Improving the Utility of Biorepositories .................................................................. 77
Chapter 7: Strengthening the Cancer Research and Care Workforce
The Cancer Research Workforce .......................................................................................................... 81
• An Aging Workforce ....................................................................................................................... 81
• Supporting Young Investigators .................................................................................................... 82
• Bringing New Disciplines into Cancer Research ....................................................................... 85
The Cancer Care Workforce .................................................................................................................. 85
• Oncologists and Other Physicians ................................................................................................ 86
• Expanding the Expertise of Oncologists and Other Physicians ............................................... 87
• The Nonphysician Clinical Workforce ......................................................................................... 88
Cross-Cutting Workforce Issues ........................................................................................................... 90
• Workforce Diversity ....................................................................................................................... 90
• Recruitment and Retention ........................................................................................................... 92
Chapter 8: Accelerating Health Care Delivery System Improvements for
Better Patient Outcomes
Barriers to Health Care Delivery System Improvements .................................................................. 99
• Impact of a Patient Rescue Imperative ......................................................................................... 99
• Inequitable Resource Distribution and Failure to Apply What Is Known ............................100
• Fragmented, Uncoordinated Care ..............................................................................................100
• Limited Clinical Trial Participation, Reimbursement, and Referral .....................................101
• Education and Communication Issues ......................................................................................102
Improving Health Care Coordination, Efficiency, and Quality ......................................................104
• Health Service Delivery Innovations to Improve Care Coordination ...................................104
• Cancer-Specific Strategies to Improve Coordination and Quality of Care ...........................105
Technological Advances with Potential to Revolutionize Health Care Delivery .........................107
• Technologies for Information Management and Collaboration .............................................107
• Consumer Tools and Technologies ............................................................................................110
PART III
CONCLUSIONS AND RECOMMENDATIONS ..............................................................................113
Conclusions ........................................................................................................................................114
Recommendations .................................................................................................................117
References ................................................................................................................................123
Appendices
A. Roster of President’s Cancer Panel Meeting Participants—
The Future of Cancer Research: Accelerating Scientific Innovation ....................................147
B. The National Cancer Act of 1971................................................................................................151
C. U.S. Cancer Incidence and Mortality Rates, Selected Cancer Sites, 2004-2008 ...................158
D. Examples of NIH and Other Young Investigator Awards .......................................................160
E. Recommended Survivorship Care Plan Elements ....................................................................162
President’s Cancer Panel Reports: Bibliography, 2000-Present