Maintaining a strong investment in cancer care
The American College of Surgeons (ACS) Commission on Cancer (CoC) is charged with recognizing cancer care programs and their commitment to providing comprehensive, high-quality, and multidisciplinary patient-centered care. The ACS and COC are dedicated to improving survival and quality of life for cancer patients through standard setting, prevention, research, education, and the monitoring of comprehensive quality care. As a result, access to CoC standardized reporting tools, educational and training opportunities, resources, and advocacy efforts are thriving.
The ACS has a number of cancer-related advocacy priorities. This agenda was established at the COC Advocacy Committee meeting in February 2018, and attendees at the 2018 ACS Leadership & Advocacy Summit in May brought these concerns to their legislators’ attention in Capitol Hill visits. Details on a few key priorities are highlighted below.
Pediatric cancer research
Pediatric cancer death rates have declined by nearly 70 percent over the last four decades. Nonetheless, cancer remains the leading cause of death from disease among children according to the National Cancer Institute (NCI), which estimates that 10,380 new cases of cancer were diagnosed last year in the U.S. in infants and children from birth to age 14. Approximately 1,250 children are expected to die from the disease this year. Although advancements have been made in childhood cancer research, much needs to be done to ensure that children facing a cancer diagnosis have access to the highest quality of care.
The Childhood Cancer Survivorship, Treatment, Access, and Research (STAR) Act, H.R. 820/S. 292, was introduced by Reps. Michael McCaul (R-TX), Jackie Speier (D-CA), Mike Kelly (R-PA), and G.K. Butterfield (D-NC) and Sens. Jack Reed (D-RI), Shelley Moore Capito (R-WV), Chris Van Hollen (D-MD), and Johnny Isakson (R-GA). On March 22 the Senate passed its version of the STAR Act, S. 292. The ACS strongly advocated for passage of the STAR Act during the 2018 Leadership & Advocacy Summit, and on May 22, the House passed S. 292. President Trump signed the legislation into law June 5.
This legislation is intended to advance pediatric cancer research and child-focused cancer treatments, as well as improve childhood cancer surveillance and provide resources for survivors of childhood cancer. The STAR Act contains the following provisions:
- Authorizes the NCI to build upon existing efforts to collect biospecimens for childhood cancer patients enrolled in NCI-sponsored clinical trials, with the goal of collecting and maintaining relevant clinical, biological, and demographic information on all children, adolescents, and young adults with cancer
- Authorizes grants to state cancer registries to identify and track the incidences of child, adolescent, and young adult cancer
- Enhances research on the late effects of childhood cancer through the following measures:
- Improve collaboration among providers so that physicians are better able to care for this population as they age
- Establish a pilot program to begin exploring innovative models of care for childhood cancer survivors
- Ensure pediatric expertise at the National Institutes of Health (NIH) by requiring the inclusion of at least one pediatric oncologist on the National Cancer Advisory Board
- Improve NIH childhood health reporting requirements by including pediatric cancer
Improving quality of life for cancer patients and families
The ACS CoC maintains that palliative care plays an important role in improving the quality of life for cancer patients and their families. Unfortunately, not all palliative care programs have the interdisciplinary teams necessary to provide comprehensive, high-quality care. H.R. 1676/S. 693, the Palliative Care Hospice Education and Training Act, introduced by Reps. Eliot Engel (D-NY) and Tom Reed (R-NY) and Sens. Tammy Baldwin (D-WI) and Capito, respectively, would establish Palliative Care and Hospice Education Centers to improve the training of health professionals in palliative care. H.R. 1676/S. 693 also would establish traineeships for individuals preparing for advanced education in nursing, social work, or physician assistant studies in palliative care.
Educating patients and providers on the benefits of palliative care has the potential to significantly improve quality of life for patients suffering from serious and complex chronic conditions. On June 27, the U.S. House Energy and Commerce Subcommittee on Health approved H.R. 1676. The full Energy and Commerce Committee is now reviewing the bill.
Cancer research and prevention funding
The fiscal year (FY) 2018 omnibus appropriations bill, H.R. 1625, demonstrated Congress’ dedication to cancer research and prevention by allocating $37 billion in funding to the NIH—a $3 billion increase over FY 2017. The legislation also provided $5.9 billion for the NCI, including $300 million for cancer research through the Beau Biden Cancer Moonshot. As members of Congress begin work on FY 2019 appropriations, the ACS is strongly encouraging them to maintain the bipartisan commitment to ensuring cancer research and prevention remains a budgetary priority.
For FY 2019, the ACS and the CoC urge Congress to support the following funding recommendations:
- NIH—$39.3 billion, including $6.4 billion for the NCI
- Centers for Disease Control and Prevention (CDC) Cancer Programs—$514 million
The House Appropriations Committee recently released proposed funding amounts for FY19. The bill provides $38.3 billion for the NIH, an increase of $1.25 billion over the FY 2018 enacted level. This total includes $400 million, a $100 million increase, for the Beau Biden Cancer Moonshot. However, CDC Cancer Programs funding remains flat.
Colorectal cancer screening
According to the NCI, colorectal cancer is the second-leading cause of cancer-related death in the U.S. This statistic is especially troubling as colorectal cancer is largely preventable because of effective screening methods. Under current law, Medicare waives coinsurance and deductibles for preventative colonoscopies. However, when a polyp is discovered and removed, the procedure is reclassified as therapeutic for the purposes of Medicare billing, and patients are therefore required to pay the coinsurance.
The Removing Barriers to Colorectal Cancer Screening Act, H.R. 1017/S. 479—sponsored by Reps. Charlie Dent (R-PA), Leonard Lance (R-NJ), and Donald M. Payne, Jr. (D-NJ), and Sens. Sherrod Brown (D-OH), Roger Wicker (R-MS), Ben Cardin (D-MD), and Susan Collins (R-ME)—would waive Medicare’s cost-sharing requirement for preventative colonoscopies, even if a polyp or tissue is removed. This bipartisan legislation will eliminate an unintended cost barrier for Medicare beneficiaries to life saving colorectal cancer screening and would help to ensure that the threat of unanticipated costs do not deter a patient from having the screening performed.
Congressional resolution recognizes ACS cancer Programs accreditation
ACS Cancer Programs, including the COC and the National Accreditation Program for Breast Centers, consist of consortiums of professional organizations dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education, and the provision of comprehensive quality care.
Reps. Lynn Jenkins (R-KS) and Mike Thompson (D-CA) introduced H.R. 503, a resolution recognizing the importance of voluntary accreditation by the ACS Cancer Programs and its value in ensuring access to cancer care. ACS accreditation demonstrates a cancer program’s commitment to providing high-quality, comprehensive care to patients and critical support to their families. Accreditation further allows cancer centers to continuously evaluate performance and make improvements where needed. Patients treated in accredited cancer programs have access to the full continuum of patient-centered care including distress screening, patient navigation, and delivery of survivorship care plans that detail treatments received and provide detailed information on future care needs.