Agenda for NCI’s New Cancer Control Division

BETHESDA, Md—The National Cancer Institute’s mint-new Division of Cancer Control and Population Science got its marching orderings only days before officially beginning operations. The National Cancer Advisory Board (NCAB) accepted the recommendations of a committee report titled “A New Agenda for Cancer Control Research” as a basic operating plan for the division.

The new division, part of an NCI reorganization first announced by director Richard D. Klausner, MD, in July, is headed by Barbara K. Rimer, DrPH, former director of the Duke University Cancer Prevention, Detection, and Control Research Program and the former NCAB chair. Dr. Rimer resigned her position with the advisory board to accept the new NCI post.

The report, 8 months in the making, was prepared by a 21-member committee led by David B. Abrams, PhD, director of the Center for Behavioral and Preventive Medicine, Brown University School of Medicine.

“We really believe that combining the best of behavioral-population-public health science with biomedical science and innovations in diagnostics and therapeutics gives us a much more powerful armamentarium for cancer prevention and control,” Dr. Abrams told the NCAB.

Among the committee’s key recommendations:

Create a unit focused on basic behavioral and social research in cancer control. Historically, NCI’s cancer control research has emphasized intervention and applications, and paid limited attention to funding basic behavioral and social research, the group said. However, a need exists for a greater understanding of the behavioral and psychosocial factors necessary to attain better prediction, prevention, and control of cancer.

The panel noted that this recommendation echoed several previous review groups that also had found “a huge gap in the understanding of basic processes of behavior change, thereby impeding the ability to develop successful cancer control interventions.”

Create a research focus in informatics and communication. This should include use of websites and other electronic-based systems; creation of a cancer-control “expert system” that can be readily updated for a variety of users; and the development of walk-up systems, such as kiosks, to serve as communications sources about cancer control.

Establish programs that recognize the role of behavioral prevention across the life span. In the committee’s view, primary prevention research should develop effective ways to change individual behavior associated with cancer risk, such as smoking and low consumption of fruits and vegetables; identify methods to reduce exposure to potential carcinogens; and discover ways of achieving behavioral changes within populations.

Increase integration of and support for cancer screening research. The panel urged “a base for screening research” in the new NCI division and the coordination of cancer-screening research throughout the NCI.

Create a research focus on rehabilitation and survivorship. About 7.4 million Americans currently live with cancer. Most are either in remission or cured of their disease, but many of them suffer from adverse treatment effects on major organ systems, cognitive function, and quality of life.

“The emerging set of life-limiting and life-threatening problems of cancer survivors is in need of research aimed toward prevention where possible, and intervention/rehabilitation when not preventable,” the report said. [See pages 5, 36, and 38 for more on survivorship.]

Establish research links to various health care delivery systems. Research is needed on how to introduce or improve cancer prevention and control services within managed care organizations, “not only for those who seek medical care, but to the broader insured population for which they are responsible,” the committee said.

Expand cancer surveillance and produce a “cancer report card.” The panel urged that the NCI’s Surveillance, Epidemiology, and End Results (SEER) program include additional populations, obtain more data from patients’ medical records and the patients themselves, and use these new data “to produce a timely report card on the cancer burden.”

Maintain strong support of biometry and applied research within the new division. “Cancer control researchers—as well as basic, clinical, and prevention researchers—depend on reliable data, the collection of which is dependent on appropriate expertise in study design, modeling, and data analyses,” the report noted.

Focus research efforts on underserved populations and those with a disproportionate cancer burden. A number of “special populations,” including Hispanics, American Indians, African-Americans, blue-collar workers, and low-income and low-literacy groups, “have disturbingly high cancer incidence and mortality rates,” the panel noted.

It urged a program of extramural intervention research targeted to the needs of underserved and high-risk populations; the inclusion of social, behavioral, and population scientists in this program; and expanding efforts “to identify gaps in research and the cancer prevention and control needs of these groups.”

Expand training in cancer control research. Currently, “the level of commitment to training in cancer control is woefully inadequate to take advantage of opportunities to reduce cancer incidence, morbidity, and mortality.”