Major Cancer Bill Introduced in Senate

Sen. Dianne Feinstein (D-Calif), whosesecond husband died of colon cancer, seems to be following in the footsteps ofretired Sen. Connie Mack, once the leading advocate of cancer care legislationin the Senate. Sen. Feinstein’s new bill, the National Cancer Act of 2002, hasan array of provisions including at least one that may slow the progress of thelegislation. Sen. Feinstein wants to give the Food and Drug Administration (FDA)the authority to regulate tobacco, a proposition that has been presented toCongress before to no avail.

A letter sent to Sen. Feinstein on February 26 by several cancergroups said they strongly support tobacco regulation but have a number ofreservations about provisions in the new bill. For example, the bill would capthe growth of the National Cancer Institute (NCI) budget at 10% between fiscal2004-2007. That cap would be instituted after a 15% annual growth up to fiscal2003. The letter said, "Such limits on NCI appropriations are at leasttheoretically inconsistent with the concept of a professional judgmentbudget."

One provision is directed specifically at oncologists: Publicand private health insurance plans would pay oncologists to become overallmanagers of a patient’s care, or what the senator refers to as "cancerquarterbacks." However, in their letter, the cancer groups pointedly said,"We are concerned that reimbursement for coordination activities ascontemplated by the provision will be so insignificant as to have no impact oncancer care." For example, Medicare already has codes for reimbursingoncologists (and other physicians) for referring cancer patients to hospices,but filling out the required paperwork is so time-consuming that oncologists donot use those codes.

Sen. Feinstein believes cancer will be cured in her lifetime.One way she proposes to hasten the arrival of a cure is to provide grants andother incentives totaling $100 million a year for 5 years to spur on theinitiation of more clinical trials. approximately 400 new drugs are held up inthe development process because the resources to fund research of these drugsare not available, the senator says. In fact, only 5% of adult cancer patients(vs 60% of children) are currently enrolled in clinical trials. The bill alsorequires that private and public insurance programs cover the routine costs ofclinical trials.

These incentives to sponsors of clinical trials would workhand-in-hand with the provision requiring private insurers to pay routinemedical costs associated with clinical trials and cover more types of cancerscreening tests. In addition, insurers would have to pay for smoking cessation,nutritional counseling, and genetic testing.

There are 28 other senators cosponsoring the bill, including allfemale members of the Senate (both Republicans and Democrats) but only one maleRepublican (Sen. Gordon Smith, R-Ore). The lack of GOP male cosponsors and thereservations of cancer groups means that the bill will undergo a relatively longmodification process.