Managed Care, Federal Budget Cuts Threaten Medical Progress,Warns President's Cancer Panel

Forty years of research have had a tremendous impact on the treatmentof leukemia in both children and adult's, according to a panelof experts appearing before the President's Cancer Panel in Chicagothis summer. But those experts also reported their fears thatnew ideas no longer will enter the medical marketplace as quicklyas they have in the past. The panel is a three member, Presidentiallyappointed advisory committee that meets regularly to assess theefficacy of the National Cancer Program.

"Since the 1950s, research has steadily improved the outlookfor patients with leukemia, and that progress continues,"said Harold P. Freeman, MD, chairman of the President's CancerPanel and director of surgery at Harlem Hospital Center in NewYork City. "In just the past several years, scientists havefound a new drug, all-trans retinoic acid, that induces remissionsin adults with a rare leukemia called acute promyelocytic leukemia(APL)."

In addition to Dr. Freeman, the other members of the panel areFrances M. Visco, JD, of the National Breast Cancer Coalition,and Paul Calabresi, MD, of Brown University/Rhode Island Hospital;the executive secretary is Maureen Wilson, PhD, of the NationalCancer Institute.

A committee advisory to the Food and Drug Administration recentlyrecommended that the agency approve use of this drug for relapsedpatients. In 5 years, research spearheaded by the National CancerInstitute (NCI) has brought this highly active drug into the clinicalarena, thus providing a new means of achieving remission in thistype of leukemia.

"Managed care squeezes payers, providers, and ultimatelythe recipients of care," Dr. Freeman said. "Federalfunding constraints and the impact of managed care on drug development,translational research, and clinical research threaten to stymiethe kind of medical progress Americans have enjoyed for decades."The President's Cancer Panel is concerned that cancer treatmentoptions that are suboptimal but less expensive will be reimbursable,while innovative and improved therapies will not be testable dueto lack of funds. "This is one of the greatest threats tothe mission of the National Cancer Program since its foundingin 1971," Dr. Freeman said.

Recommendations

The Panel recommended that the cancer research community reviewhow it communicates the results of clinical trial outcomes andwith whom; that the efforts of professional societies, academicorganizations, and Federal policy makers be coordinated to provideconsistent, rigorously reviewed, medically and scientificallysound, minimum guidelines for insurance support of health care-includingclinical trials; and that a public-private partnership beestablished to forge incentives for providers, payers, and recipientsof clinical care to participate in clinical trials, the benefitsof which can be assessed through health outcomes analysis.

"Studies in leukemia have shown that patients who participatein clinical studies have higher rates of remission and longerresponses to treatment than patients who do not," said Freeman."Access to clinical trials must be maintained and expandedfor those patients who desire that treatment option. The FederalGovernment has played and must continue to play a unique rolein funding and review of high risk or long-term research; otherwisewe face the demise of medical progress as we know it. Privatizationwill not address this need and managed care with its cost containmentfocus cannot accomplish it."