On Thursday, March 10 AcademyHealth hosted—along with partners American Cancer Society Cancer Action Network, Celgene, and Research!America—its second congressional briefing on the health research continuum, titled “From Discovery to Delivery: Research at Work Against Cancer.” The event was standing room only, and more than half of the attendees were congressional staff.
The continuum model of this briefing is unique in that it walks attendees through the evolution of a disease or condition from the research perspective, illustrating how the different types research, from basic to health services and translational research, play distinct, complementary roles in improving health and health care.
This briefing focused specifically on cancer research.
With the administration’s recent announcement of the ‘Moonshot’ initiative, a $1 billion investment to eliminate cancer as we know it, there has been a renewed focus on this terrible disease. In 2016 alone, more than 1.6 million new cases of cancer will be diagnosed, and it will claim an estimated 600,000 American lives. Cancer doesn't discriminate; it has touched virtually everyone. AcademyHealth President and CEO Dr. Lisa Simpson proved this much in her opening remarks as she asked whose lives had been touched by cancer in some capacity; it seemed as though almost every hand was raised.
While it's easy to talk about cancer in statistics, it's important to remember that "each of those numbers is a person's life story," said Dr. Simpson.
One such life story came from panelist and cancer survivor (or, as he says, cancer thriver) Michael Holtz, who was diagnosed with rectal cancer in 2012. Holtz, according to his surgeon, should be “dead or still very, very sick from cancer," but because of a number of factors, including cancer research, Holtz recovered. Chemotherapy, 28 days of radiation therapy, and surgery were all part of Holtz’s treatment regimen. Yet, despite the hardship and some losses, Holtz feels he is leading a good life – with perpetual hope that research will be able to reduce the side effects patients like him endure. He implored members of Congress to fund this work, to build on the support provided last year to cancer research so fewer people may have to hear the words, “You have cancer.”
To build on the points made by Holtz, pharmaceutical industry representative and panelist Dr. Joel Beetsch of Celgene spoke to advancements being made in clinical research. Over the past several years, there have been significant advancements, but there is a substantial gap between discovery and deployment. Currently, approximately 1 percent of health care dollars are dedicated to new targeted cancer therapies, which can have a huge return—creating true and lasting value for stakeholders. To continue making progress, partnerships—within a culture of integration and collaboration—are key, Dr. Beetsch said.
Another area of opportunity is the intersection of value, access, and equity. According to Dr. Jan Eberth, University of South Carolina, where you live and how much money you make shouldn't dictate the kind of care received. Dr. Eberth used her and her MD Anderson Cancer Center colleagues' needle biopsy study to illustrate how access can predict patient outcomes. In the study, she and her team examined patient, physician, and structural factors related to the receipt of needle biopsies for the diagnosis of breast cancer and its later impact on breast cancer care. The needle biopsy procedure, proposed by several professional organizations as a quality indicator, is nearly as accurate as an open surgical biopsy, has a lower complication rate, costs less, and exposes fewer women to unnecessary invasive procedures. The study results found that access indeed played a role: if a patient lived far away from a needle biopsy provider, she would be less likely to get a needle biopsy and more likely to have a surgery. Additionally, people who didn't have a needle biopsy were twice as likely to have multiple surgeries to remove their breast lump. Ultimately, Dr. Eberth said, having a needle biopsy saves the system money, and saves women from having unnecessary surgeries.
Adding to Dr. Eberth’s health services research perspective was Dr. Larry Kessler, University of Washington professor and Agency for Healthcare Research and Quality (AHRQ) grant recipient, who opened his presentation with a powerful quote from Atul Gawande:
“Research on our health care system can save more lives in the next decade than bench science, research on the genome, stem-cell research, cancer vaccine research, and everything else we hear about on the news.”
Within the health system, one way to save more lives is getting the right treatments to the right population in a timely fashion, which includes factors related to burden and cost as well as variation in care. Dr. Kessler effectively showed not only how health services research can help us understand what’s happening within the health care system itself, but also how health services research can positively shape patient outcomes. Among his many examples were data showing that cancer patients are at 2.5 times the risk of filing for bankruptcy. Dr. Kessler also presented statistics around the utilization of chemotherapy or radiation therapy in the last 30 days of life. When treatment options have failed, he noted that continuing those treatments expose patients to side effects that negatively impact quality of life, an important consideration for caregivers and patients' families. Understanding which treatments work best, for whom and in what circumstance, can therefore reduce both financial burden and improve patient experience.
Speakers acknowledge that progress has been made across the continuum of cancer research, but there is still much to be done. This includes more collaboration across disciplines, re-examining fee-for-service incentives, and continued funding for the health research enterprise and the federal agencies that support this critical work: from the National Cancer Institute's basic and clinical research to AHRQ's support of the health services research that helps get those findings deployed to patients in the right way at the right time.