Looking at cancer disparitites

with a long lens

Robert Croyle, director of the Division of Cancer Control & Population Sciences at the National Cancer Institute, sat down with Synthesis editor Dorsey Griffith during a recent visit to Sacramento. They discussed challenges and opportunities in addressing cancer health disparities. This is an excerpt of their conversation.

In this era of “personalized” cancer treatment based on genetic profiles, you oversee a program that supports population-based strategies to tackle cancer on a grand scale. How do you reconcile the two approaches?

A: Linking the individual to the population as a whole is a huge and complex challenge both scientifically and from the perspective of policy. The way that we engage with the public is at the individual level. But a lot of the most powerful levers to improve individual health are through macro, population-level policies. It’s a challenge to explain that a population-based strategy can be incredibly cost effective and have a broader impact.

Is tobacco control a good example of that given its relationship to cancer death rates?

A: Yes. We are about to embark on a new strategy, utilizing the FDA’s legal authority to regulate nicotine levels in cigarettes. NCI-supported research shows that when you provide smokers with a lower-nicotine cigarette, people reduce consumption. This has the potential to be a real game-changer in making cigarettes a lot less appealing and less addictive for teenagers.

What are the thorniest challenges in controlling cancer?

A: The scientific advances are outstripping our capacity to pay for care. Compelling new treatments that are very expensive increase the risk of exacerbating the gap between rich and poor in terms of what cancer care you get. It’s one reason we are developing a new focus on rural populations.

In today’s political climate are you concerned about our ability to ensure cancer care for all?

A: We can prioritize research that examines the impact of economic factors on cancer care. You want good evidence to drive policy, and we need more direct, comprehensive and compelling evidence on what many refer to as “financial toxicity,” and that is cancer patients who go bankrupt as a result of their diagnosis and treatment, or who don’t adhere to their medication regimen and don’t fill their prescription or come to follow-up visits because the financial burden is too extreme. When you look at maps of cancer incidence and mortality you see substantial geographic disparities.

With the aging population, we anticipate more cancer patients and survivors. Are we prepared?

A: We call it the “silver tsunami,” an aging population and a growing number of cancer survivors. This is an area where we are kind of playing catch-up. We have good knowledge acquired about late effects of cancer, but we are still developing strategies about what is appropriate in terms of monitoring and surveillance about cancer survivors. We have developed a lot of tools, but getting those used in the entire population is challenging, and we don’t know the degree to which providers are providing state-of-the art, evidence-based (survivor) care.

What is the role of former Vice President Joe Biden’s Moonshot initiative?

A: It reflects passionate leadership from Vice President Biden. But it also coincided with remarkable advances in immunotherapy and other modalities. A lot of Moonshot initiatives are focused on translational research to accelerate progress in treatment, but the Moonshot also serves to increase visibility of cancer as a problem and cancer research as part of the solution. One aspect of the Moonshot is increasing capacity and incentives for data sharing.

What are the realistic achievable goals to reducing cancer health disparities?

A: One way is to really build and expand on what we have. The nation has a tremendous cancer research infrastructure and capacity in basic, clinical and population-level research. But what we haven’t fully done is exploited that to improve cancer care for the entire population. Caring for cancer is not a direct responsibility of NCI, but the NCI absolutely has a responsibility to make sure our research enterprise serves the public as a whole, and there are many, many ways we can leverage our research to improve care.

For more information on the work of the Division of Cancer Control & Population Sciences, please visit cancercontrol.cancer.gov.

Moonshot grant funds HPV vaccination and tobacco cessation research

The NCI Division of Cancer Control and Population Sciences and Office of Cancer Centers have funded two Moonshot initiatives to be carried out at the UC Davis Comprehensive Cancer Center.

One will examine barriers to use of the human papilloma virus (HPV) vaccine, which may prevent cervical and many oral cancers, and a second will examine ways to better integrate tobacco treatment into cancer center services.

A one-year grant led by Moon Chen Jr. and Julie Dang, will examine how to accelerate uptake of the HPV vaccine among adolescents, with plans to use the information collected to develop strategies to increase vaccination rates. The funds are the result of the Cancer Moonshot Blue Ribbon Panel Report on expansion of the use of proven prevention strategies.

The initiative led by Elisa Tong builds on a strong, UC-wide effort launched at UC Davis to address tobacco usage at every clinical encounter. The new funding will help researchers work with cancer providers and staff, including pharmacists, to refine and evaluate how clinicians and other cancer center staff identify and treat patients who smoke. This effort will continue to enhance how electronic medical record tools can be leveraged to help cancer care providers offer and refer patients for evidence-based cessation treatment.