Journal of the National Cancer Institute Advance Access originally published online on October 9, 2007
JNCI Journal of the National Cancer Institute 2007 99(20):1502-1503; doi:10.1093/jnci/djm196
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© Oxford University Press 2007.
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Cancer Groups Hold Iowa Forums To Ask Presidential Hopefuls, "What Will You Do?"
Presidential candidates from both parties were invited to two forums in late August to talk to cancer advocates, patients, and survivors about what they would do to advance cancer research and improve access to treatment and prevention programs if elected.
Many candidates appeared at the meetings in Iowa sponsored by Lance Armstrong's Livestrong and the Susan G. Komen Foundation, including Republicans Sam Brownback, Rudy Giuliani, Mike Huckabee, Mitt Romney, and Tommy Thompson, and Democrats Hillary Clinton, John Edwards, Dennis Kucinich, and Bill Richardson. They discussed their proposals to reform the health care system and how doing so would help both new cancer patients and survivors.
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"We need to have a universal health care system so that every man, every woman in this country, when they're diagnosed with cancer gets absolutely all the treatment that they need, state-of-the-art treatment," said Edwards, whose wife, Elizabeth, announced in late March that her breast cancer had returned. Speaking at a 2-day Livestrong forum in Iowa, Edwards and Clinton were the only candidates to offer proposals that address specific issues that cancer patients and survivors face.
All the candidates appeared to agree that the National Cancer Institute, along with the National Institutes of Health in general, needs a dramatic increase in funding.
"Why is it that only 5% of research grants are approved for cancer research, and 95% are rejected? Why is it that the budgets for the National Institutes of Health have been flat or declining in the last 4 years? Why has the budget for the National Cancer Institute gone down over the past 4 years when we are losing this battle," asked Richardson, who suggested that, if elected president, he would make Lance Armstrong the nation's first Cancer Czar.
Clinton said that the current administration has slowed the pace of new discoveries by allowing funding to falter.
"We need to get back to unleash the genius of our researchers, our physicians. We need to get more people into clinical trials," Clinton said, to applause. "We need to speed up the approval of drugs from the Food and Drug Administration."
Richardson, Clinton, and others promised that they would work to once again double funding for medical research at NCI and NIH. That's a commitment that the advocacy community is likely to hold them to.
"Currently, the federal government invests approximately $5 billion annually researching cancer, a drop in the bucket for a disease that costs our country more than $200 billion annually in medical costs and lost productivity," said Matthew Moore, a senior policy advisor at the Komen Foundation.
Investing in cancer research also makes financial sense for the federal government, according to the candidates.
"Not only can we find an answer for cancer, but in the process we will save billions and billions of dollars," Edwards said.
Huckabee mirrored that statement: "It costs a lot less money to provide screenings than to wait until people are diagnosed in stage 4."
As governor of Arkansas, Huckabee eliminated deductibles and copays for colonoscopies, mammograms, and prostate screening for government employees. He also passed a statewide indoor smoking ban, as did Richardson in New Mexico.
Many of the candidates described how their overall health care proposals would benefit cancer patients. That is appropriate given that cancer is affected by many of the same problems that affect patients in general, Moore said.
"For example, the need for more preventative medicine, patients' access to quality care, high costs, and a shortage of doctors in some regions of the country. In addition, there are disparities in the health care system, just as there are disparities in cancer. Racial and ethnic minorities, and women with low incomes, are more likely to be diagnosed with late-stage breast cancer and are more likely to die from the disease," he said.
However, there are some issues that are specific to cancer that should also be addressed, such as the need for groundbreaking research and rapid access to new treatments, Moore said.
In a statement, Clinton has laid out a detailed list of campaign promises that include expanding the number of NCI Cancer Centers nationwide; increasing by fivefold the number of patients participating in clinical trials; improving access to cancer screening and smoking cessation programs; and developing programs to provide information, education, and support for cancer patients and survivors.
Edwards used the forum to announce his national strategy for cancer survivorship, which includes social and medical support for cancer patients, as well as their families and caretakers. He also vowed to push for health care reforms that ensure access to prevention and screening programs and comprehensive treatment for those diagnosed with cancer.
"Every single woman diagnosed with breast cancer should get exactly the same kind of treatment that Elizabeth has gotten," he said. Until the March announcement, Elizabeth Edwards' cancer was considered in remission after receiving treatment in 2004.
Putting Cancer on the Political Map
None of the cancer advocates interviewed for this article could recall a previous presidential election in which cancer rose to the level of a campaign issue.
"Cancer groups and cancer survivors have been working to get state and national candidates, both Republicans and Democrats, to commit to increasing the U.S. investment in the fight against cancer for a long time," Moore said. "Despite the fact that cancer kills one in four Americans, some 560,000 this year alone, it has been difficult to get candidates to focus on the disease."
High-profile advocacy, such as that sponsored by Armstrong's Livestrong Foundation, has also helped to put the issue on the political map, said Nancy Davidson, M.D., president of the American Society of Clinical Oncology.
It was clear from the forums that the candidates are no different from the average American in that virtually all people had been touched by cancer, either themselves or through a loved one. While Elizabeth Edwards' ongoing battle with breast cancer and Rudy Giuliani's bout with prostate cancer are well known, Huckabee recounted how surgeons found a tumor on his wife's spine. Brownback talked about being diagnosed with melanoma and seeing his father undergo a radical colon resection. Barack Obama's mother died of ovarian cancer, and Fred Thompson and John McCain are both also cancer survivors.
Those experiences may give the candidates a more intimate view of the problems that cancer patients and survivors face, Davidson said. For example, Huckabee talked about the difficulty of finding health insurance for his wife because of her cancer history, and Edwards spoke about the brain drain in medical research due to stagnant NIH funding. "We're awfully worried in our field that our new generation of researchers and practitioners who we need are going to abandon the field because of the funding crisis that we're reaching. I applaud him for putting that out there," Davidson said.
The candidates themselves recognized that talking about these issues in the campaign is a positive step. As Huckabee said at the Livestrong event, "I don't have all the answers about how we fix this. Nobody does. But the fact that we are engaging in this conversation tells us that there are a lot of people in this country who are finally beginning to realize that if we would spend some money on the front end on prevention and research, we would spend a lot less money on the back side of treating people at the catastrophic level."
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