DIRECTOR'S MESSAGE
Healthcare Reform and Cancer: Easy choices, hard choices
Dr. Tim Byers
“Change” and “hope” were key words for last year’s national election. We now find ourselves in a summer boiling with hopeful change for our healthcare system. As Congress debates across divergent views about which particular changes will be helpful or harmful, and which will be affordable or too expensive, this seems like an opportune time to reflect on how the coming changes might affect our cancer mission.
A coalition of cancer organizations led by the American Cancer Society has teamed with other groups such as AARP to advocate for broader access to health care. Most members of Congress now seem to agree with the American public that the problem of limited access to affordable healthcare needs to be fixed. For whatever specific remedy Congress chooses, if one outcome is better access to both cancer prevention and screening services and to state-of-the-art cancer therapy, we will have won an important battle. Broader access to prevention and treatment will greatly remedy the poorer cancer outcomes we now see in America among people of color and among those of lower socioeconomic status.
Cost and cost-efficiency are huge questions for the healthcare reform remedies now under debate. For cancer, some of these decisions are easy. Providing mammograms, colonoscopies and effective smoking cessation interventions for all Americans at age 50 or earlier would be an easy way to both prevent suffering and lessen the costs of diseases among people who will some day be in Medicare. Providing more universal access to proven treatments for cancer, such as routine post-surgery radiation or chemotherapy for risk-defined subgroups of patients, are also relatively easy choices.
Tougher decisions will ensue for questions about who should get expensive treatments on oncology’s cutting edge. Covering costly targeted therapies will be controversial because of their high cost for what is sometimes a small benefit, or because their benefits are uncertain as oncologists sometimes prescribe them based on logical biologic links to a patient’s tumor profile rather than direct evidence from large randomized controlled trials. Financing and controlling this “new oncology” in an open access healthcare setting will involve many hard choices that are likely to be framed in the Congressional debate as rational regulation versus rationing.
Many of us will view healthcare reform through the cancer lens. Looking through that lens, I see both easy choices and hard choices to come. This is an exciting time of hope for change in our healthcare system.
System improvements can substantially accelerate the tremendous progress we are now seeing in cancer prevention and treatment in America. It is the role of academic cancer centers such as UCCC to not only become engaged in the development of new therapies, but also to become engaged in the types of research and informed advocacy that can optimize their use. Let’s all try to find ways to become engaged in this important matter.
Tim Byers, MD, MPH
Interim Director, University of Colorado Cancer Center
Grohne Chair in Cancer Prevention and Control