It is up to the oncology community to advocate and lobby for the integration of preventive services as part of best practices. We have the resources; we just need the resolve.
—Margaret I. Cuomo, MD
Margaret I. Cuomo, MD, is a board-certified radiologist who served for many years as an attending physician in diagnostic radiology at North Shore University Hospital, Manhasset, New York. Dr. Cuomo is the daughter of former New York Governor Mario Cuomo and sister to Governor Andrew Cuomo. She is also the author of the recently published treatise, A World without Cancer: The Making of a New Cure and the Real Promise of Prevention (see review published in this issue). The ASCO Post spoke with Dr. Cuomo about the book’s thought-provoking themes.
In your book, you state that you strongly believe our priorities [regarding cancer treatment] are misplaced. Please expand on that sentiment.
Another statement in the book that echoed mine is from Dr. Ronald Herberman: “We are stuck in a paradigm of treatment.” And many other prominent researchers that I interviewed shared the feeling that we are stuck in a status quo of treatment. However, we have enough financial and intellectual resources to address both issues, improving treatment and prevention. What we have now is not a balanced approach, because we are not dedicating enough attention to prevention.
I also mentioned the President’s Cancer Panel, a body of three appointees who are charged with monitoring the nation’s cancer program. In 2010 and 2011, the panel held meetings built around the theme, The Future of Cancer Research: Accelerating Scientific Innovation. Their report found that the areas of cancer prevention and early detection are inadequately addressed.
Several years later, I see little to indicate that we’re implementing the changes advised by the President’s Cancer Panel. The NCI’s budget allocates only about 2% for cancer prevention. So there’s a real disparity in the way our resources are being allocated, leaving a lot of work to do in that area.
Drug Approval Considerations
You stress the need for having value and cost-effectiveness integrated into the drug approval process. Do you think that’s an achievable goal?
Yes, it is. For the book, I interviewed Dr. John Marshall and Dr. Ezekiel Emanuel, and they both stressed that of all the world’s industrialized nations, the United States stands alone as the only country that does not include an element of value in its drug evaluation process.
But value is trending upward. For instance, Memorial Sloan-Kettering Cancer Center has indicated that it would not give [ziv-aflibercept (Zaltrap)] to patients with colon cancer due to the drug’s exorbitant price—about $11,000 per month—and the associated meager improvement in median survival of only about 1.4 months. Memorial Sloan-Kettering made the point that [bevacizumab (Avastin)] offers the same survival time with less cost. So a major cancer center made a value decision, which is a huge step forward.
The larger point to be made on a national level is that current drug pricing practices are unsustainable. No other market works this way. If you were to make a product that is equal in value to another product but you charged twice the price, you’d go bankrupt. We need to have a serious discussion on the national level about introducing cost and value into our cancer drug pipeline.
Moving Prevention Forward
You make a strong case for prevention, noting that more than 50% of all cancers are preventable. Do we need moon shot–like leadership effort to move prevention forward?
We need a coordinated effort that is centralized under one roof, so to speak. That is why I proposed the National Cancer Prevention Institute, a federal entity that would focus our attention on prevention.
This issue needs the kind of leadership that President Kennedy showed when he delivered his speech at Rice University in Houston, saying, “We choose to go to the moon … not because [it is] easy, but because [it is] hard.” He set a time frame of 10 years, and the mission was accomplished in 8 years. It happened because we rallied around a task and created a truly collaborative effort. That’s what we need in the cancer prevention arena.
Any last thoughts you’d like to share about your book?
In 2002, ASCO demonstrated its commitment to cancer prevention by establishing the standing Cancer Prevention Committee. The Society did that to ensure the integration of prevention into the practice of oncology. It was a progressive initiative. In 2004, the Cancer Prevention Committee conducted a survey of community oncologists, asking about the barriers they faced in offering prevention-oriented messages to patients. Three-fifths of the oncologists cited economic barriers to offering those services—in other words, insufficient reimbursement.
That was 10 years ago. Is it any different today? The medical community is a major stakeholder in this issue, and it is up to us to advocate for adequate reimbursement for delivering prevention services. It is up to the oncology community to advocate and lobby for the integration of preventive services as part of best practices. We have the resources; we just need the resolve. ■
Disclosure: Dr. Cuomo reported no potential conflicts of interest.