This past year, President Joe Biden announced the appointment of six members to the National Cancer Advisory Board (NCAB; see related article). This board plays a crucial role in advising and assisting the director of the National Cancer Institute (NCI) in setting the activities of the national cancer research program. Composed of both scientific and public members, the NCAB makes recommendations for the support of grants and contract proposals as well as advises the NCI director on policy development, program implementation and evaluation, and research needs.

Included among President Biden’s appointments to the new term of the NCAB is Richard J. Boxer, MD, FACS, Clinical Professor of Urology at the David Geffen School of Medicine at the University of California, Los Angeles. This is Dr. Boxer’s second term on the board—he was first appointed in 1995 by President Bill Clinton—and he brings to the position a vast array of expertise in cancer, both as a physician and a patient. A three-time cancer survivor (lymphoma, melanoma, and thyroid cancer), Dr. Boxer has treated more than 7,000 patients in his 50-year career and was a key developer nearly 2 decades ago of the clinical protocols used in telemedicine today. In 1996, he represented the United States at the World Health Organization, as a private citizen, and recently served as a member of the Board of Directors of Conquer Cancer^®, the ASCO Foundation.

In a wide-ranging interview with The ASCO Post, Dr. Boxer talked about his role on the National Cancer Advisory Board, what he hopes to accomplish during his 5-year term, and how telemedicine may help to reduce disparities in cancer care.

Giving Back to the Cancer Community

Please talk about your specific responsibilities on the National Cancer Advisory Board and what you hope to accomplish.

In 1971, when President Richard Nixon signed the National Cancer Act into law, it set up two main responsibilities for the National Cancer Advisory Board. One was to oversee the NCI’s budget for cancer research, because it is a large amount of taxpayer money, and there needs to be some oversight to make sure it is spent wisely. Two was to provide advice to the NCI director on policy development and program implementation.

For me, the biggest contribution I can make is to help the NCI director think about different approaches to the prevention, treatment, and cure of cancer that are based on the science we know about and the science we would like to know about. America—and in fact the world—depends on the scientific discoveries coming out of the National Institutes of Health and the NCI. Those of us on the National Cancer Advisory Board have a great responsibility to our fellow citizens to help maintain and accelerate scientific progress from the agency.

“America—and in fact the world—depends on the scientific discoveries coming out of the National Institutes of Health and the NCI....”

— RICHARD J. BOXER, MD, FACS

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I am eternally grateful to NCI-funded research, which made it possible for me to survive three cancers, and want to give back to the cancer community, including the researchers, clinicians, and, importantly, the very courageous people who participated in clinical trials and helped us advance the science and improve outcomes for people with cancer. In addition to these priorities, I also want to promote the science of immunotherapy in more effective treatments for cancer as well as the use of artificial intelligence to advance scientific research in the disease. I hope to help develop strategies to increase the number of adults participating in clinical trials, because new therapies will become even more targeted in the future.

Fewer barriers to trial participation would expedite trial completion and improve the generalizability of trial results. Clinical trials must be open to all populations of Americans, so every minority patient is represented and helped by the research. Every taxpayer funds NCI research, and every American family should benefit from its results. Research suggests that a clinical trial system that enrolls patients at higher rates produces treatment advances at a faster rate and improves outcomes for patients with cancer.¹

Understanding the Causes of Cancer

Over the next 5 years, what areas of research do you think will have the greatest impact on patient care?

Greater advances in the use of monoclonal antibodies and immunotherapy in general will be critical in improving patient care. I hope that as an advisory board, we will be able to push toward more research into the causes of the increasing rates of aggressive cancers, such as pancreatic cancer and glioblastoma multiforme. Although there have been some advances in these diseases, they are still challenging to treat, and the prognosis remains grim.

We will also be focusing on young-onset cancers, which are on the rise, to try to better understand the potential causes of young-onset colorectal, lung, and breast cancers, especially what environmental factors might be in play. If we can determine the environmental associations, we might be able to prevent more of these cancers in younger adults.

There is a lot to be done, not just in the clinic and in the research laboratory, but in more effective strategies to educate the public about the risk factors of developing cancer and how to reduce those risk factors to prevent cancer—for example, through exercising regularly, maintaining a healthy weight, quitting smoking, using sunscreen, and limiting alcohol use.

Using Telemedicine to Reduce Disparities in Cancer Care

You helped create the clinical protocols for telemedicine 17 years ago. Telehealth was instrumental in helping facilitate cancer care during the COVID-19 pandemic. What role do you see technology playing in oncology patient care in the future?

Telemedicine will become an increasingly valuable asset to everyone in the health-care system. It brings medicine to the patient wherever the patient lives rather than bringing the patient to medicine.

From 2006 to 2013, I was Chief Medical Officer at Teladoc, where we built the clinical program for the nation’s largest telemedicine company. The processes, procedures, and quality assurance metrics we developed back then are still being used today.

“Every taxpayer funds NCI research, and every American family should benefit from its results.”

— RICHARD J. BOXER, MD, FACS

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Even before the COVID-19 pandemic, which greatly increased use of telehealth practice, telemedicine demonstrated at least equivalency to in-person care and high levels of patient and health professional satisfaction. Teleoncology has also been demonstrated to improve access to care and reduce health-care costs. Teleoncology applications include remote chemotherapy supervision, symptom management, survivorship care, palliative care, and approaches to increasing access to cancer clinical trials. It has even been shown to improve outcomes compared with in-person care for some patients.²

Telemedicine may also help address disparities in access to health-care services for both patients living in rural areas and in urban centers, who may have limited access to inexpensive, quality care. So, the future potential for this technology to improve the patient and clinician experience, reduce health-care costs, and improve quality care is great. 

DISCLOSURE: Dr. Boxer is a consultant for Intercept Health and UpScript Pager.

REFERENCES

1. Unger JM, Cook E, Tai E, et al: Role of clinical trial participation in cancer research: Barriers, evidence, and strategies. Am Soc Clin Oncol Educ Book 35:185-198, 2016.

2. Sirintrapun SJ, Lopez AM: Telemedicine in cancer care. Am Soc Clin Oncol Educ Book 38:540-545, 2018.