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Erudition and Assessment on the Longest War in the Modern Era


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A little after noon on December 23, 1971, President Richard Nixon entered the White House state dining room. Before 137 esteemed guests from government, science, and industry, he signed the landmark National Cancer Act. It was, in short, a national commitment to conquer cancer. President Nixon would call it the most significant action of his administration.

According to the report by a group of experts commissioned by President Nixon, cancer was the number one health concern of Americans. The nation was caught up in a “moonshot” sense of hope. In 1969, The New York Times ran a full-page advertisement by the Citizens’ Committee for the Conquest of Cancer, backed by well-known philanthropist Mary Lasker. It said: “Mr. Nixon: You Can Cure Cancer.” It was taken from a quote by Sidney Farber, MD: “We lack only the will and the kind of money and comprehensive planning that went into putting a man on the moon…. Why don’t we try to conquer cancer by America’s 200th birthday?” That was by 1976.

BOOKMARK


Title: A New Deal for Cancer: Lessons From a 50 Year War

Editors: Abbe R. Gluck and Charles S. Fuchs

Publisher: PublicAffairs

Publication Date: November 2021

Price: $26.99, hardcover, 416 pages

As we know, no silver bullet was discovered. Despite much progress, cancer has remained our number one health concern over the past 50 years since the signing of the National Cancer Act. To move forward to our original goal, it is important to sum up and honestly assess the triumphs and failures. To that end arrives a new book, A New Deal for Cancer: Lessons From a 50 Year War, in which some of the brightest thinkers in the oncology community share their wisdom and vision.

A New Deal for Cancer, edited by Abbe R. Gluck and Charles S. Fuchs, is organized into 4 parts and 19 chapters. The book runs the gamut from the clinic to the lab and through the corridors of payers and policymakers without suffering from redundancy fatigue—no easy task. Any time a major new book on cancer arrives, it begs the simple question: What does it add to the discussion? The answer here is a deeper dive into well-traveled areas and some new stuff as well.

The Cancer Surveillance State

A New Deal for Cancer opens with a chapter by the author of The Emperor of All Maladies, Siddhartha Mukherjee, called “The New Borders of Cancerland.” In this first chapter, the stage is set to bring readers into the present, on-the-ground reality of patients with cancer and their oncologists. He frames much of the chapter by posing a searching question: “Yet, as we all become cancer patients, how do we exist in a world defined by surveillance, identification of risk, and early detection?’

To answer that question, he focuses on a woman he had met in 2005, Laura M, “whose life had been overturned by cancer.” Laura was disease free but haunted by the thought of recurrence. In an era when there are exponentially more cancer survivors, this is a profound and ubiquitous psychosocial challenge.

Laura’s story illustrates a new anxiety about illness that has gripped our culture: the 24/7 state of unease about being under constant diagnostic surveillance for illnesses before they even take root in our bodies. It has even spawned a new word, “previvor,” a term used to describe a person who is a survivor of an illness to which he or she is predisposed but has yet to develop. Dr. Mukherjee gives readers a concise yet thorough examination of our cancer culture’s emotional challenges, despite the advances that have turned once deadly cancers into manageable disease.

Changing Landscape

One of the more interesting and provocative chapters in the opening part of the book is by Edward Benz, Jr, MD, in which the President and CEO Emeritus of Boston’s Dana Farber Cancer Center takes readers into the business of running a cancer institution, a discussion that brings the thorny issue of drug costs to the fore. He argues, quite successfully, that simply cutting drug prices sounds like a good idea; however, he then dives into the little-known phenomenon called “cross-subsidization,” in which many high-value and essential services for patients with cancer, including research, are paid for by over-reimbursed services and goods.

In this part, readers also get different points of view. In the discussion by K. Robin Yabroff, PhD, MBA, Scientific Vice President for Health Services Research at the American Cancer Society, on cancer care health insurance, Dr. Yabroff summarizes evidence for the association between access to health care and outcomes, across the broad spectrum of care settings. This is well-trod territory, but Dr. Yabroff breaks it down into digestible bites while never scrimping on solid and incisive information.

To round things off, Immediate Past President of the American Medical Association, Barbara McAneny, MD, offers a perspective from the front lines of care on the physician-owned practices that, due to large-scale consolidation, are losing ground in favor of large hospital and cancer centers. Although this trend seems inevitable, she argues that we are losing a personal care access portal for patients in the community. Moreover, she writes: “The result of the widening payment gap has been that many physician practices have found no alternative to being acquired by hospitals when they could not cover expenses. Empirical research has shown that prices tend to increase with consolidation, without an increase in the quality of care.”

Part 2 opens with a piercing look at how cancer policy affects different communities. Here, Otis Brawley, MD, Distinguished Professor at Johns Hopkins University, and Cooley LLD Law Associate, Matt Nguyen, JD, reject the “flawed view that biological factors constitute a key driver of racial disparities in cancer” and place the blame on well-established structural inequities in the system. This is necessary but sensitive territory.

Each Part Counts

The meat of this well-written book is based on explicating various iterations of value in a cancer care delivery system that wrestles with payment issues and an untenable rise in costs. To that end, many of our new targeted therapies and immunotherapies are placed under the value-based microscope, giving readers a granular view of what goes into delivering cancer care on a public health level. It is always informative and at times breathtaking. For instance, Yale Professor of Medicine and Public Health Cary Gross, MD, and Memorial Sloan Kettering’s Chair in the Department of Medicine, Deborah Schrag, MD, MPH, remind us of the importance of state governments and the regulatory landscape for the delivery of multidisciplinary services—things we tend to view as bothersome impediments to care.

Fittingly, the book closes with “Cancer and the President,” when then President Barack Obama asked his Vice President to lead a new Cancer Moonshot. It’s always good to end with a new beginning.

Although a bit policy heavy at times, A New Deal for Cancer offers new perspectives to issues the oncology community has long grappled with. For that, it is highly recommended for readers of The ASCO Post


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