NBTS Response to 2018 Cancer Progress Report to Congress and the American Public

The annual AACR report largely echoes the same conclusions from previous years’ editions, as well as other similar reports like the 2018 Annual Report to the Nation on the Status on Cancer, prepared yearly by the National Cancer Institute (NCI), Centers for Disease Control and Prevention (CDC), the American Cancer Society (ACS), and the North American Association of Central Cancer Registries (NAACCR). Specifically, the report continued to emphasize the encouraging trend of significant declines in the U.S. cancer death rate paired with meaningful increases to the combined five-year survival rates for U.S. cancer patients.

Additionally, the report highlights that during the past 12 months 22 treatments for cancer were approved for the first time by the US Food and Drug Administration (FDA) or approved for new types of cancer.

Overall, the authors note that major cancer research efforts have had significant success in “driving down overall U.S. cancer…death rates and increasing the number of children and adults who are living longer, higher-quality lives after a cancer diagnosis.”

Yet, also reflective of previous documentation on the state of cancer in the United States, the new Cancer Progress Report is careful to mention that areas persist where advances have not been equitable. And, as we’ve unfortunately become accustomed to, brain cancer is explicitly documented as one of the few areas in all of oncology where, not only do the standard trend lines of declining mortality not apply, but death rates have actually been increasing in recent years.

“While death rates for the four most commonly diagnosed cancers in the United States—breast, colorectal, lung, and prostate cancer—have been declining for more than a decade, those for other forms of cancer—most notably brain, liver, and uterine cancer—have been increasing in recent years,” according to the report.

It also deserves mention that none of the aforementioned 22 newly FDA approved anticancer treatments were for brain cancer patients.

Finally, in addition to extending survival for patients, the ability to live a high-quality of life, as the above quote from the report illustrates, is also an important ‘scorecard’ for cancer patients. However, the observation that children and adults are living “higher-quality lives after a cancer diagnosis,” also does not necessarily apply in neuro-oncology. In fact, just last week a new study from St. Jude Children’s Research Hospital found that only 40% of adult survivors of pediatric brain tumors achieve complete independence, and a full 26% were categorized as “nonindependent” (for which survivors in this category also reported reduced physical quality of life).

That said, ultimately the authors of today’s report recommend several policy prescriptions to continue to advance potentially transformative research that can lead to new and more effective anticancer treatments, to include:

• Continuing support for robust, sustained, and predictable growth of the NIH budget by providing an increase of at least $2 billion in fiscal year (FY) 2019, for a total funding level of at least $39.1 billion.
• Ensuring that the $711 million in funding designated through the 21st Century Cures Act for targeted initiatives, including the National Cancer Moonshot, is fully appropriated in FY 2019 and is supplemental to the healthy increase for the NIH’s base budget.
• Increasing the FDA base budget in FY 2019 to $3.1 billion, a $308 million increase above its FY 2018 level, to ensure support for regulatory science and accelerate the pace of development of medical products that are safe and effective. Specifically, the AACR supports a funding level of $20 million for the FDA Oncology Center of Excellence in FY 2019.
• Supporting the Centers for Disease Control and Prevention (CDC) Cancer Prevention and Control Programs with total funding of at least $517 million. This includes funding for comprehensive cancer control, cancer registries, and screening and awareness programs for specific cancers.

NBTS agrees with, and supports, all of these measures. But what should now also be abundantly clear is that more must be done specifically for cancers like brain cancer, which have not benefited equally from past and current approaches toward cancer policy and funding. Key national institutions of influence, including Congress, FDA, the National Institutes of Health, as well as the philanthropic sector, should continue efforts to not only add more dollars to the research pool for all cancers, but to specifically work with neuro-oncology experts, patient advocates, patients, care partners, and those entities that develop treatments, to devise strategies and opportunities to address the unique challenges facing cancers, like those of the brain. Indeed, it will take a more concerted effort from that of the public, private, and non-governmental sectors to optimize the important and recent federal investments in cancer research and generate greater progress for patients with malignant brain tumors.