A report from the National Academies of Sciences, Engineering, and Medicine recommends a national strategy for cancer control, based on the principles of systems engineering, to coordinate the priorities and actions of multiple stakeholders, improve resource integration and promote joint accountability.
Of the World Health Organization’s nearly 200 member countries, the United States is one of the few that does not have a centralized national plan for cancer control. While the multiple organizations involved in cancer control have been successful individually, persistent fragmentation does not permit the systemic changes needed to maximize benefits for patients and society, says the report, called Guiding Cancer Control: A Path to Transformation.
The Academies' report offers 10 conclusions supported by 25 findings. Its central message is that national cancer control efforts should address the overarching system, not just its individual components.
The U.S. Dept. of Health and Human Services, in cooperation with a wide range of federal agencies, should lead the U.S. National Cancer Control Plan, the report recommends. The plan should aim to:
- Improve availability of preventive, screening, diagnostic, therapeutic, palliative, and survivorship interventions.
- Encourage delivery of care and social services aligned with the preferences and values of patients and families.
- Leverage scientific advances to improve therapies and better understand their scientific, clinical, and economic impacts.
- Integrate a broad range of data sources, including clinical, social, and behavioral data.
- Use cloud computing, machine learning, and artificial intelligence tools for continuous analytics, rapid reporting of trends and patterns, and improved forecasting and performance reviews.
- Minimize waste stemming from conflicting clinical practices and guidelines.
- Launch and expand public engagement, literacy, and outreach activities.
A Dashboard for Multicriteria Decision-Making
In support of a U.S. National Cancer Control Plan, HHS and the federal partner agencies should fund and support an independent organization or a consortium to prototype and develop a planning and monitoring tool that would be publicly available, evolvable, and customizable across contexts and organizations, recommends the report. The committee envisions a dynamic dashboard that would reflect the current state of cancer control efforts and allow users to simulate, predict, and analyze how the system would react to possible policy changes or interventions.
For example, federal policymakers could use the tool to predict the range of possible outcomes from introducing new treatments (such as immunotherapies) versus prevention efforts (such as campaigns to encourage people to get HPV vaccines). Another potential use could be to assess which policies are most likely to reduce disparities in cancer outcomes among various groups. The tool could pull information including behavioral differences (such as tobacco use or dietary choices), differences in health insurance coverage, and differences in treatment adherence.
The Convergence of Biology, Big Data Analytics, and Technology
In the coming years, the system of cancer control will become even more complex with the large-scale aggregation of genomic, environmental, behavioral, and other patient data. Continued innovations in big data — large amounts of data from different sources including cancer registries, electronic health records, insurance claims, and sensor technologies — will require sound storage mechanisms and new capabilities and competencies.
While the goal of the planning and monitoring tool is to guide decision-making, the tool will only be as good as the data informing it, says the report. It recommends that HHS and partner agencies periodically consult with state and local governments, as well as the private and nonprofit sectors, to ensure the planning tool is refreshed with the latest data.
In a statement, Howard Burris III, M.D., president of the American Society of Clinical Oncology, said ASCO applauded the National Academies of Sciences, Engineering, and Medicine for its recommendations. “As the report notes, stakeholders in the cancer community must work together to drive innovation and solve big, systemic problems that impede patient access to high-quality care. ASCO is working to fulfill that need in a number of ways,” he said, pointing to the CancerLinQ platform, which aggregates and analyzes information from electronic health records across the United States. “In addition, our Targeted Agent and Profiling Utilization Registry (TAPUR) Study is evaluating new uses for targeted therapies outside of Food and Drug Administration-approved indications in patients with advanced cancer to increase efficiency and reduce duplication in care and research.”