the tobacco industry or threats citing international trade and investment agreements are: • Graphic warnings in the Philippines, Sri Lanka, and Thailand. • Plain packaging in the United Kingdom and Ireland. • Pack-size restrictions in Peru. • A ban on flavorings and additives in Brazil. • The Tobacco Products Directive from the European Commission. • Retail display bans in Norway and Scotland. • Tobacco marketing bans in the Philippines and South Africa. • Smoke-free laws in Pakistan and the Philippines. • Bans on sales of tobacco products near educational establishments in India. • A health law in Indonesia. “One of the problems with the international trade agreement system is that these decisions don’t have any legal precedent, so even if Philip Morris loses in the Uruguay case, technically there is nothing that can stop them from bringing another case along the same lines,” Myers says. “A company with virtually unlimited resources like Philip Morris can continue to use these cases to threaten and intimidate countries even if they’re likely to lose.” The fund will show these countries they have an ally and demonstrate to the tobacco industry that the Bloomberg Philanthropies and The Bill and Melinda Gates Foundation are prepared to “go toe to toe with the industry,” Myers adds. In addition to providing financial and legal assistance to low-income and middle-income countries facing legal action, the Anti-Tobacco Trade Litigation Fund will support: • Technical assistance in legislative drafting and documentation to avoid legal challenges and trade disputes. • Coordinated efforts to document industry wrongdoing. • Communications support to educate the public about industry challenges to tobacco control policy and abuse of the trade system. • Assistance in accessing knowledgeable tobacco control experts and mobilizing support among the global public health community. • Creation of a network of senior lawyers experienced in trade litigation to support countries.
David Versus Goliath? Tobacco control advocates note the importance of enacting strong antitobacco laws in developing countries that are increasingly being targeted by the industry. There currently are 1 billion smokers worldwide, according to The Tobacco Atlas, produced by the American Cancer Society and the World Lung Foundation, which was unveiled earlier this year (www. tobaccoatlas.org). The Atlas also notes that although 90% of the world’s population live in countries that have ratified the Framework Convention on Tobacco Control, only 10% are covered by comprehensive tobacco advertising, promotion, and sponsorship bans, and only 16% by comprehensive smoke-free laws.
Sovereign countries should be able to initiate public health laws and defend them on the basis of their public health merit. —Kenneth Michael Cummings, PhD, MPH Kenneth Michael Cummings, PhD, MPH, a tobacco policy expert at the Hollings Cancer Center of the Medical University of South Carolina in Charleston, calls the Anti-Tobacco Trade Litigation Fund helpful, but says he is not sure it is enough to fight Big Tobacco, which has been known to spend $10 million on a single legal case. “Four million is a good start, but it’s like putting a quarter on the table as a tip,” he adds. “Others should be contributing to the fund, and higher-income countries should be helping lower-income countries.” Dr. Cummings likens the ongoing battle by individuals, lawmakers, and the public health community against the tobacco industry to a true “David versus Goliath” story. He references the “Patton letter,” a 1988 letter by an attorney for R. J. Reynolds Tobacco Company paraphrasing General George S. Patton by stating that the industry wins lawsuits not by spending all their money but by forcing their opponents to spend all of theirs. “Sovereign countries should be able to initiate public health laws and defend them on the basis of their public health merit,” he says. “We need to keep fighting for policies that make it impossible for tobacco companies to do business as usual.” DOI: 10.1002/cncr.28998
ASCO Report Highlights Challenges in Delivering High-Quality Care
A
s the numbers of patients with cancer and survivors of the disease continue to grow along with rising health care costs, oncology practices must examine how they can transform themselves to deal with these pressures, according to a new study by the American Society of Clinical Oncology (ASCO).1 “The State of Cancer Care in America: 2015” report, published in the Journal of Oncology Practice and presented at a Congressional briefing, describes trends in the oncology workforce and practice environment that impact patient care and access. 2292
Positive developments cited in the report include the fact that in 2014, the US Food and Drug Administration added 10 new treatments to its list of more than 170 approved anticancer agents while also approving 4 new medical devices and tests that may improve early cancer detection. At the same time, more than 770 therapies currently are in the research and development pipeline, including therapies that are demonstrating dramatic results. Nevertheless, the report outlines a number of challenges in delivering high-quality care, including growing cancer
Cancer
July 15, 2015
Majority of Survivors of Childhood Cancer Experience Comorbidities
E
care demand, disparities in access to cancer care, an oncology workforce that remains constant but may soon be outpaced by growing demand, an aging oncology workforce, gaps in racial and ethnic workforce diversity, poor coverage in rural America, and increasing professional burnout. At the same time, oncology practices are continuing to experience extreme volatility, dealing with issues such as: • Financial instability and changing payment models. For example, 72% of practices report continuing to work in a fee-for-service payment system. Medicare recently announced plans to dramatically change 85% of that system based on a quality-based model by 2016 and 90% by 2018. • Continuing practice consolidation. Approximately onequarter of all community-based oncology practices report that they are likely to affiliate with a hospital over the next year. • Major concerns over preauthorization. The administrative burden imposed on insurance companies is reducing time for patient care. Peter Yu, MD, past-president of ASCO, says that patients need providers to find better ways to pay for and incentivize quality, value-based care. Toward that end, ASCO is developing and testing an alternative payment approach.
Congress Can Help
© ROB HILL / FOTOLIA.COM
The report also makes a series of recommendations, including the following to Congress: • As the 21st Century Cures initiative moves forward in the House and the “Innovation for Healthier Americans” initiative progresses in the Senate, Congress must ensure interoperability of medical records and provide resources for patients to track and report quality measures. • Support continued breakthroughs in cancer therapies by increasing the budgets of the National Institutes of Health and the National Cancer Institute.
Reference 1. American Society of Clinical Oncology. The state of cancer care in America, 2015: a report by the American Society of Clinical Oncology. J Oncol Pract. 2015;11:79-113. DOI: 10.1002/cncr.29539
stimates indicate that although the number of survivors of childhood cancers is increasing, the majority of those who have survived for 5 years or longer have at least 1 chronic health condition, according to new data.1 Researchers, led by Siobhan Phillips, PhD, MPH, assistant professor of preventive medicine at Northwestern University in Chicago, Illinois, estimated the number of survivors of childhood cancer in the United States to be 388,501, an increase of 59,849 from a 2005 estimate by investigators at the NCI. Among the survivors, approximately 84% survived for 5 or more years after diagnosis. The researchers evaluated cancer incidence and survival data recorded between 1975 and 2011 from 9 Surveillance, Epidemiology, and End Results registries (SEER) in the United States and data from the Childhood Cancer Survivor Study cohort. The studies provided information regarding adverse and late effects of cancer treatment from more than 14,000 longterm survivors of childhood cancers at 26 cancer centers across the United States and Canada. Using the probability of each measure of morbidity from the Childhood Cancer Survivor Study, investigators then multiplied these estimates by the relevant estimate number of US survivors from the SEER data. Dr. Phillips and her colleagues, in collaboration with the NCI and St. Jude Children’s Research Hospital, found that an estimated 70% of childhood cancer survivors had a mild or moderate chronic condition, whereas an estimated 32% had a severe, disabling, or life-threatening chronic condition.
“Profound” Burden of Disease The findings demonstrate that a singular focus on curing cancer does not offer a complete picture of cancer survivorship, Dr. Phillips says, adding that the burden of these chronic conditions is “profound, both in occurrence and severity.” As a result, she urges the cancer community to focus on how to effectively decrease the morbidity burden and develop care and rehabilitation models that optimize longevity and well-being among survivors of childhood cancer. Dr. Phillips says many of the morbidities are somewhat modifiable in the general population; however, the same prevention guidelines may not apply to survivors of childhood cancers. Among the preventive factors that health care researchers and providers need to better understand are physical activity, diet, and the treatment of characteristics that may make survivors more susceptible to these morbidities, she says.
Reference 1. Phillips SM, Alfano CM, Perna FM, Glasgow RE. Accelerating translation of physical activity and cancer survivorship research into practice: recommendations for a more integrated and collaborative approach. Cancer Epidemiol Biomarkers Prev. 2014;23:687-699. DOI: 10.1002/cncr.29540
Content in this section does not reflect any official policy or medical opinion of the American Cancer Society or of the publisher unless otherwise noted. © American Cancer Society, 2015.
Cancer
July 15, 2015
2293
David Versus Goliath? Tobacco control advocates note the importance of enacting strong antitobacco laws in developing countries that are increasingly being targeted by the industry. There currently are 1 billion smokers worldwide, according to The Tobacco Atlas, produced by the American Cancer Society and the World Lung Foundation, which was unveiled earlier this year (www. tobaccoatlas.org). The Atlas also notes that although 90% of the world’s population live in countries that have ratified the Framework Convention on Tobacco Control, only 10% are covered by comprehensive tobacco advertising, promotion, and sponsorship bans, and only 16% by comprehensive smoke-free laws.
Sovereign countries should be able to initiate public health laws and defend them on the basis of their public health merit. —Kenneth Michael Cummings, PhD, MPH Kenneth Michael Cummings, PhD, MPH, a tobacco policy expert at the Hollings Cancer Center of the Medical University of South Carolina in Charleston, calls the Anti-Tobacco Trade Litigation Fund helpful, but says he is not sure it is enough to fight Big Tobacco, which has been known to spend $10 million on a single legal case. “Four million is a good start, but it’s like putting a quarter on the table as a tip,” he adds. “Others should be contributing to the fund, and higher-income countries should be helping lower-income countries.” Dr. Cummings likens the ongoing battle by individuals, lawmakers, and the public health community against the tobacco industry to a true “David versus Goliath” story. He references the “Patton letter,” a 1988 letter by an attorney for R. J. Reynolds Tobacco Company paraphrasing General George S. Patton by stating that the industry wins lawsuits not by spending all their money but by forcing their opponents to spend all of theirs. “Sovereign countries should be able to initiate public health laws and defend them on the basis of their public health merit,” he says. “We need to keep fighting for policies that make it impossible for tobacco companies to do business as usual.” DOI: 10.1002/cncr.28998
ASCO Report Highlights Challenges in Delivering High-Quality Care
A
s the numbers of patients with cancer and survivors of the disease continue to grow along with rising health care costs, oncology practices must examine how they can transform themselves to deal with these pressures, according to a new study by the American Society of Clinical Oncology (ASCO).1 “The State of Cancer Care in America: 2015” report, published in the Journal of Oncology Practice and presented at a Congressional briefing, describes trends in the oncology workforce and practice environment that impact patient care and access. 2292
Positive developments cited in the report include the fact that in 2014, the US Food and Drug Administration added 10 new treatments to its list of more than 170 approved anticancer agents while also approving 4 new medical devices and tests that may improve early cancer detection. At the same time, more than 770 therapies currently are in the research and development pipeline, including therapies that are demonstrating dramatic results. Nevertheless, the report outlines a number of challenges in delivering high-quality care, including growing cancer
Cancer
July 15, 2015
Majority of Survivors of Childhood Cancer Experience Comorbidities
E
care demand, disparities in access to cancer care, an oncology workforce that remains constant but may soon be outpaced by growing demand, an aging oncology workforce, gaps in racial and ethnic workforce diversity, poor coverage in rural America, and increasing professional burnout. At the same time, oncology practices are continuing to experience extreme volatility, dealing with issues such as: • Financial instability and changing payment models. For example, 72% of practices report continuing to work in a fee-for-service payment system. Medicare recently announced plans to dramatically change 85% of that system based on a quality-based model by 2016 and 90% by 2018. • Continuing practice consolidation. Approximately onequarter of all community-based oncology practices report that they are likely to affiliate with a hospital over the next year. • Major concerns over preauthorization. The administrative burden imposed on insurance companies is reducing time for patient care. Peter Yu, MD, past-president of ASCO, says that patients need providers to find better ways to pay for and incentivize quality, value-based care. Toward that end, ASCO is developing and testing an alternative payment approach.
Congress Can Help
© ROB HILL / FOTOLIA.COM
The report also makes a series of recommendations, including the following to Congress: • As the 21st Century Cures initiative moves forward in the House and the “Innovation for Healthier Americans” initiative progresses in the Senate, Congress must ensure interoperability of medical records and provide resources for patients to track and report quality measures. • Support continued breakthroughs in cancer therapies by increasing the budgets of the National Institutes of Health and the National Cancer Institute.
Reference 1. American Society of Clinical Oncology. The state of cancer care in America, 2015: a report by the American Society of Clinical Oncology. J Oncol Pract. 2015;11:79-113. DOI: 10.1002/cncr.29539
stimates indicate that although the number of survivors of childhood cancers is increasing, the majority of those who have survived for 5 years or longer have at least 1 chronic health condition, according to new data.1 Researchers, led by Siobhan Phillips, PhD, MPH, assistant professor of preventive medicine at Northwestern University in Chicago, Illinois, estimated the number of survivors of childhood cancer in the United States to be 388,501, an increase of 59,849 from a 2005 estimate by investigators at the NCI. Among the survivors, approximately 84% survived for 5 or more years after diagnosis. The researchers evaluated cancer incidence and survival data recorded between 1975 and 2011 from 9 Surveillance, Epidemiology, and End Results registries (SEER) in the United States and data from the Childhood Cancer Survivor Study cohort. The studies provided information regarding adverse and late effects of cancer treatment from more than 14,000 longterm survivors of childhood cancers at 26 cancer centers across the United States and Canada. Using the probability of each measure of morbidity from the Childhood Cancer Survivor Study, investigators then multiplied these estimates by the relevant estimate number of US survivors from the SEER data. Dr. Phillips and her colleagues, in collaboration with the NCI and St. Jude Children’s Research Hospital, found that an estimated 70% of childhood cancer survivors had a mild or moderate chronic condition, whereas an estimated 32% had a severe, disabling, or life-threatening chronic condition.
“Profound” Burden of Disease The findings demonstrate that a singular focus on curing cancer does not offer a complete picture of cancer survivorship, Dr. Phillips says, adding that the burden of these chronic conditions is “profound, both in occurrence and severity.” As a result, she urges the cancer community to focus on how to effectively decrease the morbidity burden and develop care and rehabilitation models that optimize longevity and well-being among survivors of childhood cancer. Dr. Phillips says many of the morbidities are somewhat modifiable in the general population; however, the same prevention guidelines may not apply to survivors of childhood cancers. Among the preventive factors that health care researchers and providers need to better understand are physical activity, diet, and the treatment of characteristics that may make survivors more susceptible to these morbidities, she says.
Reference 1. Phillips SM, Alfano CM, Perna FM, Glasgow RE. Accelerating translation of physical activity and cancer survivorship research into practice: recommendations for a more integrated and collaborative approach. Cancer Epidemiol Biomarkers Prev. 2014;23:687-699. DOI: 10.1002/cncr.29540
Content in this section does not reflect any official policy or medical opinion of the American Cancer Society or of the publisher unless otherwise noted. © American Cancer Society, 2015.
Cancer
July 15, 2015
2293
