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Cancer Policy Monitor: May 10, 2022

MAY IS NATIONAL CANCER RESEARCH MONTH 

The American Association for Cancer Research (AACR) initiated and supports National Cancer Research Month to highlight the importance of lifesaving research to the millions of people around the world affected by the collection of devastating diseases we call cancer. Learn more.

Appropriations Update from Capitol Hill

With the release of President Biden’s Fiscal Year (FY) 2023 budget, the momentum shifts to Congress for hearings and the next stage of the annual appropriations process. Recently, Department of Health and Human Services (HHS) Secretary Xavier Becerra testified before the House Appropriations Subcommittee on Labor, Health and Human Services, and Education, as well as the Senate Finance Committee, in support of the Biden administration’s funding priorities for FY 2023. The budget proposes $127.3 billion in discretionary funding for HHS including $49 billion for the NIH, which would receive a marginal increase of approximately $275 million to its base funding and an increase of $4 billion for ARPA-H. In addition, if enacted, the budget would result in a cut of $199 million for the NCI. Members of Congress across the aisle expressed concern over the low funding proposal for NIH’s base budget activities. Additional hearings with leadership of the NIH, CDC, and other government agencies are expected in the coming weeks. In addition, House Majority Leader Steny Hoyer announced his intention to begin markups, the process of debating and amending legislation through subcommittees and the full Appropriations Committee, beginning with subcommittee markups in mid-June and a goal of full committee markups in late-June. The AACR will continue to advocate for robust, sustained, and predictable funding levels for the NIH and NCI.

An Op Ed on “How to Reduce Racial Disparities in Cancer” in The Hill is follow-up article from a special session at the AACR Annual Meeting in New Orleans

This Op Ed “How to reduce racial disparities in cancer“, which appeared in the DC publication, “The Hill” on April 12, 2022, is a follow-up article to one of the Regulatory Science and Policy Sessions that took place at the recent AACR Annual Meeting (April 8-13) in New Orleans. A goal of the session was to begin the process of developing a framework around the possible establishment of a public-private partnership that is aimed at bringing everyone together to ensure diversity in clinical trials, as well as establishing enduring models to allow for more rapid uptake of new promising treatments for cancer patients no matter where they are located (in all communities and throughout the nation). The Op Ed, which was written by Kathy Giusti, who is the founder and chief mission officer of the Multiple Myeloma Research Foundation, and John Carpten, who is an AACR Board Member and distinguished leader at the University of Southern California, calls for collective action through a public-private partnership (PPP), led by the Foundation for the National Institutes of Health (FNIH), involving all key stakeholders, with support from the Cancer Moonshot. This approach builds on successes during COVID.

AACR Annual Meeting Session Shares Advice on Supporting Smoking Cessation for Patients with Cancer

-Nicholas Warren, PhD

Smoking cessation following a cancer diagnosis can extend survival and improve quality of life, in some cases, as much as anticancer therapies. The Surgeon General’s 2020 Smoking Cessation Report found that smoking cessation also helps reduce the risk of heart disease, COPD, reproductive issues, and many other health problems. Unfortunately, approximately 40 percent of adults who smoke do not receive advice from their health care providers about smoking cessation; this contributes to less than one third of adults who attempt to quit smoking using evidence-based therapies. In an effort to help cancer centers and oncologists better support patients with cancer trying to overcome nicotine addiction, the National Cancer Institute (NCI) created the Cancer Center Cessation Initiative (C3I) in 2017 with funding from the 21st Century Cures Act. The program has since expanded to 52 cancer centers across the United States. During the AACR Annual Meeting 2022 in New Orleans, Louisiana, a session titled “Supporting Smoking Cessation Among Patients with Cancer Who Use Tobacco Products,” moderated by Roy S. Herbst, MD, PhD, chair of the AACR Tobacco Products and Cancer Subcommittee and chief of medical oncology at Yale Cancer Center, brought together C3I leaders to share lessons learned about effectively supporting smoking cessation among patients with cancer.

The session featured Stephanie Land, PhD, a program director in the NCI’s Tobacco Control Research Branch who leads C3I among other tobacco research initiatives. Notably, Dr. Land shared that 20-30 percent of newly diagnosed patients with cancer currently smoke, and they have a 60 percent greater likelihood of dying from cancer compared to patients who do not smoke. During the panel discussion, Dr. Land expressed hope that all patients with cancer will soon have cessation support services available where they receive cancer treatment.

Sarah Clark, TTS, clinical director and operations lead for the C3I site at Northwestern University shared how its cessation program has leveraged funding from NCI to create an automated referral and outreach system. When patients visit the Robert H. Lurie Comprehensive Cancer Center at Northwestern, they self-report smoking status and other health issues in a questionnaire that is entered into their electronic health record (EHR). The EHR sends an automated message to the tobacco cessation team to contact patients to set up counseling appointments and work with oncologists to write prescriptions for cessation medication. Buy-in from oncologists to talk with patients about smoking is also essential to support cessation attempts. Additionally, the EHR can send automated individualized and mass outreach messages throughout the course of cessation treatment, increasing convenience for patients and providers.

Tracy Crane, PhD, co-lead of the Cancer Control Research Program at the University of Miami discussed her efforts to set up a cessation program at the University of Arizona and bring that experience to the University of Miami. At the University of Arizona Cancer Center, the cornerstone of the program are oncology nurse navigators who meet with nearly all new patients to coordinate care and navigate the cancer treatment process. Therefore, it was a natural step to utilize nurse navigators in screening for tobacco use and referring patients to the new cessation program. Due to the diverse patient population in southern Arizona, Dr. Crane emphasized it was also important to coordinate with community outreach teams and ensure tobacco treatment specialists were fluent in multiple languages. Dr. Crane is now working to replicate this success in Miami.

Michael Fiore, MD, has been a long-time national leader in tobacco policy and serves as the director of the University of Wisconsin Center for Tobacco Research and Intervention. Dr. Fiore shared plans to expand smoking cessation programs for patients with cancer beyond the current C3I sites with the help of the Commission on Cancer, which is a coalition of more than 1,500 cancer treatment facilities. His goal is to take a population-based approach to make sure every patient with cancer who smokes has support to use the most effective cessation therapies available. Dr. Fiore also spoke to gaps that often occur in insurance coverage of cessation therapy. In response, some C3I sites provide nicotine replacement therapies in bags, like how dentists provide floss and toothpaste.

This session remains available for streaming on the Annual Meeting website for conference registrants. The AACR will continue to convene experts in smoking cessation and spread awareness about evidence-based therapies.

FDA Unveils Ban on Menthol Cigarettes and Flavored Cigars

-Nicholas Warren, PhD

This April was a big month for tobacco policy. The U.S. Food and Drug Administration (FDA) Center for Tobacco Products (CTP) unveiled long-awaited draft product standards that would ban menthol cigarettes and flavored cigars. These welcome developments are estimated to save hundreds of thousands of lives and will help address health disparities caused by the tobacco industry.

The draft product standards for combustible tobacco products are the most significant tobacco control policies proposed since the Family Smoking Prevention and Tobacco Control Act (TCA) was signed into law in 2009. Menthol and other flavors are well demonstrated to increase smoking initiation, nicotine exposure, and the difficulty of quitting. The tobacco industry has also used these products in predatory marketing campaigns focused on racial and ethnic minorities. While the TCA prohibited most flavors of cigarettes, it exempted menthol flavors while asking the FDA to consider if menthol was “appropriate for the protection of public health.” In 2011, the FDA CTP Tobacco Products Scientific Advisory (TPSAC) determined that menthol cigarettes pose greater public health risks than non-mentholated cigarettes. In 2013, the American Association for Cancer Research (AACR) and other public health groups signed a citizen’s petition further highlighting the evidence of the harms of menthol and called on FDA to ban menthol cigarettes. Following a lawsuit, FDA CTP responded to the citizen’s petition by agreeing to move forward on the draft menthol ban in April 2021. This story highlights the impact of persistent advocacy efforts from public health groups to beat fierce opposition from the tobacco industry in reducing tobacco-related illness. The draft rules are open to public comment between May 4 and July 5. The AACR intends to submit comments on these rules and encourages others to submit their own comments on the how these rules will benefit public health.

These developments also cap off the career of outgoing FDA CTP Director, Mitch Zeller. Mr. Zeller is retiring after nine years as Director of FDA CTP. The AACR looks forward to working with the new Acting Director, Michele Mital, to further reduce tobacco-related illness.

EPA Toxicology Draft Assessment Links Inhaling Formaldehyde with Head, Neck, and Blood Cancers

-Calais S. Prince, PhD

On April 14, the U.S. Environmental Protection Agency (EPA) publicly released a draft assessment identifying formaldehyde inhalation as a cause for nasopharyngeal cancers and myeloid leukemia for groups exposed to occupational formaldehyde levels.  

Formaldehyde is a strong smelling, colorless chemical that is used in various products. Indoor and outdoor formaldehyde exposure is common as it is released by building materials; home furnishings; powerplants; incinerators; cigarette smoke; e-cigarette aerosol; and car exhausts. For most people, formaldehyde exposure is brief. However, workers that produce or use formaldehyde are exposed to higher levels for longer periods of time than the general public.  

The EPA has been grappling with formaldehyde exposure regulations for decades. Almost 30 years ago, the EPA classified formaldehyde as a probable carcinogen when exposure is high and prolonged. In addition, the EPA released a draft formaldehyde assessment in 2010 that was met with opposition by industry and some policymakers. The 2022 draft assessment is open for public comment through June 13, 2022. It will then undergo peer review by the National Academies of Sciences, Engineering, and Medicine.

Cancer Survivorship Panel Moderated by STAT’s Angus Chen

Cancer survivorship is one of the largest emergent fields in cancer research. STAT interviewed members of the AACR Scientist↔Survivor Program® at the AACR Annual Meeting 2022 to learn more about the challenges of recognizing and filling the needs of the growing community of “cancer survivors.” Watch now

Save The Date! The 10th Annual Rally for Medical Research

The 10th Annual Rally for Medical Research Hill Day will take place Wednesday, September 14, in Washington, D.C., bringing patients, caregivers, researchers, clinicians, and other advocates together for meetings with congressional offices in support of funding for the National Institutes of Health (NIH).  A reception for attendees will be held Tuesday, September 13. For more information please visit the Rally’s website or contact [email protected].