The American Cancer Society Cancer Action Network (ACS CAN) issued a letter to CDC director, Thomas Frieden, regarding investment of prevention funding in the Patient Protection and Affordable Care Act. The letter emphasizes key areas, such as tobacco control, combating obesity and reducing disparities, where investment can maximize health and wellness and advance our progress in promoting cancer prevention and improving quality care. The full text of the letter follows:
April 23, 2010
Dear Dr. Frieden,
On behalf of millions of cancer patients, survivors and their families the American Cancer Society Cancer Action Network (ACS CAN), the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, thanks you for your continued leadership in our mutual fight against cancer. We appreciate your allocation of American Recovery and Reinvestment Act (ARRA) funds to cancer prevention, and strongly support your
continued perseverance in expanding tobacco control efforts, combating obesity, increasing utilization of life-saving cancer screening tests, improving quality of cancer and survivorship care, and decreasing health disparities.
The American Cancer Society Cancer Action Network (ACS CAN) was very supportive of the substantial infusion of resources for prevention and public health provided in the Patient Protection and Affordable Care Act (PPACA). The ten-year $15 billion investment will begin to transform our “sick care system” to one that focuses on disease prevention and management as well as improved wellness and quality of life.
This letter offers recommendations for focusing PPACA prevention and public health funding to maximize health and wellness and advance our progress in promoting cancer prevention and improving quality care. Specifically, the Society and ACS CAN propose that the CDC and the Department of Health and Human Services (HHS) allocate prevention and public health funds toward enhancing the following initiatives.
Tobacco Control
Tobacco use accounts for a third of cancer deaths today and accounts for $193 billion in health care expenditures and productivity losses. Despite the tremendous health risks associated with tobacco, one in five high school students and adults in the U.S. continue to smoke. Currently, only one state meets CDC’s own Best Practice recommendations for tobacco control funding levels. Cessation quitlines across the country reach only about 1 per cent of smokers, while CDC recommends at least a 6 per cent reach. Funding levels for tobacco control in ARRA must be sustained and funding for the Office of Smoking and Health increased, to ensure continued progress in reducing tobacco use and exposure to secondhand smoke.
Specifically, ACS CAN recommends the allocation of increased resources to:
¥_ Expand national tobacco cessation initiatives, including support for state, tribe, and territory-based
tobacco quitlines and the promotion of quitline services.
¥_ Support state comprehensive tobacco programs that are proven to decrease smoking prevalence,
increase quit rates, and prevent people from ever starting to use tobacco.
¥_ Enhance surveillance and evaluation of tobacco control programs and clinical and community
interventions, which will lead to more effective policy interventions and better health outcomes.
¥_ Build capacity and infrastructure within specific medically underserved populations to better address
tobacco-related health disparities.
Combating Obesity
Obesity is associated with a number of cancers, among them colorectal, pancreatic, breast and prostate cancer. American Cancer Society research clearly shows that obesity correlates with and causes cancer.
Society scientists estimate that approximately 187,000 cancer deaths in 2009 were attributed to poor nutrition, physical inactivity, and obesity. Current trends in obesity threaten to reverse America’s nearly 20-year decline in cancer death rates.
Similar to efforts we have made together in tobacco control, a multifaceted, population-based policy approach could significantly improve nutrition and physical activity and reduce obesity rates by removing barriers to healthy food choices and opportunities to be active. To be effective, the strategy must reflect the diverse needs and cultural preferences of communities and populations and involve collaboration across industry, community organizations, employers, health plans, non-governmental organizations, and local, state and federal governments.
We fully support funding the state, local and community programs in ARRA and also the First Lady’s important new “Let’s Move” initiative. We hope these programs will be used help identify and advance the most effective health interventions and policies to combat obesity.
Increasing Use of Cancer Screening Tests
With the exception of lung cancer, for which the major prevention strategy is avoidance of tobacco products, screening for cancer is the primary method for preventing death and morbidity from other common cancers, specifically cervical, breast, and colorectal cancers. In addition, screening for colorectal or cervical cancers
can identify and result in the removal of precancerous abnormalities, preventing cancer altogether. Following the recommendations for cancer screening from the American Cancer Society is an important complement to health behaviors that reduce the risk of developing cancer.
We are pleased that PPACA includes first-dollar coverage for all prevention services with a U.S. Preventive Services Task Force recommendation of “A” or “B,” and for annual mammograms for all women over 40 in both Medicare and all commercial health plans. No-cost coverage will improve overall rates of cancer
screening.
Going forward, we believe that the National Breast and Cervical Cancer Early Detection (NBCCEDP) and the Colorectal Cancer Control Program (CRCCP) will continue, even after 2014, to play a critical safety-net role, especially in minority and underserved communities. These programs have been very successful in
saving lives despite the fact that they remain substantially underfunded. As you know, NBCCEDP today serves fewer than 15 percent of eligible women aged 40 to 64. For this reason, we are deeply concerned about the President’s proposed FY11 budget which recommends a $4 million cut from NBCCEDP. This will
result in 7,000 additional low-income and uninsured women losing access to mammograms and pap tests. These and other cuts proposed in CDC cancer programs will adversely impact state and local health efforts where 17,000 state and local health jobs have been eliminated in recent years. We strongly urge you to consider using PPACA dollars to bring these lifesaving cancer screening programs up to full strength.
Improving Quality Cancer Care and Data Collection
Over the next ten years, the number of cancer survivors will increase by as much as 55 percent over the 11 million today. Patients and survivors often experience quality of life problems ranging from unrelieved pain, stress and side effects to late effects and other chronic health problems associated with their disease and treatment. While these conditions can limit patients’ ability to follow treatment recommendations and interfere with physical and mental quality of life, many patients face significant barriers when seeking information about care and treatment, and obtaining support services to manage their cancer and symptoms after they are diagnosed. Quality of life cancer care requires patients, families, doctors and others to develop an integrated plan at the time of diagnosis, taking into consideration the multiple transitions patients experience both in accessing treatment and across the disease course from treatment into long-term survivorship and at the end of life.
With additional resources, CDC’s National Comprehensive Cancer Control Program (CCCP) could help build infrastructure, capacity, and expertise by providing needed patient information, support, resources, and provider training. We urge CDC to allocate additional funding to CCCP for this purpose, and to encourage the routine use of care coordination planning and patient navigation with particular emphasis on addressing the needs of medically underserved groups
We also urge you to make a strategic investment in enhancing capacity, scope, and coordination across our national cancer surveillance and monitoring data systems, including the National Program of Cancer Registries, Behavior and Risk Factor Surveillance System, as well as other such initiatives and resources to evaluate measures addressing physical and mental quality of life in patients, survivors, and informal caregivers. These data systems are essential for evaluating and tracking cancer and trends, improving cancer prevention, control and care activities, and prioritizing use of resources to strengthen the national cancer program and demonstrate its return on investment, all of which are critical in sustaining future funding increases.
Addressing Health Disparities
Despite recent advances in cancer prevention, screening, and treatment, a disproportionate number of the uninsured, certain racial and ethnic groups, and other medically underserved populations are still not benefiting from this progress. Eliminating disparities in cancer screening, diagnosis, treatment, and care is
essential to improving health outcomes for all people facing cancer.
Research has shown that individuals from medically underserved populations are more likely to be diagnosed with late-stage diseases and have worse outcomes. We know that we need targeted public health interventions to overcome the many barriers they face. Improvements in the health insurance system will reduce the effects of disparities, but will not eliminate them. We ask that HHS and CDC work with us to better understand the complexities associated with cancer disparities.
We urge that a significant proportion of the Community Transformation Grants and Research on Optimizing the Delivery of Public Health Services grants authorized by Patient Protection and Affordable Care Act focus on implementing public health programs and services to reduce health disparities in medically underserved communities.
We further urge CDC to focus strategic attention on integrating existing and new programs and evaluating whether a more comprehensive approach to prevention may be appropriate and more effective for those who are hard-to-reach. For example, combining tobacco dependence treatment with early detection programs
may help streamline health care delivery for providers while also providing quality care for patients.
Incorporating integrated demonstration projects in existing or newly authorized programs such as the Healthy Aging, Living Well program or the Community Transformation Grants could be a better way to reach all Americans.
Conclusion
Passage of the Patient Protection and Affordable Care Act presents significant opportunities for a renewed emphasis on prevention and provides the single largest federal investment in prevention and wellness in our nation’s history. These provisions identify national priorities for prevention, better integrate federal and state prevention efforts, and coordinate prevention and wellness services in communities nationwide. CDC has a principal role in implementing these activities. We would welcome a meeting to discuss further ACS CAN’s proposals for improving cancer prevention, detection and care, and how we can be a useful resource for you
and your staff in our mutual fight against cancer.
Sincerely,
Molly Daniels
Interim President
FOR MORE INFORMATION, CONTACT:
Alissa Havens or Steven Weiss
American Cancer Society Cancer Action Network
Phone: (202) 661-5772 or (202) 661-5711
Email: [email protected] or [email protected]
