US Needs a "Systems Approach" to Attacking Cancer, Report Says

A report released Thursday from the National Academies of Sciences, Engineering, and Medicine said the United States needs a US National Cancer Control Plan that uses a system approach to reshape cancer control efforts, targeting everything from prevention, machine learning, palliative care, assessing value, rooting out financial conflicts of interest, and more.

With an aging US population, there will be an expected wave of cancer diagnoses in the coming years, said the committee that wrote the report. A national cancer control system will be much more effective, efficient, and responsive to shifts in technology and policy to successfully address this change, the report said.

The report, which makes 10 recommendations, also calls for HHS to fund an independent organization that specializes in systems engineering, industrial design, software development, and information and visual analytics to prototype and develop a publicly available, interactive, and evolvable planning and monitoring dashboard. Such a tool would allow users to simulate, predict, and analyze how the system would react to possible policy changes or interventions.

In addition, the report calls for the Government Accountability Office to periodically review and report to relevant congressional committees about the achievement of goals specified in the plan.

Taking a systems approach will coordinate the priorities and actions of multiple stakeholders, improve resource integration, and promote joint accountability and overcome current fragmentation, said the report, called Guiding Cancer Control: A Path to Transformation.

The recommendations are:

• To apply the tools of complex systems analyses for assessing the “value” of cancer control interventions, establishing robust policy and incentive assessments to guide the development and commercialization of products and services, developing new financing and payment mechanisms that alleviate overall cost burden
• To improve the availability of preventive, screening, diagnostic, and therapeutic interventions, and encourage timely palliative care, hospice care, survivorship services, and related social services
• To leverage advances in and apply “multiomic” diagnostics, which will improve therapies and better understand their scientific, clinical, and economic impacts
• To integrate the use of social, behavioral, and other information made possible by the convergence of communication, social media, cognitive, financial, and sensor technologies as well as electronic health records, cancer registries, and insurance claims to establish large-scale interoperable data sources
• To use cloud computing, machine learning, and artificial intelligence tools for continuous analytics, rapid reporting of trends and patterns, and improved forecasting and performance reviews (and to assess these tools for their ability to protect individual privacy and the security of data systems)
• To discourage direct-to-consumer marketing and advertising of clinical products and services from companies, medical centers, intermediary firms, and other organizations by terminating the tax deductibility of these business expenses, and to tighten and enforce rules to halt misleading promotional tactics and strategies that tout products and care services not backed by evidence
• To minimize the waste and harm that stem from disparate clinical practices, interventions lacking evidence of effectiveness, and conflicting clinical practice guidelines
• To track and monitor financial links, incentives, and disincentives throughout the processes and systems of cancer control and rigorously require conflict-of-interest disclosures across cancer care, research, and patient advocacy activities
• To expand and support reproducibility strategies for developing reliable evidence in cancer control from biomedical, clinical, public health, and social science research
• To launch and expand public engagement, literacy, and outreach activities, including K—12 curriculums, to broaden the understanding of cancer prevention

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. In 2018, about 600,000 people in the United States died from cancer, and about 1.7 million people received a new diagnosis of cancer. Additionally, the national economic toll of cancer is estimated to be nearly $600 billion annually.