Progress Against Cancer Addressed at Symposium
MADISON - Are we winning the war against cancer?
The question, posed by the University of Wisconsin Carbone Cancer Center's eighth annual cancer symposium, refers to President Nixon's declaration of a so called 'war on cancer' when he signed the National Cancer Act in 1971.
In the nearly four decades since Nixon's declaration, there have been significant advances in the treatment of the disease. Yet, there remains a wide disparity in how those advances affect the population because, as Patrick Remington, MD, MPH, said during his opening presentation, "Cancer is not a single story."
By 2000, the National Cancer Institute (NCI) indicated that mortality from cancer declined for the first time since national record-keeping was instituted in the 1930s. However, according to Dr. Remington, the progress in the prevention and treatment of cancer is mixed.
Based on age, cancer mortality rates are actually increasing among women and older people. Progress in cancer control is relatively minimal when compared to other diseases including heart disease and stroke.
"Soon, they will no longer be able to say heart disease is the leading killer in the U.S.," said Dr. Remington, referring to data from the Centers for Disease Control that shows cancer will soon become the leading cause of death in the U.S.
Dr. Remington suggested that there needs to be a shift in emphasis, moving from research on treatment to research on prevention, if progress against cancer is going to be accelerated.
"The single best measure of progress against cancer is age-adjusted mortality rate," explained Dr. Remington. "According to this measure, we are making minimal progress."
He added that because cancer rates are not the same among all groups - significant disparities exist between cancer rates based on age and gender - the focus of attention needs to turn to what he called the "unacceptable cancer health disparities" that exist in the U.S.
The Disconnect Between Discovery and Delivery of Care
During his keynote address, Harold Freeman, MD, echoed Dr. Remington by explaining that, "There's a disconnect between what we know and what is actually delivered to people."
Dr. Freeman is the president and founder of The Ralph Lauren Center for Cancer Care and Prevention in New York City and founder of The Harold P. Freeman Patient Navigation Institute. As a surgeon for more than 40 years in Harlem, New York, he has seen first-hand the effects of cancer on the poor.
Based on his work as president of the American Cancer Society, he found almost universally that poor people meet significant barriers when they attempt to seek treatment for a medical condition. Many experience more pain and suffering because the disease is often at a later stage. And, they tend to make extraordinary sacrifices, losing their jobs or even their dignity, in seeking care.
"People who are uninsured are forty percent more likely to die of cancer," said Dr. Freeman. "People should not die of cancer because they are poor."
Based on his own research, Dr. Freeman found that a black male in Harlem had less of a chance of reaching age 65 than a male in Bangladesh.
"The 'Third World' could be in the same city in which you live," he said.
Dr. Freeman stressed that what is known about disease prevention and treatment must be applied to all people, irrespective of their ability to pay.
"Poverty should not be an offense punishable by death," Dr. Freeman emphasized.
Building the Plane We Are Riding On: Health Care Reform
While there is a desperate need for significant change in how health care is delivered in the U.S., there are tremendous challenges to reforming the system. Katharyn May, DNSc. RN, FAAN, dean of the UW-Madison Nursing School, discussed a few of those challenges.
May commented that the reason for a health care reform debate in the U.S. is because of the money being spent on health care, not because of humanitarian reasons.
"In 2000, $2.4 trillion was spent on health care in the U.S. and it is expected to reach $3.2 trillion in 2012," she said.
While the current debate is focused on health insurance reform, May pointed out, the discussion has yet to be about reforming how health care is actually provided in the U.S.
"The heavy lifting comes in reforming the delivery systems," May said.
According to May, health care professionals offer a critical perspective to the debate and need to make their voices heard.
When it comes to reforming the delivery system, May said we are "building the plane we are riding on." And she offered a few critical steps, including:
- Clarifying the principles and holding our leaders accountable to maintaining them
- Rationalizing the money
- Encouraging system integration, meaningful and productive innovation and elimination of fraud
"Only once these issues have been addressed can we focus on reforming the delivery system," she said.
May concluded by offering a challenge to health care providers.
"I would challenge you to pay attention to our particular responsibility," she said. "We have to step up in the next phase - the delivery of care. We have to put the patients first. Ask those whom we serve, 'What can I do for you today.'"
Limited Literacy Skills Significantly Affect Health
Offering another perspective on the challenges confronting health care workers, Michele Erikson, executive director of Wisconsin Literacy, Inc. ,explained how limited literacy can significantly impact a patient's ability to seek and understand medical care.
"The U.S. is the only country in the world where today's high school students are less likely to graduate high school than their parents," Erikson said.
According to the National Assessment of Adult Literacy, 93 million American adults, or 43 percent, have very poor or marginal literacy skills. In Wisconsin alone, 39 percent of adults struggle with the functional literacy skills required to succeed in everyday life.
For those who do struggle, it is often a secret they keep from their health care providers, their coworkers, their children and even their spouses.
"We spend more on premium-label ice cream each year than on adult basic literacy programs," said Erikson.
The problem is that literacy is actually the strongest predictor of an individual's health status - not age, race or even income. Individuals with low literacy skills often don't understand their condition, don't take medication correctly, often don't follow preventive lifestyle measures, and have difficulty managing their own care. Yet most patients will tell their provider they do understand because they are embarrassed to admit they don't.
According to the American Medical Association, individuals with limited health literacy skills have average health care costs of $13,000 compared to $3,000 for those with higher health literacy. Adults with low literacy have increased rates of advanced disease, preventable disease, and mortality rate. They also have more visits to the hospital.
Erikson pointed out that to address the problem, it is necessary to take a multifaceted approach. In addition to literacy and reading programs for adults and children, the health care system can do several things to help patients ranging from using simple language and drawing pictures to creating a shame-free environment. It's also important for patients to help themselves and bring a family member or friend to a doctor visit, bring a list of all current medications, ask questions, and enroll in a local literacy program.
"Our health care system is becoming more consumer-driven," said Erikson. "If individuals can't take control of their care or manage their care, it could be catastrophic."
Public Awareness Crucial in Advancing Cancer Prevention
Helping patients manage their care is critical if any progress is to be made against cancer and other diseases.
"If we apply what we know now, we can significantly reduce the number of deaths from cancer," said Dr. Bradford Hesse, chief of the National Cancer Institute's (NCI's) Health Communication and Informatics Research Branch (HCIRB).
According to research being conducted by the NCI, public awareness is one of the crucial themes in advancing cancer prevention.
"Coca-Cola and Marlboro have bigger marketing budgets than all of NCI," said Dr. Hesse.
How health care experts and providers talk about stories influences behaviors. Patients will hear stories, go onto the Internet to read more about a particular condition and approach their doctor. This is why it is important for physicians to figure out how to handle patients with too much information and help them sort through all of the conflicting information.
"The reason it matters," Dr. Hesse explained, referring to the importance of public awareness, "is that misleading information can cost lives."
Hesse, like many throughout the day, remained optimistic about the progress in preventing and treating cancer.
"Working together, we are making a difference," concluded Dr. Hesse . "But we can do better, we can accelerate success against cancer now. They key lies in marked partnerships, and the power of collective action."
Date Published: 11/03/2009