By Rose Hoban
The future of cancer treatment is within reach. It just needs some rocket fuel.
That was the message given Wednesday by Vice President Joe Biden at Duke University, where he visited to boost President Barack Obama’s “Cancer Moonshot” initiative, announced during the State of the Union address in January.
In that speech, Obama tasked Biden with leading a nationwide effort to accelerate efforts to find cures for the many forms of cancer. The initiative includes proposals for billions in additional dollars for the National Institutes of Health, with close to $200 million for the National Cancer Institute.
In 2015, Biden lost his 46-year-old son, Beau, to an aggressive form of brain cancer. He said the new initiative was “not his idea,” but when Obama approached him about leading the effort he said he jumped on it.
Biden also said he’s ready to make the fight against cancer a “major component of what I’m going to be doing with the rest of my life.”
During the nearly two-hour event, Biden discussed aspects of cancer research and treatment, barriers to care and what needs to happen to advance the science. He also took suggestions and input from researchers and patient advocates involved with cancer care throughout the Triangle.
“One area of consensus is that we really are at an inflection point,” Biden said about what he’s learned since starting work on the initiative. “I was stunned to learn how much has changed in the last five years.”
While Biden said several times that he was “not naive” about the difficulty of finding cures for the many forms of cancer, he also expressed optimism.
“The science is ready,” he said repeatedly.
Big data, big promise
By the end of Biden’s presentation, no one could doubt his enthusiasm for the potential of “big data” in cancer research and treatment. He used the phrase at least a dozen times to talk about genetic data, information on treatment responses and pharmaceutical knowledge being collected by cancer researchers.
“Big data” is the term used to refer to reams of information, which, on the surface, doesn’t reveal much. But once the data are aggregated with the assistance of sophisticated statistical analyses, researchers can pull revelations from the mountains of raw bits and bytes.
As an example, Biden talked about a recent study showing that women with ovarian cancer taking one type of blood pressure medication lived significantly longer than others with the same diagnosis who didn’t take that pill.
“The way that was found is comparing outcomes,” he said. “It’s something that never would have happened or been picked up by biology alone, or researchers working in silos, but it did get picked up because of data and computing advances and the ability to look across wide patient populations.”
He encouraged researchers, drug companies and academics to share information more freely about what works, urging pharmaceutical companies, in particular, to collaborate.
“Getting that done is like getting a nuclear deal with Iran,” he said to laughter from the crowd.
“We have to make sure the information is being shared so that oncologists in Fayetteville can access information from a world-class institution like Duke,” Biden said.
Getting treatment where it’s needed
“People of color, as with any other chronic illness, we fare worse,” Gayle Harris, Durham County’s health director, told Biden during the round-table portion of his visit. “Most of the times, our illnesses are detected far, too far, into the progression of the disease.”
And of the only 5 percent of patients who end up in clinical trials, few are minorities.
James Atkins, a researcher with the Southeast Clinical Oncology Research Consortium, made an emotional plea for easing access to clinical trials for oncologists outside academic research centers.
Clinical trials should be made available to any oncologist credentialed by the NCI, Atkins said, cutting off Biden’s response.
“If somebody comes into my office today with a malignant tumor for which I do not have a clinical trial, but there is one at the government.com, I go ahead and access it; I download the forms off the Internet,” he said. “I fax it in, the drugs are shipped,”
“It doesn’t have to be as complicated as it is,” Atkins said.
Atkins also made specific suggestions about streamlining FDA audits, which drew murmurs of approval from the crowd.
“I’m going to ask you to be willing tomorrow to get on the phone with one of the docs in my operation and lay out in detail just what you said here,” Biden responded, telling him to be as specific as possible with his suggestions.
Cost: the final frontier?
Biden concentrated primarily on the science, but several observers noted one of the biggest barriers to cancer care is cost.
Harris recounted the story of a cousin who spent enormous amounts of money looking to cure a case of pancreatic cancer. She told of how the family exhausted treatment at three academic centers, to no avail, while also exhausting their savings.
“That wreaks havoc on a budget,” she said. “And they had the skills to navigate the system.”
That cost of care is what preoccupies Duke oncologist Yousef Zafar.
“We need to focus on how to get the right care to the right patient at the right time,” said Zafar, who did not attend the Biden presentation. “Part of getting the right care to patients involves understanding the cost of that treatment.”
“It doesn’t take hundreds of thousands of dollars of medical debt for patients to feel the pinch,” he said.
Zafar said there’s evidence showing that out-of-pocket costs as little as $100 per month can induce cancer patients to stop life-prolonging treatment.
“Some patients might say, ‘I’d rather not have my family go into medical debt even if this therapy could extend my life,’” he said.