Cancer Research Faces Changes With Health Care Reform

Many doctors and medical researchers applauded a new federal focus on comparative effectiveness research that was boosted through the 2009 stimulus package and codified with the signing of the health care reform bill in March. This shift will support—and in many cases require—work to establish which treatments work best.

The changing policies, however, present "a conundrum" for cancer work, Amy Abernethy, an oncologist at Duke University Medical Center in Durham, N.C., said here Tuesday at the annual meeting of the American Association for Cancer Research. Actually, they present at least a couple.

The first challenge is that comparative effectiveness research, by necessity, focuses on broad populations of patients. But as Abernethy pointed out, "in oncology, we take care of individuals." Newly prioritized research might turn out new results about treatments that are best for most breast cancer patients with a defective HER2 protein, for example, but many other individuals with different genetic factors might still need trial-and-error treatment until research finds what works best for them.

Another big quandary is that though zeroing in on the most medically effective and cost-effective treatment for individual patients is a respectable goal, the current literature on treatments leaves many researchers and clinicians wanting. Few studies (less than a third) published recently in major medical journals have added to the overall comparative effectiveness literature, according to a March 2010 paper in The Journal of the American Medical Association.