The 21st Century Cures Act – What will IR`s Contribution be?
D. Biederman, MD.
In an era of ever increasing political polarization, it was a welcomed sight to see the 21st Century Cures Act recently signed into law by President Obama on December 13, 2016 with sweeping bipartisan support. The bill provides substantial funding to a number of pressing public health issues including the prescription opioid drug abuse epidemic, neurodegenerative diseases, and cancer research and care. It funds the latter of these most significantly with 1.8 of its 6.3-billion-dollar total, a plausible reason why it has been widely dubbed "The Cancer Moonshot," akin to the landmark challenge president Kennedy laid forth before the nation on May 25th, 1961 to put Americans on the moon before the decade ended.
The use of the word "Cure" in the title of the bill combined with its association with the lunar landing, for which the distinction between success and failure was well delineated, could potentially cause one to lose sight of the stated purpose of the bill: " To make a decade’s worth of advances in cancer prevention, diagnosis, and treatment, in five years." While there are indeed promising treatments such as Chimeric Antigen Receptor T-Cell (CART) therapy, which may well provide a cure for some types of cancer, equating complete cure to the lunar landing equivalent of the moon shot challenge risks being faced with the perception of failure even if significant improvements in quality of life and survival are achieved in the next decade absent a complete cure. Vice President Biden, a man personally impacted by the tragedy of cancer with the death of his son Beau, ostensibly addressed this point when he delivered a poignant speech at the ceremonial bill signing. In this speech, he described the importance of the 21st Century Cures Act as representing so much than an all or nothing challenge. He echoed physicians treating – and patients battling – cancer when he stated:
“This legislation is going to give hope. Every day, millions of people are praying -- praying for hope, praying for time, praying that somehow something will happen just to extend their -- they're not even praying for cures most of the time. Those of you who are doctors in the audience, how many times have you heard a patient say, “Doc, can you just give just three more weeks so I can walk her down the aisle, or, just give me another two months, it's my first grandbaby and I want see him or her born. It's all a matter of hours, days, weeks, months.”
The exponential growth of Interventional Oncology (IO) in the past two decades has led to improvements in quality of life and survival across multiple treatment modalities. While the majority of currently available treatment options in IO often fall short of complete cure, steady progress has been made in increasing the all-important "time" aspect of illness alluded to by the Vice President. The progress in IO in this regard, often creating months and sometimes even years for patients while maximizing their quality of life should not be overlooked. It is the opinion of the author that discounting the potential role of IO in the 21st Century Cures Act would be in contradistinction to the words of Vice President Biden as well as the intent of the bill and a disservice to patients who may not have a decade to wait. Having Interventional Radiologists as participants in this "Cancer Moonshot" effort as Principal Investigators or in as active participants in multidisciplinary research efforts stands to provide a significant benefit to patients now.
The seemingly impossible "giant leap for mankind" made on July 20th, 1969 was achieved through a collaborative effort by some of the world's greatest scientific innovators. Achieving an equivalent feat in medicine is likely to entail a similarly monumental undertaking. This legislation authorizes the NIH to finance high-risk, high-reward research. An active role of Interventional Radiology, a specialty with a storied history of innovation, pushing boundaries, and re-defining limits is likely to result in a substantial contribution to what appears to be an exciting future of accelerated progress in cancer treatment.
