107th Congress

National Cancer Act of 2002

S. 1976/H.R. 4596 and S. 2955

Background

Cancer, a group of diseases characterized by the uncontrolled growth and spread of abnormal cells, is the second leading cause of death in the United States, exceeded only by heart disease. In the United States, one of every four deaths is from cancer. In 2002, approximately 555,500 Americans are expected to die from cancer, and about 1,284,900 new cancer cases are expected to be diagnosed. Everyone is at risk for developing cancer; however, the occurrence of cancer increases as individuals age. About 77 percent of all cancers are diagnosed at ages 55 and older.

The first comprehensive cancer legislation, the National Cancer Act of 1971 (P.L. 92-218), was introduced as part of a "war on cancer" initiated by former President Richard Nixon. That bill also created the National Cancer Institute (NCI). The goal of the National Cancer Act of 2002 is to reinvigorate those early efforts to defeat cancer by updating the 1971 legislation. During the 107th Congress, two cancer bills by the same name, the National Cancer Act of 2002, were introduced. On February 28, 2002, Senator Dianne Feinstein (D-CA) introduced S. 1976; a companion measure, H.R. 4596, was introduced by Representative Lois Capps (D-CA) on April 25; and Senators Sam Brownback (R-KS) and Judd Gregg (R-NH) introduced S. 2955 on September 18.

Provisions of the Legislation/Impact on NIH

At the news conference announcing her sponsorship of the bill, Senator Feinstein stated her belief that the National Cancer Act of 2002 may be the most important legislation she has ever sponsored. The provisions of the bill are drawn from recommendations made by the National Cancer Legislative Advisory Committee to increase cancer research, translate research into effective cancer prevention, detection, and treatment methods, and ensure quality care.

S. 1976 would have provided for a comprehensive Federal effort relating to treatments for and the prevention of cancer, and for other purposes. Title I of the bill expanded cancer-related research, prevention, and treatment programs. The following specific provisions were relevant to the National Institutes of Health (NIH):

• Authorized for NCI $4.8 billion for fiscal year (FY) 2003, $5.3 billion for FY 2004, $5.8 billion for FY 2005, $6.4 billion for FY 2006, and $7.1 billion for FY 2007
• Directed NCI to prepare one or more strategic plans to identify unmet needs and the level of funding needed in areas of prevention, treatment, early detection, and quality of life, and to expand research in behavioral science, prevention, health disparities, palliative care, quality of life, environmental risk factors and gene-environment interactions, symptom management, tools for early detection, and cancer survivorship
• Required the Director of NCI to establish translational cancer research centers, and authorized $100 million in FY 2003 and $100 million for each of the FYs 2004 through 2007 for this purpose
• Required the Director of NCI to carry out a program to increase patient and provider participation in clinical trials, including an outreach program, a diversity assurance program, an assistance program, and culturally appropriate materials
• Required the Agency for Healthcare Research and Quality (AHRQ) to convene cancer experts, including representatives of NCI, to coordinate the development and regular update of cancer care guidelines
• Required the Director of AHRQ to coordinate Federal research and implementation initiatives to improve the quality and outcomes of cancer care with the Director of NCI, among others
• Directed the Centers for Disease Control and Prevention to coordinate its activities authorized under this bill with NCI
• Directed NCI, in coordination with the Secretary of Veterans Affairs, to ensure a sufficient number of cancer researchers by increasing the number and amount of institutional training grants and career development awards
• Required the Director of NCI, in consultation with the Director of NIH, to establish a cancer research loan repayment program
• Required the Director of NCI to develop and implement postdoctoral stipends, authorizing $79 million for FY 2003, $86 million for FY 2004, $95 million for FY 2005, $105 million for FY 2006, and $115 million for FY 2007 for this section
• Required the Director of the National Institute of Environmental Health Sciences, in coordination with NCI, to prepare and submit a strategic plan that identifies the unmet needs regarding research on environmental risk factors for cancer and gene-environment interactions, and describes how to increase the amount of such research and resources for such research. Such sums as may be necessary would have been authorized to carry out this research.

S. 2955—National Cancer Act of 2002

Senators Brownback and Gregg introduced S. 2955 as an alternative to S. 2965, the Quality of Care for Individuals with Cancer Act. (See the article entitled "Quality of Care for Individuals with Cancer Act.") During his introductory remarks, Senator Brownback gave a brief legislative history of NCI, noting that the Institute has the privilege of a "bypass budget," which is the ability to submit the NCI budget directly to the President. Senator Brownback stated that he was introducing the bill for those that die from, are diagnosed with, and are survivors of cancer.

Title I—Public Health Provisions. Of interest to NIH, this title would have:

• Required the Secretary of Health and Human Services (HHS) to develop a plan that outlined strategies by which State cancer registries funded by NCI could share information
• Required the Secretary of HHS to contract with the General Accounting Office to determine the indicators that State cancer registries should maintain and disseminate in order to ensure maximum usefulness for patients, advocates, health care providers, and researchers
• Reauthorized the Breast and Cervical Cancer Program through 2007
• Revised various NCI authorities to include pain and symptom management
• Established the existing NCI Office on Cancer Survivorship in statute. The Office would have been required to collaborate with other appropriate NIH entities and submit a report to Congress describing survivorship activities and strategies for future activities. The percentage that NCI would have been required to spend on cancer control would have been increased from 10 percent to 13 percent. The 3 percent increase would have been designated for the Office of Survivorship.

Title II—Research Provisions. Of interest to NIH, this title would have:

• Allowed NCI to cofund grant projects with private entities for any purpose described in NCI's authorizing statute
• Amended NCI's bypass budget authority to allow the Secretary of HHS to change the budget, specified that the House and Senate Budget Committees would receive the budget, and required that the National Cancer Advisory Board must accept comments on the budget from nongovernmental organizations and compile significant suggestions into a report to the Director of NCI. The Director of NCI would have been required to respond to any suggestions prior to submitting the budget.
• Included a Sense of the Senate that 1) the current procedure of sending one research protocol through multiple local Institutional Review Boards (IRBs) may not be the most efficient method of protecting patients, 2) NCI should be commended for its work in centralizing the IRB process, and 3) the research community should continue to streamline the IRB process in order to bring lifesaving treatments to patients as quickly as possible
• Required NCI to 1) integrate trials conducted by private manufacturers into the NCI clinical trials online database, and 2) establish an education program to provide patients and providers with information on accessing the NCI clinical trials database online and about the Food and Drug Administration's process for approving the use of drugs and biologicals for a single patient

Title III—Medicare Provisions. This Title contained provisions applicable to Medicare regarding reimbursement for items and services used in the course of cancer therapy, payment for drugs and biologicals, coverage for palliative care, improvement of the coverage of hospice care, and coverage of all treatments for cancer patients.

Status and Outlook

S. 1976 was introduced on February 28, 2002, and was referred to the Senate Health, Education, Labor and Pensions Committee.

H.R. 4596 was introduced on April 25, 2002, and was referred to the House Committees on Energy and Commerce, on Education and the Workforce, and on Ways and Means, for consideration of the provisions within the jurisdiction of the committee concerned. On July 25, it was referred to the House Education and the Workforce Subcommittee on Employer-Employee Relations.

S. 2955 was introduced by Senator Brownback on September 18, 2002, and was referred to the Senate Health, Education, Labor and Pensions Committee.

Although there was no further action on this legislation during the 107th Congress, it is anticipated that similar legislation will be introduced in the 108th Congress.