How vision and leadership shaped the U.S. National Cancer Institute's 50-year journey to advance the evidence base of cancer control and cancer care delivery research

Abstract

In 1971, Congress passed the National Cancer Act, landmark legislation that reorganized the National Institutes of Health's National Cancer Institute (NCI). The Act included a new focus on cancer control, including the requirement that the NCI award research grants and contracts, in collaboration with other public agencies and private industry, to conduct cancer control activities related to the diagnosis, prevention, and treatment of cancer. The requirement placed the NCI at the nexus of a rapidly changing science and a complex and dynamic healthcare delivery system and involved an evolutionary transformation to advance cancer control and cancer care delivery research along the cancer care continuum. Analysis is based on a qualitative ethnographic approach using historical records, oral histories, and targeted interviews. The multimethod approach provided the opportunity to describe to the vision, leadership, and struggle to build an infrastructure, expand expertise, and forge collaboration with the NCI and a complex and changing healthcare system. As the 50th anniversary of the National Cancer Act approaches in 2020, the process and these achievements are at risk of being taken for granted or lost in the flow of history. Documenting the process, milestones, and key players provides insight and guidance for continuing to improve cancer care, advance research, and reduce cancer incidence and mortality. Cancer care is a microcosm of the larger healthcare system providing insight and lessons on the importance of developing and maintaining a research infrastructure and the role of multi- level collaboration and partnerships involving both the private and public sectors.

Precision Oncology-Based Targeting of Signaling Pathways toward a Holistic Approach to Cancer Therapeutics

“…Considering the vast number of incidences, a formal initiative to address the menace of cancer on part of the government system as called for, and it indeed appeared in the United States as the National Cancer Act of 1971 signed by President Richard Nixon aimed at promoting cancer research and application of the outcomes for minimizing cancer incidences and mortality rates related to cancer. The act was euphemistically described as the "War on Cancer", and the year 2021 marked the 50th anniversary of the signing of the act into law [5]. The National Cancer Program that was borne from this initiative resulted in the beginning of a concerted effort across the length and breadth of the country to develop the infrastructures required for the treatment, cure, and eradication of cancer.…”

Precision Oncology-Based Targeting of Signaling Pathways toward a Holistic Approach to Cancer Therapeutics

“…Considering the vast number of incidences, a formal initiative to address the menace of cancer on part of the government system was called for, and it first appeared in the United States as the National Cancer Act of 1971 signed by President Richard Nixon aimed at promoting cancer research and application of the outcomes for minimizing cancer incidences and mortality rates related to the disease. The act was euphemistically described as the "War on Cancer", and the year 2021 marked the 50th anniversary of the signing of the act into law [5]. The National Cancer Program that was borne from this initiative resulted in a concerted effort across the length and breadth of the country to develop the infrastructures required for the treatment, cure and eradication of cancer.…”

Achieving a multilevel evidence-based approach to improve cancer care in the U.S. post-COVID era: What is the role of management?

“…Behind the IOM’s disparaging evaluation of the country’s cancer care delivery system and the health system at large [ 6 , 7 ], particularly evident when faced with the challenges of COVID-19, are efforts within the cancer care community to design an integrated and evidence-based approach to improving health care. These research and clinical program efforts, which involve both the public and private sectors, operate at the interface between evolving science, its clinical application, and a changing health care system, one that represents a microcosm of the larger health care system [ 8 ], with implications for both management and the clinical community. As Dr. Harvey Fineberg, in his closing days as president of the IOM, reminded the clinical, research and managerial communities, “If we can solve the problems of cancer care, then we have the key to solving health care more broadly.”…”