President Biden’s Cancer Moonshot Program aims to cut cancer fatalities in half over the next 25 years. So what does this very ambitious plan really mean for cancer patients?
SurvivorNet has been reaching out to leaders in the field of oncology for their takes, and one particularly enlightening conversation we just had was with Dr. Craig Bunnell, Chief Medical Officer at the preeminent Dana-Farber Cancer Institute and a specialist in breast cancer oncology. Dr. Bunnell shared his professional opinion on the administration’s initiative and gave us many helpful insights on developments in cancer research.Read More
Dr. Bunnell became the chief medical officer in 2012 and joined Dana-Farber in 1996. He is also a member of the Breast Oncology Center in the Susan F. Smith Center for Women’s Cancers.
Below is a lightly-edited transcript of the conversation we had with Dr. Bunnell.
SurvivorNet: Dr. Bunnell, what is your perspective on President Biden’s announcement that his goal is to cut cancer deaths in half over the next 25 years?
Dr. Bunnell: The president announced what I think is a very ambitious, but realistic initiative that we believe will improve cancer prevention, strategies, increase cancer screening and early detection, improve treatments, and reduce cancer disparities. These are areas that Dana-Farber has been in the forefront for years and we’ve seen the dramatic and life changing successes.
SurvivorNet: The President has committed $200 million to cancer research, what is the best way to allocate those funds?
Dr. Bunnell: There are a lot of really smart people who are charged with doing this, but I think you want to look at improving screening. You want to look at ways to decrease preventable cancers. You want to look at ways to improve our treatments and then expand access to those treatments.
We do have disparities and those have become more obvious to people through the COVID-19 pandemic. Those disparities also exist in cancer and I think expanding access to those improved treatments and screening will be critically important.
SurvivorNet: It is publicly known that the pharmaceutical industry pays for drug trials, but can we talk a bit about what the government could or should be providing in terms of funding and support for these trials as well?
Dr. Bunnell: The issue is really doing the work that needs to be done in order to get to a place where you can actually develop that drug and that’s not something that industry is as invested in— I mean that’s not their business. So part of this is really providing the initial funding and the pivotal investments for breakthrough technologies, for the basic science, for the platforms that have the ability to transform these areas of medicine.
SurvivorNet: Let’s say the funding from the administration is deployed and more trials are readily available; how do we get people into those trials?
Dr. Bunnell: Part of the original moonshot goes back to 2016 when President [Barack] Obama tasked then vice president [Joe] Biden with bringing focus and funding to these areas of cancer research that would benefit patients and part of that entailed fostering this greater collaboration, which included engaging patients to help get them involved in cancer research and clinical trials, developing patient-centric networks to improve outreach and engagement and education.
So a big part of the first part of moonshot was actually to foster that engagement that’s carried through into this second phase, this new reigniting of ‘moonshot’ by trying to increase greater patient engagement, to look at things like telehealth research, to determine how we can use telehealth to improve cancer care.
SurvivorNet: What could the moonshot initiative do for patients who need help today?
Dr. Bunnell: I think that there are a lot of things that may seem obvious, but really aren’t. One is screening. For example, during COVID screening went way down. What we know from that is it will result in patients presenting at later stages. It will result in increased cancer deaths. We need to actually have improved screening and improved access to screening and we need to have improved education around preventable cancers. One of the things that came out of COVID was our increased use of telehealth. Prior to COVID there was very little telehealth that took place at all.
With COVID, a lot of the regulatory barriers dropped, a lot of the financial barriers to telehealth dropped, and the pandemic allowed us to advance telehealth in a way that we never would have done in that period of time without the presence of the pandemic. One of the problems now as the pandemic eases is that some of those barriers that had gone away have been resurrected and I will tell you that we in cancer know that telehealth was incredibly important for providing greater access to our patients, greater education for our patients, and greater resources for our patients. And when that goes away, it means that we lose the potential benefits we could have had.
It is no longer legal for me to perform a telehealth visit for a patient in most states in this country, and so a cancer patient who lives in a rural area that could benefit from having access to an NCI designated comprehensive cancer center, a dedicated cancer center, no longer has access to be able to have that consultation with a multidisciplinary team that specializes in their type of cancer.
SurvivorNet: A multi-cancer early detection blood test is gaining popularity, but how likely is it to come to fruition?
Dr. Bunnell: I think that’s going to require very large clinical trials to demonstrate the value of these sort of multi-cancer detection tests. I think there’s tremendous promise in being able to do a blood test and pick up cancers very early or even in a pre-cancerous state, in which we can actually prevent the development of those cancers. You have to make sure that those tests are really bringing value and adding improvements in survival, which is going to require very large clinical trials to do that.
SurvivorNet: On the flip side of that what about over-treatment?
Dr. Bunnell: That is absolutely correct. We need to make sure that those tests are not picking up cancers that will never be relevant in a person’s life. It’s finding that way in which you’re able to intervene in a way that actually improves quality of life, improves survival, and doesn’t result in unnecessary treatments for cancers that never would’ve been relevant.
SurvivorNet: So it is safe to say we have a ways to go before we have a multi-cancer detection type blood test?
Dr. Bunnell: Absolutely. And we have the ability to get there, but we’ll never get there unless we have the sort of focus and funding that something like moonshot provides.
SurvivorNet: And for our final question, do you see yourselves at Dana-Farber as an important part of the global cancer education for the country?
Dr. Bunnell: Yes, absolutely. An example of that would be we have created a clinical pathway system that is actually something that is exportable to other centers so that they can actually take a particular patient and go through this computer-based algorithm to understand both, what are all of the options that are available, but what’s the right option at this time for this particular patient and based on the best literature, the most up to date literature that’s there.
Those are the sorts of systems we need in order to help support oncologists across the country, but particularly oncologists who are in the community. I’m a breast medical oncologist. All I do is treat breast cancer. For an oncologist in the community they are treating breast cancer, colon cancer, rectal cancer, lung cancer and it’s very hard to know the most up to date literature in every single cancer that’s out there, and so ways that we can create a system to support them is really important.