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The Complexity of Cancer Control

The causes and effects of cancers are complex, requiring efforts across a broad spectrum from basic risk awareness through treatment, survivorship, and end-of-life care.

A diverse multitude of agencies and organizations representing a wide range of sectors and interests carry out this important work.

A report by the National Academies of Sciences, Engineering, and Medicine highlights the need for and characteristics of a coordinated national cancer control plan.

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The Burdens of Cancers
Are Far Reaching

The burdens of cancers are as complicated as the disease itself, affecting patients, families, and society as a whole. These broad and diverse burdens exact physical, financial, and psychological tolls on patients and families while health systems and the nation also incur the immense costs.

  • Although age-adjusted death rates from cancer have been steadily declining over the past 30 years, about 600,000 people in the United States died from cancer in 2018.
  • Over the next 12 months, about 1.7 million people will hear the devastating words, “You have cancer.”
  • Costs associated with cancer are one of the top reasons for personal bankruptcy in the United States. One-third of patients undergoing cancer treatment go into debt.

Cancers Disproportionately
Affect Different Communities

The U.S. has made significant advances in cancer prevention, detection, and treatment, but this progress isn’t felt equally by all communities across the country. Cancer outcomes and mortality differ greatly based on race, ethnicity, socioeconomic status, and geography.

  • Due to the aging of the U.S. population, there will be a 30 percent increase in the number of new cancer cases among America’s white population by 2030...
  • … but the cancer incidence will increase by:
    • 142 percent for Hispanics
    • 132 percent for Asians/Pacific Islanders
    • 76 percent for American Indians/Alaskan Natives
    • 64 percent for blacks
  • The risk of cancer death for those with no more than a high school education is much higher than for those with a college education.

Cancers Are Complex

Cancer control is complicated because cancers are complex. Cancers can appear in different organs, respond differently to varying types of treatments, and progress along different paths. Understanding these nuances is the first step in transforming cancer control efforts, leading to better outcomes at a lower cost.

  • There are hundreds of types of cancers.
  • Cancers may be classified in many ways, including:
    • By stage (e.g., Stage I-IV),
    • By age (e.g., pediatric),
    • By association with infections (e.g., HPV-related cancers).
  • The combination of environmental factors and personal factors, such as genetics, can complicate efforts to predict, prevent, treat, and survive cancer.

Many Participants Are Involved In Cancer Control

Cancer control needs to consider many factors, including the environment, economy, policy, education level, food quality, and housing. Thus, cancer control efforts are situated in a wide variety of places across the country. Despite their wide reach, these programs are not coordinated by a unified approach.

  • There are a total of 65 cancer plans across the U.S., located in all 50 states, the District of Columbia, 8 Pacific Island jurisdictions, and Puerto Rico, each working to meet its community’s specific needs.
  • Each plan focuses on educating the public about cancer, increasing access to high-quality care, and reducing health disparities, but they each have their own approach to implementing and evaluating their plans.
  • Over a dozen federal agencies, and many nonprofit organizations and for-profit companies, contribute to cancer control efforts in these communities.

A Life Course Approach to Cancer Control

Addressing the complexity of cancers takes work across the continuum of cancer care. From prevention and detection to survivorship and hospice care, each step in this continuum involves a wide range of participants, including patients and families, caregivers, health care providers, health systems, and insurers.

Conclusion

As our society ages and the number of people diagnosed with cancer grows, the U.S. approach to cancer control needs to become more effective, efficient, accountable, and integrated than it is today.

A cohesive national strategy for cancer control would coordinate the work of a wide-reaching range of participants to improve access to timely, effective cancer care. These efforts will help reduce cancer’s burden on patients, families, and society as a whole.