Doroshow James H, Croyle Robert T, Niederhuber John E
National Cancer Institute, Bethesda, MD 20892, USA.
Oncologist. 2009 Feb;14(2):110-6. doi: 10.1634/theoncologist.2008-0270. Epub 2009 Jan 15.
In recent years, the National Institutes of Health's largest institute, the National Cancer Institute (NCI), has adapted to difficult economic conditions by leveraging its robust infrastructure -- which includes risk factor surveillance and population monitoring, research centers (focused on basic, translation, clinical, and behavioral sciences), clinical trials and health care research networks, and rigorously validated statistical models -- to maximize the impact of scientific progress on the public health. To continue advancement and realize the opportunity of significant, population-level changes in cancer mortality, the NCI recommends that five national-level actions be taken: (1) significantly increase enrollment of Medicare patients into cancer clinical trials through adequate physician reimbursement, (2) increase NCI/Centers for Medicare and Medicaid Services collaboration on clinical trials research to evaluate the therapeutic efficacy of anticancer drugs, (3) establish a national outcomes research demonstration project to test strategies for measuring and improving health care quality and provide an evidence base for public policy, (4) leverage existing tobacco-control collaborations and possible new authorities at the U.S. Food and Drug Administration to realize the outstanding health gains possible from a reduction in tobacco use, and (5) increase colorectal cancer screening rates though intensified collaboration between federal agencies working to address barriers to access and use of screening. These cost-effective strategies provide the opportunity for extraordinary results in an era of budget deficits. Of the chronic diseases, cancer has the strongest national research infrastructure that can be leveraged to produce rapid results to inform budget prioritization and public policy, as well as mobilize new projects to answer critical public health questions.
近年来，美国国立卫生研究院规模最大的机构——国立癌症研究所（NCI），通过利用其强大的基础设施来适应艰难的经济状况。该基础设施包括风险因素监测与人群监测、研究中心（专注于基础科学、转化科学、临床科学和行为科学）、临床试验与医疗保健研究网络，以及经过严格验证的统计模型，以最大限度地提高科学进展对公众健康的影响。为了继续推进并实现癌症死亡率在人群层面显著下降的机遇，国立癌症研究所建议采取五项国家级行动：（1）通过给予医生足够的报销费用，大幅增加医疗保险患者参与癌症临床试验的人数；（2）加强国立癌症研究所与医疗保险和医疗补助服务中心在临床试验研究方面的合作，以评估抗癌药物的治疗效果；（3）设立一个国家级结局研究示范项目，以测试衡量和改善医疗保健质量的策略，并为公共政策提供证据基础；（4）利用现有的烟草控制合作关系以及美国食品药品监督管理局可能拥有的新权力，实现因减少烟草使用而可能带来的显著健康收益；（5）通过联邦机构之间加强合作，解决结肠癌筛查的获取和使用障碍，提高结肠癌筛查率。在预算赤字的时代，这些具有成本效益的策略提供了取得非凡成果的机会。在慢性疾病中，癌症拥有最强大的国家级研究基础设施，可利用其迅速产生成果，为预算优先排序和公共政策提供信息，并推动新项目解答关键的公共卫生问题。
