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In addition, recent research breakthroughs hold the promise of great progress toward understanding the basic biology of cancer and devising treatment approaches that will manage it for a lifetime, or perhaps, even prevent it altogether.
"I think the bright side is that we are making continual inroads into our understanding of cancer and how cancer comes about in the first place," says Vanderbilt-Ingram's Deputy Director David H. Johnson, M.D.
But these very breakthroughs make lagging federal funding hard to take, says DuBois, because they have revealed so many promising avenues in the battle to beat cancer, but will require adequate funding to explore.
Getting ready for the patient flood
Public health experts for a few years have been tuned into trying to determine the health care impact of the aging baby boomers. In 2001, researchers met in a workshop sponsored by the NCI and the National Institute on Aging to develop goals to specifically address aging and cancer. This initiative was aimed at accelerating research in seven identified areas. It was funded with a five-year grant program totaling about $25 million, explains Ernest T. Hawk, M.D., M.P.H., and director of NCI's Office of Centers, Training and Resources. Eight cancer research centers received these planning grants and are at work on a wide range of the most challenging aging-and-cancer issues, including comorbidity, treatment efficacy and tolerance, the prevention and management of cancer, and the biology of aging.
Reflected in design of these programs, as well as in research throughout the NCI-funded Cancer Centers, is what Hawk calls a "cultural change" in the way researchers are doing business. He calls it "team science," when projects bring together basic and clinical scientists in a multidisciplinary effort to find and use cancer answers.
In addition, cross-institutional cooperation is promoting information flow from bench to bedside and back again, Hawk says. He points to the partnership between Vanderbilt-Ingram and Meharry Medical College as an example of how institutions can work together to generate and disseminate research aimed at preventing and treating cancer.
"It's not enough to make a new scientific discovery," Hawk explains. "The other part of that mission is making that into a new clinical tool."
Several national nonprofits are working on models meant to predict the impact the baby boom generation will have on health care, explains Eyre. The American Cancer Society, as well as the American Diabetes Association and the American Heart Association, will be using the models to help them positively influence and manage this impact, he says.
"We know it will be substantial," says Eyre.
However, these future-look efforts are taking place in a time of retrenching for cancer research, as NCI continues to assess its programs to decide how to allocate its curtailed funds.
"We have a fairly robust portfolio of basic
science grants," observes Hawk. But he says maintaining the current level of translational research — which has, as its goal, linking laboratory discoveries to clinical therapies — will be challenging with fewer dollars to go around.
"Those sorts of things can be difficult to sustain," he says.
Leaning on the learning curve
The good news is that the incidence of cancer — to researchers, the number of people out of 100,000 who develop the disease — has remained stable since the early 1990s. But even though the individual cancer rate is not rising, the big boomer group will push up the nation's overall cancer burden as they move into old age.
Observers worry about a range of issues when considering how to meet the health care needs of this supersized generation, including whether we'll have enough oncologists and other specialists to treat them and if patients will be able to pay for care.
And older cancer patients carry their own set of special circumstances. They often suffer from one or more chronic conditions, with hypertension, arthritis and heart disease leading the list. These other diseases — called comorbidities — make treating their cancer more complicated.
"They may not be able to tolerate the level of therapies of younger patients," says DuBois.
And while patients in the United States aren't excluded from clinical trails based solely on age, they don't participate in great numbers. This means the learning curve may be steeper for managing the side effects of new cancer drugs and therapies for older patients.
But Johnson, past president of the American Society of Clinical Oncology, thinks the knowledge that has been gained about controlling cancer treatment side effects in other patients will translate to older people.
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