A Leader in Both Research and Practice

Ben Leach
Published Online: Tuesday, October 15, 2013
Sandra M. Swain, MD

Sandra M. Swain, MD

Those who are selected to serve in the prestigious position of president of the American Society of Clinical Oncology (ASCO) are often tasked with making as big an impact in the world of oncology as possible in their 1-year term. But few of ASCO’s past presidents were faced with the multitude of challenges that arose during the presidency of Sandra M. Swain, MD, who is medical director of the Washington Cancer Institute at Medstar Washington Hospital Center and a professor of Medicine at Georgetown University, and is currently ASCO’s immediate past president.

During her term, oncologists felt the impact of a series of budget cuts as a result of sequestration. This came at a time when doctors were also going through the growing pains of changes in the healthcare system as new laws began to take effect. Recently, Swain sat down with Oncology & Biotech News to discuss these challenges and the other pressing issues that will face ASCO in the years to come, as well as her work on the groundbreaking breast cancer drug pertuzumab and the challenges of treating breast cancer patients who are or wish to become pregnant.

OBTN: What was your reaction when the sequester was enacted and what impact have the budget cuts had on cancer care?

Swain: I don’t think anyone thought that the automatic budget cuts, known as sequestration, was really going to happen. I think that’s the shocking thing about it at all. I think the reason Congress even put it in place is because they didn’t think it was going to happen and then this past spring it really did happen. Several things were going through my mind. The first thing was the decrease in NIH funding, which is really affecting the research on many levels.

First of all, with those cuts, you’re not having young researchers being excited and wanting to come into research because they can see all the struggles. That’s really a detriment to having the young creative minds coming into research and involved in the discovery process. Those are the people usually who make the great discoveries when they can be creative, when they’re energetic. That’s really a big problem right there. And then just to decrease funding for things like clinical trials, the clinical trial system, and the cooperative group system is a big problem. It’s already underfunded and we know that many great advances have occurred in clinical oncology with the use of federal funding for clinical trials. For example, Herceptin was approved based on two federally funded clinical trials that put their data together. That has saved many, many thousands of lives and will continue to save more. Without that kind of funding for clinical research we will only be doing trials with the pharmaceutical industry. That’s not necessarily a bad thing. I think we absolutely need to do trials with industry and they have a lot of great drugs. However, we also need to have the flexibility to do those kinds of trials that the pharmaceutical industry is not interested in or may not be related to a specific drug or may involve multidisciplinary therapies. Those are a couple of the concerns for the NIH funding.

Another area that the sequester has affected is the FDA. The FDA has been fabulous in the oncology division in the last several years. The agency has approved more than a dozen drugs for our patients and has really been very progressive in trying to work with the oncology community and approve drugs in a timely way for the high unmet needs of our patients. The agency has also been working long hours to address important drug shortages for oncology and other areas of medical care. Without the funding and with the sequestration cut to the FDA, there’s less money for medical reviews to have drugs approved at an earlier time for our patients and less funding to do the FDA’s important work in monitoring the safety of our nation’s drug and food supply.

The third oncology-related impact the sequester has had is on Medicare. Sequestration reduced Medicare payments by 2%, and it ended up cutting not only the services but reimbursement for oncology drugs. That has hurt a lot of practices because they have to buy the drugs, and then they end up losing money on some of the drugs and they can’t afford to treat the patients.

Moving forward, what needs to be done to address the effects of these budget cuts?

As far as the funding for reimbursement, we at ASCO are continuing to work with our colleagues on the Hill discussing with them how important it is for cancer care because 65% of patients with cancer are Medicare patients. That’s two-thirds of the patients, so it really affects an overall majority of patients with cancer. We are actively talking to our colleagues on the Hill trying to make them aware of the problems with the cuts and working with them to restore funding.

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