Local hospitals are part of national 'moonshot' to speed cancer care and seek cures.

A year after then-President Barack Obama announced a “cancer moonshot” to accelerate the fight against cancer, oncology professionals are beginning to figure out what the initiative means for patient care and research.

The moonshot aims to achieve a decade's worth of progress on research, prevention and treatment in the next five years. There's also hope the efforts could even cure cancer.

While treatments have improved and the national mortality rate for cancer has decreased, more people feel the impact of the disease every year. The National Cancer Institute estimates that 1.68 million new cases were diagnosed in the United States last year.

Obama signed a $6.3 billion bill in December to fund drug treatment, a precision medicine initiative and the moonshot effort. The new administration hasn't said whether it backs the effort, but experts say research will continue regardless.

The moonshot means more than additional funding to fight cancer; it's also a push to change how the oncology industry thinks. “Calling this initiative a ‘moonshot' sets the tone for collaboration rather than competition, because in a moonshot everyone is working together to overcome a major problem,” says Praveen Dubey, MD, chair of the OhioHealth Oncology Clinical Guidance Council.

Dubey believes central Ohio is well-prepared to benefit from the initiative's efforts to accelerate cancer research, “In central Ohio, we have great institutions that provide great cancer care, and this is helping us work together to better manage oncology practices in the Ohio area.”

Positioned to Lead

Achieving the goals of the moonshot will demand collaboration between the government, healthcare systems, hospitals, private companies and researchers.

“We all agree that no one wants to get cancer, everyone's afraid of getting cancer. This bill said we can get behind preventing and curing cancer in our lifetime, and that's new and it's wonderful,” says Michael Caligiuri, MD, CEO of the James Cancer Hospital and Solove Research Institute at the Ohio State University.

Caligiuri believes the moonshot will provide local researchers and medical providers with opportunity to lead new efforts on the national stage.

He says many of best practices about collaboration that are outlined in the moonshot have been in place in Columbus for decades. An example of cooperation among the central Ohio oncology community is its effort to eradicate Lynch syndrome.

Lynch syndrome is a hereditary condition that significantly increases an individual's risk of developing colorectal cancer, endometrial cancer and other cancers. “Eighty percent of the people that carry the gene develop colon cancer in their lifetime, normally before the age of 50. If one of your parents has Lynch syndrome, there's a 50 percent chance you or your siblings will carry the gene,” says Caligiuri.

More than a decade ago, Mount Carmel Health System, OhioHealth and Ohio State University joined forces to analyze all cases of colon cancer in Columbus to find occurrences of Lynch syndrome. The gene appears in only about one in 20 cases of colon cancer.

The group's first effort to screen for the gene was a success. More than 100 people who had cancer related to Lynch syndrome or who carried the gene were identified because the hospitals shared data and testing procedures.

Gene carriers who hadn't developed cancer were put on a preventive treatment regimen that Caligiuri says will keep them from ever developing cancer. Researchers also were able to expand screening efforts to the families of the original group of patients. The gene's hereditary nature means it's easy to find those most at risk and put them on preventive treatments.

The program's early successes and a $4 million grant from Pelotonia led to a statewide expansion of screening efforts. Today, 51 hospitals in Ohio are involved with the Ohio Colorectal Cancer Prevention Initiative. “We've shown by doing this (screening program) for $4 million, we saved the state $40 million in healthcare costs, and 736 years of life have been saved by this program,” says Caligiuri.

One of the goals of the moonshot is to create an effective national screening program for Lynch syndrome because it's easily detectable, treatable and preventable. Cases are identified by a simple blood test.

Caligiuri says local practitioners have important experience implementing large-scale screening programs that could help any national efforts. “We've been working with the National Cancer Institute to do this and we already collaborate with other leading institutions,” Caligiuri says. “OSU is a leading, if not the leading, institution on Lynch syndrome testing.”

Community Collaboration

Central Ohio's collaborative oncology community is also on display through the Columbus National Cancer Institute Community Oncology Research Program. The program works to bring state-of-the-art cancer prevention and treatment programs to physicians and patients at community hospitals.

Timothy Moore, MD, a medical oncologist with Mount Carmel Health System, is the principal researcher for Columbus NCORP. Moore says groups like his are necessary for putting moonshot initiatives into practice. “By employing and engaging the community oncology practitioners in central Ohio, you can get some real-world experience and data that can be very useful.”

Clinical trials including community hospitals tend to provide data that is more representative of the general population, which can create a more accurate picture of a treatment's effectiveness.

Columbus NCORP originated in 1983 at Grant Medical Center. It's now a consortium of 15 hospitals and more than 80 physicians. It means area hospitals now have an infrastructure to implement parts of the moonshot that might require a greater amount of data to be collected and shared.

Moore cautions that while central Ohio has ways to spend resources from the moonshot–he says many areas do not–it's important to consider the organizational complexities of putting new efforts into action. “Not only do we need to spend money on research, we need to spend money on the infrastructure so we have enough people.”

In order for patients to participate in some clinical trials, including those created by the moonshot, hospital staff must take multiple steps to gather and synthesize health records and pull specimens before a patient can undergo treatment.

This process requires hospital and administrative staffs to do tasks outside of their job duties, which can add stress to departments. “These new generations of studies have more demands, so we're going to need to support the pathology departments at hospitals with extra personnel that have to go above and beyond their normal duties to pull specimens and data that are required for patients to participate in these new studies,” says Moore.

While Moore expressed concern about the stress the moonshot could cause if not implemented properly, he is optimistic about what lies ahead. “I'm hopeful that the term ‘moonshot initiative' means we're going to be swinging for the fences, that we're really going to do a number against cancer.”

Bailey Cultice is a freelance writer.