President Biden's Cancer Moonshot Goals Will Hinge on Cancer Care Equity

President Joe Biden gave a much-needed boost of hope to all those impacted by cancer by reigniting the Cancer Moonshot program and renewing the national effort to “end cancer as we know it.” 

In May, the White House convened the Cancer Moonshot Goals Forum to highlight work supporting a key pillar of this Moonshot: reducing the cancer death rate by at least 50 percent over the next 25 years. It is a bold but attainable goal, given recent advancements in the field. 

But achieving this laudable goal requires change beyond the breakthrough cancer treatments and innovation we’re seeing in the labs. We must embrace a new model for care delivery that enables more people to access optimal cancer care. Without challenging the status quo and addressing barriers that restrict access, this Moonshot goal will simply not be possible. 

Advancements with treatment have outpaced the way we deliver and pay for cancer care in the U.S., limiting the number of patients we can help. The rapid developments and the many challenges community oncologists face with adopting innovation have made cancer one of the few areas of medicine where the gap between optimal care and typical care is widening, not shrinking.  

The progress following the 2015 Cancer Moonshot has meant that more unique genetic and genomic variants of cancer can be diagnosed, with tailored treatment plans created for an individual’s specific form of cancer – greatly improving outcomes. However, these solutions often require expertise of subspecialists limited to leading academic centers. The current system creates a labyrinth of obstacles that inhibit patients from receiving the specialized care they need and deserve, which disproportionately impacts patients from historically underserved communities who continue to face unnecessary systemic barriers that prevent access to care at these institutions.  

In California, fewer than half of cancer patients received care aligned with national guidelines between 2004 and 2016. A study published by the UC Davis Center on Population Health shows some cancer patients with Medi-Cal, the state’s Medicaid program, fare worse than those with other types of insurance. In certain cases, patients in the program have poorer outcomes than those with no insurance at all. Medi-Cal cancer patients cannot consistently access the most highly specialized treatments, clinical trials, and care from subspecialists, like those available at a National Cancer Institute-designated comprehensive cancer center. 

While this is all sobering, there is hope on the horizon. California has recognized these challenges and is working on solutions to increase cancer care equity that other states can emulate. The California legislature is considering the California Cancer Care Equity Act (SB 987), which would expand access to optimal cancer care and clinical trials available at comprehensive cancer centers for Medi-Cal patients who receive a complex cancer diagnosis. The bill, which unanimously passed the California Senate, would remove a key barrier that disproportionately prevents minorities and those from underserved communities from accessing clinically appropriate cancer care. 

This legislation builds on a first-of-its-kind resolution passed unanimously by the state legislature in 2021, The California Cancer Patients Bill of Rights (SCR 11), which laid out the rights those navigating a cancer diagnosis should expect. This resolution is now being used as a model for legislative activity in other states. 

Both SB 987 and SCR 11 recognize that because cancer care is different, the way we pay for and deliver that care must be different, too, or we will continue to see disparities worsen and lives needlessly shortened. The current system is not designed to keep up with the pace of change, and too often fails to prioritize saving more lives by more rapidly embracing access to emerged and emerging cancer tests and treatments. 

As a result, the biggest challenges currently facing cancer care aren’t research or innovation – it’s the unnecessary and misguided barriers the system has created that separates patients from the treatments that could save their lives. 

We are living in the golden age of cancer discovery. We’ve seen the impact that CAR T cell therapy, precision medicine, and the advances in genetic and genomic testing have made in improving outcomes. Cancer mortality rates have decreased by 31 percent over the last three decades.  

To meet the challenge of the Moonshot, we must ground our solutions with practical reforms that connect more people to optimal care. We have an opportunity to create a new model of care that enables earlier detection, more precise diagnosis, more targeted therapies and better supportive care. Passing this legislation will foster solutions that promote more equitable and consistent access to the cancer care innovation already taking place. 

Harlan Levine, M.D., is president of strategy and business ventures for City of Hope.