Cancer Moonshot Takes Aim at Smoking

But Will $21M 'Transform' Cancer Care?

Nick Mulcahy

January 03, 2019

The much ballyhooed Cancer Moonshot program, which has been criticized for its pie-in-the-sky aspirations, includes $21 million in funding for a down-to-earth program to help cancer patients stop smoking, point out a trio of essayists this week in The New England Journal of Medicine.

The Moonshot is funding "a highly feasible, readily available and cost-effective strategy for increasing the success of cancer treatment and rates of recovery — smoking cessation," write the authors, led by Robert Croyle, PhD, of the National Cancer Institute (NCI).

The general lack of quit-smoking programs, which have proven benefits, is a "core gap in cancer care," they say.

So, with its Moonshot money, the NCI has launched a nationwide effort known as the Cancer Center Cessation Initiative (C3I) to use the science of quitting at 42 NCI-designated cancer centers. The NCI has spent $16 million so far, with the final $5 million earmarked for 2019.

The quit-smoking money, however, represents a small slice of the Moonshot pie.

For example, smoking cessation funds for 2018 were $11.5 million out of the larger $300 million Moonshot budget for the year.

Overall, the 21st Century Cures Act, which was signed into law in December 2016, authorized $1.8 billion of Cancer Moonshot funding over a 7-year period.

Despite the limited money for quitting smoking, the essay authors, two of whom are spearheading the NCI's cessation program, have a Moonshot-sized belief in their $21 million effort.

"The initiative has the potential to transform clinical cancer care so that evidence-based smoking-cessation treatment is an integral component of care for every person who smokes," write Croyle and colleagues.

The initiative has the potential to transform clinical cancer care. Dr Robert Croyle and colleagues

Bishal Gyawali, MD, of Brigham and Women's Hospital in Boston, Massachusetts, is a critic of Moonshot initiatives, including those in the US, UK, and Europe, but likes what he sees with the quit-smoking program.

"This program will probably provide higher return value on investment than other often-hyped but evidence-free strategies within the Moonshot program," he told Medscape Medical News.

But he would like to see more funding and a much larger target audience — all smokers, not just cancer patient smokers.

Gyawali would also like to see an eventual analysis of Moonshot budget expenditures and cancer impacts. "We would be able to evaluate the strategy that provided the highest value," he said.

Gyawali, who coined the term Cancer Groundshot, a complementary strategy to Moonshots that employs proven cancer control and treatment methods, was a bit disappointed by the lack of community cancer centers in the funding pool.

"It came as a surprise to me that the program involved only big NCI-designated cancer centers," he said.

The selection of elite centers "probably increased the chances of successful implementation in the short term," Gyawali speculated.

The NCI's program "includes several innovative features," the essay authors claim.

"Every patient with cancer who smokes and presents to a funded center," they write, "should be identified, urged to quit, offered evidence-based cessation treatment, and tracked in order to assess treatment outcomes."

Plus, the cessation treatment should be integrated, via EHR technology, into "cancer care workflows." Finally, every center has to have a plan to support the ongoing program after the NCI money runs out.

Dr Croyle, his coauthors, and Dr Gyawali have disclosed no relevant financial relationships.

New Engl J Med. Published online January 2, 2019. Full text

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