Report: US makes progress with cancer prevention policies, but some states still fall short

Progress has been made across the United States to pass and implement legislative solutions to prevent and fight cancer, according to an American Cancer Society Cancer Action Network report.

“How Do You Measure Up? A Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality” illustrated which states have improved policies to help prevent cancer and also highlighted the progress that still must be made in several areas.

“We’ve learned so much in the last decade when it comes to preventing, screening and better treating cancer. State lawmakers play an important role in putting that knowledge into practice,” Chris Hansen, president of the American Cancer Society (ACS) Cancer Action Network, said in a press release. “By enacting evidence-based policies, state lawmakers can help reduce suffering and death from cancer and improve the financial health of their states.”

The report showed 14 states have adopted evidence-based policies and best practices in two or fewer of the 10 legislative priority areas measured by the ACS Cancer Action Network. Only two states — Maine and Massachusetts — adopted evidence-based policies and best practices in seven of the 10 categories; and no state adopted evidence-based policies and best practices in eight or more policy areas.

“Nearly half of all cancer deaths could be prevented if everyone were to stop using tobacco, eat healthy foods in moderation, exercise regularly and get recommended screenings,” Hansen added. “But without policies in place to make this a reality for all, cancer will continue on its course to claim more than half a million people in America this year alone.”

Although states are progressing with policies to eliminate treatment barriers, there are missed opportunities to significantly reduce cancer burden.

Tobacco use

To decrease tobacco use, the ACS Cancer Action Network urged for:

an increase in the price of all tobacco products through regular and significant tobacco tax increase;
the implementation of comprehensive smoke- and tobacco-free policies that apply to all tobacco products;
and fully funded and sustainable statewide tobacco prevention and cessation programs, with an increase in comprehensive insurance coverage for cessation.

As of July 1, the United States averaged a $1.63 per pack state cigarette excise tax; however, these tax rates vary widely by state.

A review of all 50 states, the District of Columbia, Puerto Rico and Guam showed 24 states and territories tax above the national average per pack, 15 tax between 83 cents and $1.65 per pack, and 14 tax equal to or below 82 cents per pack.

Of those same areas, 26 states and territories are 100% smoke free in nonhospitality workplaces, restaurants and bars, and 12 are 100% smoke free in one or two nonhospitality locations. Fifteen have no 100% smoke-free state laws.

Five states offer individual, group and telephone counseling and all seven FDA–approved cessation medication coverage for all Medicaid enrollees. Twenty-seven offer at least one type of counseling and at least one FDA–approved tobacco cessation medication coverage for all enrollees. Eighteen offer no type of counseling or no FDA–approved tobacco cessation medication coverage for all enrollees.

In 2016, states budgeted $468 million for tobacco prevention and cessation programs, which represents only 14% of the CDC’s recommended level of funding for statewide tobacco control programs.

Five of the states and territories spend more than 50% of the CDC-recommended funding level, 13 spend 25% to 49.9%, 31 spend 1% to 24.9%, and four spend less than 1% of the CDC-recommended funding level.

Healthy lifestyles

Studies have shown that achieving and maintaining a healthy weight, eating a healthy diet and being physically active reduces the long-term risk for cancer.

The ACS Cancer Action Network recommended legislators focus efforts on changing policies in:

establishing science-based nutrition standards for all foods and beverages sold or served in schools;
increasing the quality and quantity of physical education in K-12 schools, supplemented by additional school-based physical activity;
increasing funding for research and interventions focused on improving nutrition, increasing physical activity and reducing obesity; and
reducing the marketing of unhealthy foods and beverages, particularly to youths.

In addition to school-based initiatives, the report also called for policies to promote more active transportation and recreation opportunities for children and adults.

Indoor tanning

Age-restriction laws that prohibit the use of indoor tanning devices for individuals under the age of 18 have been effective; however, research showed that parental consent laws have not sufficiently deterred minors from using tanning devices.

Fourteen states and territories enforce laws prohibiting tanning for minors with no exemptions, whereas the remaining 39 either have no state law regarding tanning or enforce a law that allows for signed parental permission, requires parental accompaniment or allows for physician prescription.

As a result, the ACS Cancer Action Network recommended laws to restrict access to tanning devices to individuals under 18, without exceptions, in every state.

“In addition, states need to ensure enforcement measures and oversight mechanisms are in place to guarantee [adolescents] are not gaining access to these harmful devices,” the report’s authors wrote.

Access to care

The ACS Cancer Action Network called upon the U.S. Department of Health and Human Services, state legislatures and departments of insurance to adopt policies that would improve prescription drug formulary transparency and cancer drug affordability, and to improve network adequacy through a better insurance marketplace and closer monitoring of individuals diagnosed with serious disease.

Although oral chemotherapy offers more flexibility to patients’ during treatment, health plans often require higher cost-sharing for these drugs. Therefore, 44 states and territories have enacted oral chemotherapy fairness legislation, and five have actively considered legislation. Only four have not enacted any oral chemotherapy fairness legislation.

“This flexibility is particularly important for people living in rural areas who would have to travel long distances to the nearest treatment facility, as well as for employed patients and family members who are trying to limit time away from work during treatment,” the report’s authors wrote. “Patients need affordable and accessible access to all forms of chemotherapy, so their doctors can use the treatments best suited for their condition and circumstances.”

The ACS Cancer Action Network also urged for an increase in access to health coverage through Medicaid.

Thirty states have broadened Medicaid eligibility, covering individuals under 138% of the federal poverty level. The other 20 states have a governor or legislature opposed to improving access to health care coverage through Medicaid, which includes an estimated number of individuals under 100% of the federal poverty level in the coverage gap, according to the report.

Therefore, the ACS Cancer Action Network recommended to:

increase eligibility to cover all individuals up to 138% of the federal poverty level;
impose reasonable cost-sharing, consistent with that allowed under the Affordable Care Act, and limit barriers to care through high out-of-pocket cost-sharing, wellness programs that create unintended barriers, employment referral programs and lock-out provisions that deny enrollees access to care for extended periods of time;
adequately cover benefits and services critical to cancer patients, such as nonemergency transportation; and
provide patients managing complex chronic conditions such as cancer the option to enroll in coverage designed for the medically frail, while providing greater flexibility in benefits, delivery system, care management and cost sharing.

Screening

Almost 1,000 state, local and national organizations have joined the effort to substantially reduce colorectal cancer by 80% in adults aged 50 years or older by 2018 through regular screening.

Many states are above the national average; however, no state has reached the goal of 80%.

Only 10 states offer state appropriations for the breast and cervical screening programs that are 100% or more than the CDC award, 15 are between 33% to 99% of the CDC award, 21 are less than 33% of the CDC award, and four have no state funding.

Under the Affordable Care Act, states have the opportunity to increase access to health care coverage through a Medicaid program.

“Adequate funding is necessary to continue providing benefits and services to women who have historically accessed the program for cancer screenings, but the program will also provide educational outreach and potentially lifesaving screening services to women who continue to lack an affordable health care coverage option and remain uninsured,” the authors of the report wrote. “Failure to achieve adequate funding levels will leave millions of women vulnerable to cancer diagnoses at later stages, where survival is less likely and more costly.” – by Kristie L. Kahl

Reference:

American Cancer Society Cancer Action Network. How do you measure up? A progress report on state legislative activity to reduce cancer incidence and mortality. Available at: http://www.acscan.org/content/report-cards/2016/. Accessed on Aug. 11, 2016.