State lawmakers across the country are missing important opportunities to pass and implement proven legislative solutions to prevent and fight cancer, according to a report released August 9 by the American Cancer Society Cancer Action Network (ACS CAN). For interactive national and state-by-state details, as well as a full copy of the report, visit www.acscan.org/measure.
How Do You Measure Up?: A Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality grades states on the strength of evidence-based policies that help to prevent cancer, which kills roughly 1,670 people a day nationwide, forces patients to pay nearly $4 billion in out-of-pocket expenses every year, and in 2015 cost the country more than $80 billion in direct medical expenditures.
This annual snapshot of key state policies shows that many states are falling behind in their efforts to prevent cancer and promote access to health coverage. The report grades states in nine specific areas of public policy that can help fight cancer: increased access to health care coverage through Medicaid, funding for cancer screening programs, passage of quality of life (palliative care) policies, implementation of balanced pain control policies, smoke-free laws, cigarette tax levels, funding for tobacco prevention and cessation programs, coverage of tobacco cessation treatment through Medicaid programs, and prohibiting minors from using indoor tanning devices.
"Right now, families across America are in the fight of their lives against cancer and they need all the help they can get," said Chris Hansen, president of ACS CAN. "State lawmakers have policies at their fingertips that are proven to help prevent and treat cancer—policies that could mean the difference between life and death for people in their states. By passing the cancer-fighting measures laid out in this report, lawmakers will not only be saving lives today and for years to come, they'll be reducing long-term health care costs that can be reinvested back into state economies."
A color-coded system is used to identify how well a state is doing. Green represents the benchmark position, showing that a state has adopted evidence-based policies and best practices; yellow indicates moderate movement toward the benchmark; and red shows where a state is falling short.
Overall, the report found:
- Eighteen states reach benchmarks in only two or fewer of the nine legislative priority areas
- Thirty states and the District of Columbia measure up in just three to five of the nine areas
- Only two states – California and Massachusetts – meet benchmarks in six or more of the nine categories
- No state meets benchmarks in eight or nine policy areas
Special Section: Pain policy
Pain policy is the focus of a new special section in this year's report, which found that between 2015 and 2018 the number of state legislative proposals related to pain management and opioid issues rose from fewer than 80 proposals to more than 470—a six-fold increase. Although these policies are intended to curb the ongoing opioid abuse problem, the unintended results are making it much harder for cancer patients and survivors to access their prescribed pain treatment. The report found only four states have passed balanced pain policies that help combat opioid abuse and misuse while preserving legitimate access to pain management for cancer patients and survivors.
"Opioid abuse is a critical public health crisis that must be addressed," Hansen said. "But state lawmakers shouldn't create barriers that prevent cancer patients and survivors from accessing their prescribed pain treatments. Many cancer patients and survivors need pain treatment to live and complete even the most basic day-to-day tasks. State lawmakers should pass balanced pain policies that curb abuse while preserving access to pain medication for the cancer patients and survivors who need it."
Access to Health Care: Medicaid
Access to quality health coverage has been directly linked to cancer outcomes, yet 17 states still have not increased access to their Medicaid programs to help provide more low-income Americans with comprehensive, affordable health coverage. Research shows individuals without health care coverage are more likely than those with coverage to be diagnosed with cancer at a later stage, when it is more costly and difficult to treat, and when individuals are less likely to survive. Medicaid provides a critical safety-net for more than 2.3 million Americans with a history of cancer, including one-third of all childhood cancer patients at the point of diagnosis.
Despite tobacco being the number one preventable cause of death nationwide, states continue to fall short when it comes to passing laws to prevent tobacco addiction and death. Only 25 states and the District of Columbia have implemented laws requiring 100 percent smoke-free workplaces including restaurants and bars and only three states are spending more than 50 percent of the CDC recommended funding level for their tobacco prevention and cessation programs. Furthermore, just 10 states offer the full spectrum of cessation services, including individual, group, and telephone counseling and all seven Food and Drug Administration-approved tobacco cessation medications, in their Medicaid programs.
Quality of Life
In 2018, three states passed legislation to increase access to and awareness of palliative care, specialized medical care that focuses on care coordination and relief from pain, stress and other symptoms of treatment for life-threatening diseases such as cancer. Palliative care alongside curative treatments can improve patient outcomes, reduce hospital readmittance and increase patient and family satisfaction. It is also shown to reduce medical costs. In total, 23 states have passed palliative care legislation.
Additionally, prohibiting minors under 18 from using indoor tanning devices, which the World Health Organization classifies as carcinogenic, is a cancer prevention policy that is increasing in popularity nationwide. Currently, 17 states and Washington, D.C., have laws in place that protect young people from the risks associated with these devices (up from 15 states and the District in 2016).
The American Cancer Society estimates that more than 1.7 million people in the United States will be diagnosed with cancer and more than 600,000 will die from the disease this year.