America’s love affair with tobacco has a long and sordid history. As automated machines ushered in a new age of modernization in the early 20th century, cigarettes were readily available as never before. Although some in the temperance movement believed tobacco products were the gateway to alcohol and drug abuse, by the 1930s and 1940s, physicians were touting cigarettes as almost a healing treatment that calmed the nerves and desensitized the body with positive effects. 

An ONS priority bill, the Palliative Care and Hospice Education and Training Act (PCHETA) emphasizes how providers are educated and trained in palliative care, enabling them to provide a higher level of care to their patients. PCHETA legislation—and its reception on Capitol Hill—has evolved from being misinterpreted as training providers to hasten death to a true understanding that palliative care is patient-centered care, and it provides patients and their family members with further treatment options, symptom management resources, and quality of life. In a display of bipartisanship, Senators Tammy Baldwin (D-WI) and Shelley Moore Capito (R-WV) reintroduced PCHETA legislation to the Senate floor for consideration.

On March 26, 2019, more than 40 nurses came together at the Maryland General Assembly’s Senate President’s Conference Center for the Oncology Nurses Night in Annapolis. This was the Greater Baltimore Chapter of ONS’s (GBCONS’s) third advocacy trip to the statehouse, but it was the first statewide ONS event. All four Maryland chapters were active in planning the night, and many new advocates were inspired to speak out.

Oncology nurses advocate for their patients every day, and it’s easy to see firsthand the difference it can have in those patients’ and families’ lives. But there’s a way to make an even larger impact by using those same advocacy skills at the local, state, or even national level—potentially changing thousands or even millions of lives of patients, survivors, and families across the United States.

As part of the rising wave of precision medicine initiatives, the National Institutes of Health (NIH) launched the All of Us campaign in 2018. This one-of-a-kind research program aimed to collect data from more than one million Americans, including factors about lifestyle, environment, and biology, to understand impacts on health and well being. The information would help researchers to better understand the individual nature of health to ultimately inform decisions about delivering precision medicine.  

When the Affordable Care Act (ACA) was first implemented, the government encouraged private insurance companies to participate in the health insurance marketplace to increase competition and keep prices low for patients. According to several private insurers, the government committed to reimbursing companies if the cost of their healthcare claims exceeded premiums charged in the first three years. To date, no payments have been made between the government and private insurance companies, and a new lawsuit is making its way through the judicial system.

As challenges mount to find new and innovative ways to provide quality health care at affordable prices for patients, a battle is brewing over what patients can and cannot know about their healthcare costs. On June 24, President Trump released an executive order directing his administration to take steps to improve healthcare prices and transparency to address the pricing woes patients face.

Candidates in the first Democratic presidential debate spent some time addressing issues related to healthcare access. In point-blank questions, they were asked what they might do in support of Medicare for All, especially whether they’d be in favor of eliminating private insurance companies. Many were supportive of the overarching legislation, some were wary of eliminating insurance companies outright, and others flat out opposed it.

Since 2016, then-candidate Trump promised he was going to bring healthcare costs under control. In a White House announcement on June 24, 2019, the president took steps to add transparency to the process by requiring insurance companies, hospitals, and physicians to identify fees and costs in public and simple ways for patients to see in advance and to understand.

In a perpetual search to refine research and scientific advancements in the pursuit of fighting cancer, the National Institutes of Health (NIH) is investing in research that will help practitioners further understand how treatments and combinations of treatments can benefit patients. Through a focus on precision oncology, researchers are examining which combinations of therapies would work best for each individual patient based on a number of factors, including genetics and genomics.

The advent of e-cigarettes and vaping mechanisms has shifted the dynamic of underage tobacco use for the first time in more than a decade. In fact, the U.S. surgeon general declared the situation a national epidemic. Known as e-cigs, vapes, e-hookah, vape pens, and electronic nicotine delivery systems (ENDS), the mechanisms look similar to USB flash drives, pens, and other items not typically associated with tobacco consumption.

The House Appropriations Committee recently released its draft outline for the Labor, Health and Human Services, and Education 2020 funding bill, allocating more than $189 billion in discretionary funding for education and training, medical research, and health care. The legislation includes funding for the National Institutes of Health (NIH), U.S Food and Drug Administration, Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), and Centers for Medicare and Medicaid Services. For 2020, the House Appropriations Committee increased funding by $11.7 billion over 2019 levels.

According to the Centers for Disease Control and Prevention, 50 million Americans experience acute and chronic pain daily. Managing the pain is debilitating and costly, and the impact on the economy is felt through employment issues along with a heightened burden on the healthcare system.

Two U.S. senators from different parties, who hail from states with the largest and most successful tobacco crop, have come together to raise the national smoking age. Mitch McConnell (R-KY) and Tim Kaine (D-VA) have teamed up to cosponsor the Tobacco-Free Youth Act (S. 1541), a bill that would restrict the marketing, sale, and distribution of tobacco products to anyone under the age of 21. A similar bill, Tobacco to 21 Act (H.R. 2411), was introduced in the House by Diane Degette (D-CO).

Healthcare advocates assembled in the U.S. Congress to hear from panelists about the national epidemic of youth smoking. From those conversations, a common theme emerged: many believe that the rise in youth vaping and smoking is directly related to marketing and sales tactics by large tobacco manufacturers.

In March and April 2019, the Centers for Medicare and Medicaid Services (CMS) issued several proposed and final rules that affect patient coverage for cancer-related benefits, payment models, and the paperwork nurses often complete to ensure those benefits are billed correctly.

The word advocacy comes from the Middle English word “advocacie” or “intercession” and the Anglo-French word “advocassie,” meaning “pleading.” As a profession, I believe nurses pride ourselves as being advocates for our patients and their families. I can easily say that most nurses—myself included—think of advocacy in terms of daily practice. We’re always making sure patients have the right resources and knowledge and have their basic needs met to get through their daily treatments.

As the 2020 presidential campaign kicks into high gear, the much-anticipated candidacy of former Vice President Joe Biden was announced. Biden, along with his wife Jill, had to make the necessary legal adjustments to cut ties with their formal involvement in the Biden Foundation, including a number of cancer-related projects. The Bidens made the move to eliminate any potential conflicts of interest with a presidential run.

In the aftermath of the 2018 midterm election, one domestic policy issue shone through as a common ground for most Americans: healthcare costs. In particular, the dramatic rise in prices for prescription medication seems to be a pervasive worry among voters. To address the issue, elected officials in Washington, DC—in a bipartisan fashion not often seen—have consulted and impaneled congressional hearings to understand the economic impact medication costs.

In May 2019, the National Cancer Institute (NCI), Centers for Disease Control and Prevention (CDC), American Cancer Society, and North American Association of Central Cancer Registries (NAACCR) released a report detailing the decreasing cancer mortality rates in the United States. It’s a welcome trend among the cancer community, highlighting past efforts in prevention, screening, and early detection—along with improving rates of treatment success. 

Health care is driving domestic policy agenda, and voters have shown it’s a crucial component in their decision making. The money associated with healthcare costs has been a driving factor in politics year after year. Public opinion polling found that health care is the most important factor when it comes to financial burden for Americans, reports from 2018 indicated that Americans spent more than $88 billion on health care alone.

In a letter to the U.S. Food and Drug Administration (FDA), Senator Dick Durbin (D-IL) shared harsh criticism for the agency’s lack of attention to the youth smoking epidemic. His letter from May 29, 2019, detailed efforts that the agency could be taking to curb the rise in youth tobacco use. The smoking cessation community, of which ONS is a palpable member, has sided with Durbin on the importance of continued FDA oversight on e-cigarettes and the vaping industry’s kid-friendly, fun-flavored tobacco products. Groups like the Campaign for Tobacco Free Kids have been forceful in comments to the agency about the need for stricter regulations on products.

Medicare Part D will continue to give patients access to certain cancer drugs, according Centers for Medicare and Medicaid Services’ (CMS’s) final ruling issued May 16, 2019. The final rule does not allow for utilization controls like step therapy and prior authorizations for patients who are already in an established treatment regimen; does not restrict drugs that have had certain price increases over a specified time period; and does not restrict new formulations of an existing protected class drug.

Government service isn’t forever. Dynamic, transformative leaders enter and leave federally appointed positions for a variety of reasons and new appointments. Such was the case for the National Cancer Institute’s (NCI’s) former director Norman Sharpless, MD, who was appointed to head the U.S. Food and Drug Administration in April 2019 after Scott Gottlieb, MD, announced he would step down as of June 2019.

Washington is the first state in the country to offer a public insurance option to its residents after Governor Jay Inslee signed the bill into law on May 13, 2019. Is it any coincidence that Inslee is also running for president? Coming from a traditionally “blue” state with a strong progressive legislature allowed this Democratic candidate to deliver on a particularly interesting policy.

It’s never too late to honor those who served the United States with great valor, especially during times of war and hardship. In April 2019, a group of federal legislators submitted a bipartisan, bicameral bill to honor cadet nurses who served during World War II. At the time, cadet nurses were not recognized with veteran distinctions, despite often serving in active warzones and filling a desperate need for medical care.

In an increasingly rare show of bipartisan common ground, U.S. Senators Todd Young (R-IN) and Doug Jones (D-AL) introduced the Nursing Where It’s Needed (Nursing WIN) Act in April 2019. The bill would assist nurses in underserved areas of the country—particularly rural communities—that are facing nursing staff shortages.

Unlike other types of breast cancer, a triple-negative diagnosis doesn’t have any of the common receptors found in other breast cancers, presenting potential treatment challenges to patients and providers. To assist patients with triple-negative breast cancer, the Centers for Disease Control and Prevention (CDC) created a new virtual program, allowing patients to consult and ask questions to a virtual coach in the comfort of their own homes.

After recent a best-selling book-turned-movie detailed her story, Henrietta Lacks’ extraordinary impact on cancer research continues to become common knowledge to more people. However, many more are still unaware of how her story, struggle with cancer, and tumor cells changed the face of cancer care. For that reason, Representative Elijah Cummings (D-MD), along with a congressional delegation from both chambers, introduced legislation to both honor her role in history and improve access to medical research to traditionally underrepresented groups.

Nestled in the sleepy suburbs of Washington, DC, lies an influential agency that continues to have a growing impact on every American’s life. In fact, public opinion surveys indicate that the agency enjoys a broad range of support in the federal government and across the country in its work protecting people. Seen almost daily on the evening news, FDA encompasses a vast network of public health priorities important to many people’s daily lives. 

Through a combination of expert clinical knowledge, relationship-building skills, and routine selection as the most trusted profession in the United States, nurses are one of the most impactful healthcare professionals when it comes to addressing patient issues. Challenges—like financial toxicity and limited access to care—are central to nursing advocacy efforts, and oncology nurses know firsthand the negative impacts they have on patients with cancer.

Advocacy is a pillar for both ONS and me, personally. As a professor, organizer, chapter leader, and now ONS president, engagement in oncology nursing issues is an essential part of what I do and who I am. In March 2019, I accompanied ONS staff along with my ONS Pittsburgh Chapter colleague, Grace Campbell, PhD, MSW, RN, CRRN, assistant professor at the University of Pittsburgh, to meet with Congressional Representative Connor Lamb’s (D-PA) district office director.

U.S. Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, released a statement on March 28, 2019, about FDA’s new efforts to reduce tobacco-related disease and death through greater, far-reaching regulation on the tobacco industry. Coming on the heels of his announced departure from his role as of June 2019, the work would ensure his legacy as a staunch proponent of smoking cessation.

Each year, federal agency leaders submit their budget proposals to the U.S. Congress for review. Often, the committee of jurisdiction will request formal testimony from an agency, which provides an opportunity for the department to speak directly to the elected officials who have the authority to fund programs and projects of interest.

Trying to find a path forward is a common theme among elected officials in Washington, DC, and drug pricing appears to be a bipartisan initiative. In that vein, Senator Chuck Grassley (R-IA)— working with representatives from both sides of the aisle—announced his plan to release a drug pricing proposal by the beginning of summer 2019.

The state of Kentucky has seen some of the most success in reducing its uninsured rate thanks to the Affordable Care Act’s Medicaid expansion that took effect on January 1, 2014. The results of a new study, published in the Journal of the American College of Surgeons, showed that as the number of insured individuals rose, so too did important cancer screening rates.

In a bold move, Senate Majority Leader Mitch McConnell (R-KY) announced on Thursday that he would put forward a bill to raise the national age for tobacco product purchases to age 21. It’s a remarkable move on many levels, not the least of which is that McConnell is from Kentucky—a region of the country that produces tobacco products. More importantly though, McConnell made a public statement about the rise in youth consumption through vaping.

Reducing the high cost of prescription drugs continues to be a priority focus for both the U.S. Congress and Trump administration, and ONS is closely monitoring and providing input on how key proposals could affect patient access to oncology care.   

In March 2019, U.S. Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, surprised the healthcare community by announcing his resignation, set to take effect in June 2019. With 18 months still remaining in the commissioner’s term, speculation arose throughout the healthcare advocacy community as to who might fill the position. Not long after Gottlieb’s announcement, the Trump administration named National Cancer Institute (NCI) Director Ned Sharpless, MD, as the acting commissioner of the FDA.

For more than five years, the cancer advocacy community—along with the larger healthcare environment—has presented and promoted a comprehensive piece of legislation focusing on patient-centered care, palliative care training, and hospice education. Advocates are familiar with the Palliative Care and Hospice Education and Training Act (PCHETA)—an initiative that contains many of ONS’s policy priorities and one that ONS members have lobbied for on Capitol Hill.

On April 8, 2018, nearly a dozen Democratic senators announced they would investigate the marketing practices of e-cigarette giant Juul along with a new deal to sell a minority stake of the company to Altria, maker of Marlboro cigarettes. Not long ago, the U.S. Food and Drug Administration (FDA) and Juul—along with others in the smoking cessation community—supported efforts to use electronic tobacco mechanisms to help 60 million Americans quit smoking. However, along the way, the U.S. surgeon general and FDA discovered that youth smoking and vaping have seen a dramatic increase from the advertising, marketing, and distribution of e-cigarettes.

Each spring marks a new budget season in Washington, DC. It’s a time of year that provides a glimpse into policy priorities for the fiscal year. In March 2019, the Office of Management and Budget released its 2020 funding allocations for the entire federal government. The budget was comprised after each federal department spent the preceding months looking at their previous year’s budget and outlined programmatic priorities that align with the president’s agenda.

According to a Gallup Poll released on April 2, 2019, Americans borrowed approximately $88 billion to pay for health care in 2018. At a National Academies of Science healthcare conference on April 4, the main takeaway was that many Americans surveyed reported that they could not afford to have a serious illness like cancer. The cost of care, even with insurance, is more than many can financially withstand. Oncology nurses know how patients must maneuver through the system to defer costs, sometimes resulting in delayed or alternative approaches to care.

As an oncology advanced practice nurse and administrator for cancer services, every day I care for patients and caregivers coping with cancer. I mentor nursing staff in best practices to deliver care, and I create a work environment conducive to advancing quality cancer care. However, my commitment to supporting people with cancer does not end at the walls of my workplace.  Oncology nurses are called to be a visible change agent in our communities—and beyond—to continue the worthy work of championing quality care for people diagnosed with cancer, along with spreading prevention and early detection information.

The 116th congressional session is well underway. Committee meetings are being held and policy discussions are taking shape all over Capitol Hill. In January 2019, the U.S. House and Senate held separate public hearings on the biggest healthcare issue from the 2018 midterm election: drug pricing.

It’s been almost a decade since the Institute of Medicine—now the National Academies of Medicine (NAM)—released The Future of Nursing: Leading Change, Advancing Health report. Although many aspects of the nursing profession have been enhanced, still others are woefully lacking in change. Healthcare workplace safety incidents are still too high—up to 12 times higher than in the overall workforce—educational opportunities are still too expensive, and scope-of-practice authority is still too limiting in many states—all of which are ONS policy priorities.

The day the administration releases the president’s budget, outlining funding levels for federal departments and their respective programs, has become an annual event around the Beltway. When that document was unveiled on March 11, 2019, it arrived on Capitol Hill like a lead zeppelin. Under the proposed budget, the National Institutes of Health’s (NIH’s) budget would see a 13% cut, and the National Cancer Institute (NCI) would have its budget reduced by 15%. The dramatic cuts in domestic spending on health, education, and welfare programs were so stark that patient advocacy and provider groups released statements individually and through coalitions to respectfully—or less so—inform decision makers that efforts will begin immediately to advocate for maintained funding levels.

In early January 2019, I had the opportunity to represent ONS before the Virginia State Senate Finance Committee on the growing epidemic of electronic cigarettes and vaping device use among youth. In Richmond, VA, I delivered testimony about the dangerous health ramifications of this newer trend of tobacco use.

Health care remains a top domestic policy issue for Americans. Across the board—regardless of political ideology—Americans are concerned about the quality of health care, access to providers, and rising costs associated with medications and treatment. In February 2019, the Centers for Medicare and Medicaid Services’ (CMS) Office of the Actuary released a report outlining the projected growth in national health spending from 2018–2027.