More than 70% of the world’s population—5.6 billion people—live in a country that has a formal best practice tobacco control policy, a fivefold increase since 2007, according to the World Health Organization. The organization published its findings from the Ninth Report on the Global Tobacco Epidemic in Lancet Oncology.

From President Richard Nixon’s war on cancer in 1971 to President Joe Biden’s commitment to “ending cancer as we know it” in 2022, fighting the disease has been a bipartisan focus. Yet in that era, when cancer hit home, policymakers often hushed their own diagnoses. But times change, and many of today’s lawmakers are now boldly sharing their personal experiences with cancer as inspiration for action.

U.S. Senators Ben Cardin (D-MD) and Amy Klobuchar (D-MN) and U.S. Representatives Debbie Wasserman Schultz (D-FL), Brian Fitzpatrick (R-PA), and Mark DeSaulnier (D-CA) introduced the Comprehensive Cancer Survivorship Act in December 2022 to address gaps in survivorship care and formulate standards to improve quality of cancer care and navigation needs of survivors.

As the most trusted professionals for 20 years in a row, nurses witness the needs of those in our care and are suited to translate them to legislatures, regulatory agencies, nongovernmental organizations, and insurers. We do that by speaking plainly about the impact that cancer has on patients and their families. As experts, our ideas and language can translate into practice changes to transform cancer care.

Research and practice changes funded through healthcare legislation have influenced today’s care delivery across all settings: hospitals, clinics, and even homes. And with their constituents laser-focused on health in today’s pandemic society, legislators have never made that happen so quickly.

More than $560 million in provider relief fund (PRF) phase four distribution payments reached more than 4,100 healthcare institutions across the United States in February 2022, according to the U.S. Department of Health and Human Services (HHS). The funding will be used to help healthcare institutions prevent, prepare for, and respond to the COVID-19 pandemic, including maintaining operations at facilities and recruiting and retaining healthcare professionals during the workforce shortage.

Internationally recognized for expertise in health services research, the U.S. healthcare system, and health policy analysis, Robert Otto Valdez, PhD, MHSA, was appointed as director of the Agency for Healthcare Research and Quality (AHRQ) in February 2022, where he leads the agency’s work in improving and promoting patient safety.

Katrina A.B. Goddard, PhD, a genetic epidemiologist who worked on 25 federally funded research studies, is the director of the Division of Cancer Control and Population Sciences (DCCPS) as of October 2021, where she oversees a range of cancer-related research.

Serving on the team that launched the Cancer Moonshot Initiative was just one of the many achievements in Francis Collins’, MD, PhD, 12-year tenure as the director of the National Institutes of Health (NIH). Collins announced in October 2021 that he is stepping down from his role by the end of 2021 after serving as NIH director for three presidential appointments, during which he advocated for increasing NIH’s research budget, learning more about the human genome, and developing treatments tailored to unique genetics.

Young people who see anti-vaping advertisements and prevention campaigns are more likely to have accurate e-cigarette knowledge, which can lead to a decrease in tobacco use and consequently, lung cancer diagnoses, according to a July 2021 study from the Truth Initiative, an organization devoted to educating youth about smoking and tobacco industries.

On April 28, 2021, in his first congressional address to the U.S. Congress, President Joe Biden proposed another major piece of legislation to put the country back on a path to enhance public health and promote economic growth. It was the latest in a series of bills from the new administration that have implications for oncology nurses and patients with cancer. 

President Joe Biden made several campaign promises to improve or safeguard health care for all Americans with a focus on scientific and medical evidence. Shortly after the transfer of power, the Biden administration appointed and nominated public health experts to lead the various federal agencies dedicated to safety and biomedical research. 

Through two letters—one to President Joe Biden and Vice President Kamala Harris and another to U.S. Senate and House leaders—the Nursing Community Coalition, on whose steering committee ONS sits, congratulated policymakers while outlining the need for continued support of nurses in health care. 

“The first 100 days,” a phrase coined by President Franklin Delano Roosevelt in 1933, is an opportunity for a new administration to outline its early accomplishments and set a tone of reassurance. Under that philosophy, the Biden-Harrison transition team issued a series of announcements and nominations beginning in November 2020 to set a tenor and provide insight on the first phase of the new presidency.

Lung cancer knows no state boundary or political ideology. But it can bring the two sides together, like it did when U.S. Senators Tina Smith (D-MN), member of the Senate Health Committee, and Marco Rubio (R-FL) introduced a resolution to recognize November as National Lung Cancer Awareness Month. The resolution, which ONS supports, promotes the importance of and need to improve lung cancer early detection.

Building on the success of the 21st Century Cures Act passed in 2016, U.S. Representatives Diana DeGette (D-CO) and Fred Upton (R-MI) have begun work on the follow-up Cures 2.0 Act, intended to “safely and efficiently modernize the delivery of health care in the wake of the coronavirus pandemic,” the representatives said in a press release.

More than a decade has passed since the Institute of Medicine (now known as the National Academy of Medicine) published its Report on the Future of Nursing in 2010, yet not a great deal has improved.

When standing up for patients, championing treatments, or stopping an unfair process, nurses speak truth to power. Being on the front lines is part of every nurse’s routine, but many shy away from engaging in the policy world under similar circumstances that affect the profession, patients, and peers. It doesn’t have to be that way. Nurses can educate themselves on the candidates and policy issues and lend their voice to the political conversation.

The public push for a transformation in tobacco policy began with a persistent legislator seeking real change. Opening his historic congressional hearing in 1994, U.S. House of Representatives Energy and Commerce Committee Chair Henry Waxman (D-CA) said, “The truth is that cigarettes are the single most dangerous consumer product ever sold. Nearly a half million Americans die every year as a result of tobacco. This is an astounding, almost incomprehensible statistic. Imagine our nation’s outrage if two fully loaded jumbo jets crashed each day, killing all aboard. Yet that is the same number of Americans that cigarettes kill every 24 hours. Sadly, this deadly habit begins with our kids. Each day 3,000 children will begin smoking. In many cases they become hooked quickly and develop a life-long addiction that is nearly impossible to break.” 

As the largest ONS chapter in the United States with more than 2,000 members, the Houston ONS Chapter is primed to make an impact with the state’s lawmakers. In August 2019, chapter members did just that, combining forces with other local chapters for a pilot event featuring ONS policy education and advocacy training deep in the heart of Texas. Almost 100 ONS members participated to get support and education to speak with decision makers about the needs of the profession as well as the patients oncology nurses serve.

While representing ONS in June 2019 at the National Institute for Nursing Research in Bethesda, MD, I met with my state’s congressional delegation to introduce ONS’s health policy legislative agenda to their offices on Capitol Hill. Despite it being one of the hottest days on record for the nation’s capital, the congressional offices offered a cool place for health policy discussions.

In February 2019, the U.S. Surgeon General declared the rise of youth vaping was the latest epidemic facing the American public. Reversing a two-decades-long trend of declining smoking rates among underage smokers, e-cigarette use and vaping have become commonplace among children younger than 18.

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. 

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.

In a move that echoed the Department of Justice’s (DOJ’s) previous stance on the Affordable Care Act (ACA), the Trump administration’s DOJ announced it was siding with a lower court’s ruling that stated ACA was invalid and unconstitutional. Siding with conservative state attorneys general who sued and won a lower federal court judgment on the constitutionality of law, DOJ issued a terse, two-sentence letter supporting the judge’s decision to strike the law down.

On January 25, 2019, President Trump announced a deal to end the longest U.S. government partial shutdown in history—35 days of closed public places and programs, furloughed or unpaid federal employees, and an apprehensive American nation. What was its impact on health policy and, more specifically, cancer care?

Pediatric cancers have more than an 80% overall cure rate, and that, at first glance, seems like something to celebrate. However, in terms of lives lost to different pediatric cancers, the American Cancer Society estimated that more than 1,100 children under the age of 15 will die from their disease in 2019—roughly one in five children diagnosed. Although survival rates are improving in cancers like acute lymphocytic leukemia and Hodgkin lymphoma, other childhood cancer types haven’t seen increased survival since the early 2000s.

Since their inception, e-cigarettes have made the public health sector uneasy. Initial reports suggested that e-cigarettes could be an opportunity for long-time adult smokers to step down their usage, acting as a bridge to smoking cessation. However, recent reports indicate that youth vaping and e-cigarette use has risen sharply in the past two years—creating an entirely new generation of smokers. U.S. Surgeon General Vice Admiral Jerome Adams, issued a statement declaring youth vaping a national epidemic.

Race and economics are still driving cancer treatment and survivorship, ONS member Janice Phillips, RN, PHD, FAAN, explained in her article, “Unfair Diagnosis: Socioeconomic Gap Drives Cancer Outcomes,” published in January 2019 in Scientific American.

Election results may appear to be seismic shifts, jarring the foundations of the American political system to its core as voters stare in disbelief, attempting to translate the meaning of the public’s intent. But is that really the case?

Since 2016, ONS has gathered hundreds of nurse advocates in the nation’s capital to speak truth to power during its annual Hill Days conference. This two-day meeting brings more than 100 oncology nurses to Washington, DC, to learn about the Society’s health policy legislative agenda and to be trained in how to educate elected officials on the priority issues most important to ONS members.

A billion dollars was once an astronomical amount of money to spend on one federal agency. But since the 1950s when Senator Dirksen (R-IL) was a leading voice for fiscal conservatives, the federal government’s budget has ballooned, with both political parties equally responsible for increases. During this time, great achievements have been made, and much of it in biomedical research at the National Institutes of Health (NIH), as what former Senator Arlen Specter (R-PA) often referred to as the crown jewel of the federal government.

When Senator John McCain (R-AZ) passed away in August 2018 from aggressive glioblastoma just one day after his family announced he stopped treatment, it put a poignant highlight in Washington on a need of which oncology nurses are far too aware: palliative care and hospice. Ideally, palliative care begins at the time of a cancer diagnosis and is aimed at managing symptoms throughout the cancer journey. Hospice begins when a patient’s prognosis is six months or less, yet in most cases, as McCain’s illustrates, patients begin hospice far too close to death. Many point to a lack of awareness and education—for patients and the public as well as oncology nurses and other palliative care providers.

As the U.S. government’s arm of patient-centered research, the Patient-Centered Outcomes Research institute (PCORI) is driving new initiatives and opportunities focused on unlocking novel treatment methods and cutting-edge interventions to better care for patients. On September 24, 2018, PCORI announced its new Board of Governors, naming ONS member Christopher Friese, PhD, RN, AOCN®, FAAN, as the agency’s first nursing research representative to hold a seat on the board.

The Biden Cancer Summit was held in Washington, DC, on September 21, 2018. The day-long event was filled with cancer-related educational sessions—some hosted by ONS leadership—discussing ways to move cancer research and care forward. Formerly dubbed the National Cancer Moonshot Initiative, the country-wide effort to make a quantum leap in cancer care has evolved in into the Biden Cancer Initiative (BCI). BCI’s ongoing work will continue to break down barriers and help providers and researchers overcome obstacles as they work toward progress in cancer care.

’Tis the season. Well, at least in DC, it’s an exciting time. A political year. A long summer recess. A host of bills that are on the verge of passing. We are all aflutter with anticipation of the possibilities. But legislators need to remember who sent them to Washington and for what reason. Advocacy begins at home, and elected officials are heartened by what their constituents request, especially when that legislation is bipartisan and emotional and can affect people’s lives.

On July 23, 2018, the U.S. House of Representatives passed by voice vote two ONS priority bills that would provide palliative care training, awareness, and research and funding to build the nursing workforce.

Through tremendous bipartisan support, the House of Representatives passed comprehensive opioid legislation to address the national abuse epidemic in the United States on June 22, 2018. For many healthcare advocates, an opioid legislation package has been a long time coming. The opioid crisis has been in the news since before the 2016 presidential election but was brought to the forefront during that campaign.

On June 27, the House Energy and Commerce Subcommittee on Health passed by voice vote two health bills that have been among ONS’s top legislative priorities: the Palliative Care and Hospice Education and Training Act ([PCHETA], H.R. 1676) and the Title VIII Nursing Workforce Reauthorization Act (H.R. 959). The bills are now poised for consideration by the full House Energy and Commerce Committee.

April is designated as National Cancer Control Month in the United States. It’s a federally endorsed observation, annually encouraged by a proclamation from the president. April is dedicated to raising awareness for cancer prevention and treatment throughout the country. Approved through a joint resolution by Congress in 1938, the yearly presidential announcement serves as a reminder to all Americans that awareness of the factors that cause or prevent cancer are crucial to the public health.  

At the center of the President Lyndon B. Johnson’s great society was Medicare, a federal program designed as a partial safety net primarily for America’s older adults. It was signed into law on July 30, 1965. Controversial at the time, it is now sacrosanct and often referred to as the “third rail of politics”: touch it and die.

I was selected to represent ONS as a panelist at the Cancer Innovation Coalition meeting held in Washington, DC in February 2018. The meeting, “Integrating Patient Perspective into Clinical Pathways: A Dialogue Between Stakeholders,” brought together patient advocates, healthcare professionals, and technology stakeholders to address and identify the importance of patient-centered care and involving patients in clinical pathways. The National Patient Advocate Foundation released an article outlining the topics covered in our discussion.

Presidential appointees come, and presidential appointees go. Recently, the Center for Disease Control and Prevention’s (CDC’s) director resigned for financial conflicts of interest. The new Department of Health and Human Services (HHS) secretary, Alex Azar, sought to fill the important public health role as soon as possible. With opioids, the flu, vaccine shortages, and cancer prevention under the purview of the CDC, finding a new director was crucial to continuing the agency’s work. Since many of the CDC’s top officials are often reported on in the news, replacing the director was also essential for public trust in public health.

Legislation ushering experimental drugs and treatments to patients without U.S. Food and Drug Administration (FDA) approval hit a snag on March 13, 2018, after it failed to garner enough votes in the House of Representatives. The right-to-try bill, a priority for the Trump administration, didn’t accrue the two-thirds majority vote needed to pass it along to the Senate. Lawmakers opposed to the bill had lingering questions about the safety concerns connected to bypassing FDA regulations for patients searching for new treatments. Patient advocacy groups have been speaking out against tenets of the bill, expressing concern for removing the FDA from the process.

We live in the greatest age of scientific discovery and medical breakthroughs. Advances in the innovation and understanding of diseases are providing more insight into how we treat, and often cure, people with life-threatening illnesses. What was once deemed a death sentence diagnosis is now described as a chronic disorder, that can be handled with the help of the patient and a team of healthcare providers.

To ensure more Americans understand the public health implications of cancer, the Centers for Disease Control and Prevention (CDC) is taking an active role in creating awareness activities. By posting commonly asked questions, the CDC hopes to demystify cancer and its treatment to the uninitiated, while also helping survivors and caregivers better comprehend the cancer journey.

On February 14, 2018, Valentine’s Day, I had the honor of representing the ONS at the Congressional Families Caucus with Alec Stone, ONS director for public affairs, who made the connection between Congressional Families and ONS. The Congressional Families Caucus is made up of spouses of congressional members serving in the House of Representatives and Senate.

Putting together the federal budget is an arduous task. Department by department, suggestions for program funding increases and decreases are reviewed, discussed, analyzed, and submitted. Budget officials are trying to match the administration’s priorities and review the fiscal environment, not to mention craft spending items to gain support from congress, who ultimately votes on the budget.

The U.S. Congress continued its budget pattern in February, enacting another extension of the 2017 budget agreement into law on February 8, 2018. The current iteration of the budget law will raise caps on defense and non-defense spending over two years and keep the federal government running through March 23, but more importantly, it includes the following provisions of special interest to ONS.

The federal government structure in Washington, DC, is hard to ignore. U.S. children are taught about it in schools, and we hear about it regularly as elections, legislation, appointments, and the like are discussed in the news. Less recognized, though, is that each state has a similar legislative structure.