[Congressional Record Volume 148, Number 118 (Wednesday, September 18, 2002)]
[Senate]
[Pages S8760-S8762]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       THE NATIONAL AQUATIC INVASIVE SPECIES ACT OF 2002 (NAISA)

  Ms. STABENOW. Mr. President, I would like to express my strong 
support for the National Acquatic Invasive Species Act of 2002 (NAISA)
  Last year, I introduced S. 1034, the Great Lakes Ecology Protection 
Act which sought to curb the influx of invasive species into the Great 
Lakes. This is an immense task, as more than 87 nonindigenous aquatic 
species have been accidentally introduced into the Great Lakes in the 
past century. I am proud to say that this bill had strong bipartisan 
support with 12 Great Lakes Senators as original cosponsors.
  Today, I am proud to join Senator Levin as an original cosponsor of 
NAISA which will provide a national strategy for preventing invasive 
species from being introduced in the Great Lakes and our Nation's 
waters. I am also pleased that NAISA incorporates many of the ideas 
from the Great Lakes Ecology Protection Act in formulating a national 
standard.
  Invasive species have had a devastating economic and ecological 
impact on the U.S. They have already damaged the Great Lakes in a 
number of ways. They have destroyed thousands of fish and threatened 
our clean drinking water.
  For example, Lake Michigan once housed the largest self-reproducing 
lake trout fishery in the entire world. The invasive sea lamprey, which 
was introduced from ballast water almost 80 years ago, has contributed 
greatly to the decline of trout and whitefish in the Great Lakes by 
feeding on and killing native trout species.
  Today, lake trout must be stocked because they cannot naturally 
reproduce in the lake. Many Great Lakes States have had to place severe 
restrictions on catching yellow perch because invasive species such as 
the zebra mussel disrupt the Great Lakes' ecosystem and compete with 
yellow perch for food. The zebra mussel's filtration also increase 
water clarity, which may be making it easier for predators to prey upon 
the yellow perch. Moreover, tiny organisms like zooplankton that help 
from the base of the Great Lakes food chain, have declined due to 
consumption by exploding populations of zebra mussels.
  We have made progress on preventing the spread of invasive species, 
but we have not yet solved this problem. NAISA will create a mandatory 
national ballast water management program to prevent the introduction 
of invasive species into our waters, as well as, encourage the 
development of new ballast treatment technology to eliminate invasive 
species. NAISA also will greatly increase research funding for these 
treatment and prevention technologies, and provide necessary funding 
and resources for invasive species rapid response plans. In addition, 
the bill will increase outreach and education to recreational boaters 
and the general public on how to prevent the spread of invasive 
species.

[[Page S8761]]

  As Members of the U.S. Congress, we have a responsibility to share in 
the stewardship of our Nation's natural resources. As a Great Lakes 
Senator, I feel a particularly strong responsibility to protect a 
resource that is not only a source of clean drinking water for more 
than 30 million people in the Great Lakes, but is vital to Michigan's 
economy and environment. I am proud to support a bill that will provide 
innovative solutions and necessary resources to this long-standing 
environmental problem, and will also protect water resources for the 
enjoyment and benefit of future generations of Americans.
                                 ______
                                 
      By Mr. KENNEDY (for himself, Mr. Frist, Mrs. Feinstein, Mrs. 
        Hutchison, Mr. Harkin, Ms. Collins, Mr. Biden, Mr. Bond, Ms. 
        Landrieu, Mr. Reid, Mr. Bingaman, Mr. Dodd, Mrs. Clinton, Mr. 
        Hollings, and Mr. Edwards):
  S. 2965. A bill to amend the Public Health Service Act to improve the 
quality of care for cancer, and for other purposes; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. KENNEDY. Mr. President, it is an honor to join my distinguished 
colleagues, Senators Frist, Harkin, Hutchison, Biden, Landrieu, Reid, 
Bingaman, Dodd, Clinton, Hollings, and Edwards in introducing the 
``Quality of Care for Individuals with Cancer Act.''
  The goal of this important bipartisan legislation is to help close 
the gap between what modern medicine can do today to reduce cancer 
deaths, and the actual medical care that cancer patients receive.
  In the past two decades, the nation has made extraordinary progress 
in treating and curing cancer. In fact, we have made so much progress 
that our greatest challenges in health care today is taking the 
scientific breakthroughs in the laboratory and bringing them to the 
bedside of the patient.
  Too often, we cannot say that American cancer patients are receiving 
the best possible care. Our goal is to match the nation's excellence in 
cancer research with state-of-the-art excellence in cancer care.
  The reward will be seeing a young mother with breast cancer live to 
be a grandmother, enable a toddler with leukemia grow up to be 
President, or a father win the Tour de France for a fourth time.
  Many examples of inadequate care could be cited. For example, only a 
third of all Americans over age fifty have had proper colorectal cancer 
screenings in the last two years. Clearly, there are far too many 
needless and correctable failures in our current system of cancer care.
  By creating uniform ways to measure the quality of cancer care, and 
establishing new, improved and better coordinated ways to monitor care, 
we can do more to see that cancer patients receive state-of-the-art 
care, no matter where they live.
  In response to the needs of cancer survivors, and with the help of 
the Lance Armstrong Foundation, this bipartisan bill will also 
establish new survivorship programs to facilitate the delivery of 
services to cancer patients and their families.
  Just as importantly, we want to make the best cancer care easier for 
patients to obtain. Our bill will improve the networking of the doctors 
and other providers to whom patients go for their care.
  Many of us know family members and friends suffering from cancer. We 
are all to familiar with the feelings of shock, denial, hope, fear, and 
vulnerability that comes when a loved one, especially a child, is found 
to have cancer.
  Dealing with the challenges is never an easy task for any family. But 
the continuing breakthoughs in medical research make clear that much 
more can be done to save and enhance the lives of cancer patients. We 
need to do all we can to make this care available and affordable to all 
patients.
  Make no mistake about it, we have come a long way. But much more must 
be done to improve the lives of cancer patients.
  Mr. FRIST. Mr. President, I am pleased to join Senators Kennedy, 
Hutchison, and others in introducing the ``Quality of Care for 
Individuals with Cancer Act''. This bill represents our next step in 
the battle against cancer. It is critical to increasing access to 
timely, quality health care.
  Cancer is the second leading cause of death among Americans, claiming 
one life each minute. Most of us know someone who has cancer, or who 
has died from cancer. One out of every 4 Americans will die from this 
terrible disease. We have done a tremendous job investing in cancer 
research in this country. We must now make sure the knowledge gained 
from those investments is being applied, and that research advancements 
are translated into improved patient care.
  If you have cancer, the quality of care you receive should not be 
affected by where you live, where you get your care, or whether you 
have health insurance coverage. You should have access to quality care 
whether you have just been diagnosed with cancer, are a cancer 
survivor, or are dying from this disease. The care given should take 
the patient's values and concerns into account and should be provided 
in a culturally competent manner.
  Based on a recent Institute of Medicine's report, ``Ensuring Quality 
Cancer Care'', this bill would coordinate the development and 
collection of information on quality cancer care using quality measures 
that examine care from diagnosis through the end-of-life. Clearly, a 
better system is needed to rapidly identify the results of ongoing 
research with quality implications and ensure that this is transferred 
into daily medical practice.
  Individuals with cancer receive care from a number of specialists 
during the course of their cancer, and the responsibility for 
navigating through the system often rests on the individual. 
Comprehensible and ongoing communication among providers, patients and 
caregivers is essential to coordinated care. There are two 
demonstration projects authorized by this legislation to help improve 
the coordination of care. One demonstration project provides individual 
case managers to better coordinate care within the health care system 
or to help get patients into the system. The second attempts to improve 
coordination between providers and hospitals so that individuals with 
cancer receive seamless care throughout their course of treatment.
  While receiving care, some individuals with cancer do not receive 
care known to be effective for their condition, such as the delivery of 
palliative care. Much of the suffering from symptoms associated with 
cancer and its treatment could be alleviated if currently available 
symptom control measures and other aspects of palliative care were more 
widely used. This bill authorizes demonstration projects which will 
provide palliative care at any stage of cancer care and train health 
care providers in symptom management. The legislation also seeks to 
help provide better pain and other symptom relief so that individuals 
with cancer do not suffer the consequences of their disease or 
treatment.
  For the nine million Americans living with cancer, this bill provide 
hope in improving the quality of life for individuals with cancer by 
translating what is already known to be effective care to all 
individuals with cancer. For those areas in which we need to 
investigate, demonstration projects will further our knowledge.
  I am pleased to introduce this important legislation, and I look 
forward to its ultimate enactment into law. I want to thank my 
colleagues, Senators Kennedy, Hutchison, and others, for their work on 
this bill. I ask that the summary, section-by-section, and list of 
supporting organizations be printed in the Record.
  There being no objection, the additional material was ordered to be 
printed in the Record, as follows:

     Quality of Care for Individuals With Cancer Act--Kennedy-Frist

       Cancer is a dreaded disease and the second leading cause of 
     death. Over the preceding decades much progress has been made 
     on how to detect, treat and cure individuals who have cancer 
     and those who are affected. But too often, the typical 
     standards of care fall short of the best standards of care.
       Unfortunately, many cancer patients are getting 
     inappropriate care--too little care, too much care in the 
     form of unnecessary procedures, or the wrong care. Simple 
     screening procedures are underutilized and radical 
     interventions are often needlessly performed. Receiving 
     quality care should not be determined by where a patient 
     lives, where they get their care, or whether or not they have 
     health insurance. Unfortunately

[[Page S8762]]

     this is not the case, and variations in quality of care can 
     have dire outcomes. A recent study found that women on 
     Medicaid are likely to be diagnosed with cancer at a later 
     stage and are three times more likely to die of breast cancer 
     than women not on Medicaid.
       The problem: Even with tremendous advancements in treatment 
     and diagnosis, individuals with cancer are still not 
     receiving quality care. Due to lack of data, the magnitude of 
     the problem of inadequate care is not known. Comprehensive 
     data systems do not currently exist with which to measure 
     quality and there is no national cancer care program or 
     system of care within the United States.
       Our solution: Collect better information to discover where 
     problems exist and create statewide plans to address the 
     problems. The bill will draw together Federal agencies and 
     private entities to coordinate the development and collection 
     of information on quality of care. States will receive funds 
     to expand state cancer registries to collect information on 
     quality of care and develop and improve state-wide cancer 
     control programs that address particular needs for each 
     state.
       The Problem: Individuals with cancer often have 
     difficulties negotiating through a complex system of care. 
     Like other chronic illnesses, efforts to diagnose and treat 
     cancer are centered on a variety of individual physicians and 
     can be in multiple settings. Coordination between these 
     entities is often lacking, and the responsibility for 
     navigating through the system often rests on the individual 
     with cancer. Improving coordination can save lives. Research 
     has shown that cooperation among pediatric oncologists has 
     resulted in cure rate increases of 30 percent even in the 
     absence of new therapeutics to treat disease.
       Our Solution: Provide case-managers to guide patients 
     during treatment and improve the coordination of care. Two 
     programs will be developed to help individuals with cancer 
     receive coordinated cancer care. The first provides 
     individual case-managers to help get patients into the system 
     or to act as contacts throughout their care and assist with 
     information, referrals, and care coordination within the 
     system. The second improves coordination between doctors, 
     hospitals, and other health care professionals so that 
     individuals with cancer receive seamless care throughout 
     their treatment.
       The Problem: While research has produced new insights into 
     the causes and cures of cancer, efforts to manage the 
     symptoms of the disease and its treatments have not kept 
     pace. Palliative care, which includes pain and symptom 
     management and psychosocial care, is an area where 
     individuals with cancer have traditionally received 
     relatively poor quality care. For example, less than half of 
     individuals with cancer who suffer from pain receive adequate 
     relief of their pain, and only a very small percentage of 
     cancer patients are offered referrals for palliative care.
       Our Solution: Improve palliative care. The bill will 
     develop programs to provide palliative care and train 
     professionals to provide better palliative care for both 
     adults and children with cancer.
       The Problem: Cancer survivors continue to need quality care 
     while living with, through, and beyond cancer. Although 1,500 
     people die each day from cancer, increasingly, individuals 
     with cancer survive their disease. The more than nine million 
     cancer survivors in the United States face unique care needs, 
     including post-treatment programs and support, which are 
     often inadequately addressed by a system focused on diagnosis 
     and disease treatment.
       Our Solution: Initiate programs to address the unique needs 
     of survivors. The bill develops post-treatment programs 
     including follow-up care and monitoring to improve the long-
     term quality of life for cancer survivors, including 
     children.
       The Problem: Insufficient attention is being paid to 
     individuals with cancer in the final stages of their disease. 
     One-half of those diagnosed with cancer die of the disease. 
     Unfortunately, appropriate end-of-life medical and social 
     support, which would help maximize the quality of life for 
     these individuals and their families, is often unavailable. 
     This is particularly true for children. Most physicians do 
     not receive adequate training on the provision of appropriate 
     end-of-life care. A 1998 study found that 100 percent of 
     residents and 90 percent of attending physicians wanted more 
     support in dealing with issues surrounding the death of a 
     patient.
       Our Solution: Avoid needless pain and suffering by 
     improving end-of-life care. The bill provides grants to 
     coordinate end-of-life cancer care and train health care 
     providers in end-of-life care. Pilot programs will also be 
     developed to address the special needs of children.
                                  ____


    Quality of Care for Individuals With Cancer Act--Kennedy-Frist, 
                       Section-By-Section Summary


             title i--measuring the quality of cancer care

       Seeks to facilitate a contract to a national consensus 
     organization to investigate the validity of existing quality 
     measures and to then establish recommendations for core sets 
     of quality cancer measures. These recommendations would be 
     published within AHRQ's annual report and, after four years, 
     the General Accounting Office will evaluate the extent to 
     which Federal and private sector health care delivery 
     programs have incorporated these quality measures.


                  title ii--enhancing data collection

       Serves to reauthorize the CDC's National Program of Cancer 
     Registries, including new provisions to monitor and evaluate 
     quality cancer care and to increase linkages with various 
     entities to examine disparities in quality cancer care. It 
     also authorizes the CDC's National Program of Cancer 
     Registries--Cancer Surveillance System to advance the 
     development, expansion, and evaluation of State registries 
     and encourages CDC to work with states to meet North American 
     Association of Cancer Registries certification.


  title iii--monitoring and evaluating the quality of cancer care and 
                                outcomes

       Supports research to measure, evaluate, and improve the 
     quality of cancer care, and funds private/public partnerships 
     to enhance the usefulness of such information, including 
     fostering the development or adoption of model systems of 
     care or speeding the pace of improvement in quality of cancer 
     care.


          title iv--strengthening comprehensive cancer control

       Authorizes the CDC's Comprehensive Cancer Control Program 
     to develop an integrated and coordinated approach to cancer. 
     The Program will establish guidelines regarding the design 
     and implementation of state comprehensive cancer control 
     plans, and awards grants to develop, update, implement, and 
     evaluate such plans.


         title v--improving navigation and system coordination

       Provides grants to develop, implement, and evaluate case 
     management programs to enhance the quality of cancer through 
     improved access and navigation. Grants are also awarded to 
     develop coordinated systems of health care providers. 
     Finally, this title defines ``palliative care'' and ``quality 
     of cancer care.''


           title vi--establishing programs in palliative care

       Provides grants to improve palliative care for adults and 
     children with cancer by: integrating programs, conducting 
     outreach and educational activities, providing education and 
     training to health care providers; designing model programs; 
     creating pilot programs for children; and for other 
     activities.


             title vii--establishing survivorship programs

       Establishes demonstration programs to develop post-
     treatment public health programs and services including 
     follow-up care and monitoring to support and improve the 
     long-term quality of life for cancer survivors, including 
     children. A focus on cancer survivorship is also added to 
     cancer control programs.


               title viii--programs for end-of-life care

       Provides grants to develop, implement, and evaluate 
     evidence-based programs for the delivery of quality cancer 
     care during the end-of-life to individuals with cancer (with 
     a special emphasis on children) and their families.


                title ix--developing training curricula

       Provides grants for the development of curricula for health 
     care provider training regarding the assessment, monitoring, 
     improvement, and delivery of quality of cancer care.


                      title x--conducting reports

       Requires IOM reports to: evaluate Federal and State 
     Comprehensive Cancer Control programs; evaluate the quality 
     of cancer care medicare and medicaid beneficiaries receive 
     and the extent to which coverage and reimbursement policies 
     affect access to quality of cancer care; evaluate access to 
     clinical trials; and analyze gaps in and impediments for 
     quality of cancer care. An additional long-range IOM report 
     will provide a follow-up assessment of the bill's success in 
     achieving its initiatives.
                                  ____


    Organizations Supporting the Kennedy-Frist, Quality of Care for 
                      Individuals with Cancer Act

       Alive Hospice;
       American Cancer Society;
       American Pain Foundation;
       American Society of Breast Disease;
       The Children's Hospital at the Cleveland Clinic;
       Colorectal Cancer Network;
       Intercultural Cancer Council;
       Lance Armstrong Foundation;
       Oncology Nursing Society;
       Pain Care Coalition;
       Research Triangle Institute International;
       Stanford University Center for Biomedical Ethics; and
       Vitas Healthcare Corp.

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