Leadership Perspectives

By Allen S. Lichter, MD
CEO

The scientific potential of medical research in our country has never been higher than it is today. The past 20 years of oncology research have produced many remarkable successes in the fight against cancer. The rate of deaths from cancer dropped by about 2.1% each year from 2002 to 2004, nearly twice the decrease that occurred throughout the 1990s. Two-thirds of patients are alive five years after being diagnosed with cancer, compared with just half of all patients with cancer in 1975. Treatments have become more targeted and less toxic than ever. There are currently more than 10 million cancer survivors living in the United States, including those who have battled the most common cancers of the breast, colon, and prostate. These extraordinary steps forward represent the achievements and dedication of scientists, clinicians, and institutions from around the world.

However, the significant progress made against cancer in the past two decades is at risk. U.S. biomedical research has been in the longest period of flat and declining federal investment since the National Institutes of Health (NIH) budget was doubled from Fiscal Year 1999 to 2003. For Fiscal Year 2008, President George W. Bush and Congress approved a budget that provided for a very minimal (less than 1.5%) increase in funding for the NIH. In fact, when adjusted for inflation, the NIH budget has actually decreased by 13% since Fiscal Year 2003, a trend that jeopardizes the ability of many scientists to conduct their research and hampers progress in the improvement of patient welfare.

The effects these funding decreases have had on cancer research are already noticeable. The NIH has lost 13% of its purchasing power since 2003, affecting all branches of medical research, including the National Cancer Institute (NCI). NCI’s ability to fund vital projects in genetic, epidemiologic, behavioral, social, applied, and surveillance cancer research has been severely restrained. Adjusted for inflation, NCI has lost 12% of its purchasing power since 2003—a decrease that equates to a $500 million loss in funding. This has a long-term effect on the ability of researchers to find promising new treatments for a devastating disease.

Effects of Funding Cuts on Patients, Investigators at All Career Stages
At its height, the NCI Clinical Trials Cooperative Group enrolled nearly 30,000 people with cancer in hundreds of clinical trials. Faced with the threat of a 10% budget cut in Fiscal Year 2007, the Groups took steps to postpone or delay up to 95 phase II and III clinical trials and closed programs conducting research on brain cancer, melanoma, sarcoma, and pediatric cancers. Flat funding has taken its toll on the cooperative groups—accrual has fallen by 6.5%, or 1,811 participants, from Fiscal Year 2002 to 2007. In addition, the complexity and regulatory requirements of trials are increasing.

Limited federal funding also will lead to fewer patients enrolled in clinical trials through NCI’s Community Clinical Oncology Program. The number of patients in treatment trials is expected to drop to 6,100 in 2008, down from 6,400 last year and nearly 8,000 the year before. By making budget cutbacks that affect the ability of scientists and institutions to participate in clinical trials, further advances in the treatment and prevention of cancer will become more difficult.

Languishing funds at NCI and other research institutions also are having a measureable effect on the biomedical research infrastructure in the United States. The scientists who conduct the valuable research on which physicians and patients depend are experiencing new challenges that hinder their efforts to make necessary progress. The NCI is currently able to fund only 20% of the grant applications it receives. NCI also has announced that it will fund fewer competing grants in Fiscal Year 2008 than in Fiscal Year 2007 (down to 1,283 from 1,312). Researchers are spending less time on cutting-edge projects with great scientific potential and more time simply seeking funding.

Even a scientist’s ability to move forward new ideas to combat cancer has seen significant challenges. In 2004, researchers in the NCI Cooperative Group submitted 51 new research concepts and 128 new protocols for approval; in 2007, these numbers shrank to 20 new concepts and 67 new protocols. Additionally, the number of trials open for accrual fell from 426 in 2004 to 374 in 2007.

Funding cuts and the problems they create not only affect professionals who are currently in the field, but also those young professionals at the beginning of their careers. Increasingly competitive grant processes and declining numbers of grants awarded to scientific investigators steer these young people away from the pursuit of a research career. Indeed, many potential new investigators no longer see the point of entering a highly competitive field that offers fewer opportunities for success. In 1998, the chance of being funded on the first try was 21%; today, that number has dwindled to 9% for new investigators and 7% for established researchers. If numbers continue to slide in this manner, our country risks losing a new generation of scientific investigators and the pioneering efforts they could bring to medical research.

Reversing the Trends
Cancer research is paramount to the improvement of our nation’s health. Without the opportunity to develop better screening methods, diagnostics, treatments, and mechanisms to control cancer, the remarkable progress that has been made against this devastating disease will be delayed or lost. The consequences of the current lack of appropriate funding will put future advancements at risk at a time of great scientific potential. Therefore, our nation’s leaders must renew their commitment to cancer research and biomedical achievement. This will require not only restoring appropriate levels of funding for NIH and NCI to keep pace with inflation each year, but also with an investment of the resources that are required for researchers to make up for lost ground in the highly competitive global medical research arena.

America’s status as a world leader in science and technologic development is slowly slipping away. The number of clinical trials for new drugs being successfully conducted outside of the United States is steadily increasing, and the ability of the nation’s scientists to keep pace is on the decline. At last year’s Annual Meeting, four of the five most important studies presented came from outside of the United States. Truly, all advancements in cancer care are victories for physicians and patients around the world, no matter their country of origin. But the United States must be able to contribute equally with our international allies to do our part in the fight against cancer and to fulfill our responsibility to the 1.4 million Americans who will develop cancer this year.

What can ASCO do to help reverse these trends? As the world’s leading organization representing health care professionals who treat people with cancer, the Society is obligated to advocate for the needs and concerns of its members, in accordance with the mission of the organization. Thus, ASCO is joining other leaders in the biomedical research community in calling on Congress to increase the NIH budget by 6.6% for Fiscal Year 2009. This increase is essential to maintaining current research activities, keeping pace with inflation, and initiating the reversal of the devastating toll of recent flat and declining funds. ASCO respects the professional judgment of the NCI in requesting a total of $5.26 billion (a $455 million increase over FY 2008 funding levels). ASCO will work to ensure that Congress approves the largest possible total funding increase to support NIH and cancer research.

ASCO also is developing tools and tactics to educate policymakers, the media, and the general public on the need for increasing funding to promote research and progress in cancer care. Despite the significant advances of recent oncology research, there is still much work to be done. Finding new treatments for the most deadly cancers, such as lung and pancreatic cancer, are among the most pressing needs of the cancer research community. Oncologists and people with cancer need improved screening tools and ways to manage the side effects of cancer and its treatment. Increased funding also is necessary to help scientists translate the growing backlog of genetic research discoveries into effective treatments for patients. None of these steps forward can occur without the aid and support of the federal government.

Research advances have transformed the ways in which cancer is prevented, detected, and treated; because of this evolution, cancer has become a much more survivable disease. It is ASCO’s hope that the achievements of the past 20 years of oncology research will continue to improve cancer care for the people living with cancer. We have come so far in cancer care and we cannot afford to allow this progress to slip away.