Richard L. Schilsky, MD, FACP, FASCO
CONGRESS RECENTLY passed its fiscal year (FY) 2017 spending bill, which contains an additional $2 billion for the National Institutes of Health (NIH). This marks the first time in more than a dozen years that Congress funded back-to-back increases for the NIH, demonstrating the bipartisan consensus that’s been built around the need to support biomedical research. This achievement would not have been possible without strong advocacy work by the oncology community, as well as the fierce support from members of both political parties, who spoke up about the need to take the nation’s investment in research seriously.
Although the additional funding increase is a major win for researchers, physicians, and—most important—individuals with serious and life-threatening diseases, this is not the end of the story. As oncologists, we know that much of the progress made in the prevention, diagnosis, and treatment of cancer is incremental. Each new research or treatment breakthrough is built on the discoveries of those that came before. Only after sustained and methodical scientific investigation, do scientific findings translate into meaningful improvements in treatments we can deliver to our patients.
The same deliberate approach has to be taken with federal research funding. It’s not enough to support a funding increase 1 year and then make steep cuts or keep the budget flat the following year. We know all too well what happens with an unpredictable funding environment: studies are halted just as they’re getting off the ground. Researchers see an unstable funding environment and decide to choose a different career path. Resources and talent are squandered, and it’s difficult to forge a path forward. A 2013 ASCO survey found that 75% of responding researchers said the lack of federal funding was impacting their ability to conduct clinical oncology research, and 38% had to reduce the amount of time they spent on research.1
ASCO’s recent analysis of Annual Meeting abstract submission and session statistics tells a similar story: from 2008 to 2015, the number of submitted abstracts reporting NIH-funded studies dropped from 575 to 199. Increasingly, the best clinical research is funded by commercial interests and conducted outside the United States.
Moving Beyond Decades of Progress
A PREDICTABLE and stable funding environment doesn’t just make it easier for researchers and institutions to plan ahead; it also gives hope to millions of people with cancer and their families. When the number of clinical trials drops, so do the opportunities for people with cancer to enroll in trials and access promising new therapies.
“It’s not enough to support a funding increase 1 year and then make steep cuts or keep the budget flat the following year.”— Richard L. Schilsky, MD, FACP, FASCO
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When I was in medical school in the 1970s, many of my fellow students had little interest in oncology and pursued other specialties, believing a cancer diagnosis offered grim prospects for their future patients. With only surgery, radiation, and a few chemotherapy options—none of them good—only half of our patients lived for more than 5 years after diagnosis. Consider that the first computed tomography (CT) scan was conducted just after I graduated from medical school, and it took several days to create one low-quality image. The first study on adjuvant chemotherapy for breast cancer wasn’t published until 1975. Tamoxifen was approved as the first “targeted” therapy in 1977, based on the discovery of the estrogen receptor 20 years before and the pathognomonic chromosomal translocation in chronic myeloid leukemia was described in 1973, but imatinib was still more than 2 decades away.
Little by little, we made progress. Today, a high-quality CT scan can be completed in just a few seconds, and adjuvant chemotherapy is a major component of treating breast cancer, colorectal cancer, non– small cell lung cancer, and even pancreatic cancer. We’re beginning to learn how to analyze the makeup of a tumor and pinpoint the exact treatment that can attack a particular cancer the most effective way. We’re discovering how to turn the body’s own immune system against cancer to wipe out the disease entirely. Forty years ago, many of these innovations would have been considered science fiction—a complete fantasy. That’s not the case today. Today, two of three people with cancer live at least 5 years after diagnosis because of these and many other advances in early detection and treatment.
Era of New Cancer Discoveries
DESPITE THIS PROGRESS, our field has so much more to discover. We know that immunotherapy can work, but we don’t yet know what kind of cancers respond best to it. We know that precision medicine holds promise, but we don’t yet know how to target therapies to every form of cancer or to prevent the emergence of resistance. And, although so many of our patients go on to live long and healthy lives, many individuals with cancer will still die of their disease.
“In 2001, a cancer researcher had a 27% chance of securing federal funding for research; today, that number is somewhere around 16%.”— Richard L. Schilsky, MD, FACP, FASCO
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In 2001, a cancer researcher had a 27% chance of securing federal funding for research; today, that number is somewhere around 16%. Even with the recent funding boosts, securing federal funding is a challenge. Factoring in inflation, the National Cancer Institute (NCI)’s budget is still below what it was a decade ago.
This summer, Congress will begin to consider funding levels for FY 2018. We applaud lawmakers for their leadership in FY 2017 and FY 2016 but urge continued federal investment in basic and translational research—the very backbone of our nation’s biomedical research enterprise—and strong support for our national clinical trials network.
To paraphrase my colleague and ASCO’s Immediate Past President Dan Hayes, MD, FACP, FASCO, if we want to continue to treat patients as we do now, then we can halt our research and stop learning. If we want to move beyond where we are now, however, the United States must continue to invest in research. Robust investment in biomedical research is the only way more individuals with cancer will live beyond 5 years, and a cancer diagnosis will no longer be accompanied by dread and fear.
Stable, predictable funding increases will allow our nation to continue to build on the promise of today’s research and improve outcomes for all patients with cancer.
DISCLOSURE: Dr. Schilsky reported no conflicts of interest.
1. ASCO Impact Survey: Federal funding cuts to cancer research. September 2013. Available from http://www.asco.org/sites/www.asco.org/files/results_ of_asco_federal_research_funding_survey.pdf. Accessed July 5, 2017.