Money Well Spent: the Need for Federal Funding in Cancer Research

Evidence-Based Oncology, February 2015, Volume 21, Issue SP3

While many of us struggle each year to keep our personal health resolutions, elected officials face similar challenges: maintaining their commitment to our nation’s health. There is real hope for bringing an end to the death and suffering that cancer causes, but doing so requires that we make the fight against cancer a national priority.

In 1971, President Richard Nixon publicly resolved to make a national commitment to defeat cancer when he signed the National Cancer Act. Passage of the Act dedicated federal resources to fight cancer by creating the National Cancer Program, which is led by the National Cancer Institute (NCI). Since the early 1990s, this federal investment in cancer research has led to the development of early detection and treatment tools that have resulted in a 22% drop in death rates in both men and women1; many cancers are no longer the automatic death sentence they were a generation ago. In fact, since death rates peaked 2 decades ago, we have averted more than 1.5 million cancer deaths. But, we can’t rest on our laurels. Answers continue to elud us when it comes to detecting and treating many types of cancer. To fully maximize our potential for progress, research funding must be dependable and consistent.

Research is not like a light bulb that can be turned on and off depending on when funding becomes available. Patients enrolled in clinical trials who have exhausted other treatment options cannot put their disease on hold while a trial awaits funding. Unfortunately, researchers who are forced to halt multi-year projects when funding runs out must abandon potential discoveries in process. The fact remains that the federal government is, by far, the largest public investor in cancer research and a critical player in our ability to promote discovery in a disease that is forecast to kill more than 589,000 Americans this year.2

On a positive note, research has led to vaccines and early detection tests that can prevent some cancers altogether, as well as treatments that can both increase the number of years of survivorship for millions along with the quality of those years. Targeted and precision therapies for a number of cancers are directly attacking the disease, rather than the patient’s entire body—significant progress from the days when those lucky enough to survive the disease were often left with lifelong debilitating side effects.

Robust and sustained investment in basic science and clinical research is paramount to maximize public and private innovation that has turned the war on cancer into an imminently winnable fight. Government-funded basic research and clinical trials serve as the building blocks for private-sector research and development. This public-private partnership is responsible for bringing promising new lifesaving treatments to patients, and it is essential to ultimately defeating this disease.

In my lifetime, cancer research has gone from a good bet to a sure one. Redoubling the federal investment in cancer research would accelerate progress against the disease and likely result in advances in other diseases, too. Unfortunately, the federal research investment has stagnated in recent years—as the cost of doing research has gone up.

Cancer is claiming more than 1600 lives in America every single day.2 Meanwhile,in recent years, the budget of the NCI has fallen woefully short of what’s needed. For most of the last decade, year over year, NCI funding has failed to keep pace with increased research costs. This stagnated funding has resulted in only 14% of research grant applications receiving support, compared to 24% just a decade ago,3 and the average age of a first-time grant recipient has increased from 37 years in 1980 to 42 years today.4 We risk losing promising young researchers to better-resourced research programs overseas, or to other professions altogether, taking with them the lifesaving potential of research never realized.

Past investment in research transformed the way cancer was diagnosed, far beyond the body part where a tumor is found. We now have the ability to develop tests to detect genetic mutations known to cause certain types of cancers and to tailor therapies that address those same mutations. Yet, we risk squandering our past investment if there is no follow through with funding to make those potential tests and treatments a reality.

Despite the promise of an investment that could yield tremendous dividends for public health, our national commitment to keep up President Nixon’s resolution is wavering. We cannot afford to put off until next year, or the next decade, the fight to defeat a disease that is the leading cause of death among adults aged 40 to 79 years and expected to overtake heart disease as the leading cause of death among all Americans within the next several years.

While we remain without effective measures to prevent, detect, and treat some of the most deadly cancers, investing in research is just one piece to solving the cancer puzzle. A discovery is only as valuable as its application, and inadequate funding is allowing promising discoveries to languish in labs. We have an obligation to get new detection tests and treatments from the laboratory to the patient’s bedside. Proven ways to prevent cancer or detect it at the earliest, most treatable stages, are seriously underutilized.

On a more critical note, access to quality healthcare remains out of reach for tens of millions of Americans, despite significant progress achieved thanks to key provisions of the Affordable Care Act (ACA). We could prevent roughly half of all cancer deaths by applying what we know works: specifically, getting recommended screening tests and addressing harmful lifestyle factors such as tobacco use, obesity, poor nutrition, and inadequate physical activity. If we want to accelerate progress against cancer, we must realize we already know how to dramatically reduce death and suffering from the disease.

Proven tobacco control measures curb deadly tobacco use. If we increased the number of states and communities with comprehensive smoke-free workplace laws, passed significant tobacco tax increases, and fully funded tobacco preventionand cessation programs, we could perhaps reduce disease and death from tobacco use, which today accounts for 1 in every 5 deaths in the United States.5

ACS CAN AND CANCER POLICY

Defeating cancer is as much a matter of public policy as it is of scientific discovery. Lawmakers play a critical role in determining how much progress we can make, as a country, in fighting cancer. The American Cancer Society Cancer Action Network (ACS CAN) was created to give a voice to those affected by cancer so they can encourage lawmakers at all levels of government to join the fight to make cancer a national priority.

ACS CAN mobilizes cancer advocates in every state and Congressional district nationwide to hold lawmakers accountable to their constituents for the decisions they make related to cancer. The organization works to defeat cancer by helping to protect and increase public investment in ground-breaking medical research and by improving nationwide access to the latest prevention and early detection measures, treatments, and follow-up care that are proven to save lives.

We’ve long known that increasing access to care is critical to the cancer fight. In 2007, ACS research revealed what had not been proven before: the lack of access to quality healthcare reduces a person’s ability to survive cancer.6 We knew then that if we didn’t see a true systems change in American healthcare policy, we simply could not achieve our goals to save more lives, faster.

During the debate over healthcare legislation in Congress, ACS CAN advocated for critical patient protections. For too long, cancer patients and survivors had been forced to choose between their lives and their life savings, as they were charged unfairly or denied health insurance altogether because of a preexisting condition. ACS CAN staff and volunteers urged lawmakers from both political parties to help ensure all Americans get access to the cancer prevention, early detection, treatment, and follow-up care they need.

Key provisions in the ACA are improving access to care for cancer patients, cancer survivors, and their loved ones. ACS CAN continues to work with elected officials from both parties in Congress and throughout the States to protect critical provisions and improve the law for people with cancer and their families. Lawmakers are being urged to accept federal funds to increase access to Medicaid coverage so our nation’s most vulnerable have access to mammograms, colonoscopies, and other lifesaving cancer screenings and treatments they cannot currently afford. Where you live should not dictate whether you have access to care to help prevent, treat, and survive cancer.

Cancer advocates continue to stress to policymakers at every level that there is still much work to be done to eliminate death and suffering from this disease. While we have made strides in making some cancers a chronic condition you can live with, many of the more than 1.6 million diagnosed this year won’t be given such promising news. With 1 in 2 men and 1 in 3 women expected to be diagnosed with cancer in their lifetime, now is not the time to relent. Because cancer is primarily a disease of the aged, cancer incidence increases as the population ages. In fact, cancer incidence rates are projected to rise by nearly one-third (31%) by 2025.2

We can—we must—make this century cancer’s last. To bring cancer under control as a major public health problem in the United States, we must take 3 critical steps: • Redouble our efforts to research the causes and cures of cancer • Promote and elevate prevention into standard practice nationwide • Ensure access to quality healthcare for all Americans.

EBO

If we want to win a final victory in the war on cancer, we must resolve to renew our national commitment to this fight this year. It’s a resolution worth keeping.

John R. Seffrin, PhD, is CEO of the American Cancer Society Cancer Action Network.

References

1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2015. CA: Cancer J Clin. 2015;65(1):5-29.

2. Cancer facts and figures 2015. American Cancer Society website. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2015/index. Accessed January 13, 2015.

3. Building on opportunities in cancer research. National Cancer Institute website. http://www.cancer.gov/aboutnci/budget_planning_leg/plan-archives/NCIs-Annual-Plan-Budget-Proposal-Fiscal-Year-2016.pdf. Accessed January 13, 2015.

4. Catalyst for cures: how federally funded cancer research saves lives. American Cancer Society Cancer Action Network website. http://www.acscan.org/content/wp content/uploads/2013/02/ACSCAN-Research-Report_FINAL.pdf. Accessed January 13, 2015.

5. The health consequences of smoking—50 years of progress: a report of the Surgeon General, 2014. HHS website. http://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html. Accessed January 13, 2015.

6. Report links health Insurance status with cancer care. American Cancer Society website. http://www.cancer.org/cancer/news/news/report-linkshealth-insurance-status-with-cancer-care. Published December 20, 2007. Accessed January 13, 2015.

A link to ACS CAN’s 2014 report on state legislative activity to reduce cancer incidence and mortality can be found at http://www.acscan.org/content/wp-content/uploads/2014/08/HDYMU-2014-Report.pdf.