ASCO’s report on Clinical Cancer Advances for 2013 highlighted dozens of research breakthroughs that will improve the lives of people living with cancer and will set the stage for the next generation of discoveries. This year’s ASCO Annual Meeting will showcase dozens more. Yet despite these advances, the sober reality is that 1.6 million Americans will be diagnosed with cancer this year, and the number of new cancer cases will increase by nearly 40% by 2030, due largely to our aging population. One of every four deaths in the United States is caused by cancer, which this year will claim the lives of nearly 580,000 Americans, making it the second leading cause of death in the country.1 The progress reported at this year’s Annual Meeting is cause for hope and optimism that the hundreds of diseases we call cancer are coming under control, but the future of cancer care relies on our ability to build upon these advances.
Due largely to our nation’s investment in cancer research over the last 4 decades, people diagnosed with cancer are living longer and better than ever before, and more are being cured. Cancer-related deaths have continued to decline in the United States by 1.5% per year over the past decade, and a person diagnosed with cancer today has a better than two-thirds chance of being alive 5 years from now. Scientific breakthroughs in cancer are occurring at a breathtaking pace and are being translated into new drugs and devices that benefit patients more quickly than ever before. Yet this progress against cancer is in jeopardy of being stalled just when the opportunities and needs are greatest.
The National Institutes of Health (NIH) budget (Fig. 1) has been flat for more than a decade and, when adjusted for inflation and the additional cuts imposed by sequestration, is nearly 25% lower today than in 2003. As a result, the number of new research grants NIH is able to fund has fallen sharply since 2003, with 2,110 fewer awards made in fiscal year (FY) 2013 than a decade ago. As a result of sequester cuts, the budget for funded grants was cut by 10%, and more than 600 viable research projects went unfunded last year.2 Who knows which of these might have led to the next breakthrough in cancer prevention or treatment? These budget cuts are far more damaging and their effects far more long lasting than the immediate effect on funded research. Young people are giving up on research careers, researchers with funding are curtailing projects and laying off staff, and promising clinical trials are being put on hold. The nation’s research infrastructure is beginning to crumble while other countries are investing heavily in biomedical research, resulting in the domestic loss of the field’s brightest young minds.
A recent ASCO survey3 revealed that many ASCO members are spending less time in research, reducing the scope of funded projects, and downsizing their research programs. Enrollment on National Cancer Institute (NCI)-supported clinical trials is approaching the lowest level in decades because NCI has had to impose a cap on enrollment at 12,000 adult patients per year (approximately 50% of previous highs), and fewer definitive phase III randomized trials are being mounted. This trend is particularly troubling because NCI-funded trials typically address important areas of research that are of little interest to the pharmaceutical industry but are important to patients, such as research in cancer screening and prevention, studies of quality of life and symptom control, research to reduce disparities in cancer care, comparative trials of similar agents, and studies combining different modalities of treatment.
Meanwhile, other regions of the world are forging ahead of the United States in investing in research. Many pivotal clinical trials are now conducted overseas, and China, Russia, and Europe are all investing heavily in basic science. As the Washington Post recently editorialized,4 “The research NIH funds is precisely what we should demand from government. It is critical to our future as a healthy society and world leader in science, and it’s not something the private sector will do in the government’s stead.” NIH Director Francis Collins, MD, PhD, has been equally vocal, stating that with continuing budget cuts “deep and long-term damage” to U.S. biomedical research is at stake.
ASCO, along with our many partners in the cancer community, continues to call for a renewed commitment to federal funding of cancer research. The need is simply too great, the opportunities too tangible, and the potential for clinically meaningful outcomes too near to continue down the path we are on. That’s why ASCO has called on Congress to provide an NIH budget of at least $32 billion for the next fiscal year to begin to reverse the decade-long decline in NIH spending power. Unfortunately, the FY 2014 budget passed by Congress provides an appropriation of only $29.9 billion for NIH and $4.92 billion for NCI—roughly 3.5% and 3.0% increases, respectively, over FY 2013 post-sequestration funding levels. This level of funding is simply inadequate to accelerate progress against cancer in the years ahead. Patients diagnosed with cancer often describe a feeling that their lives have been put on hold while dealing with their illness. As a nation, we run the risk of putting cancer research on hold, as chronic underfunding leads to missed opportunities and researchers exiting the field. It will not be easy to recapture the lost momentum in the research community, but it is vital that we try. Our patients deserve nothing less.
For examples of the powerful research that is being conducted by federally funded Cooperative Groups, attend this year’s Plenary Session, to be held Sunday, 1:00 PM-4:00 PM, N Hall B1 (with a satellite viewing area in E Hall D1). Two of the four abstracts being featured in this year’s Plenary Session would not have been possible without Cooperative Group research, and all of the studies were at least partially funded with federal dollars.