Cuts to Cancer Research Loom Large

If enacted, what could they mean for the future of oncology?

Naveed Saleh, MD, MS

Disclosures

June 16, 2017

Where to Cut?

If cuts are inevitable, which types of cancer research should receive less funding? Some detractors point to basic medical research as an area ripe for cuts. Typically, basic medical research, such as molecular, biochemical, genetic, and physiologic studies, is believed to be less disease-oriented and does not involve patients, whereas clinical studies focus on patients and disease.[6] Because the practical applications of basic medical research can sometimes be difficult to readily identify, detractors have questioned its value compared with that of clinical research. (In reductive terms, translational research bridges that gap between basic and clinical research.)

Li and colleagues[7] examined the relationship between grants for "basic" versus "applied" (clinical) research and the generation of patents. The researchers found that 10% of NIH grants directly result in the generation of patents, and 30% of NIH grants generate articles that are cited by patents, thus indirectly contributing to patents. These direct and indirect contributions are similar among basic and applied research. Moreover, it can take 10 or more years for these contributions to come to fruition. In other words, Li and colleagues found that both basic medical research and clinical research funded by the NIH contribute to the generation of patents, and it can take some time for these contributions to come to light.

Because the diagnosis, prevention, and treatment of cancers is intrinsically multidisciplinary, experts caution against preferential funding.

"These breakthroughs don't just come from applied therapy," Caligiuri noted. "They come from us understanding how viruses work, how signaling works, and how the immune system works. Understanding these basic pieces of the puzzle allows us to put the puzzle together when a more applied therapy comes along. We never know where the answer is going to come from."

Thanks to immunotherapy, for example, a small percentage of people with non-small cell lung cancer, melanoma, and bladder cancer have achieved remission. Consequently, immunotherapy research initiatives have benefited from novel sources of funding. Because the diagnosis, prevention, and treatment of cancers is intrinsically multidisciplinary, however, experts caution against preferential funding. "We should not overemphasize certain areas of research," said Caligiuri. "I'm a firm believer that we really never know where the next breakthrough is going to come from."

Consider that prevention gets much less press than immunotherapy, yet the potential for screening to reap rewards is staggering. Caligiuri cited a recent investment in the Ohio Colorectal Cancer Prevention Initiative to screen 3000 Ohioans for Lynch syndrome, a hereditary disorder that increases the risk for not only colorectal cancers but also other aggressive cancers. This $4 million investment returned $40 million in reduced costs associated with cancer treatment—a 1000% return on investment—and saved 736 years of life, according to Caligiuri. The Cancer Moonshot plans to expand screening for Lynch syndrome nationwide, potentially resulting in billions of dollars saved and countless years of extra life for patients who receive a diagnosis early.

Whether President Trump's proposed cuts to the NIH will make their way past Congress is unclear. Any such cuts will probably deal a major blow to cancer research and treatment as we know it. Even if these cuts are never passed, however, their mere mention can be demoralizing to all stakeholders involved.

"Just putting out the idea [of decreased NIH funding]...even if it doesn't occur, has already had a negative effect," said Matulonis. "It is bad for morale. The work you are doing is thought not to be important. It is awful."

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....