A Prescription for Increasing the Rate of Progress Against Cancer

Cancer Progress Report 2014: Contents

In this section you will learn that to increase the rate of progress against cancer we must:

  • sustain growth in funding for biomedical research;
  • develop the workforce of tomorrow;
  • enhance patient engagement and awareness;
  • advance regulatory science and policy; and
  • promote evidence-based prevention strategies.

The efforts of many thousands of basic, translational, and clinical researchers have led to a profound understanding of the genetic and molecular basis of the more than 200 diseases we collectively call cancer and has provided us with new and improved ways of preventing, detecting, diagnosing, treating, and, in some cases, curing these diseases. This progress would not have been possible without past investment in the NIH and NCI, which are charged with providing vital funding to and scientific oversight of the biomedical research community.

Although tremendous advances in our understanding of cancer have been made, there remains much that we do not yet know about the disease, underscoring the importance of making biomedical research a national priority again. Prioritizing biomedical research will provide us with a more comprehensive understanding of the biology of cancer and its causes, and it will enable the translation of this knowledge into health care advances at a much more rapid rate than is happening today. Revitalizing investment in biomedical research will ensure that scientists have the funds they need to continue to make groundbreaking discoveries, and that early-career researchers will be more than adequately trained to meet the challenges ahead. It will also enable the development and expanded use of the novel research tools and technologies that are transforming science. With additional support for the NIH and NCI, we can be confident that extraordinary progress will be made against cancer for many years to come (see sidebar on A Prescription for Increasing the Rate of Progress Against Cancer).

Sustain Growth in Funding for Biomedical Research

During the past half century, bipartisan support from Congress and the administration for the NIH and NCI has enabled extraordinary progress against cancer. In doing so, it has saved countless lives, created jobs, and promoted economic growth in the United States. It has also catalyzed the development of the biotechnology industry and secured the United States position as the global leader in science and innovation. Therefore, if we are to increase the rate of progress we are making in the battle against cancer, while at the same time ensure that economic growth in the life sciences continues, it will require sustainable increases in federal funding for the NIH and NCI (see sidebar on NIH: A Catalyst of Progress).

From Jan. 1, 2010, through July 31, 2014, we have realized remarkable returns on the federal government’s prior investments in cancer research through the NIH and NCI. In fact, in those four and a half years, 39 new anticancer agents and 11 new uses for previously approved anticancer therapeutics have been FDA approved. In addition, this time period saw four new imaging technologies and FDA clearance for broad clinical use of a DNA sequencing machine and reagents.

For the NIH and NCI to have the resources required to build upon prior and current progress, biomedical research must once again become a national priority for our policymakers. Members of Congress must restore the $1.6 billion in NIH funding that was cut as a result of sequestration, and provide sustained funding increases at a rate that is at least comparable to biomedical inflation (see Figure 14). In fact, NIH’s current funding level is $3.5 billion less than where it would be today if it had simply grown at the same rate as biomedical inflation since 2010; this translates to a loss of more than $5 billion in purchasing power since that time.

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Develop and Retain the Workforce of Tomorrow

As a result of diminished federal support for biomedical research, a new research grant application to the NIH in 2013 had a less than one in six chance of receiving funding (152). Faced with an inability to sustain their research programs, some established NIH-funded investigators are leaving the field, which means that there are fewer opportunities for training. In addition, with fewer and smaller grants (153, 154), some established researchers are unable to take on new graduate students and postdoctoral scientists, and expert laboratory staff members have been let go. These cuts not only reduce the research capacity of our nation’s laboratories but they also discourage promising trainees and early career scientists from even pursuing a career in cancer research, an outcome that has grave consequences for future innovation in the field. By adversely affecting the promise and progress in cancer research, these losses will unquestionably be detrimental to the lives of patients with cancer in the future.

In addition to allocating the funds necessary to recruit and retain the best and the brightest to the field of biomedical research, we must equip our workforce with the knowledge and skills to conduct state-of-the-art cancer research (see sidebar on World Class Training). Cancer is a complex disease requiring multifaceted and interdisciplinary solutions. Further, an understanding of the advances in one field can have a profound effect on another. For example, the development of cancer immunotherapies would not have been possible without basic research in immunology and without the new technologies that exist today. Likewise, drugs that were originally developed for cancer patients have led to treatments for macular degeneration, hepatitis, psoriasis, and other diseases.

To capitalize on the full breadth of our research enterprise, both trainees and established investigators should be encouraged and have opportunities to engage with and learn from researchers across fields, including mathematics; engineering; and the physical, chemical, and social sciences.

Enhance Patient Education and Engagement

To obtain a deeper understanding of cancer and speed the development of new and improved cancer interventions, it is essential to engage patients throughout the continuum of research and care. Unfortunately, fewer than 5 percent of adult cancer patients participate in a clinical trial (155). Participation is even smaller among the elderly, women, racial and ethnic minorities, and people living in rural areas. To achieve outcomes relevant to all segments of the population, it is essential to increase the number and diversity of clinical research participants through a combination of outreach, education, and policy changes aimed at overcoming the barriers that prevent individuals from participating in these studies.

However, advancing patient-centered cancer research involves more than simply increasing the number and diversity of patients participating in research. Research policies should encourage the engagement of patients in the conception, design, and dissemination of research in order to address the questions that are most important to them, their loved ones, and their caregivers; help researchers to measure health outcomes from the perspectives of patients; minimize the barriers to patient participation; and ensure that research findings are shared with the patient communities that they are intended to benefit.

Another way to advance patient-centered research is to better integrate laboratory and clinical data, making it possible for researchers to use data generated in the clinic to answer scientific questions and helping health care providers rapidly deliver care that is consistent with the latest research findings (see Figure 8). To make this vision a reality, it will be important to facilitate the development of data infrastructure, standards, and policies that enable the capture, aggregation, analysis, and utilization of large volumes of high-quality clinical information while protecting the rights and privacy of the patient community.

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Maximize Opportunities in Regulatory Science and Policy

Translating a deeper understanding of cancer biology into a new medical product benefitting cancer patients costs an average of about $1 billion, and the process can take over a decade (see Clinical Trials). The growing field of regulatory science holds the key to improving efficiencies in this process.

Regulatory science is the study of developing new tools, standards, and approaches to assess the safety, efficacy, quality, and performance of medical products (see sidebar on Regulatory Science) and is an integral part of FDA’s review and decision-making processes. FDA’s regulatory science initiatives are aimed at developing evidence-based regulatory policies and expediting development of more safe and effective medical products for cancer patients everywhere.

Thanks to the amazing progress made thus far against cancer, as highlighted in this document, the FDA is increasingly being asked to evaluate and regulate many novel therapies and technologies, such as immunotherapies and DNA sequencing. In many cases, the medical products under review are so novel that the current means of regulating them are inadequate. Thus, to continue or accelerate the current pace of progress against cancer, it is essential that advances in regulatory science parallel those in basic, translational, and clinical science.

To advance regulatory science, regulators must have the resources to support research that informs the regulatory process, as well as a sufficient budget to recruit, develop, and retain a highly qualified regulatory staff. Likewise, enhanced scientific exchange, cooperation, and collaboration among stakeholders from academia, industry, advocacy, and government are critical to advancing this field. Fostering meaningful exchange among these groups can be accomplished by ensuring that regulators are permitted to travel to national and international scientific meetings, where they can be kept abreast of the latest developments in the field and interact with foremost scientific experts in an open, neutral venue. These exchanges will ensure that the best evidence is used to evaluate novel medical products and that advances in regulatory science are communicated to the entire biomedical research community to inform their work.

 The FDA is ensuring that Americans have access to safe and effective medicines while encouraging the development of innovative cancer treatments in a timely fashion. Sustaining a strong and well-informed FDA, which is an active part of the biomedical research community, is necessary to continue making progress against cancer and deliver hope to patients and their loved ones everywhere.

Promote Evidence-based Cancer Prevention Policies

Developing a better understanding of the numerous factors that contribute to cancer risk (see Figure 4) will help researchers and policymakers to develop effective cancer prevention strategies. As noted earlier in this report (see Healthy Living Can Prevent Cancer From Developing, Progressing, or Recurring), one of biggest success stories in cancer prevention is in the area of tobacco control. This progress was made possible through research demonstrating the adverse health consequences of smoking and through the implementation of policy and educational initiatives aimed at preventing tobacco use and encouraging cessation.

To continue our progress against cancer, we must continue to prioritize cancer prevention research as an important area of focus and implement cancer prevention and control programs (see sidebar on Eliminating Tobacco Use Faster). Comprehensive strategies for reducing cancer risk should include improvements in cancer risk assessment, screening methods, and other clinical interventions; public education and outreach regarding risk reduction; and the implementation and enforcement of social and economic policies aimed at promoting healthy behaviors.

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Cancer Progress Report 2014 Contents

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