Summer 2014 
 

Thomas A. Sellers, MPH, PhD, is Executive Vice President and Center Director, H. Lee Moffitt Cancer Center and Research Institute, in Tampa, FL


Commentary Overview

* At a time of expanding scientific discovery, decreases in funding are jeopardizing cancer centers' ability to deliver the promise of science to patients.

* Without more federal funding, younger generations of academic researchers will be forced to leave science, risking delayed discoveries and increased cancer morbidities and mortalities.

* Moffitt Cancer Center's Total Cancer Care database exemplifies how federal funds from NIH and NCI can intensify the impact of investments from state and local government and the private sector.
About AACI Commentary

As part of AACI's efforts to feature the work and views of its member centers, AACI has launched AACI Commentary, a quarterly editorial series. Written by cancer center leaders, each edition will focus on a major issue of common interest to the nation's cancer centers.



Extending Federal Research Funding: "Total Cancer Care" and the Promise of Science

BY THOMAS A. SELLERS, MPH, PHD

This is an exciting and promising time in science and cancer research, and the research is having an impact. The cancer death rate has declined by one percent each year for the past two decades, resulting in more than one million lives saved. The number of Americans living with, through or beyond a cancer diagnosis has almost tripled since the 1970s.

According to the most recent AACR Cancer Progress Report (cancerprogressreport.org), 13 new drugs to treat a variety of cancers; six new uses for previously approved cancer drugs; and three new imaging technologies have been approved in just the past 18 months. Moreover, there are now 41 FDA-approved therapies that target specific molecules involved in cancer, compared with 17 five years ago, and just five 10 years ago.

At a time of unlimited potential for further progress, the enthusiasm of the scientific community is muted by the sobering realization that the resources needed are simply not available because of demoralizing decreases in funding. Despite the additional funds provided in the current fiscal year, the National Institutes of Health (NIH) and the National Cancer Institute (NCI) budgets remain below fiscal year 2012 levels and below levels prior to sequestration. In fact, the NIH has lost more than 22 percent of its budget after inflation over the past decade.

These cuts not only have a negative impact on the pace of biomedical research productivity, but also on future generations of scientific researchers. The competition for scarce grant dollars is so fierce that it is driving many new investigators out of the field, before they even get in the game. Who is going to be left to carry on the great tradition of biomedical research in this country?

A significant milestone for cancer research -- which NCI funding made possible -- was the discovery that cancer develops as a result of alterations in the genetic material of cells. Research in genomics has propelled technological innovations that are making it possible to efficiently read every known component of the DNA from an individual's cancer. These discoveries are changing the way doctors view cancers, categorizing them increasingly by the genetic changes that drive them and less by where they originate—in the breast, brain, lung, or liver, for example. In fact, by continuing to invest in how different cancers share molecular features and applying the knowledge learned across many different types of cancers, we are optimistic that this will most improve treatments for patients whose cancers have five-year survival rates less than 50 percent, such as in the case of small-cell lung cancer, which has a five-year survival rate less than 15 percent.

Total Cancer Care
At Moffitt Cancer Center, an ambitious research protocol called Total Cancer Care seeks to gain consent from every cancer patient who comes through the door to provide access to their medical record, permit us to analyze their tumor to understand the molecular changes that have accumulated, and to follow them for the rest of their journey with cancer. We built a first-of-its-kind health research information platform to integrate the data, and created new departments to deal with data quality and governance and to educate the clinical, research, and administrative workforce on the myriad potential applications. More than 100,000 patients have been enrolled in this unique partnership.

One way that Total Cancer Care's database accelerates the improvement of cancer care is by allowing us to identify genetic factors which cause some patients to respond differently to treatment than other patients. Knowing these factors can help us select the treatment best suited to each patient and their disease without the trial-and-error process of the past. Researchers use the data to identify targets for drug development and clinical investigators test new therapies on the subset of patients that would be predicted to benefit. This precision medicine approach is expected to further improve outcomes, reduce side effects, and eliminate the use of treatments that can be predicted to not work for that patient.

The Total Cancer Care study was initiated with investment from the pharmaceutical industry and state and local government, and serves today as a powerful resource for scientists seeking federal grants to test new ways to detect and treat cancer. This public-private partnership exemplifies how federal funds from the NIH and NCI can extend the reach and intensify the impact of investments made at the state and local level and through the private sector.

The future can be bright
Without increased funding now, the spectacular advancements we have witnessed in the past will not be there in the future. Without increased funding, the younger generations of academic researchers will be forced to leave science for other fields. With the loss of researchers we risk delaying breakthroughs and discoveries, which could translate to increased morbidities and mortalities associated with cancer. Scientific momentum has ushered in a new era in which we can develop even more effective interventions and save more lives; this is not a time for the NIH and NCI budgets to be in retreat. Cancer researchers at Moffitt and other cancer centers across the country are on the verge of breakthroughs that will benefit cancer patients, but our ability to realize this potential will depend in large part on the level of NIH and NCI funding that will be available for cancer research in the future.

With robust support, research can help us to accomplish the ultimate goal once articulated by the late Dr. Ernst Wynder, "To help people die young, at an old age".

This AACI Commentary is excerpted from Dr. Sellers' written and in-person testimony before the United States Senate Special Committee on Aging, delivered on May 7, 2014. John DeMuro, federal government affairs director at Moffitt Cancer Center, Mary Lee Watts, director of government relations for the American Association for Cancer Research, and Andrew Stothert, graduate assistant at the University of South Florida, contributed to the testimony.


 
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