Sustaining Cancer Research and Oncology: A Call to Congress

In this month's Chief Insights in Oncology, Robert L. Ferris, UNC Lineberger Comprehensive Cancer Center and editor-in-chief of Targeted Therapies in Oncology, discusses his August column.

Click here to read Ferris's full column from this month.

Ferris, with 25 years of experience in the field, notes that while financial pressures have always existed, he has "cannot recall a period during which this immensely productive clinical oncology and research enterprise faced simultaneous threats to its foundation, as we have observed in the past 4 months." These threats are multifaceted, impacting both research funding and clinical care delivery.

A major concern is the dramatic proposed cuts to the National Cancer Institute (NCI) budget. Historically, a 10th percentile funding payline for R01 grants was considered a disappointment. However, the current proposals suggest a "fundable threshold of merely the fourth to fifth percentile at best." This would have "devastating consequences for the return on investment in discovery, translation, clinical trials, and biotech and pharmaceutical commercialization."

Ferris notes "widespread alarm" over "dramatic and sudden alterations to the NCI Cancer Centers program and its peer review process for NCI designation—effectively changing the rules midgame at the very institutions responsible for deploying 75% or more of the national cancer research and NCI budget." This instability directly impacts the institutions crucial for driving cancer research.

Beyond research, the clinical realm faces significant challenges. Concerns are escalating regarding "Medicare, Medicaid, and various hospital-based reimbursement mechanisms." Specifically, proposed changes affecting the 340B Drug Discount Program are deemed "equally troubling." This program is described as "a cornerstone for subsidizing and supporting high-quality care in eligible disproportionate share hospitals when direct professional billing is insufficient."

The financial instability poses a significant threat to the future of the oncology workforce. Ferris states, "As a physician-scientist, witnessing potential risks to the future talent pipeline in academic oncology is deeply concerning." He highlights that many in the field "chose these careers despite opportunities for higher salaries, lower tuition costs, or more immediate permanent employment" and that the field has been "fortunate to attract the brightest minds." The current situation jeopardizes this ability to attract and retain talent.

Ferris quetsions whether "Congress truly grasp[s] the magnitude of what is at stake" and express hope that "some leaders within the US Senate and House of Representatives do recognize the immense value that a productive workforce, coupled with exceptional cancer prevention and timely care, holds for both the health and economic competitiveness of our nation." The plea is for Congress, particularly the Appropriations Committee leaders, to "perceive the profound value of this tremendous enterprise, built upon more than 50 years of national investment, which should not be disregarded or deconstructed in a mere year or two."

The US oncology enterprise, a global leader in cancer research and care, is facing severe and simultaneous financial threats from proposed NCI budget cuts and changes to reimbursement mechanisms. These challenges risk devastating consequences for scientific discovery, clinical trials, patient access to care, and the future pipeline of oncologists and researchers. Ferris issues a direct and urgent appeal to Congress to recognize the immense value and national investment in this enterprise and to take immediate action to safeguard its foundation.