Federal budget cuts have hit cancer researchers hard, threatening new treatments and the search for a cure
Three words can change a life: You've got cancer. "When someone hears those words, the next thing they're hoping to hear is, 'We've got something that can help you,' " says Dr. Michael Caliguiri, director of the Ohio State University Comprehensive Cancer Center and chief executive of the James Cancer Hospital and Solove Research Institute. "Research is what will drive the cure to cancer."
Unfortunately, the lackluster economy and inability of lawmakers to pass a meaningful federal budget-which resulted in sequestration and last October's government shutdown-have led to significant cuts in funding to research new cures and treatments for cancer.
Those budget cuts have hit close to home, and local research institutions such as OSU and Nationwide Children's Hospital have turned to private donations to fill some of the gap.
In 2012, the National Institutes of Health funded 369 grants worth $142 million for all medical research, including cancer, at OSU, according to the American Cancer Society. In 2013, the agency funded 358 grants worth $128 million. Last year, cuts in funds from the National Cancer Institute due to sequestration forced OSU to reduce the number of participants in clinical trials by about 50 percent.
"It has a real, adverse effect on our ability to fund the science our patients depend on," Caliguiri says.
Nationwide Children's Hospital received about $29 million in NIH research grants, including $7 million for cancer research, in 2012. In 2013, the hospital received about $25 million total, including about $5 million for cancer research.
"It's really an unprecedented era in terms of deterioration in cancer funding," says Dr. John Barnard, president of the Research Institute at Nationwide Children's Hospital. "We lean on philanthropy more than we ever have before."
Nationwide Children's Hospital seems to be constantly sponsoring events to bring in donations. They host 5k and 10k races, as well as golf outings. Some doctors have also posted impassioned pleas for research donations on the hospital's web site.
These events and private donations have not been able to completely replace the research dollars lost to federal budget cuts, but the hospital is trying to maximize the money in every way it can, Barnard says. "Philanthropy definitely doesn't make up the difference, but we can apply those dollars in a ways we couldn't use federal dollars, like to recruit premier scientists."
Nationwide Children's Hospital conducts between 125 and 150 pediatric cancer clinical trials and research studies at any one time, and has put a lot of effort into keeping the pace of research going strong. "We're (managing) to do more research than we've ever done before, because we have more talent," Barnard says. "We've been lucky because Columbus is a highly philanthropic city."
Still, they're cautious about what the future holds for cancer research, especially for children. "The reality is childhood cancer is 100 times less common than adult cancer, so it's hard to get on the government's radar screen when we have the burden of disease being far more common in adults," Barnard says.
Because childhood cancer is more rare, there is also little or no research conducted by private pharmaceutical and biotech companies, leaving pediatric researchers more reliant on a shrinking pool of federal funds.
"Unfortunately we're in the era of doing more with less and most of us don't see a light at the end of the tunnel of federal funding. All of us in cancer research are looking to increase philanthropy and seek other means of support," Barnard says. "The problem is real advances in research come from very early stage work that isn't necessarily fundable by pharmaceutical companies, and donors have a harder time understanding it. It's fundamentally important, and that is what the federal government supports."
At OSU, the outlook is equally gloomy.
"We absolutely depend on philanthropy to fill the funding gap," Caliguiri says. They rely more each year on money raised by the Pelotonia bike race and events such as the Buckeye Cruise for Cancer.
The idea for the Pelotonia race, which raised $70 million last year and directly funds cancer research at OSU, came about "because we knew we had to do something different, because (traditional) funding isn't working. The NIH has been pillaged," Caliguiri says. "We're trying to think creatively, but there is still no way we can make up the difference in funding."
Pelotonia money pays for research, as well as $2 million in student fellowships to keep talented young cancer researchers from leaving the field. It's paid for drug trials that the NIH couldn't afford, and funds several $100,000 idea grants for innovative, new research deemed promising by peers.
This fills a critical need, Caliguiri says. "The NIH typically funds low-risk projects, and wants at least 50 percent of the work done before they fund it. There is too little money for innovation."
OSU has about 300 cancer researchers, a number that has held steady in recent years, and runs between 250 and 300 clinical trials at any one time. They have also recruited nearly 200 physicians who are experts in particular cancers. "We're doing a lot of exciting things," Caliguiri says, but with sustained federal funding "we could just be doing a lot more."
It's a sentiment that is widespread in the cancer community.
"There have been so many advances, and there are so many really extraordinary new opportunities that have the potential to make a difference in patients' lives, it's frustrating that every year the funding is cut more," says Jon Retzlaff, managing director of science policy and government affairs for the American Association for Cancer Research. "Cancer is such a complex disease, and requires more scientists working on it, but now we're finding they're less and less able to."
Philanthropy can only do so much. Even though nonprofits such as the American Cancer Society and the Susan G. Komen breast cancer foundation raise money and fund research, their contributions are not enough to make up for federal cuts.
"What they do is fantastic, but the National Cancer Institute funds nearly $5 billion in research and these groups all together only provide in the small millions," Retzlaff says. "It's helpful, but it will never be able to replace or fill the government's role."
The vast majority of medical and cancer research-about 80 percent-is funded by the National Institutes of Health and the National Cancer Institute, but that funding has declined by nearly 25 percent, adjusted for inflation, since 2003, according to the American Society of Cancer Researchers. Due to sequestration, the NCI cut funding for programs by 5.8 percent, a total of $250 million, in 2013. The agency is now funding the lowest number of research projects since 2001.
Federal cancer research funding overall totals about $4.8 billion a year, but more cuts loom on the horizon. The NIH budget will fall from about $29 billion in 2013 to $19 billion if sequestration continues for the next eight years, according to the Association of American Medical Colleges.
The long-term side effects of today's strained fiscal landscape are delayed innovation and a pressing brain drain. The state of Ohio lost about 700 jobs in medical and cancer research in 2013, due to sequestration, according to the American Cancer Society.
In the wake of the recession, private companies are cutting back on research as well. "It's creating a crisis for young people who have trained to become cancer researchers," Caliguiri says. "Working, promotion and putting food on the table is equated with an NIH grant. Twenty years ago, the average age for a first grant was 32. Now it's 43. We can't expect them to finish their training in their late twenties then wait 20 years for their first grant. Young people are where all the ideas come from, and instead of dreaming, they're getting disenchanted."
Right now, patients are reaping the benefits of research conducted during more generous times a decade or more ago, Retzlaff says. Today's cuts, however, mean talented researchers are leaving the field just as the nation is headed for a significant uptick in cancer rates. The majority of cancers occur in those over age 65, and by 2030, as the youngest of the baby boomers enter this demographic, cancer rates are expected to spike by up to 67 percent, according to the American Association for Cancer Research.
"We don't know what great ideas are going unfunded, or what ideas lab chiefs will choose not to pursue because their grant was cut," says David Pugach, director of federal relations for the American Cancer Society Cancer Action Network. "Even with today's challenges, we're not investing enough to combat the disease. When the cancer rates skyrocket as the boomers age, we will not be in a position to detect the disease at its earliest possible stages or have the most effective treatments, and the costs of that in sheer dollars and cents alone will be astronomical."
Cancer is the No. 1 killer of Americans, and is also the most costly disease. In 2008, cancer cost the U.S. $77.4 billion in direct medical costs and $124 billion in lost productivity due to premature death, according to NIH reports.
Overall, the federal budget for cancer research is already very small considering "we're trying to address a problem that kills between one-third and one half of all Americans," says Dr. Clifford Hudis, president of the American Society of Clinical Oncology.
"Federal funding for research is not a boondoggle or a waste," Hudis says. "It's one of the most rewarding expenditures for everyone, returned many times over in health benefits and in economic growth."
Denise Trowbridge is a freelance writer.