Photorealistic, microscopic rendering of tumor cells – Generated with Sora
A new study revealed that US federal cancer research funding from the National Institutes of Health (NIH) and Congressionally Directed Medical Research Programs (CDMRP) disproportionately favors cancers with high incidence rather than high mortality, leaving cancers like lung, liver, and colorectal consistently underfunded. The analysis also found that cancers more prevalent among Black patients are systematically underserved.
From 2013 to 2022, the cancers receiving the most federal funding were breast ($8.36B), lung ($3.83B), and prostate ($3.61B). However, cancers with some of the highest mortality burdens, such as hepatobiliary ($1.13B), cervical ($1.12B), and uterine ($435M), received significantly fewer resources. Importantly, funding was strongly correlated with disease incidence (Pearson correlation coefficient [PCC], 0.85) but poorly correlated with mortality (PCC, 0.36). Moreover, federal funding levels were predictive of the number of clinical trials per cancer type (PCC, 0.76), reinforcing the concern that underfunded cancers lack research momentum and therapeutic advancement.
In an interview with Targeted Oncology, Suneel Kamath, MD, gastrointestinal medical oncologist at Cleveland Clinic Cancer Center, further discussed these new data, highlighting the significant disparities in federal cancer research funding relative to disease mortality.
Targeted Oncology: What is the background on this NIH and federal funding disparities study?
Suneel Kamath, MD: This is something I have been studying for over many years now. I’ve always noticed that certain diseases, when talked with our patients about, they are always very familiar with and others, [people are not familiar with]. I realized that so much of that comes down to the amount of federal funding, nonprofit funding, and everything that goes to those diseases. I have always wondered, does that also then relate to the treatments that we have, the outcomes we are able to achieve for our patients?
I started to look into where the dollars go from for both the NIH and the CDMRP. I started to look at where the dollars are going, and does that really line up with what people get, the incidence of different cancers, and also the mortality rates, what people really die of. Not surprisingly, there really is not a lot of alignment between those factors. Even though you would think it is logical, things that affect more people, that cause more deaths, we would fund those better. It turns out not to be the case.
Can you summarize your key findings on disparities in cancer research funding across the different tumor types?
I looked at the amount of NIH and CDMRP funding over a 10‑year period, 2013 to 2022, so it was the most recent that I could get. But I compared that to 3 things: the incidence of different cancers, mortality rates, and then the number of clinical trials that are ongoing for each of those different tumor types. What I found was that there was a good relationship between how many federal dollars there were with the incidence of a cancer, so the more common ones—like lung, breast, prostate, and colorectal—were getting higher amounts of funding, as it should be. But if you look then at mortality rates, so cancers with high mortality rates, which are now pancreatic, a lot of the liver cancers, colorectal, we start to see that there was a significant drop‑off in dollars there.
What that tells you is that we are very good at funding cancers that have a high incidence, and that’s probably because it just makes sense—a common disease, there are more people there to advocate for it. It is more likely that people are aware of it. So, the dollars are there. There’s more advocacy to your [representatives] and our federal government to make sure there is funding for those. But those that have higher mortality rates, they do not have nearly as many voices to advocate for those. So, dollars lag quite a bit for those, and it was really for pancreatic, liver, [and] lung as well are probably the most underfunded disease[s], I would say.
There’s probably some stigma going on there as well. Lung cancer has that association with smoking, and people tend to blame the patient, forgetting that the fastest‑growing incidence of lung cancer actually is in nonsmokers. I think probably that stigma is sort of unfounded and unfair. So, several tumor types really have lagged a lot in federal funding. If you look at the number of clinical trials in those diseases, as you would expect, there’s a very strong relationship between the number of dollars that go to a particular tumor type and the number of trials ongoing for that tumor type. So, things like uterine cancer, liver, and pancreatic cancer have fewer clinical trials ongoing vs well‑funded ones like breast cancer, lymphoma, or leukemia, for example.
The problem there, of course, is, cancers that have high mortality rates, if you put very few dollars towards researching those, you will continue to have bad outcomes and high mortality rates. The only way we are going to reverse this cycle is if we really start to think more carefully about funding diseases that affect the most people in the worst possible way and causing death due to that disease. We need to focus our funding towards those high‑mortality cancers to start reversing that trend.
How can oncologists, advocates, or stakeholders use this data to help drive more equitable research moving forward?
We are learning this year that even cancer research funding is not a protected entity in our federal government. We should not take that for granted. We need to advocate for funding for the research we need to do to help our patients.
In addition to advocating for the diseases that that person might treat or see, I think we need to advocate for a more rational algorithm or some sort of formula or score that we would use to determine where we put our dollars. Especially as those dollars become more scarce, it becomes that much more important to make sure that diseases we need the most progress in and have the funding make that progress. I would say that is advocating to your local [representatives], even with patients—I’ve talked about this with the people I take care of, there’s many that have been very active themselves with advocacy groups or mentoring other patients. So, I sense that they have that outward drive to make things better for others. I make them aware of this as well and have them be an agent of change as well. It is sort of a collective voice across a lot of people that can make a big difference here.
What would you want a community oncologist to know about this research?
I would emphasize that many of the underfunded cancers are still very common. There’s this tendency to think it’s only the rare diseases that are not getting enough funding. Lung cancer is the second most common cancer, no, and it has the highest mortality rate of all of them, but it’s still an extremely underfunded disease. I do not think that it is just only the rare diseases that are affected by this. It has many very common ones too.