Questioning Cancer Research Priorities

Approximately three quarters of funding for cancer research goes to biology research and drug development in Europe, and this concerns Professor Richard Sullivan, King’s Health Partners Integrated Cancer Centre in London and chairman of the European Cancer Research Managers Forum. He noted that the imbalance in cancer research funding is even greater in the United States. Prof Sullivan said he specializes in the “politics of prioritization in cancer research.” He explained that these priorities are not static: “Cancer research is a very dynamic area…when you think about prioritization of cancer research, you have to think of one slice of time. Things change very, very quickly.”

Over the past several years, Prof Sullivan’s group has been analyzing not only how research money is spent but also what the needs are going to be in the next decade. He said that in the next 50 years, the burden of cancer is going to shift to rapidly expanding low- and middle-income and developing countries. As a result, Prof Sullivan believes the global needs for cancer research suggest more funding is needed for preventive strategies, pediatric oncology, and early diagnosis. “You can take the quite reasonable view that we know the risk factors now,” he said. “What we don’t understand is how to take that research on prevention and apply it in populations because we don’t understand the behavior of those groups or how that might change over the next 20 to 30 years.” As an example, he noted that studies show many European men will live with rectal bleeding for a year before seeing a physician.

Prof Sullivan also said more research money should be devoted to developing and evolving surgical technology, observing that less than 3% of today’s funding goes toward this purpose. “When you consider surgery is one of the most important areas of control and cure,” he said, “that’s extraordinary low.” He said it is government groups and the charitable sector that really need to reconsider how they spend their research dollars because pharmaceutical research and biological research will continue regardless.

Prof Sullivan’s view on how to prioritize funding seems somewhat at odds with the new push by oncology organizations and government groups to personalize cancer care. Current research demands are focused heavily on identifying genetic or biological markers that affect disease progression or treatment response and developing drugs tailored toward cancer patients with specific biomarkers. As a result, organizations like the National Cancer Institute and ASCO are encouraging more funding in these areas, not less.

Another effort Prof Sullivan’s group is working on is establishing a “Global Cancer Fund” that would support more translational research, similar to current research efforts on infectious diseases like HIV, malaria, and tuberculosis that are underway in developing nations heavily burdened by these illnesses. He said, “Developed countries have a responsibility to investigate which cancer control approaches are exportable and to support those institutions working in those areas.” He concluded that there is also a need for more creativity in research, particularly with an aging population that will have increasingly complex healthcare needs. He encouraged more collaboration across “unusual disciplinary boundaries,” and greater attention to cultural differences and the role they play in cancer.