Adapting the Translational and Clinical Infrastructure to Meet Tomorrow's Challenges
In an analysis of cancer trends over decades, 5-year survival of patients with cancer has risen from approximately 20 percent in 1935 to 50 percent in 1971 to 64 percent by 2003. Although increased screening during this interval has influenced these survival trends, a very reliable endpoint, the number of cancer deaths per 100,000 Americans, has also been falling since about 1990.
Deaths from lung cancer, for example, have been declining in men since 1991 and in women have plateaued since 1995, predictably following the substantial decrease in per capita cigarette consumption that began in the 1960s. Mortality from colorectal cancer has been declining for women since 1975 and for men since the 1980s.
One of the challenges we face is to accelerate these encouraging trends. Partnerships like those with Avon are one way of doing so, as are events such as Breast Cancer Awareness Month, which allow the research and advocacy communities to reach out to the public and patients in new and different ways.
Another important component of this effort will be the continued emphasis on translational research. Many models exist of optimum interactions between laboratory, clinical, and public health investigators. Translational research, described by some as "from bench to bedside," more accurately involves bidirectional interactions between laboratory and clinical and population science.
In addition to funding research grants, NCI also continues to fund infrastructure to facilitate translational research. NCI-designated cancer centers are the centerpiece of this infrastructure, serving as leaders in the discovery of the nature of cancer and development of more effective approaches to prevention, diagnosis, and therapy. Cancer centers also deliver medical advances to patients and their families, educate health care professionals and the public, and reach out to underserved populations. The National Cancer Advisory Board has recently approved new guidelines for NCI-designated cancer centers, which incorporate the recommendations made by its P30/P50 working group in February 2003. The new guidelines - posted on the NCI Web site at http://cancercenters.cancer.gov/documents/CCSG_Guide12_04.pdf - provide more flexibility to NCI-designated cancer centers. They include new sections on the formation of partnerships, consortium centers, and affiliations; staff investigator support for clinical investigators; and guidance on newer specialized resources, such as informatics and imaging. The guidelines for the SPORE program also are being revised and, like the cancer center guidelines, will reflect the P30/P50 working group's recommendations, including the formation of a parent committee that will review applications across cancer sites and provide a more global management function for the program.
Translational research also requires a cadre of investigators with the appropriate training. NCI remains committed to training the next generation in laboratory, clinical, and population science. To mitigate the impact of a flat budget for 2004, NCI initially supplemented the allocation to the training grant program by a total of $4 million. End-of-the-year money allowed funding of additional training grants. We also were able to provide a number of interim support awards to institutional grants that just missed the payline and had to resubmit. All in all an additional $8.6 million was awarded subsequent to the initial funding projections. NCI also received and reviewed 326 loan repayment applications, of which 176 (54 percent) were funded at a total of $8.2 million.
Whether through innovative partnerships with nonprofit groups or industry, the launch of initiatives such as the NCI Alliance for Nanotechnology in Cancer, or more flexible cancer center guidelines, our work must continuously overcome hurdles and address challenges. Hopefully these initiatives will be reflected in annual cancer trends, and patients and their families will reap the rewards.
Dr. Karen Antman