NCI Professional Judgment Budget Proposal
NCI’s proposal for a significant budget increase in fiscal year (FY) 2024 is designed to capitalize on important scientific opportunities in pursuit of the goal to end cancer as we know it for all people. These opportunities include
- the exceptional ideas being put forth by the cancer research community, reflected in the explosion of R01 applications in recent years. Investigator-initiated research supported through research project grants, including R01 grants, is the source of some of the most innovative and transformative ideas in cancer research.
- the need to expand and modernize cancer clinical trials, which are essential for moving new methods of preventing, diagnosing, and treating cancer from the laboratory to physicians' offices and other clinical settings to improve care and quality of life for people with cancer or those at risk of cancer.
- the successes of the Cancer Moonshot℠, which NCI will build upon to sustain the progress made through the 21st Century Cures Act and continue to improve our understanding of cancer and identify new approaches to prevent, detect, and treat cancer.
- a continued commitment to advancing health equity and ensuring rapid dissemination and delivery of standards of care so that the benefits of cancer research reach populations that, for too long, have not benefited fully from research progress.
With the necessary increases to NCI’s budget and sustained investments over time, we can leverage the scientific and societal opportunities before us to deliver the research advances that the American people want and deserve.
Funding at the level proposed will also represent progress toward NCI’s goal of increasing the R01 payline—that is, the percentile of R01 grant applications NCI can fund. NCI must also continue to support the expansive infrastructure and resources that are all vital parts of the National Cancer Program—from cutting-edge technology and unprecedented access to cancer data, to nationwide networks of scientists and research centers.
Additional key NCI investments include the
- NCI-Designated Cancer Centers, which deliver the latest cancer treatments to patients in communities across the United States, play an important leadership role in laboratory and clinical research, and provide training for biomedical researchers and health care professionals
- NCI clinical trials networks, which currently enable NCI to enroll patients at over 2,599 academic and community sites across the country
- Childhood Cancer Data Initiative, an ambitious effort in data collection, sharing, analysis, and access to improve the future for children, adolescents, and young adults with cancer
- Specialized Programs of Research Excellence (SPOREs), cornerstones of NCI’s efforts to promote collaborative, interdisciplinary translational cancer research through grants that involve basic and clinical scientists working together to develop new approaches to the prevention, early detection, diagnosis, and treatment of cancer
- NCI Equity and Inclusion Program, which is addressing cancer disparities and growing a more diverse and inclusive cancer research workforce across all NCI programs
Sustained, robust increases are needed so we do not miss out on promising ideas
Investigator-initiated research is the main engine of innovation in the nation’s biomedical research enterprise. Many major cancer research advances (such as targeted therapies and immunotherapies for patients with cancer, and vaccines and drugs to prevent cancer) grew out of such lines of inquiry. NCI must support as many new ideas as possible to ensure that we do not miss the most promising opportunities to make progress against cancer.
In FY 2021, NCI awarded more grants across all mechanisms than ever before—a testament to the enthusiasm and expertise of the cancer research community and sustained national investment in cancer research. Without robust funding increases, NCI’s ability to make similarly aggressive investments in the future is limited.
Most NCI grants provide 5 years of funding to researchers. While this timeframe is necessary for testing ideas with sufficient rigor, the number of new grants awarded each year cannot grow without robust annual funding increases. NCI must support both the cost of grants that carry over from previous years (out-year costs) and the initial-year costs of newly awarded grants. When grants conclude, the allocation that would have gone to them becomes available to support new grants and out-year costs of grants made in previous years. However, this amount is not enough for NCI to increase the number of new awards, year after year. That can only be achieved through sustained funding increases that allow NCI to raise the R01 payline and fund more new ideas each year, particularly in the form of R01 grants.
Over much of the past decade, NCI has experienced a tremendous increase in R01 grant applications, outpacing budget increases. This means we support far fewer grants than we would like, and we are surely missing out on many ideas that could bring us that much closer to ending cancer as we know it. Greater difficulty securing funding for meritorious research also discourages current and future cancer researchers, which poses a further drag on progress.
Focusing on R01 grants, the payline for established investigators in FY 2019 was at the 8th percentile, down from the high of the 16th percentile in FY 2009. Thanks to Congress’s continued support, NCI was able to increase the R01 payline to the 11th percentile in FY 2021, an increase of 37%. NCI has set a goal to reach a payline at the 15th percentile by FY 2025, as we believe this is the minimum payline needed to maintain the strength of the field.
Since FY 2018, the payline for early-stage investigators has been 5 percentile points higher than the payline for established investigators. NCI is committed to nurturing a pipeline of talented and diverse scientists to ensure the future strength of the cancer research workforce. Funding described in this proposal will enable paylines for early-stage investigators to grow from the current 16th percentile to the 19th percentile, enabling NCI to attract more scientists early in their careers through dedicated support.
Cancer Moonshot: New goals, new opportunities
Early in 2022, President Biden announced the reignition of the Cancer Moonshot with the goals of reducing overall cancer death rates by 50% in the next 25 years and improving the quality of life for all people living with cancer and cancer survivors. To achieve the President’s goals and to change the experience of cancer as we know it, the whole-of-government approach must rest on a solid foundation of scientific research.
NCI is uniquely positioned to lead the research that will result in changes in standards of care for people with cancer and to conduct the implementation research needed to identify optimal methods to deliver research findings and other evidence-based knowledge into clinical practice. NCI will build on its legacy of directing the National Cancer Program and the progress made from research funded through the 21st Century Cures Act, which initiated the Cancer Moonshot.
The initial Cancer Moonshot supported a wide range of cancer research goals that included accelerating discovery, increasing collaboration, and expanding data sharing. Over the past 6 fiscal years, NCI has funded almost 300 new projects that are delivering important insights into the mechanisms that drive cancer, addressing cancer disparities, identifying evidence-based strategies for health care delivery, and developing new approaches to prevent and treat cancer.
For example, patient-derived tumor models from diverse populations are being created, characterized, and shared with the research community to understand why certain populations sometimes respond differently to cancer therapies. Another Cancer Moonshot project is developing interventions to overcome barriers to colorectal cancer screening in American Indian populations. Also, Cancer Moonshot–supported networks are working to expand the benefits of immunotherapy for adults and children with cancer. The research done by the Immuno-Oncology Translational Network has led to new insights into how ovarian cancer responds to immunotherapy.
In this next phase of the Cancer Moonshot, NCI will sustain this progress and build upon these successes to continue to improve treatment outcomes and quality of life for all. With support from the White House and bipartisan congressional support, NCI can change the experience of cancer as we know it for all people, by focusing on the following:
- expanding and modernizing cancer clinical trials and the enterprise supporting them
- continuing to invest in basic and translational research to ensure a continuous stream of new approaches to cancer prevention, diagnosis, and treatment
- ensuring equitable health care delivery of current and new standards of care for cancer prevention, screening, and treatment
- expanding and enhancing the diversity of the cancer research workforce