Highlighted Scientific Opportunities in Cancer Research
NCI continually pursues new and emerging scientific opportunities that, with further investment, would catalyze progress in cancer research. With more knowledge than ever before, researchers have many opportunities to make research advances faster, expand clinical trial access to more people, and clarify the many influences on cancer risk and patient outcomes.
Read about five areas of opportunity for fiscal year 2025 and how sustained investments in each area would support the goals and strategies of the National Cancer Plan.
Improving Patients’ Lives through Symptom Science
More people with cancer are living longer after their diagnosis, which marks the beginning of cancer survivorship. With more than 18 million cancer survivors in the United States, delivering optimal cancer care must include a focus on mitigating the immediate and long-term effects of cancer and its treatment, including the development of second cancers. We must also understand how co-occurring health conditions—such as high blood pressure, diabetes, and other chronic illnesses—contribute to cancer outcomes. Investments in symptom science, a field of research to identify individuals at risk for developing treatment-related symptoms and limit the occurrence and severity of those symptoms, are critical for allowing cancer survivors to maintain productive and vibrant lives.
Reaching the goals of symptom science is not easy. Every patient is unique in their genetic makeup, health status, and lived experiences. Some cancer treatments have severe or difficult-to-treat side effects—such as cardiotoxicity, neurotoxicity, and pain—that can interrupt or delay treatment. And novel therapies will create new challenges that must be addressed. Therefore, research on how to monitor, prevent, and reduce these cancer-related complications is critical, especially in young cancer survivors who may live decades after their cancer diagnosis.
Sustained investments in symptom science research and innovative long-term care of cancer survivors will enhance treatment delivery, limit long-term side effects, and have a positive impact on millions living with cancer now and in the future.
Revolutionizing Cancer Clinical Trials
Clinical trials are essential for achieving progress against cancer. They help provide the evidence that informs health care providers on the best approaches for preventing, diagnosing, and treating cancer, and on how to manage cancer-related symptoms. As part of ongoing work to modernize clinical trials, NCI is working to increase clinical trial accrual, maximize the diversity of participants, and expand clinical trial infrastructure into communities that are medically underserved or underrepresented.
More work is needed to revolutionize clinical trials. This includes designing flexible or pragmatic trials that save on cost and time, incorporating artificial intelligence technologies to accelerate progress, and re-examining clinical trial inclusion criteria to make participation easier for patients.
With additional investments, NCI can build on the lessons learned from clinical trials conducted during the COVID-19 pandemic (such as using telemedicine) and harness the full capabilities of the extramural clinical research community and the NIH Clinical Center to expand access to clinical trials. As clinical trials become more decentralized, investments are needed to study novel strategies to harmonize data across the myriad of clinical studies and incorporate real-world evidence, while always safeguarding patient privacy.
One of the National Cancer Plan strategies for developing effective treatments includes moving promising new treatments from discovery to clinical trials more quickly and ensuring equitable access to all treatments. Another National Cancer Plan strategy is to develop new methods to detect cancers early, especially ones that don’t yet have effective screening tests. As new screening strategies emerge, clinical trials can help bring these lifesaving methods into routine practice sooner. These strategies rely on continued investment in NCI clinical trials programs to enable their successful modernization and growth.
Clarifying the Impact of the Environment on Cancer Risk
Environmental exposures, including the air we breathe, the food we eat, and the places we live and work, can have a large impact on cancer development, progression, and survivorship. However, precisely how such environmental exposures alter the trajectory of cancer is difficult to capture and varies dramatically between people and from one location to the next. We need to focus on accurately measuring environmental exposures; understanding how our bodies respond to our physical environments, social influences, and economic circumstances; and learning how environmental exposures affect cancer outcomes.
NCI supports research on environmental impacts along the entire cancer continuum. This spans studies on cellular changes after toxic exposures to research on why some communities are disproportionately impacted by environmental factors associated with cancer risk. For example, NCI-supported research is looking at the impact of climate change on cancer rates, cancer care delivery, cancer-related behaviors, and health equity.
More investments are needed to harmonize and integrate measurable information about environment-related cancer risk with information about tumor biology, such as from The Cancer Genome Atlas and the Human Tumor Atlas Network. This work could help identify people who are more susceptible to specific exposures and inform cancer prevention and treatment strategies.
Such investments in environmental risk research are critical to supporting the National Cancer Plan goals of preventing cancer and eliminating inequities. Over decades, NCI has built a foundation to effectively conduct this type of research.
Harnessing the Power of Cancer Data
Imagine a cloud-based platform that automatically manages the ever-increasing amount of cancer-related data and is accessible to the entire cancer community, from computational biologists to laboratory scientists to clinicians and patients. Building an interconnected Cancer Research Data Ecosystem to collect, integrate, and share data from a broad range of sources is critical to maximizing the utility of data from every laboratory experiment, every clinical trial, and every patient experience.
The NCI-supported Cancer Research Data Commons; Surveillance, Epidemiology, and End Results (SEER) Program; and Childhood Cancer Data Initiative are fundamental components of the data ecosystem. Many NCI programs, such as the Human Tumor Atlas Network and Cancer Systems Biology Consortium, are already poised to incorporate data collected through these efforts into a better understanding of cancer. NCI also supports research to advance artificial intelligence and machine learning methods to analyze cancer data, while bringing together diverse perspectives to ensure robust and ethical use of artificial intelligence for cancer research.
However, a cloud-based platform that could integrate these distinct types of data into one virtual ecosystem does not yet exist. We also require better tools that allow the broad scientific and clinical community to use these data in a way that preserves data security and patient confidentiality.
With such an ecosystem, the cancer research community could more efficiently and effectively harness the power of data. For the patient, this means more accurate predictions about cancer risks and, for those with cancer, responses to treatment. For the researcher, this means the ability to mine cancer-related data to uncover innovative approaches for early detection and treatment to reduce the burden of cancer for patients and their families.
Unraveling the Complexity of Cancer Metastasis
The spread of cancer cells from the primary tumor to other sites in the body, a process called metastasis, is responsible for most cancer deaths. Decades of cancer biology research have led to a basic awareness of how metastasis happens. However, a deeper understanding is needed to prevent and treat this often-devastating progression of the disease. NCI-supported research—driven in part by the Metastasis Research Network—is diving into the complex mechanisms underlying the metastatic process, including its early triggers, the adaptation to new environments, the influences from surrounding tissues and immune cells, and the development of drug resistance.
Historically, metastasis has been considered a problem in the later stages of cancer, but recent research has revealed that cancer can begin spreading at the very early stages, before a primary tumor is even detectable. As a consequence, individual colonies of cancer cells, some of which may have treatment-hindering traits that are distinct from the primary tumor, can remain hidden for months, years, or even decades. Why some metastatic cells lie dormant in the body—escaping immune surveillance before emerging and growing into overt metastatic disease—is a key unanswered question.
Sustained investment in metastasis research to answer these persistent questions is essential for meeting the National Cancer Plan goal to develop effective treatments for people with metastatic cancer. NCI investments to date have led to innovative technologies that can now reveal metastases, circulating tumor cells, and tumor genomics at never-before-seen resolution. These technologies, combined with a large body of knowledge about cancer biology and advanced computational modeling, offer more opportunities than ever to unravel the complexities of the cancer metastasis process.