Funding NET cancer research

While the news on the NET cancer research front was very good at last week’s Dana-Farber Cancer Institute Gastrointestinal Visiting Committee meeting, the financial outlook was far less upbeat. We spent a good chunk of our working lunch talking about funding issues given the rapidly approaching fiscal cliff and what may turn into a weakening global economy.

I heard for years how money did not matter.

The more we talked, the more I felt like we were potentially looking at 1968 all over again. That year, faced with a budget crunch, the federal government decided

to eliminate all funding for what it saw as minor cancers. On that list was NET cancer. The next time that disease saw any federal money was 2008. Today there are two federal grants helping fund NET cancer research. They are not large, but they are there. That funding sends a message to other funders, however, as well. If it is important enough for the National Cancer Institute to fund, their reasoning goes, it may be important enough for us.

I would not bet on a cut of less than 10 percent…At current funding levels, only seven percent of all grant requests end up being funded at the federal level. Under the sequester the House and Senate agreed to in August 2011 as part of the budget ceiling deal, spending on cancer research faces a potential 10 percent cut in next year’s budget. Depending on the election and what kind of deal a lame-duck session of congress works out in the waning days of the year–if it works out anything at all–cancer funding could do better, worse, or stay where it appears to be under the sequester.

But when other cancers get a cold, NET cancer gets pneumonia. Our resources are so slender that any kind of loss of resources can set us back years.

I would not bet on a cut of less than 10 percent–and I don’t think many people in the room Friday would bet on it either. That 10 percent cut would more than wipe out all of the gains made in federal research funding at DFCI since 2003. To say there has been little growth in federal spending over the last ten years would be damning with faint praise. The increases have not even come close to keeping pace with inflation. And I would be very surprised if NET cancer research funding from the government would survive a 10 percent cut.

Inside the DFCI numbers

DFCI’s operating expenses have more than doubled over the last 10 years–as has the number of patients treated in a year. A just-completed capital campaign–and a substantial increase in philanthropy income as a result–has helped the Institute continue to expand its research footprint. But the ongoing weakness in the economy has people worried about whether those numbers can be sustained. Private support for DFCI was virtually flat this year–and giving by individuals was down about one-sixth: down over $9 million. Fortunately, corporate giving was up almost the same amount, but if the economy were to weaken substantially it is not clear that could be maintained. As both I and others have written, we do not lack for ideas when it comes to cancer research; what we lack are the financial resources to investigate every avenue that needs to be investigated.

That funding sends a message to other funders…

And nowhere is that more true than in the gastrointestinal cancers in general–and NET cancer in particular. All these cancers are difficult to detect–and traditional approaches to research and treatment don’t seem to work very well. The best answer we have is early detection and surgery in most cases. Later detection leaves us relegated to trying to slow the disease down and managing end of life care. As I wrote yesterday, there are lots of interesting ideas on the table growing out of a better understanding of the way the genomes of these cancers work–and not just for NET cancer.

As an educator, I heard for years how money did not matter. It was not true in education–and it is certainly not true for cancer research in general–or NET cancer in particular.