We’ve all been struck by the increasingly uncivil discourse among our elected, or hope-to-be-elected, politicians over the last few years. However, as disturbing as this set of circumstances appears, I remain eternally optimistic about the future of oncology within the realm of the political scene—perhaps optimism is a required personality characteristic for those of us who call ourselves oncologists!
In early May, a group of representatives from ASCO and from our sister societies, the Association of American Cancer Institutes (AACI) and the American Association for Cancer Research (AACR), met “on the Hill” in our nation’s capital. Our mission was to thank our representatives in Congress for their recent increase in National Institutes of Health (NIH) funding (an additional $2.5 billion in the 2016 budget), but also to advocate for more.
After the heady days of the 1990s, when the NIH budget was doubled, we’ve seen flat funding over the last decade. Although inflation during that period was relatively low compared to the late 1970s, it was still sufficiently progressive to result in an actuarial cut in the NIH budget of nearly 20%. We made it clear to our representatives and senators that NIH, and by inference the National Cancer Institute (NCI), needs to “not just catch up, but to keep up!”
This is not about money—it’s about people. I don’t need to tell those of you who are reading this that there is no one in our society—liberal, conservative, libertarian, or just don’t care—who isn’t touched in some way by cancer. Each of us either has it ourselves, or we have loved ones and friends who are affected.
As I enter my 34th year in oncology, I am amazed by the changes that we’ve seen in cancer diagnosis and treatment. Breast cancer, which is my day job, is a great example. When I was a fellow at the then “Sidney” Farber Cancer Institute, or SFCI (yes, I’m that old!), we were still debating whether to do radical mastectomies, let alone breast preservation. Radiation therapy delivery was fairly non-directed, there were no more than five to six chemotherapeutic agents for the disease, antiemetics were a joke (and not a funny one), and growth factor support had yet to be developed. Endocrine therapy consisted of either surgery (I became skilled at taking care of Addison’s syndrome in my patients who had been treated with adrenalectomy) or tamoxifen, megestrol acetate, or fluoxymesterone. The sedative aminoglutethimide had been found to shut down adrenal steroid synthesis, so it was being tested as an antiestrogen (again with the Addison’s syndrome!), and specific aromatase inhibitors and fulvestrant were numbered chemicals—merely twinkles in the eyes of a group of laboratorians. In 1985, “HER2” was what your mother said to you as a kid to make you take your sister along on an outing—certainly not a target for therapy of breast cancer.
Now: The odds of surviving disease-free for 5 to 10 years for most women with estrogen receptor–positive breast cancer are so high that our trials must include thousands of women and they take nearly a decade of follow-up just to observe a few percentage differences in outcomes for new treatments. Chemotherapy is not only much better, it’s much safer and better tolerated. At the SFCI in the early 1980s, all adjuvant chemotherapy was given in the inpatient ward—when’s the last time you did that? In fact, we are now stealing a page from our surgical forefathers, who courageously did studies to show less was as good as more surgery, by conducting trials to determine who doesn’t need chemotherapy.
How did all this happen? Not by accident! Rather, by hard work conducted by laboratory, translational, and clinical investigators working together to extend, and improve, our patients’ lives.
Who paid for it? We all did! Through bipartisan support of NIH-sponsored research in all three areas.
So what’s the issue? This is a time of inflection in oncology. Immune therapy. Precision medicine. Genomic-based signature assays and personalized care. Targeted therapies. These aren’t just buzzwords—they are becoming realities, thanks to ongoing laboratory, translational, and clinical research. My concern is that we may lose the opportunity to take advantage of these innovations if we do not get together and push for bipartisan support of NCI funding for research.
Yes, I’m excited about next-generation sequencing applications in oncology, but I am particularly worried about next-generation investigators in cancer, especially those with clinical training who want to conduct translational and clinical research. Medical students are graduating with educational debts of hundreds of thousands of dollars. We entice them to consider a career in research, but having a roughly one in 10 chance of getting a grant approved to support their work is not very seductive. It doesn’t take long to do that math: “Should I try to do research or go into more lucrative areas so I can pay off my education loans?” ASCO, through the Conquer Cancer Foundation (CCF), is doing its part with Young Investigator and Career Development Awards, but that’s not nearly enough. We need to have sustainable and consistent funding for the NIH and NCI to hasten the kinds of differences we all know are possible.
So why am I optimistic? When I travel to Europe for meetings, I am always struck by the fact that I take part in amiable and collegial discussions among my fellow investigators, when 75 years ago our fathers and grandfathers were trying to kill each other. If we can overcome the kinds of discord that broke the world apart in the 1940s, surely we can work together to continue to make headway against this pervasive and terrible disease that affects all of us. I don’t care what your politics are—this is an issue we all support.
What can we do? Make a contribution to the CCF so we can continue to support the next generation of investigators. As important, notify your Congressional representatives—thank them for the recent support, but enthusiastically encourage further increases in the NIH budget, regardless of which side of the aisle they sit on, so we can “catch up and keep up.” The future is now!