The importance of federal funding in cancer research: A call to action

“Healthy citizens are the greatest asset any country can have.”

― Winston S. Churchill

Michael S. Cookson, MD, MMHC, FACS

For almost my entire career, I have recognized the importance of government funding for cancer research. These trials have provided guidance and options for the treatment of patients with cancer that often define new standards of care. As a urologic surgeon, I have seen firsthand how federal funding from agencies like the National Institutes of Health and the National Cancer Institute (NCI) has shaped disease management over the past 25 years. This support has driven major advancements in understanding, diagnosing, and treating urologic cancers, ultimately improving patient outcomes and survival rates. Even as residents in training, we enrolled patients in important cooperative group trials in prostate, bladder, and kidney cancer. Many of these trials were “practice-changing” and remain standards in our clinical practices. This is collectively referred to as research-based medicine and contributes high levels of scientific evidence that can be incorporated into practice guidelines.

Among the most notable federally funded trials are those that revolutionized bladder cancer treatment, such as the SWOG 8507 trial, which demonstrated the benefit of maintenance BCG therapy in high-risk, non–muscle invasive bladder cancer.¹ Another major milestone was the SWOG 8710 trial, which established the role of neoadjuvant chemotherapy before radical cystectomy in muscle invasive bladder cancer, significantly improving survival rates.² Similarly, in prostate cancer, federal funding enabled groundbreaking research such as the Prostate Cancer Prevention Trial, which found that finasteride reduced prostate cancer risk by nearly 25%.³ The phase 3 Selenium and Vitamin E Cancer Prevention Trial (SELECT; NCT00006392) further investigated potential chemopreventive strategies, shaping our understanding of prostate cancer risk factors.⁴

The importance of government funding is a global issue. The ProtecT trial (NCT02044172), which provided key insights into the effectiveness of active surveillance compared with surgery or radiation, was another landmark study that continues to guide patient care today and was funded in the United Kingdom.⁵ Additionally, trials examining the role of immunotherapy and cytoreductive nephrectomy in metastatic kidney cancer have significantly improved treatment options.⁶ Yet, these trials and the patients who enroll are indeed local. Flash forward to the present day: last year alone, the urologic oncology clinic at my center enrolled more than 100 patients in NCI-sponsored clinical trials. These trials and the potential advances that can result from them are essential to our clinical DNA. Without these brave patients and coordinated research efforts, the answers to some of oncology’s most pressing questions would remain elusive.

A Looming Threat to Cancer Research

So, why take the time to acknowledge these past trials and their importance in ongoing research? The answer is simple: The war on cancer rages on. However, there is a real and present danger to the future of cancer breakthroughs. This year, funding for clinical trials and scientific research is under threat at a time when we should be increasing support. Recently, there have been proposed reductions in indirect costs for federally funded research that could have serious effects on cancer research. What are the potential consequences of reducing these costs? First, this would result in an immediate reduction in research capacity. Funding cuts for infrastructure and support services would limit the number of research projects and clinical trials at any given institution, leading to a nationwide decline in research output. The brakes would be slammed on innovation, making it harder to pursue groundbreaking, high-risk research—the kind that leads to paradigm-shifting discoveries.

The downstream consequences could be severe. Without sufficient funding, critical advancements in early detection and new therapies would slow, potentially leading to increased cancer mortality rates. For example, research into liquid biopsies—minimally invasive tests that detect cancer DNA in blood—has shown promise for early detection in multiple cancers, including prostate and bladder cancer. Continued investment is needed to refine and integrate these technologies into routine clinical practice.

There are also significant economic implications. Reducing research funding will lead to job losses in the biomedical research sector and hinder medical innovation. This is compounded by the already present workforce shortages in health care, exacerbated by the postpandemic economy. The economic impact of biomedical research extends far beyond the lab; it fuels biotechnology start-ups, drives pharmaceutical advancements, and supports jobs in countless ancillary industries.

The Need for Continued Investment in Cancer Research

Continued investment in cancer research, precision medicine, and early detection technologies is critical to improving patient outcomes and reducing the burden of urologic cancers. Federal funding has been the backbone of transformative discoveries, and maintaining this support is essential to sustaining progress. One of the greatest success stories of federally funded cancer research is the dramatic improvement in cancer survival rates over the past several decades. The overall cancer death rate in the US has declined by 33% since 1991, largely due to advances in early detection, targeted therapies, and immunotherapy—all of which were made possible through federal investment.⁷ Given that urologic cancers account for about 25% of all adult cancers, reductions in funding would disproportionately impact research in prostate, bladder, and kidney cancer. We must take a stand now to ensure continued progress. The fight against cancer is far from over, and we must not allow financial barriers to hinder the lifesaving research that so many patients depend on.

A Call to Action

As a clinician, researcher, and advocate, I aim to raise awareness of the potential threat posed by cuts to federal research funding. We must lobby to maintain our current funding levels and push for increased support to continue driving progress in cancer care. The words attributed to both William Bruce Cameron and Albert Einstein resonate now more than ever: “Not everything that counts can be counted, and not everything that can be counted counts.” Cancer research funding is an investment in human lives—it is immeasurable in value yet essential in impact. We must act now to protect the future of cancer research and ensure that the next generation of breakthroughs becomes a reality.

REFERENCES

1. Lamm DL, Blumenstein BA, Crissman JD, et al. Maintenance bacillus Calmette-Guerin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group study. J Urol. 2000;163(4):1124-1129.

2. Grossman HB, Natale RB, Tangen CM, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. 2003;349(9):859-866. doi:10.1056/NEJMoa022148

3. Thompson IM, Goodman PJ, Tangen CM, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med. 2003;349(3):215-224. doi:10.1056/NEJMoa030660

4. Lippman SM, Klein EA, Goodman PJ, et al. Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2009;301(1):39-51. doi:10.1001/jama.2008.864

5. Hamdy FC, Donovan JL, Lane JA, et al; ProtecT Study Group. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med. 2016;375(15):1415-1424. doi:10.1056/NEJMoa1606220

6. Motzer RJ, Tannir NM, McDermott DF, et al. Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma. N Engl J Med. 2018;378(14):1277-1290. doi:10.1056/NEJMoa1712126

7. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. doi:10.3322/caac.21763