The Future Of Cancer Research In The US

0:07It was more than 50 years ago that President Nixon declared war on cancer when he signed the National Cancer Cancer Act in 1971. And I hope that in the years ahead that we may look back on this day and this action as being the most significant action taken during this administration. It could be. Because when we consider what cancer does each year in the United States, we find that more people each year die of cancer in the United States than all the Americans who lost their lives in World War II. After that, the United States emerged as a juggernaut in cancer research funded largely by the federal government.

0:48But since President Trump took office in January, the administration's sweeping cuts to the federal workforce and government funding are upending the country's cancer research system. Trump officials have directed the National Cancer Institute to slash its contract spending by a third. That means terminating grants for life-saving cancer research. So what do these cuts mean for the present and future of cancer research and treatment? We get into it after the break. I'm Jen White. You're listening to the 1A Podcast. Stay with us. We've got a lot to get to.

1:24Let's meet our panel. With us in studio in Washington, D.C., is Retina Pradhan. She's a correspondent at KFF Health News. Retina, welcome to the program. Thank you. Also with us is Jennifer Guideup. She's a researcher studying accelerated aging in cancer survivors. She's also a former program director at the National Cancer Institute. She left in May. Jennifer, it's great to have you. Thank you. It's great to be here. And Dr. Otis Brawley. He's a physician and a professor of epidemiology and oncology at Johns Hopkins University School of Medicine. He's also an expert in cancer prevention and control.

1:58Dr. Brawley, welcome back to the program. Hello. I wrote you that for decades, government funding of cancer research had broad bipartisan support. Why is the Trump administration now directing the National Cancer Institute to slash, we're talking hundreds of millions of dollars in contracts? I think the way that I would think about it is one scientist very early on this year who works at a university that has a large cancer center that receives a lot of funding from the National Cancer Institute. The way they described it to me was there has been a—the NIH has experienced unprecedented upheaval under the Trump administration.

2:37And they said you can't go after the NIH without compromising the National Cancer Institute. And that's because it's the largest of all the NIH's various arms that research and try to solve some of the most pressing problems in our world, right? mortality and morbidity from different types of diseases. And so I think it's almost like NCI is not immune from what is happening broadly across the NIH, but obviously the stakes are very high because cancer remains the nation's second largest killer. And why has President Trump said these cuts were necessary or justified? I think across the administration and certainly even from HHS Secretary Robert F.

3:29Kennedy Jr., he has said that essentially federal health agencies, including the NIH, the CDC, and everything within it needs to be transformed because they are corrupt, because they haven't, they've committed a lot of harms. And so that is why this is happening in large extent. I also think because of DOGE, right, and its mandate, its sort of mission to enact very significant spending cuts and spending limits across the federal government. That's also why that's happening. And so that's why this is manifesting in reductions in contract spending, in firings of employees, and the climate that has been created, based on what we have heard from scientists who have left and who are still there, is that it's so untenable almost to keep staying because it's so hard to do their jobs.

4:22And so you're seeing a brain drain from the government across the government, and that is, again, NCI is very much affected by all of those broader factors. Jennifer, you used to work as a program director at the National Cancer Institute. You oversaw more than$100 million in research funding. What types of grants, programs, or contracts are being cut or terminated there? Give us more detail. Yeah, so when I was a program director at the National Cancer Institute, I was part of, you know, I was a program director, so I was instructed to start going through grants and flagging them for termination, grants related to diversity, equity, inclusion, health disparities, gender identity, projects tied to COVID-19 and vaccine hesitancy, environmental justice, and other topics that didn't align with the administration's priorities.

5:15I felt that it was unethical and I was unable to uphold scientific integrity. And so I ended up leaving my job because I felt those targeted terminations, especially those related to diversity, equity, and inclusion, violated my own values and made it hard to carry out the mission of the National Cancer Institute, which is to advance scientific knowledge and help all people live longer, healthier lives. What actually happens when the funding for a research project is cut? What does it mean for the people involved in that research? Are they able to quickly resume their work if money comes back, Jennifer?

5:56So when a grant is terminated, all research stops immediately. Data collection stops. Mice colonies, if you're doing animal research or cell lines, get called. If you're doing that type of work, if you're doing clinical trials, sites stop enrollment or pause treatments. And there are real consequences to this. So for some cancer patients, especially those with rare cancers, a clinical trial may be their only treatment option. so when you terminate a grant or it stops those patients may not be able to get their treatment even if the money restarts you can't just flip a switch and restart it on a dime all of this has ripple effects on training and research pipelines innovation and patient access to clinical trials why because it takes time to start things back up and so as a result you lose momentum in ongoing experiments or on life-saving clinical trials.

6:56You lose traction on recruitment or lose people to follow up in the study because the study was stopped. And so there are real consequences to, you know, stopping these grants and terminating them. Dr. Brawley, I'm hoping you can help us understand the state of cancer research and investment in the U.S. before January 2025 and the new administration and how you'd compare that to what you see today? Yeah, thank you for asking that question. We need to focus on what we have gotten out of Nixon's war on cancer. He signed the National Cancer Act in 1971. As a result, research just blossomed. We totally redefined what cancer was, totally redefined our understandings of cancer, And that translated into improvements in prevention, improvements in treatment.

7:54Cancer death rates in this country peaked in 1991. And going to 2022, we've had a 34 % decline in cancer death rate. We prevented at least 3 million people from dying from cancer. What I'm concerned about is we've made tremendous progress. We've got tremendous momentum. We can't lose that momentum. We've got young investigators especially, young people coming into the sciences. And by the way, the thing the National Institutes of Health and National Cancer Institute does best is train young scientists. Our research infrastructure is the envy of the world. I just don't want to stop. Well, Regina, earlier this year, the NIH lost hundreds of employees to mass firings, including dozens at the National Cancer Institute.

8:47So what is the scale of those staffing changes, both in terms of numbers and the functions they performed at the NCI? You referred to it as a brain drain. So I think it's important to, across the government, right, you have full-time employees, civil servants, who work as employees of the federal government, but also NCI and other places, of course. But the NCI really relies on contractors also to perform very key functions on research. So I think when we talk about the scale of the people who are leaving or who have been fired, a lot of them are people who aren't necessarily scientists, but are absolutely essential to help carry out day-to-day tasks, right?

9:36Basic research and fulfill orders for purchasing things or sign contracts, maintain contracts that are needed to run labs that NCI has. And so even communications, when we were reporting on this earlier this year, NCI had a large communication staff of their own, of people who weren't dealing with reporters all the time, trading emails. Their role was to disseminate health information, including making updates to cancer.gov, social media channels, blogs. These are things that patients use daily when themselves or a family member is diagnosed with the disease as a resource. Now, that communication staff has basically almost been totally eliminated.

10:22So when we think about the consolidation that's happening across the federal government and staffing, these things have real impact. And it is not so obvious, but NCI in particular, their contract, their reliance on contractors, I've heard from so many people that it's almost impossible on the inside for them to do their jobs because they can't do these very basic functions that are so important before you even get to the cutting-edge research. Lisa emails, as a cancer survivor from lymphoma, I have a compromised immune system for the rest of my life. I am at increased risk every day because the T-cell therapy for my type of cancer has now been stopped.

11:03So if or when my cancer returns, I have lost this treatment option. I've definitely aged by a decade post bone marrow transplant, and my doctors have no idea how this will impact me down the road. And Barbara in Ohio emails, I am currently in treatment for pancreatic cancer. I am receiving immunotherapy. I was diagnosed four years ago, and if not for research, I would probably be gone now. My treatment, Keytruda, has only recently been found to get positive results in pancreatic cancer patients. There are big advancements in the horizon. Research needs to continue. Dr. Jay Bhattacharya is the director of the NIH.

11:40He's faced criticism from current and former employees for cutting funding for research into improving the health outcomes of racial and ethnic minorities. The Trump administration has maligned this research as being politically or racially biased. This move is despite evidence that says racial minorities and LGBTQ plus populations have higher rates of certain cancer diagnoses and are more likely to receive diagnoses later than white or heterosexual people. Black people are also more likely to die of many cancer types than all other racial and ethnic groups. Here's what Dr. Bhattacharya told PBS in July.

12:15I believe very fundamentally that science should not be partisan. There's no such thing as democratic science or republican science. Science should be something that is for all the people. And science can't work for the people if basically everyone distrusts it. So we have to figure out a way to solve the gap, to solve this divide that we have in this country. Like, we shouldn't be using the NIH as a cudgel to paint Bobby Kennedy or President Trump as anti-science when they're not anti-science. They care deeply about science. Jennifer, I'd first like your assessment of Dr. Bhattacharya's oversight of the NIH amid these funding cuts.

12:54yeah um so dr badacharya and i says you know he says he wants to focus on improving america's health that's a goal that we share um where we diverge though is how we get there um the combination of grant terminations and policy changes like capping indirect costs at 15 for institutions that creates real instability in cancer research programs that is 100 not the correct approach. In science, process matters. Predictability and continuity are what turn discoveries into treatments. And so if you care about doing good science, that continuity and the predictability of funding is essential to support our scientists and the important work that they do.

13:41And Dr. Bromley, when we talk about cuts directed at research that looks at people of color, black people, populations that have higher rates of certain types of cancers or poorer outcomes. What does it mean for those populations that the research around the why is disappearing? Yeah. You know, let me try to define health disparities research a little bit better. Very quickly, the death rate for black women from breast cancer in Louisiana and Mississippi is twice the death rate for black women in Massachusetts. That's the disparity. We need to figure out why. Also, I would point out the death rate for white women in 15 states in the United States is higher than the death rate for black women in Massachusetts.

14:41We need to figure out why that disparity. So yeah, I'm looking at race, but what I'm basically trying to do is figure out why certain people from certain areas of the country have higher death rates and how can we get those down. It's not just looking at black people or black disease. It's not just looking at white people or white disease. It's looking at human beings and trying to decrease their risk of death. So when major research hubs like the NCI face hurdles in funding and staffing, Dr. Brawley, how does it affect cancer research at other institutions more broadly? Well, the National Cancer Institute funds research at 2 ,000 different institutions across the United States.

15:30They have a budget of about$7 billion. It's been shown that for every dollar that they give out to various institutions, it's about$2.50 in economic activity in that particular area. We're discussing the impact of massive cuts to cancer research funding. We're going to take a quick pause here, but still to come, what do these funding cuts mean for the future of patient care and treatment options? We'll be right back.

16:00Now back to the fallout for massive cuts to cancer research contracts. Dr. Brawley, help us better understand how cuts to ongoing cancer research, like clinical trials, how could that affect patient care and treatment options? Yeah, we offer clinical trials at the big cancer centers, and we offer them through the NIH in small community hospitals. There are hospitals all throughout the Midwest of the United States where a woman with breast cancer today will be offered standard treatment or offered treatment with a drug or a new procedure that we think is better in an effort to evaluate that procedure.

16:42with the cutback we're afraid that women with breast cancer men with prostate cancer people with lung cancer won't get these options for alternative therapies or for newer more advanced therapies and keep in mind the system that we've had over the last 50 years to advance these new therapies are all part of the reason why the death rate has actually gone down by 34 percent I cannot overemphasize the fact we have made progress with the current system. And I'm afraid that as we change the current system dramatically and quickly, we're going to break that system. And we're going to stop making progress and lose the momentum that we have.

17:27And Dr. Brawley, what populations are most vulnerable to experiencing disruption in their care because of these cuts? The populations that are most vulnerable are literally anyone who has a cancer. For example, we talked earlier about how the communications group at the National Cancer Institute was abolished. They were all laid off. That group kept up the database of what the latest treatments are for various cancers. This database is something that doctors all across the country, indeed all across the world, consult to figure out what is today's best treatment for the cancer of the patient in front of me.

18:14We got this email from Pat who says, My granddaughter is in the middle of a trial for her brain tumor. It was discovered when she was five and was the size of a golf ball. They can only remove half of it. She's now in a trial for chemo. They just lost funding for it as she is having an MRI today. This is so terrible. I'm so heartbroken for her and her parents. Rachina, you recently wrote a piece for KFF outlining how the number of patients receiving care this year at the National Institutes of Health's Research Hospital, it's continued to drop since February from about 80 patients a day last year to about 60 per day this year.

18:51And you also report that the number of cancer clinical trial participants at the hospital as of July was down about 20 % from last year. What reasons did the workers you spoke with cite for that decline? So I think there are a couple of things going on with that. And just for context, if we think about the NIH as a research hospital, but the patients who come there are enrolled in clinical trials, and that means that they often don't have other options for treatment for their either life-threatening or rare diseases. Traditionally, at least as of recently, the largest share of patients that come to the NIH hospital are cancer patients.

19:29So within that, most, of course, of the NIH's research dollars go outside of the NIH, and that's true of the National Cancer Institute also. For the dollars that stay at the agency, of course, it helps do research there, but also provide care here at the NIH hospital. So the reasons why that's happening, what former officials and current ones have said, is there are a couple of reasons. One is that scientists are leaving the government. If you have scientists who are leading these clinical trials and studies, if they leave, they're not recruiting patients to come here. And so that is likely a large factor in that.

20:09The other reason is immigration-related. The Trump administration's broad immigration policies and their crackdown on deportations and the like has instilled a lot of fear. And previously, there's been a good share of patients who are at the NIH hospital who don't have legal status in the U.S. and also come from abroad. And so that has caused a lot of fear, I think, in coming to the NIH hospital. And so those patients also are not getting care. And there's no question, I think, in my mind that there are cancer patients who are now not receiving treatment because of those reasons. This is something Dr.

20:51Brawley alluded to earlier, but Jennifer, I wanted to get your perspective. How do you think these sudden grant terminations affect researchers, especially early career scientists and researchers at institutions with fewer resources? Yeah, I mean, I think it has huge impacts. So a lot of the times these grants, they have line items in their budgets to hire like a PhD student or postdoctoral students to help do the work. And that's how these students get their training in part. And so, you know, when these grants get terminated, those students lose their funding and they may need to find another job or go somewhere else.

21:28some institutions actually decided this year not to enroll any doctoral students in their programs because the funding situation is so uncertain. I also want to highlight that there are NIH federally funded programs designed to train early career scientists that have also been terminated because they included underrepresented populations. So for example, the maximizing access to research careers and the URISE programs. They were designed to build a diverse pool of undergraduate students. And so when they finished college, they would hopefully transition into PhD and MD-PhD programs. Those programs aren't on.

22:10And so the U.S., you know, as Dr. Brawley and Rachna said, this is the place that you come if you want to be an exceptional scientist. And so cutting these training programs and stopping doctoral student admissions means it creates a hole in the pipeline of trainees in the U.S. And the best students and the best scientists, they follow where the stable funding is. And so if that's in another country, then we get a brain drain. And so this is how America loses its competitive scientific advantage. And so there are real consequences to this. We're hearing from lots of you. Julie emails, I was just diagnosed with lung cancer a few weeks ago.

22:48I'm terrified that I'm not going to have access to the research, advancement, or even a COVID vaccine to protect me if my immune system is compromised. I am still in the early days of this and don't yet have final answers on what type of cancer it is and what the remedy is going forward. These are scary times already, getting a cancer diagnosis made scarier by the carelessness of this administration. In Paul in Pennsylvania emails, I am currently being treated for an incurable blood cancer called multiple myeloma. I am told by my doctors that nine research grants were cut at my cancer center when Trump assumed office.

23:22I'm running out of protocols after 16 years. Dr. Brawley, what do you think is the most important move this administration could and should make to restore stability to the cancer research system nationwide? I wish we would slow down. You know, we have the greatest biomedical system in the world. We are great. I don't want to get to the point where we have to start saying, make science great again. If the current system is working, it's certainly fine to tweak it a little bit, but let's do it slowly as opposed to taking a sledgehammer and doing things very quickly. And Jennifer, as someone who worked inside the NIH, what would you like to see from this administration?

24:14Yeah, I agree with what Dr. Brawley is saying, to slow everything down and to do it. If you want to create change, okay, but let's do it in a systematic way instead of just terminating grants that don't align with what actually does make people healthy again. That's what I would like to see. We got this message from Michael in Michigan. I am a stage four cancer patient and on my second round of chemotherapy. So far, it's keeping me stable with bimonthly IV treatment. I've learned that chemo can stop working as time goes on, so I may be looking for clinical trials or alternate treatment in the future.

24:55I worry about a lack of options if needed, especially if research is cut. Archina, Congress originally appropriated around$7.2 billion in funds for the NCI this year. What, if anything, are lawmakers saying about these cuts? Well, I think the Trump administration had proposed very significant, steep cuts to the National Cancer Institute and the NIH broadly as a part of their fiscal year 2026 budget proposal, which if they pass a budget, that would take effect on October 1. Congress has basically, I don't know if ignored is the right word, but they are certainly not going along with that. They have maintained, essentially flat-funded, maybe a slight increase even.

25:42That's what they want to do for the NIH and also the National Cancer Institute. I think that shows that cancer research is something that continues to be bipartisan. And I think that any significant cuts to funding is going to be a matter of very deep concern, not only for universities where many of these dollars go to fund cancer research, but of course among their constituents. Cancer has affected almost everyone. Everyone knows someone who has either had cancer or who has lost a family member or a friend from it. And so I think it's still, there is very demonstrated bipartisan support among lawmakers right now for cancer research funding.

26:28Well, the timing here is important to note because, as you say, the fiscal year for the federal government ends on September 30th. By that time, agencies like the NIH must spend most of the appropriations they received or risk future budget cuts. Jennifer, what challenges does that pose for those agencies and workers trying to navigate the uncertainty around contracts and grant funding right now? Yeah, so, I mean, there's been additional layers of red tape and oversight added to everything. This is what my colleagues that I'm still in close contact with at the NCI tell me. They tell me that their day-to-day duties are undermined and that decisions are made by higher reps and nobody knows who those people are, by the way.

27:11And it's truly amazing because, I mean, these grant staff, program staff, grant specialists, they have been able to get some of this research money out of the door, even with the grant terminations having to reinstate some of these grants and trying to fund new grants. And with all these processes and oversight, everything's been slowed to a crawl. And so, you know, if they don't spend down the budget, as you said, by the end of the fiscal year, this can also have real consequences and they may have to give some of that money back to the treasury. And when that happens, Congress sees less need for full appropriation.

27:55This fuels arguments for tighter budgets in year ahead. And so less funding means fewer grants, fewer discoveries, and slower progress in science and public health. We got this email from Corey who says, it's important that the government assist with cancer research and funding. But what happens with all this money from the cancer charities? A few years ago, I ran a marathon for a cancer charity and they raised millions. Every year they are raising millions. where is this money going? I feel sometimes that charities could have solved cancer 20 times over by now with the money that this research is supposed to be going to.

28:27Rachana, what can you tell us about that? I think, of course, across the U.S., there are lots of foundations that are very well known in American society for raising money for cancer research. And I think, of course, foundations have played a huge role in advancing progress in mortality and morbidity from various diseases. But fundamentally, though, the issue, though, is they do not have anywhere close to the amount of resources that the National Institutes of Health and the National Cancer Institute has. So they can't plug the gap, even if you were to see a massive reduction in funding from the federal government.