What Happens If The National Cancer Institute Loses Funding?

By Louis Johnson

Cancer remains a leading cause of mortality in the United States, necessitating continuous research to enhance patient outcomes, develop innovative treatments, and ultimately discover a cure. The National Cancer Institute (NCI) serves as the principal federal agency funding cancer research, supporting clinical trials and fostering advancements in cancer prevention, diagnosis, and therapy.

Yet, it is one of many institutes and centers within the NIH impacted by recent federal funding cuts. The NCI supports both internal and external research, the latter funded by federal grants. A key change to NIH funding involves a cap on "indirect costs" for those research grants, now set at 15%. These costs cover institutional overhead. This change impacts how much funding research institutions receive, potentially reducing their resources. While the overall NIH budget may not have been strictly "cut" in the traditional sense, this policy shift redirects significant funds, creating financial strain for research facilities.

At the same time, in fiscal year (FY) 2025, the NCI is operating under a continuing resolution that maintains funding at the FY 2024 level of $7.22 billion¹. This stagnation in funding, when adjusted for inflation, effectively reduces the real value of research dollars, leading to significant consequences for cancer research and patient care.

Key Consequences Of Stagnant NCI Funding

Stagnant or reduced funding for cancer research institutions hinders the progress of therapeutic and scientific advancements, resulting in a reduced approval rate for crucial research initiatives, especially those focused on rare cancer presentations. This financial limitation disproportionately impacts emerging researchers, restricting new investigative approaches and potentially obstructing collaborative efforts between academic and industrial stakeholders. As a result, the development and accessibility of innovative treatment options are compromised, worsening existing disparities in healthcare delivery and ultimately affecting patient outcomes.

• Decline in Research Projects and Innovation. Reduced direct funding results in fewer approved research proposals, limiting the initiation of new cancer studies. This decline hampers scientific discovery and delays the development of novel treatments and diagnostic tools. Research into rare and understudied cancers, especially those affecting minority populations, may suffer disproportionately.
• Negative Impact on Early-Career Researchers. Early-career scientists depend on NCI grants to establish their research trajectories. Diminished funding increases competition for limited grants, making it challenging for emerging researchers to secure necessary support. This scenario threatens the influx of new talent (and new ideas) into the cancer research field.
• Slower Development of New Cancer Treatments. The development and testing of new cancer therapies rely on robust funding. Budget cuts can delay drug development and clinical trials, limiting patient access to cutting-edge treatments. For patients with cancers unresponsive to existing therapies, such delays can be particularly detrimental.
• Impact on Pharmaceutical Industry Development. The pharmaceutical industry relies heavily on NCI-funded basic research to identify new drug targets and biomarkers. Reduced NCI funding would limit the discovery pipeline, delaying partnerships between academic institutions and pharmaceutical companies. This slowdown affects the speed at which new therapies are brought to market and increases the costs associated with drug development. According to the Tufts Center for the Study of Drug Development, the average cost to develop a new drug is approximately $2.6 billion². Without NCI-backed innovations, pharmaceutical companies face higher risks and fewer opportunities for breakthrough therapies.
• Worsening Disparities in Cancer Research and Treatment. Certain cancers, particularly those prevalent in minority and underserved communities, already receive less research attention. Funding reductions can exacerbate these disparities, resulting in fewer treatment options and poorer outcomes for affected populations. For example, African American men have the highest prostate cancer incidence rates in the U.S. and also have the highest prostate cancer mortality rates³. Yet, this cancer is underfunded when compared to more common cancers. Addressing health inequities requires sustained investment, which is jeopardized by budget constraints.
• Decreased Access to Clinical Trials. Clinical trials are essential for evaluating new treatments and providing patients with access to experimental therapies. A reduction in funded research projects leads to fewer clinical trials, thereby limiting patient options and slowing the advancement of effective cancer treatments.
• Reduced Investment in Cancer Prevention and Public Awareness Programs. NCI funding supports programs focused on cancer prevention, early detection, and public education. Budget cuts can curtail these initiatives, leading to decreased public awareness, lower screening rates, and an increase in preventable cancer cases. This not only affects public health but also escalates long-term healthcare costs.
• Shrinking Workforce and Research Capacity. Research institutions depend on NCI funding to maintain their workforce and operational capabilities. Financial constraints may force these institutions to downsize staff, reduce research activities, and limit collaborations, collectively slowing the progress of cancer research.

Impact On Health Equity And Diversity In Clinical Trials

Adequate funding is crucial for promoting health equity and ensuring diverse representation in clinical trials. The NCI has established programs, such as the Center to Reduce Cancer Health Disparities (CRCHD), to address these issues. If funding remains flat or is reduced, the results might include:

• Reduced Support for Underrepresented Researchers. Initiatives like the Continuing Umbrella of Research Experiences (CURE) and the Intramural Continuing Umbrella of Research Experiences (iCURE) provide training and mentorship to researchers from underrepresented backgrounds. Funding reductions could limit opportunities for these individuals, hindering efforts to diversify the scientific workforce.
• Decreased Diversity in Clinical Trial Participation. Financial constraints may remove resources dedicated to recruiting diverse participants for clinical trials. This lack of representation can result in treatments that are less effective or have unforeseen side effects in certain populations, exacerbating existing health disparities.
• Exacerbation of Health Disparities. Without targeted research addressing the unique needs of diverse populations, existing health disparities are likely to widen. This can lead to unequal access to advancements in cancer prevention, diagnosis, and treatment.

Economic Considerations

When budgets remain static despite rising costs, the real value of funding diminishes, forcing difficult decisions that may leave promising projects unsupported. This scarcity of resources heightens competition for funding from major organizations, which can potentially adversely innovative approaches and discourage new researchers. Furthermore, the substantial expenses associated with establishing and maintaining research facilities place additional strain on already tight budgets, potentially delaying advancements in cancer treatment and prevention.

• Inflation and the Effect of a "Flat" Budget. Maintaining a flat budget in nominal terms does not account for inflationary pressures. For example, the NCI's FY 2025 budget remains at the FY 2024 level of $7.22 billion¹, but inflation erodes purchasing power, effectively reducing the real value of funding. This scenario necessitates difficult choices, such as prioritizing certain grants over others, potentially leaving promising research unfunded.
• Increased Competition for Limited Funding. With a shrinking pool of available funds, the competition for NCI grants intensifies. This heightened competition can result in the exclusion of innovative and high-potential research projects, as only a fraction can be supported. The increased pressure may also discourage early-career researchers from pursuing independent research paths.
• Cost of Establishing and Maintaining Research Laboratories. Setting up a cancer research laboratory involves substantial financial investment. Estimates suggest that establishing a clinical laboratory can range from $170,000⁴ to over $1 million⁵. Ongoing operational costs, including personnel salaries, equipment maintenance, and consumables, further strain limited budgets. Reduced NCI funding exacerbates these challenges, potentially leading to downsizing or closure of research facilities.

NCI’s Future And The Role Of Political Advocacy

The reduction or freezing of NCI funding poses a significant threat to cancer research progress, innovation, and equitable healthcare outcomes. Without adequate support, the U.S. risks falling behind in scientific advancements, pharmaceutical innovation, and cancer patient survival rates.

Sustained and adequate funding for the NCI often requires active advocacy from researchers, healthcare professionals, patient groups, and the public to influence policymakers and secure necessary budget allocations.

References:

1. National Cancer Institute. (n.d.-a). NCI Budget. Retrieved from https://www.cancer.gov/about-nci/budget
2. Tufts Center for the Study of Drug Development. (n.d.). Cost to Develop and Win Marketing Approval for a New Drug Is $2.6 Billion. Retrieved from https://csdd.tufts.edu/csddnews/2014/12/03/cost-to-develop-and-win-marketing-approval-for-a-new-drug-is-2-6-billion/
3. American Cancer Society. (n.d.). Cancer Facts & Figures. Retrieved from https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures.html
4. Lighthouse Lab Services. (n.d.). How Much Does It Cost to Open a Clinical Laboratory? Retrieved from https://lighthouselabservices.com/how-much-does-it-cost-to-open-a-clinical-laboratory/Care
5. Data Info. (n.d.). How Much Does It Cost to Build a Medical Lab? Retrieved from https://caredatainfo.com/how-much-does-it-cost-to-build-a-medical-lab/

About The Author:

Louis Johnson is a medical research professional with over 25 years of experience in the pharmaceutical industry. His first three years were in pharma sales with the remaining years in clinical research. His expertise lies in clinical trial management and operations with a special focus on diversity in clinical trials and healthcare equality. Louis is also skilled in process improvement, strategy, and planning. Louis has Bachelor of Arts and Master of Science degrees in biology from Hampton University and a Doctor of Health Administration (ABD) from A.T. Still University. In his spare time, he is a fitness enthusiast and a volunteer football coach. He lives in the western suburbs of Chicago.