The Oncology Community Faces Unusual Uncertainty

Robert L. Ferris, MD, PhD

The field of cancer research and treatment is, almost by definition, continually evolving. That progress has come with uncertainties and irregular leaps of progress. There are also periods of disappointment and stagnation, when the standard of care doesn’t change, right up to the point when it leaps ahead with innovative discoveries and survival benefits based on remarkably creative and effective new diagnostics or treatments. For those of us who have been in the field for decades, this cycle of exhilaration or despair is common and manageable, but recent months have raised even further uncertainty about how progress in oncology will continue. With little asked in return, National Institutes of Health (NIH) and National Cancer Institute (NCI) funding has propelled scientific and clinical advances and collaborations within and across academic institutions and translated into the pharmaceutical field and cooperative group clinical trial success. The flow of information and development of therapies with production facilities and innovations have crossed national and international boundaries and led to a community of oncology that has provided the world with unprecedented clinical benefits and scientific advancements.

However, now it is unclear from where the scientific leadership of the US and our biomedical research pipeline will be derived, as well as the funding mechanism and the world’s best scientific peer review process. The uncertainty of processes and funding streams not only impacts current discoveries and scientific progress. It also shakes the fortitude of investigators, who are staking their careers and personal commitment on an uncertain future, where funding support to run a laboratory or a trial, or federal funding for new therapies, particularly for the populations for whom Medicare and Medicaid is designated, is in question.

Millions of individuals sacrifice to contribute to this oncology enterprise, and the ability to develop new knowledge or be a caring and skilled professional who delivers oncology care, whether in community or academic settings, is at an unprecedented level of uncertainty and risk. The latter is a concern since it takes at least 10 years of education and training to help replenish the pipeline of those retiring or leaving the field. This could create a gap that could be difficult to overcome if we do not demonstrate some level of security and sufficient reassurance for the amazing and bright young individuals who want to devote their lives and professional careers to the oncology field. Time is short: These individuals are making decisions, weighing what to do with their careers, and how to apply themselves. Hopefully, as a society and as a government, we will maintain the crown jewel of the US biomedical community via the NIH and NCI, even when we have budgetary challenges and deficits that are well-recognized and pose an existential dilemma for the country. However, productivity was restored, and life spans were prolonged through the success of biomedical research, leading to increases in productivity and tax rate receipts that pay back into the system and now risk being damaged. We should not lose sight of how we got here more than 50 years after the National Cancer Act and should reflect on the amazing progress that this societal investment has produced around the world. Hopefully, our leaders in the executive and congressional branches of our federal and state governments have as broad a perspective as possible.