Financing the fight

Foundations are at ground zero in the battle against cancer

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Scientifically defined, cancer is a class of diseases in which a cell or group of cells display uncontrolled growth, invasion and sometimes metastasis.

For decades, researchers have been working diligently to come up with new ways to target the disease. It is a never-ending effort with plenty of opportunity with new discovery always looming over the horizon.

It's also an area of research with plenty of need.

According to the National Cancer Institute, 1.5 million people will be diagnosed with cancer this year, and an estimated 500,000 people will die of cancer this year. The toll is astounding, emotionally and financially, and is a challenge that researchers are working hard to overcome.

Cancer researchers work endlessly to understand disease processes and discover possible therapies. The results of these efforts often offer a lifeline of hope for people stricken with this insidious disease. The improved understanding of molecular biology and cellular biology due to cancer research has led to a number of new, effective treatments for cancer since President Richard M. Nixon declared "War on Cancer" in 1971. Since that time, the United States has invested more than $200 billion on cancer research. That total includes money invested by public and private sectors and foundations.

The shadow that cancer casts over the research landscape might best be exemplified in the number of foundations that exist to generate funding for continued research efforts for cancers of every form, from lung and breast to childhood forms of the disease.  

In the fight against cancer, there are several fronts, and foundations are serving a key role in saving lives through prevention, education, research advocacy and support.

Among the myriad aims of foundations, they create awareness about the disease and research new and better treatments for a cure.

Of course, all of this comes at a cost.

In this, the fifth and final installment of our Trends in Cancer Research series, we will examine foundation funding by examining what some groups are doing today and the challenges they face financially.

Under-funded, under-researched

The Lung Cancer Foundation of America (LCFA) finds itself at the epicenter of the fight against cancer. Worldwide, lung cancer is the most common cancer. It is the leading cause of cancer deaths in the United States, Canada and the United Kingdom. In 2010, in the United States an estimated 222,520 people (116,750 men and 105,770 women) will be diagnosed with lung cancer. It also has a disheartening 15 percent, five-year survival rate, which has remained somewhat stagnant for the past 40 years. In spite of these dismal statistics, lung cancer remains the most under-funded and under-researched cancer, notwithstanding its nationwide and worldwide health impact.   

"There is a tremendous stigma attached to lung cancer—because of the association between smoking and lung cancer, there is a sense that people with lung cancer brought the disease upon themselves," says Kim Norris, president of the LCFA. "Most people don't know that smoking is but one in a long list of behavioral, environmental and genetic risk factors that influence who will be diagnosed with lung cancer."

According to Norris, in 2008, $1,249 in federal research funds was spent per lung cancer death. By contrast, $6,590 was spent for colon cancer, $14,336 for prostate cancer and $27,480 for breast cancer.  

In 2009, the total research funding for lung cancer from the NIH, CDC and DoD combined was $199 million. By comparison, the total research funding from these federal institutions was (in millions) $1,103.85 for breast cancer, $392.24 for prostate cancer and $328.97 for colon. In terms of the private sector, in 2008—the year with the most complete information available to date—only $4.6 million total was disbursed for lung cancer research into early detection, treatment options and a cure.

In 2009 alone, the Susan G. Komen Foundation, which is just one of approximately 132 breast cancer research foundations in the United States, disbursed $60 million to back research that helps treat those coping with breast cancer today and rid future generations of the disease. Moreover, 95 percent of research funding for lung cancer is from the public sector—and public sector research funding is going down.

Michael D. Gingerich is executive director of the Foundation for Cancer Research & Wellness (FCRW), which is in its first year of incorporation.  

"Many of our program services existed for 25 years under Cancer Recovery Foundation (CRF)," Gingerich explains. "But a research component was not part of the mission or services for CRF. With the advent of FCRW, as a new initiative under the Cancer Recovery Foundation Group of Charities, in January 2010, a research effort became a new and important part of our focus."

During the course of its first year, the FCRW has specifically and primarily focused upon developing a qualitative research study in partnership with the Pennsylvania State University College of Medicine.  

"The focus is on patient/physician communications and interaction in regard to people living with cancer," Gingerich says. "We have spent this year determining the focus and identifying patient narratives in which to gain an analysis of the issues that affect the quality of patient care."

Gingerich points out that no money has been given to either FCRW or the PSU College of Medicine for this project.  

"Internal budgetary dollars have funded the development and initial phases of this project," he says. "But FCRW has identified a few dozen other foundations and non-profits that fund such research efforts and is applying to them for grant aid. PSU, it is hoped, will be applying for NIH funding in 2011."

When it comes to dollar amounts for the funding being sought, Gingerich says the amounts hoped for range from tens of thousands of dollars, hundreds of thousands of dollars to $1 million or more.

Government intervention

Herb Bone, controller of the finance department at the Fred Hutchinson Cancer Research Center, says the majority of the funding for research received at the Hutchinson Center comes from the government.  

"About 90 percent of the research funding received in FY 2010 came from federal sources," he says. "In FY 2010, the center received research grants and contracts from all sources of $323,819,000."

Of course, in the current economic landscape, even funding for cancer research can feel the pinch of turbulent economic times. Gingerich points out that funding of all sorts is harder to obtain in this current economy.  

"There have been numerous private grant opportunities available for projects of our kind," he says. "Time will tell, as our proposals have just recently been submitted, to learn if we are approved for funding."

Gingerich points out that the recent changes in Congress and the need to consider cuts in spending will determine how much the government has to offer.  

"But the economic climate has made obtaining funding much harder as foundations and the federal government have had increasingly more requests for increasingly fewer dollars available," he says.

For Norris, funding is a source of concern, with DoD funding for lung cancer falling.

"Publicly, wouldn't it make more sense to create some kind of equation that correlates funding to incident rate and mortality?" she asks. "Lung cancer is the biggest cancer killer for men and women in the U.S., but it remains the least-funded. While breast and prostate cancer do have a huge incidence, the mortality rate is very low, which is great. Unfor-tunately, the statistics are very different in the world of lung cancer."

Bone points out that there has been a recent infusion of federal funds available, but it isn't a permanent increase by any means.

"Government funding of medical research received a boost from the additional stimulus funding provided by the American Recovery and Reinvestment Act, but this boost is only temporary, and it is expected that reductions will be made after the stimulus funding is completed," he says.

With the boost provided from stimulus funding, it is possible that there will be a drop in funding after the grant awards.

"Due to the downturn in the economy, the federal government provided additional funding to fund research to allow companies to maintain the employees that they currently have or hire additional employees that may have been released from the private sector," Bone explains. "However, this additional stimulus funding is temporary in nature (two-year grant awards), and there will likely be a decrease when these grants terminate."

Show me the money

When decisions are made regarding where money will be directed, the FCRW and the research team at PSU College of Medicine note it has been a joint effort.  

"Once we identified a possible project and began the process of formulating the specifics of it, together we have and will continue to determine how the money will be used," Gingerich says.

It is Gingerich who makes the call on money that FCRW seeks independently for its expenses, along with the board.  

"For PSU, it is the administrators of the College of Medicine, working in conjunction with the research team," he adds. "For joint funding for both FCRW and PSU, we will negotiate together."

According to Bone, at the Hutchinson Center, money for research grants is awarded via a competitive proposal process, and for federal funding, there is a peer review process to review and rank the grant proposals to determine which ones are the most meritorious and should be funded with the dollars available.  

"These decisions about the quality of the grant proposal are made by scientists within the same field as the research proposal so peers are the ones grading the merits of the proposal," he says. "A ranking of the proposals is received and a 'payline' is established so that grants receiving a score above the payline are funded, and those that fall below the payline are not."  

Norris explains that for the LCFA, funding decisions are made by the organization's Scientific Advisory Board in consultation with LCFA's Board of Directors.

Funding = survival

Looking toward the future for charitable efforts, groups like the FCRW may be feeling some anxiety about the present and future.

"We also believe that the work we are doing is of value and is needed," Gingerich points out. "There still remains a significant amount of money out there to be obtained. But it will take our very best efforts at creativity and ingenuity to gain the attention and support of funders, especially when they receive, as they do, such a huge volume of requests, with limited amounts of funding dollars available."

Bone points out that as the economy and individuals' investment portfolios rebound, there is hope that charitable giving will once again increase.  

"Large donors are likely to target their contributions towards specific projects where they feel their gift will make a difference and the Hutchinson Center has a number of opportunities where donors gifts have made a difference in the past," he says.

"Foundations have also been negatively impacted by the economy's downturn and are sometimes slowing down the pace of their new awards so that they can fund all of their existing commitments on previous awards."

While funding for lung cancer has taken a hit in recent years, which Norris says has had an impact on the five-year mortality rate, the future may be a little brighter.  

"I'm hopeful that lung cancer is on the cusp of receiving the attention it deserves after being neglected for so long," she says. "In the world of lung cancer, with its dismal mortality, funding equates to survival."

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