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A STRONGER CANCER CENTERS PROGRAM
Introduction
On October 18, 19~, the National Institutes of Health (NIH) asked the
Institute of Medicine (IOM) to conduct a study of the cancer centers core
grant program of the National Cancer Institute (NCI) and to make
recommendations concerning the funding needs and organizational location and
direction of the program. The NIH initiated the request in response to the
Senate Appropriations Committee report that accompanied the NIH
appropriations bid for fiscal year 1989 (U.S. Senate, 19~:94), which stat-cd:
The Committee has heard an ever increasing series of complaints
regarding the relatively small avocation of funds to cancer centers.
The Committee intends to explore this issue thoroughly with NTH
and NCT personnel in the upcoming months and focus on the
question at hearings next year. Furthermore, the Committee
requests the NIH to contract with the Institute of Medicine to
undertake a study, to be completed for the Committee hearings
next year, which win report on the present state of the Cancer
Centers Program [and] on its funding and organizational needs
required to fulfill the role established for cancer centers In the
1971 National Cancer Act.
NCI's support of cancer research centers began in the early 1960s. The
1970 report of the Pane] of Consultants on the Conquest of Cancer argued
that multidisciplinary cancer centers were "the best organizational structure" for
an expanded effort to solve the cancer problem (U.S. Senate, 1970:89), and
the resulting National Cancer Act of 1971 authorized an expanded program of
basic operating support for existing and new centers as well as the
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establishment of a network of comprehensive "national cancer research and
demonstration centers" (P.L 92-218~.
By the late 1970s, the core grant program had reached its present size
and shape--grants to support the central functions of approximately 60 centers
that conduct large amounts of cancer research and training. (Figure I).
Currently, NCI provides core grants totaling slightly more than $101 million to
59 centers selected through a process of competitive renew. NCI proposes to
award approximately the same amounts ~ fiscal years 1989 and 1990
(Table 1~. The grants are administered by a staff of four (three professionals)
In a branch of NCI's Division of Cancer Prevention and Control.
The program of core grants has enabled NCI to develop and maintain a
network of cancer centers where high-quality research takes place.2 Scientists
and clinicians in institutions with NCI core grants receive nearly half the
research project grants awarded by the NCI through a process of competitive
peer review (Figure 2), and they receive substantial amounts of peer-rev~ewed
support from other NIH institutes, the National Science Foundation, the
Amencan Cancer Society, and other sponsors (Figure 3~. As a result, cancer
center researchers have been involved in many of the important basic, clinical,
and epidemiologic cancer research advances made in the last 20 years (see, for
example, Narin, 1987~.
The centers also are sites for more than half of the cancer research
traineeships funded by NC! (Figure 2), and many centers are involved in
cooperative oncology groups that conduct clinical trials supported by NCI, in
NCI-supported working groups that foster research on cancer of specific organ
systems (e.g., bladder, breast, pancreas), in cancer prevention and control
research and other activities, and in other aspects of the national cancer
program, such as operation of NCI's cancer information system and
participation in the~Community Clinical Oncology Program (CCOP) that
involves community physicians in clinical trials and cancer control research. As
a group, the centers are a valuable resource for the NCT in the national effort
to understand, prevent, and treat cancer and its consequences. They are also
~ The NCI's process for-awarding support grants for cancer centers is
described in Appendix A.
2 See Appendix B for a list of cancer centers with NCI core grants.
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FIGURE 1 Number of Cancer Centere and Total Core Grant
Obligations, Fiscal Years 1972-1990 (dollars in millions)
C 100 r' too m
e SO F ^~ So e
a ~ ~ ~40 e
O' 'I ' 1 ' 1:' i 1 ' 1 '' 1 ' ~ ' 1 ' 1 ' O
72 74 76 78 80 82 84 86 88 go
Fiscal Year
Number of Centers I Current Dollars
~ 1988 Dollars
SOURCE: Appendix Table E1
TABLE 1 Cancer Center Core Grant Awards (in thousands of dollars), Fiscal Years 1988-1990
Obligations
1988 1989 - 1990
- (Actual) (Estimated) (President's
Budget Source by NCI Budget Request)
Regular NCI Appropriation 96,872 97,790a 96,605_
Appropriated for AIDS Research 3,555
3455 4,740b
Total
100,427 . 101,345 ' 101,345
a
. . . .
Includes $1 million administered separately by NCI's Division of Extramural Activities for a
program.of supplemental core grants to existing cancer centers that are making special efforts
to address high rates of cancer prevalence and mortality in minority populations.
. :
b NCI plans to allocate this amount from its share of the appropriation for AIDS activities
requested by the Assistant' Secretaly for Health, Department of Health and Human Services, in
the consolidated AIDS budget for fiscal year 1990.
SOURCE: National Institutes. of Health, 1989:36, and Financial Management Branch, NCI.
3
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FIGURE 2 Share of Selected and Total NCI Grants (number and amounts)
Awarded to Institutions with Cancer Center Core Grants, Fiscal Year 1987
1°OI
80
60
20
ROT/PO' Other (grants Tralneeships Cancer Control Total Grants
Grant Mechanisms
_ Number of Grants a\\\\\ Amount of Awards
SOURCE: Calculated from data provided by NCI's Financial Management Branch
(see Appendix Table E5).
.
~ FIGURE 3 Research Support, by Source of Cancer Centers with Core
| Grants (dollars in millions), Fiscal Year 1988 or 1989
500
. 200 _ _
NCI Other NIH ACS NSF Private Sector
NOTE: NCI column does not include core grant awards.
SOURCE: Administrative Protile Database, Cancer Cantors Branch, NCI (sso Appendix Table E4).
4
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valuable community resources for cancer treatment, prevention and control,
and education serv~ces.3
NCT's Cancer Centers Program
The NCI's cancer centers program supports the core functions (see
below) of centers that are conducting high-quality interdisciplinary laboratory,
coccal, epidemiologic, and other research on the causes, prevention, detection,
diagnosis, treatment, and consequences of cancer. On average, the core grant
amounts to about 20 percent of NCT's total grant support of cancer center
institutions, although that percentage is declining (Figure 4~.
The main purpose of the core grant program is to support functions that
make a center a center rather than an assemblage of researchers pursuing
unrelated projects (a breakdown of expenditures among allowable program
categories is displayed in Figure 5~. The typical grant provides partial salary
support for the center director and senior staff, other administrative personnel,
and directors.
The core grant also enables a center to provide shared services and
equipment that would be more expensive or imnn~.~ibif~ for inrlivirl,,~1 rP~P~rrh
projects to provide for themselves. On average, more than half of the grant
funds are used to support services and resources that are shared by NCI-
funded research projects, ranging from electron microscopes and other
sophisticated research equipment to biostatistics- staff units to laboratory animal
and glass-washing facilities. These services and resources involve economies of
scale that cancer researchers could not achieve on their own with individual
research grants.4
~~ hi_ _~_~^v^~_ ~~ ^~—van eve ~~l I—~1~11
The core grant also allows centers flembili~ to explore new research
leads and to recruit and retain promising staff. A small portion of the funds
may support developmental projects, such as the research of newly recruited
investigators until they receive regular research grants, or it may cover the
salary of an investigator with an approved but unfunded research grant. In
3 See Appendix C for a map of cancer centers with NCT core grants.
4 Appendix D gives examples of shared resources supported in cancer
centers by core grant funds.
s
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- ~ ~
l :
FIGURE 4 Core Grant Support as ~ Percentage of Total NCI Support
to Institutions with Cancer Centers, Fiscal Years 1981-1988
30
O , , , , , ,
1981 1982 1983 1984 1985 1986 1987 1988
Years
FOURCE: Calculated from data provided by NCl~s Financial Management Branch.
(see Appendix Table E7).
1 - 11
FIGURE 5 Use of Cancer Center Core Grants (in percentages),
Fiscal Year 1987
(Including Program Directors)
Senior Leadership _~,,
14
(Including Planning ~ Evaluation)
Administration
12
Developmental Funds A.............
8
Al terations ~ Renov.
, 1 (. 06,
Staff Investigators
Shared Resources
51
NOTE: The analy~le is based on authorized direct costs, excluding supplements and
administrative adjustments.
SOURCE: Data from Administrative Profile Database, Cancer Centers Branch, NCI
(see Appendix Table E8).
6
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some centers, the core grant also helps to support a group of staff
investigators.
The centers are diverse in focus, structure, and size. Currently, there
are 15 laboratory science centers that do only basic research, 41 clinical
research centers that do clinical, basic laboratory, and, In some cases, cancer
control research, and 3 consortium centers that focus on cancer control.s
In the 1970s, 20 of the clinical research centers also were designated as
broadly based "comprehensive" centers under the terms of the National Cancer
Act of 1971. They are not only expected to do research and trading, but also
to demonstrate state-of-the-art patient care and to conduct cancer control
activities (e.g., community education, outreach, and intervention) (National
Cancer Advisory Board, 1985~. The designations have not been reviewed since
1978. The National Cancer Advisory Board (NCAB) is considering revised
cAtena and processes for recogm~ng centers as-comprehensive; which are
discussed later In this report.
Some cancer centers, such as Memorial SIoan-Kette~g, M.D. Anderson,
and Roswell Park, are free-stand~ng independent or state institutions, but most
centers are university-based. The consortium centers include state and local
public health agencies as weD as universities and other cancer research
· —
organizations.
The support grants range in size, from $318,000 for the laboratory
science center at Purdue to $7.4 minion for the Memonal SIoan-Kettering
comprehensive cancer center (Appendix Table Elk. The centers also vary In
overall size. Laboratory science centers tend to be the smallest. The La Jolla
Cancer Research Foundation, for example, has -an annual budget of
approximately $9 minion (about half Tom NCT and most of the rest from
other NTH institutes) (La JoDa Cancer Research Foundation, 1987:3~. The
comprehensive cancer center at Duke University, on the other hand, has a
peer-reviewed research budgee of more than $52 minion (including $16 million
from NCI and $32 million from other NIH institutes) (Appen~ Table Em.
Institutions with clinical centers may provide substantial amounts of patient
care that cannot be paid for through NCI support or research grants, but
which must be reimbursed by patients, insurance, and charitable contributions.
5 Appendix B lists the centers by type: comprehensive, clinical, basic
laboratory, and consortium.
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Over the past 5 years, the Memorial Sloan-Ketter~ng Cancer Center has raised
$368 million in charitable contributions to cover patient care, research, and
construction costs not covered by any form of third-party or government
payment, reimbursement, or grants (Memorial SIoan-Kettenng Cancer Center,
1987:33~. Individually and as a group, it is apparent that the cancer centers
are able to leverage substantial amounts of support from sources ~ addition to
NCT and NIH. Other sources include the National Science Foundation, other
federal agencies, state governments, foundations, private individuals and
businesses, and charitable organizations (Appendix Table Elk.
Conduct of the Study
The timetable for the study was very short, less than 6 months from the
request to delivery of the report, because the Senate Appropriations
Committee requested that the study results be available for hearings on
appropriations for fiscal year 1990. The IOM agreed to undertake the study
on short notice because the cancer centers supported by the NCI represent a
valuable resource in the nation's efforts to understand, prevent, treat, and
address the consequences of cancer.
The TOM was asked specifically to address funding and organization
issues concerning the core grant program, but the TOM committee found it
necessary to proceed first by reviewing the purpose of the grants and the role
of cancer centers in the national cancer program relative to other NCI-
supported programs. Committee staff, with the- cooperation of the program
planning and evaluation staffs in the offices of the NTH and NCT directors, the
staff of the cancer centers branch at NCT, and the leadership of the
Association of American Cancer Institutes and the National Coalition for
Cancer Research, which represent cancer centers, gathered and analyzed a
great deal of information about the organization and management, historical
development, financing, and impact of the program. After meeting three times
in three months to review the history and current status of the cancer centers
core grant program in detail, the stringent fiscal context facing NIH and NCI
in the foreseeable future, and the likely future directions of scientific advances
in cancer research, the committee developed the recommendations that follow.
8
Representative terms from entire chapter:
core grant
