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grants, an in-house (intramural) research program, cooperative oncology groups for clinical trials research, working groups on cancers of particular organ systems--as part of its dual mission of sunDortina cancer research ~nr1 promoting its applications. the clinical and consortium cancer centers, however, constitute an environment that is particularly conducive to the translation of scientific advances and breakthroughs into improved patient care practices and programs of cancer prevention and control. Laboratory science centers also are developing relationships with clinical programs, as well as continuing basic research on the causes and mechanisms of cancer that should result in improved methods of prevention. r r ~ A= ~ ~~~~ ~~ ~ ~~ ~ ~~ ~ ~ _ =_ Solving Short-term Funding Issues The longer-term role of the cancer centers core grant program in the national cancer program should be the subject of an intensive planning effort, which is recommended in a following section. Immediate steps should be taken, however, to ensure that high-quality cancer centers do not lose their core grants for lack of program funding. Me committee recommends that the director of the National Cancer Institute take immediate steps to avert a crisis in the funding of the program during the current fiscal year (1989!. The committee recommends further that the directors of NCI and the National Institutes of Health. with the secretary of the nen~rtm``n~ of Zenith and Human Services. work with the appropriate committees of Congress to develop an adequate budget for the program's next fi.SCal year {19901. Otherwise, the committee is concerned that projected funding levels the core grant program this year and next will result in the loss of centers with excellent peer-rev~ew priority scores before the program planning process is completed. The cancer centers core grant program has grown slowly in recent years (Figure 6~. Since 1980 most of NCI's budget growth has gone to stabilize and increase the number of research project grants (individual investigator-initiated and program project grants). The percentage of NCI,s budget going to research project grants increased from 32 percent in 1980 to 46 percent in 1988. Meanwhile, the cancer centers core grant program has received a smaller share of NCI's budget (Figure 7~. 12

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4 FIGURE 6 Percentage Growth of Cancer Centers Core Grants, Research Project Grants (RPGs), and Total NCI, Fiscal Years 1980-1990 20 15 p e r 10- c e n t a 9 e s o .. ........ Ear .. .......... . fir 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 Years (satiated) {~equeated) Core Grants ~ RPGs ~ Total NCI SOURCE: Calculated from data provided by NCI's Financial Management Branch (Appendix Table E2). FIGURE 7 Share of NCI Budget Devoted to Cancer Center Core Grants and Research Project Grants (RPGs) 50 40 pi e r c e n t 20 a 9 e 30 10 , ............. ...... . ...... ..... ........................................... l , _ ._ - O l l l 1980 1~ . 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 Years (E.t ) (Req ) - Core Grants I RPGs SOURCE: Calculated from data provided by NCI's FinancialManagement Branch (for 1980-1988) and from the President's appropriation request for 1990 (for 1989 and 1990) (Appendix Table E2). 13

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As the rate of growth of funding of the core grant program declined, the number of centers fell from 64 in 1980 to between 58 and 60 In recent- years,8 even though, beginning in 1982, NCI tried to stretch the funding by awarding only 85 percent of the individual grant amounts recommended through the peer-rev~ew process. Currently, there are 59 centers (not including 2 centers that failed to be renewed last year and that are receiving small phaseout grants in fiscal year 1989~. This year (fiscal year 1989), funding for the centers program was increased slightly (by $918,000) to $101,345,000, and the same amount has been requested in the administration's budget for fiscal year 1990 (Table I).9 However, the tote] includes $1 million a year that NCI began to allocate in fiscal year 1989 for a program of supplemental core grants to existing centers that are making special efforts to address high rates of cancer incidence and mortality in minority populations. This program is administered by NCI's Division of Extramural Activities (DEA) and does not add to the number of centers. As a result of level funding, NC! expects to fund only about 54 centers in 1989 (plus short-term phaseout grants for centers that are not renewed). Another five or so centers would be lost next year (fiscal year 1990), if Congress appropriates the amount requested in the administration's budget, reducing the number of ongoing centers to about 49 (Figure I). The centers dropped from the program would most likely be clinical centers if the basic science centers continue to receive better peer-rev~ew priority scores, as they ~ These are net totals that do not indicate substantial turnover among centers in the program. Since 1977, for example, only 36 centers have been constantly supported by the NCI. An average of two to three centers lost their core grants each year, usually because renewal applications were disapproved or received low priority scores. A few centers received new core grants after 1977 and lost them prior to 1988. Others received new core grants since 1977 and continue to be funded (AppendLx Table Eat. 9 As Table ~ indicates, a small portion of the core grant total is allocated by NCT from its funds for AIDS. Core grant funding from the cancer budget is projected to decline slightly in absolute as well as relative terms in fiscal year 1990. ~4

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have historically, because their programs are narrower in scope and more focused. Fiscal Year 1989 Situation NCI's current allocation for cancer center core grants in fiscal year 1989 is $101,345,000. There are 41 centers in the continuing years of grants approved for 3 or 5 years, leaving 17 centers competing for renewal grants.~ In addition, two new institutions have applied for cancer center core grants in fiscal year 1989. NCI, in accordance with NTH policies, provides certain inflation increases in the continuation years of a grant. ~ NCT estimates that $17.9 minion wall remain-for the 19 competing centers after funds are allocated for the 41 continuing centers, for administrative supplements and contracts, and for the supplemental grants for minority programs administered by DEA. The current level of support- for the 17 centers up for renewal is nearly $21 million. NCT estimates that the renewal applications wall have recommended budget levels that total $25.7 million. Adding the $2.3 million recommended by the review committee for the two new centers would bring the tote] to $28 million, or $10 million more than is currently available. If all the competing applications were successful and were funded at 85 percent of recommended levels, as they have been in recent years, the tote] needed would be $23.S million, still nearly $6 million more than the $17.9 million that is available. Under the current budget request, NCT has estimated that only about 12 centers can be funded, assuming they are funded at 85 percent of recommended levels. If the competing centers were funded at full A The fifty-ninth center is being supported with an administrative supplement during a change in directorship of the center. ~2 These calculations assume that each competing center achieves a fundable priority score. The amount of additional funding needed would be less to the extent that one or more competing centers do not have fundable priority scores. 15

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recommended levels, only about eight could be funded. If all 19 competing centers were funded, the awards would have to be reduced to about 64 percent of recommended levels, which would be a cut of about 21 percent from the current budget levels for the competing renewal centers. Fiscal Year 1990 Situation The adm~stration's budget asks for level funding of the program for fiscal year 1990--$101,345,000. If this happened, a situation similar to this year's would recur, resulting in the loss of another five or more centers. If the NCI director moved funds from another research activity this year to keep more high-quality centers, but the appropriation for 1990 is not increased, the loss of centers would only be deferred until next year. Also, because only about a quarter of the centers come up for renewal each year, some centers may lose their core grant even though they have significantly better pronto scores than centers funded in previous years. And because basic science centers tend to receive better priority scores on average than clinical centers, as noted previously, the centers that are lost will most likely be the clinical or comprehensive centers, where the interactions between laboratory scientists and clinicians take place that are necessary to develop patient-care applications of emerging scientific advances. Actions Needed The committee is recommending that the director of NCI take immediate steps to prevent erosion of the program's base during the current fiscal year (1989), and that the directors of NCI and NTH and the secretary of U.S. Department of Health and Human Services work with the appropriate committees of the Congress to ensure adequate funding during the next fiscal year (1990), in order to retain high-quality centers while plans for a strengthened cancer centers program are developed. Specifically, for fiscal ]2 The actual number would depend on a number of factors: the funding increase needed for the continuing grants, the number of competing applications with fundable priority scores, the funding levels actually recommended by review groups and approved by the NCAB, and the percentage of recommended funding levels the NCI chooses to pay (85 percent in recent years). 16