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SUMMARY OF RECOMMENDATIONS Strengthening the Role of Cancer Centers Many important discoveries are occurring in the basic biologic, clinical, and behavioral sciences that relate to cancer. The committee recommends that the National Cancer Institute strengthen its core support of cancer centers in. order to exploit fully the application of these advances in the prevention and treatment of cancer and its consequences. The committee believes that cancer centers provide an interdisciplinary environment that is valuable not only for research but also for the translation of research discoveries into better methods of prevention, early detection, diagnosis, treatment, and of meeting the long-term needs of survivors and family members. Solving Short-term Funding Issues The committee recommends below that 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. Immediate steps should be taken, however, to ensure that high-quality cancer centers do not lose their core grants for lack of program funding. The 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 Department of Health and Eluman Services, work with the appropriate committees of Congress to develop an adequate budget for the program's next fiscal Year (logo!. Otherwise, the committee is concerned that projected funding levels for the core grant program this year and next will result in the loss of centers with excellent peer-review pr ority scores before the program planning process is completed. Specifically, for fiscal year 1989, the committee suggests that the director allocate the additional funding needed to fund at 85 percent of recommended levels the core grants of the competing centers that have fundable priority X1

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scores, up to a limit of $6 million. For fiscal year 1990, the administration should work with Congress to develop a budget that will avoid the current situation and continue to grants to those competing centers that have excellent programs, as measured by peer-review priority scores. Planning for the Future The committee recommends that the National Cancer Institute develop a systematic program plan during the coming year to ensure adequate fiscal, managerial. and organizational resources, coordination with related programs. and effective scientific oversight for the cancer centers program. The plan should take account of the changing fiscal ant] organizational arrangements involved in the delivery of health services. Strengthening Program Organization and Management Strengthening the capacity of cancer centers to exploit the unprecedented opportunities to incorporate emerging scientific advances into better cancer prevention and treatment wall require organizational changes and increased management capacity for the core grant program. The specific decisions, however, should be left to the director of NCT, who is In the best position to determine effective ways to improve the program's location, representation, and oversight and to strengthen the program's capacity for data gathering, planning, evaluation, and implementation. The committee recommends that the director of the National Cancer Institute consider how best to increase representation of the cancer centers program in NCI planning and decision-making processes. including regular representation of the centers at the NCI executive committee meetings and creation of an external advisory committee to review their multidisciplinary programs. The committee recommends that the director of the National Cancer Institute substantially strengthen the management capabilities of the cancer centers program unit. That unit must be able adequately to plan. monitor, evaluate, and implement the cancer centers program. e XII