Disparities Found in Funding of Cancer Research

Cancers that disproportionately affect Black patients (i.e., lung, colorectal and gynecologic cancers) receive less research funding than those cancers with high incidence rates among white patients. Further, cancers associated with high mortality rates are underfunded. The disparities in funding are evident for both government (National Cancer Institute [NCI]) and nonprofit organization (NPO) sources. In addition, underfunding strongly correlates with fewer clinical trials.

“Colorectal cancer is a prime example,” says Suneel D. Kamath, MD, Cleveland Clinic Taussig Cancer Center, who presented the findings during a poster discussion session at the 2022 American Society of Clinical Oncology annual meeting. “It’s incredibly common, and is the second leading cause of cancer-related death in the United States. Despite this, you don’t hear much about it. I thought it might be because of lack of funding. I delved into it, looking at what nonprofit advocacy groups are able to raise for particular cancer types and how the NCI is allocating its funds to each disease. As I suspected, I found a great disparity in funding.”

He assessed for disparities in NCI and NPO funding from 2015 to 2018 across 10 common cancers (leukemia, lymphoma, breast, lung, colorectal, pancreatic, liver/biliary tract, melanoma, uterine, cervical, ovarian and prostate) to determine if underfunding correlates with incidence, mortality rates, race/ethnicity and the number of clinical trials.

Cancers with the largest combined NCI and NPO funding were breast cancer ($3.75 billion) and leukemia ($1.99 billion). Those with the least funding were endometrial ($94 million), cervical ($292 million) and hepatobiliary cancers ($348 million).

Combined NCI and NPO funding correlated well with individual cancer incidence (Pearson correlation coefficient [PCC]: 0.74; P = .006), but correlated poorly with mortality (PCC: 0.30, P = .346). Breast cancer, leukemia and lymphoma were consistently well-funded, whereas lung, colorectal, liver/biliary tract and uterine cancers were consistently underfunded.

“Cancers that cause many deaths are the ones that would be expected to receive more funding in an attempt to understand and reverse this trend,” says Dr. Kamath. “The opposite turns out to be true. When I looked deeper into some of the other factors that go into this, I found that cancers that are more common among Black patients also turn out to be more poorly funded.”

Both NCI and NPO funding increased proportionately as the incidence increased for white patients (PCC: 0.73; P = .007), Hispanic patients (PCC: 0.66; P = .02), Asian/Pacific Islanders (PCC: 0.77; P = .003) and Native Americans and Alaskans (PCC: 0.72; P = .008). In contrast, cancers with higher incidence in the Black population were underfunded (PCC: 0.52; P = .08). Underfunding from the NCI and NPOs for a particular cancer correlated strongly with fewer clinical trials for that disease (PCC: 0.91; P < .0001).

“For NCI funding, there was a very strong relationship between higher incidence and more funding,” he says. “That was a tight relationship, and you would expect that. I would also argue that you would expect the same thing to follow with cancers that have high mortality rates, which suggests that they have major impacts on society, and so perhaps we should focus our efforts on those. But that relationship was definitely not there. We found that many cancers with very high mortality rates were poorly funded and those with better outcomes were still getting a lot of funding.”

Dr. Kamath says that he has been building relationships with advocacy groups to help him reach leaders in Congress to raise awareness about this disparity, and he has spoken with the Congressional Black Caucus about cancer funding disparities. “My ultimate goal is to develop an algorithm or score to help decide the amount of funding devoted to each cancer,” he says. “It should be more objective than it is. Certainly, a number of factors should go into a score. How common is the disease, what is its mortality rate, does it affect younger people and what is the cost of care for a particular cancer. We should properly weigh a series of factors to create a living mechanism to decide how best to use funding resources across diseases.”

In addition, he suggests that increasing representation of the Black community in advertising and fundraising campaigns is critical and may help to address the unmet needs in diseases that disproportionately affect Black patients.