Investigators have found that federal cancer research funding tends to be allocated more heavily toward cancers that occur more often in non-Hispanic White patients than those that occur more frequently in other racial and ethnic groups, according to a new study published by Haghighat et al in the Journal of the National Cancer Institute. The findings revealed that funding across cancer sites was not concordant with lethality and that cancers with high incidence rates among racial and ethnic minorities may receive lower funding.
Background
Previous studies have shown that cancers more frequently affecting non-Hispanic White patients—including breast cancer, leukemia, and lymphoma—may receive more funding than cancers with high incidence rates among racial and ethnic minorities such as gastric cancer, endometrial cancer, and hepatic cancer.
“In my research and in clinical practice, disparities in cancer are an unfortunate but well-known entity. I’m a gastroenterologist, and disparities are of paramount concern in my areas of expertise: [gastric cancer] and colorectal cancer,” explained senior study author Shria Kumar, MD, MSCE, Assistant Professor of Medicine at the University of Miami Miller School of Medicine and a gastroenterology researcher at the Sylvester Comprehensive Cancer Center. “Racial and ethnic disparities are well documented across the spectrum of cancer types, and this is of utmost importance. The White House’s Cancer Moonshot initiative has a focus on mitigating cancer disparities, and the [National Cancer Institute (NCI)] is very attuned to the impact that disparities have on our quest to improve cancer burden,” she added.
Study Methods and Results
In the new study, the investigators compiled and analyzed statistics from federal cancer research funding sources to determine the correlations between funding directed toward reducing cancer incidence and funding aimed at decreasing cancer mortality.
The investigators first obtained data from the NCI's Surveillance, Epidemiology and End Results (SEER) database; the United States Cancer Statistics (USCS) database; and Funding Statistics between 2014 and 2018. For each year, they identified the incidence and mortality rates and person-years of life lost—both overall and by race and ethnicity—per 100,000 individuals for the 19 most common cancer sites as well as NCI funding for each cancer type.
Although previous studies of funding distribution have evaluated these three factors separately, the investigators in the new study evaluated funding using funding-to-lethality scores that incorporated all three metrics to provide a composite, objective perspective on disease burden.
Among the new findings were:
- There was a stronger correlation between funding-to-lethality scores as well as race and ethnicity–specific cancer incidence, rather than mortality.
- There was strong correlation between a cancer’s incidence among non-Hispanic White patients and its funding-to-lethality score, but this was not the case for other racial and ethnic groups, where there was only a weak to moderate correlation.
- There was a moderate to strong correlation between a cancer’s mortality among non-Hispanic White patients and its funding-to-lethality score, but there was only a weak correlation for all other racial and ethnic groups.
“We were very surprised that correlation was stronger for incidence than mortality. It shows how complex and multifaceted funding allocation is, but it really underlines the need to look at it objectively—as we did here—and use it as a tool to mitigate cancer disparities, a common goal,” Dr. Kumar stressed.
Additionally, the investigators found that breast cancer and prostate cancer had the highest and second-highest funding-to-lethality scores, while esophageal cancer and gastric cancer ranked 18th and 19th. They noted that breast cancer research received approximately 50 times more funding than gastric cancer in 2018, even though breast cancer mortality was estimated to be only four times higher than gastric cancer mortality.
Conclusions
The investigators commented that addressing these inequities could make a difference in cancer research disparities within a short period of time. “Despite initiatives to bolster cancer research funding and to mitigate disparities in cancer outcomes, there are marked disparities in federally funded cancer research that do not correlate with lethality,” the investigators stated. “Our [study] identifies discrepancies in funding by demographic groups and highlights the need to ensure that federal funds are equitably distributed. This is especially important given the discrepancies in cancer outcomes for minorities, particularly in the more underfunded cancers,” they emphasized.
“The results of this study are immediately actionable,” highlighted Dr. Kumar. “Agencies can evaluate their own recent funding distributions and those for upcoming cycles, then they can prioritize funding for cancers that disproportionately impact minorities to mitigate disparities and reduce [the] cancer burden,” she concluded.
Disclosure: The research in this study was partially supported by a training grant from the National Institutes of Health. For full disclosures of the study authors, visit academic.oup.com.
