A billion here, a billion there, and pretty soon you’re talking real money.

Everett McKinley Dirksen (R-IL) U.S. Senate majority leader from 1959–1969

A billion dollars was once an astronomical amount of money to spend on one federal agency. But since the 1950s when Senator Dirksen (R-IL) was a leading voice for fiscal conservatives, the federal government’s budget has ballooned, with both political parties equally responsible for increases.

During this time, great achievements have been made, and much of it in biomedical research at the National Institutes of Health (NIH), as what former Senator Arlen Specter (R-PA) often referred to as the crown jewel of the federal government.

Within that universe, the National Cancer Institute (NCI) continues to hold a very special place for Congress, whose Appropriations Committee historically works in uncommon bipartisan fashion to ensure continued federal funding for breakthroughs, treatments, and cures for cancer. And scientists, medical professionals, advocacy groups like ONS, and many others in the United States hope that favor continues as the NCI released its fiscal year 2020 proposal, seeking more than $6.5 billion in funding.

Although cancer is researched across many of the 27 institutes and centers on the NIH campus, the majority of funding is allocated to NCI. With a $5.74 billion budget in fiscal year 2018, NCI has benefited from an additional $400 million infusion of congressional funding dedicated for the National Cancer Moonshot Initiative, with authorization from the 21st Century Cures Act of 2016, to bolster this specific but temporary initiative.

These billions of annual dollars seem extraordinary—and of course the allocation is, and the cancer advocacy community, including ONS, is grateful for the sustained support—but scientists are only scratching the surface of what cancer really is, and more importantly, how to treat and support survivors. And Congress is tasked with prioritizing the limited federal budget, and to rank and provide funding, congressional committees ask that agencies provide a rationale for annual allotments. This exercise is called “the Congressional Justification of Appropriations, . . .  [which] includes agency priorities, requested budget levels, and performance plans (in accordance with the Government Performance and Results Act).”

Where the Dollars Go

Congressional offices wonder about agency objectives and where the money is disbursed. U.S. Department of Health and Human Services has outlined continuous NCI goals as the driving force for the appropriations: 

  • Basic research, such as genetics, cell biology, immunology, and cancer pathogenesis 
  • Translational and clinical sciences to prevent, screen, and diagnose cancer and to develop and test drugs, biomarkers, imaging technologies, diagnostics, and radiotherapies 
  • Population sciences, including epidemiologic, environment, and behavior studies 

The intent is to promote research and to enhance the quality of care that benefits patients. See Figure 1 for highlights of the NCI congressional justification from 2017, the most recent year currently available.

How Funding Is Changing Cancer Outcomes

A common question on Capitol Hill is, “Is it worth it?” The facts say yes. According to NCI, “the rates of death for all cancer types combined are declining among men, women, and children of all major racial and ethnic groups. From 1991–2015, the overall cancer death rate fell by 26.2%.” See sidebar on page 36 for the reductions for specific cancers.

In a public opinion poll, the cancer advocacy community, of which ONS is a major force, found overwhelming support for continued investment in federal funding for cancer research and treatment, with 92% favoring such commitment. Additionally, 88% responded that state and local cancer prevention programs are also a high priority. Finally, 87% said that Congress needs to work collaboratively to accomplish this goal and find a way to fund lifesaving research. 

A common idiom says that real activism is a marathon, not a sprint. ONS is in it for the long haul, and with the collective voice of 40,000 oncology nurses, NCI has a committed partner in advocating for real support in how cancer will be funded in the future.