Facing federal funding uncertainty, a looming workforce shortage and an increasingly aging patient population, cancer center leaders in the U.S. remain undeterred. Their focus remains, as it has for decades, on one mission: to push cancer research and clinical care forward in such a way that, for many patients, a cancer diagnosis is no longer a death sentence.
Between 2018 and 2022, cancer mortality rates in the U.S. decreased between 1% to 2% each year. As of 2022, the age-adjusted cancer death rate has dropped 34% since its peak in 1991. There are expected to be 26 million cancer survivors in the U.S. by 2040.
The 73 organizations partly responsible for this dramatic change in outlook form the federal government’s National Cancer Institute Cancer Centers Program. As NCI-designated cancer centers, these organizations are required to meet rigorous standards and dedicate a significant amount of their resources toward research that yields measurable advancement in the prevention, diagnosis and treatment of cancer, while also providing comprehensive clinical oncology care.
For this reason, NCI-designated cancer centers are partially funded by the federal government, under congressional approval, as part of the President’s Budget. Outside of federal funding, NCI-designated cancer centers operate under different funding models. Some engage in significant philanthropic efforts while others rely on long-held partnerships and academic affiliations.
In fiscal year 2023, NCI-designated cancer centers were awarded more than $353 million in federal grants. In recent years, this funding has supported the development of breakthrough oncologic innovations such as genomic testing and immunotherapy.
Funding practices of the National Institutes of Health — the agency of which NCI is a part — have experienced increased scrutiny under the second Trump administration.
In February, the NIH proposed capping indirect cost reimbursement for research at 15% — nearly half the current average of 27% to 28%. The agency said the move would potentially save the federal government $4 billion annually. A federal judge issued a permanent injunction to the proposal on April 4, though the government has said it plans to appeal the decision.
In March, Lebanon, N.H-based, NCI-designated Dartmouth Cancer Center Director Steven Leach, MD, told MedPage Today that the center had not received federal funding since December, and that he knew of three other NCI-designated cancer centers in similar positions.
Faced with ensuring operational success during a period of financial uncertainty, some leaders of NCI-designated cancer centers are stepping forward to share what is at stake should federal funding of cancer research and care disappear.
“In some ways, this current moment doesn’t feel that different from our experiences during COVID-19. Many of the same themes of dynamic circumstances, funding and budget challenges, skepticism toward science and general uncertainty, that were true then are true right now,” Seattle-based Fred Hutchinson Cancer Center President, Thomas Lynch, MD, told Becker’s. “What does feel different is the pace and volume of healthcare policy changes being suggested and their direct impact on cancer research and care.”
Founded in 1972, Fred Hutch has been an NCI-designated Comprehensive Cancer Center since 1973. Besides cancer, the center also conducts research on HIV and other nonmalignant diseases.
“For decades our partnership with the federal government has meant that long term, discovery-oriented research led to paradigm shifting breakthroughs and lifesaving innovations,” Dr. Lynch said.
The cancer center receives 70% of its research funding and more than 50% of its clinical funding from the federal government. Dr. Lynch told Becker’s that other funding sources would not offset the significant financial shortfall should federal support cease.
Many NCI-designated cancer centers, including Fred Hutch, receive funding from philanthropic gifts, strategic partnerships and outside investments. These funds, Dr. Lynch said, are often reserved for specific research and projects, meaning they cannot be reallocated to other areas of need.
Lexington-based University of Kentucky Markey Cancer Center, the first and only NCI-designated Comprehensive Cancer Center in Kentucky, operates under a similar model with funding from federal and state governments, community support and philanthropic gifts, according to the center’s director, B. Mark Evers, MD.
“I don’t ever envision these sources completely supplanting the need for federal funding from the NIH,” Dr. Evers told Becker’s. “Federal funding is such a significant source of support for our center, and woven into the national fabric of cancer research in such a significant and impactful way, that any cut in this funding will slow the incredible progress we’ve made against cancer in recent years.”
Federal funding has enabled Markey to serve communities in eastern Kentucky, home to some of the most vulnerable populations in the U.S. at risk of developing cancer. The center reached almost 16,000 Kentuckians with cancer prevention and education programs in 2024. As a result of this outreach, more than 1,000 patients have been referred to specific screening programs, Dr. Evers said, programs that would “absolutely suffer,” should federal funding decrease.
“Over the past 15 years, we at the Markey Cancer Center have seen significant progress to decrease the mortality of some of [the] most deadly cancers in our state,” Dr. Evers said. “While we are proud of this progress, the need to continue our work remains urgent — Kentuckians cannot afford to see that momentum altered in any way.”
The momentum of progress within cancer research and care is a driving force behind the strategies both leaders are deploying in the current landscape of uncertainty.
“We are definitely not taking a ‘circle the wagons’ approach,” Dr. Evers said. “[We] are not allowing ourselves to be paralyzed by the unknown. We are continuing to strategically recruit oncologists who treat our patients and researchers who discover tomorrow’s cures, and implement new programs as defined by our strategic plan.”
“We are in a period of remarkable progress in cancer research and care, with the pace of new technologies and treatments accelerating rapidly,” Dr. Lynch said. “It’s critical that we don’t let near-term pressures immobilize us and lose sight of our long-term plans.”
Other driving forces necessitating action in the current moment are foreseeable changes to the healthcare workforce as well as the rapidly aging population. There will be 82 million adults aged 65 and older in the U.S. by 2050 — a 47% increase from 2022 — while at the same time, more than a third of practicing physicians will reach retirement age within the next decade.
“We have to move forward with key growth strategies or, in a few years, we could find ourselves in a position where it will be difficult to meet these needs,” Dr. Lynch said. “So, while we may not be able to invest as much as we would like right now, we are still advancing our plans and [taking] key steps toward these investments, as well as identifying and implementing strategic operational and other efforts … to ensure our readiness for growth.”
Both Dr. Evers and Dr. Lynch remain unwavering in their clear-eyed commitment to the mission all NCI-designated cancer centers share: to fuel innovation for the prevention, diagnosis and treatment of cancer.
“Over the course of the last several decades, there have been a number of peaks and valleys and uncertainties regarding the sustainability of funding and our research mission,” Dr. Evers said. “It can be easy to become paralyzed by constantly worrying about the worst-case scenario or ‘what-ifs’; however, this paralysis and lack of action will not benefit the patients that we serve.”
“In unsettled times, my mindset is to remain focused on the mission,” Dr. Lynch said. “No matter what the healthcare policy or funding landscape is, we will continue to provide compassionate care to everyone who needs it and will pursue scientific breakthroughs to prevent and eliminate cancer and infectious disease.”
For Dr. Lynch, the breakthroughs affirming his resolve include harnessing immunotherapy to increase life expectancy for melanoma patients and developing multidrug treatments that enable long-term remission for patients with myeloma.
For Dr. Evers, who has spent the last 35 years caring for patients with gastrointestinal and soft tissue cancers, the fact that the field can now use the word “cure” when discussing certain malignancies gives him hope for the future.
“We must continue to set our sights on improving the lives of our cancer patients and not allow the ‘noise’ to deter us,” Dr. Evers said. “As in the past, we will weather this current storm and will come out stronger and more resilient in the long term.”
