Update: Future cancer research priorities in the USA

The USA has the best-funded health-care system in the world. Nonetheless, 1·6 million Americans are diagnosed with cancer annually; 600 000 people die from their disease every year; and many of the 15·5 million survivors need some form of supportive care to alleviate long-term symptoms. And, shockingly, it is estimated that overall cancer mortality across the entire US population could be decreased by as much as 25% by simply affording all members of society the same access to, and quality of, cancer care. A blank cheque towards funding, however, would not equate to better long-term outcomes—cancer control is a highly complex multifactorial problem. Thus, there is a clear imperative to strategically allocate funds in order to prioritise the most efficient and effective research, interventions, and measures.

In 2016, under the direction of Barack Obama's Government, and headed by Vice President Joe Biden, a Blue Ribbon Panel (BRP) was established to set out a roadmap of recommendations designed to exploit new advances in cancer diagnosis, prevention, and treatment so as to offer guidance for the allocation of federal funds. The recommendations focused on ten specific topics, with the ambitious objective of delivering 10 years of progress in half that time. The sharp focus of the BRP report inevitably limited its breadth and depth. Thus, the Commission published in this issue of The Lancet Oncology1 on future cancer research priorities in the USA was established to build on the important work started by the BRP, but with the aims of expanding on the BRP priorities and to introduce guidance on those topics not covered by the BRP report.

Comprising a group of 54 cancer clinician–researchers representing approximately 40 institutions, BRP members, and Presidents, President-Elects or past-Presidents of all major US cancer societies, this Commission examines the BRP recommendations in greater detail and expands into other priority areas, including surgical oncology, radiation oncology, imaging, health systems and health disparities, regulation and financing, population science, and oncopolicy. Overall, the Commission brings together the evidence for multiple, subject-specific recommendations. Each recommendation is given with timeframes for implementation and, taken together, form a plan of action that the authors believe has to greatest potential to accelerate gains in future research, treatment, symptom control, and health systems improvement.

We hope this Commission acts as a catalyst for cancer researchers, federal agencies, industry, funders, regulators, and all other stakeholders to come together with a united vision and appetite to implement the recommendations. Many of the actions cannot be done in isolation, so we further hope they will inspire and facilitate new international collaborations. Only by working together in a coordinated and efficient way will the advances that the USA—and, indeed, the world—needs to achieve optimum cancer care be achieved. The time for action is now.

@@@Cancer is a very personal and very present science. Unlike scientific disciplines whose events at the quantum or galactic level are observed through microscopes and telescopes, patients with cancer have cytokine storms and experience life-changing events every day at an individual level.

When President Obama announced the White House Cancer Moonshot Task Force in his final State of the Union address in January, 2016, and appointed Vice President Joe Biden to lead it, he provoked a huge response of support, relief, and hope from all around the world. This engenderment is why, when Vice President Biden convened a national Cancer Moonshot Summit in June 2016, 400 attendees in Washington, DC, USA were joined by 7000 additional people who organised and participated in Cancer Moonshot summits in every US state, Puerto Rico, and Guam. This enormous response to the challenge of Cancer Moonshot—to double the rate of progress in the prevention, detection, diagnosis, and treatment of cancer—emerged from the intensely personal nature of the disease and overwhelming interest in a national and international focus on changing the face of cancer.

As part of Cancer Moonshot, the US National Cancer Institute convened a Blue Ribbon Panel (BRP) to recommend new directions for research funded by additional money, requested by the President and Vice President and provided by Congress, for the Cancer Moonshot programme in the 21st Century Cures Act. The BRP provided ten recommended areas of research and three demonstration projects. The Future Cancer Research Priorities in the USA: a Lancet Oncology Commission1 fulfils a commitment by The Lancet Oncology to provide a forum for a distinguished group of cancer experts to examine the BRP report more closely and provide more context, detail, and specific recommendations to guide the US National Cancer Institute's implementation of Cancer Moonshot funding and research in general across the nation.

The call to action from this Commission1 puts patients first by focusing on new tools for: precision prevention, early detection programmes, improvements in clinical trials, data-sharing, and access to new drugs, and by offering a renewed focus on unique issues in paediatric cancer, patient care, and health disparities. These initiatives are a scientific roadmap for anyone—patient, researcher, or physician—who is interested in shaping the future response to cancer and changing the way in which cancer is perceived and addressed.

The challenge now is to fulfil the promise of Cancer Moonshot and specifically the recommendations of the BRP as elaborated in The Lancet Oncology commission.1 The year of Cancer Moonshot in 2016 should really become the decade of Cancer Moonshot, but inertia and the impulse to revert to old ways and familiar topics can quickly dissipate the energy and focus behind this programme. As the Commission1 shows, the priorities required are known. However, do we have the will to change our norms and instead put patients first, fund innovative, high-risk research, gamble with failure, and collaborate across institutional lines? As Vice President Biden said, a sense of urgency should be instilled into everything we do and we should be willing to change the research culture that was established decades, or even centuries, or ago. This notion is why Vice President Biden and Jill Biden formed the Biden Cancer Initiative after he left office. The mission of the Initiative is to develop and drive implementation of solutions to accelerate progress in cancer prevention, detection, diagnosis, research, and care, and to reduce disparities in cancer outcomes.

The Biden Cancer Initiative will reconsider how the US Government, academia, non-profit organisations, and the private sector can better organise their resources and systems. The Initiative will work closely with patients and patient organisations, cancer researchers, hospitals, and community health centres, research universities, governments, and private and philanthropic sectors to identify and address important issues in cancer prevention, research, and care to achieve these goals.

Future Cancer Research Priorities in the USA: a Lancet Oncology Commission1 provides a roadmap to change the course of cancer in our lifetime—a journey in which we should actively participate. Patients, caregivers, doctors, researchers, nurses, and scientists all need to embark on the course of action proposed by the report without delay.

I declare no competing interests.

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