乌鸦传媒

NEW ORLEANS -- Federal funding for medical research severely short changes gynecologic oncology when cancer lethality is taken into account, according to data presented here.

Among 13 common cancers included in the analysis, gynecologic cancers ranked near the bottom in funding support, as determined by federal spending per years of life lost for each type of cancer. Three gynecologic cancers used for the analysis -- ovarian, cervical, and uterine -- landed near the bottom of the list individually and collectively.

A comparison of ovarian and prostate cancer, for example, showed a mean expenditure of $85,000 per years of life lost (YLL) per 100 new cases of ovarian cancer. The mean soared beyond $1 million for prostate cancer. Even greater disparities resulted from analyses involving cervical and uterine cancer, Ryan Spencer, MD, of the University of Wisconsin in Madison, reported at the Society of Gynecologic Oncology (SGO) meeting.

"We observed that gynecologic cancers are disproportionately underfunded compared to most other cancer sites when using the funding-to-lethality score to standardize the impact of mortality, incidence, and person years of life lost to cancer death across various cancer sites," said Spencer. "These disparities are seen when the data are aggregated and when the data are re-analyzed by individual year and when year-over-year trends are explored.

"Given current funding projections and the decline in clinical trial availability, these trends are likely to continue to worsen, rather than improve."

SGO invited discussant Paola Gehrig, MD, of the University of North Carolina at Chapel Hill, noted that federal funding for clinical trials in all types of cancer has declined substantially in recent years. For example, the NCI funded 27% of new research proposals in 2001, but that declined to 12% by 2015. From 2008 to 2017, the number of fully funded NIH studies presented at the American Society of Clinical Oncology meeting decreased by 75%.

However, outcomes in at least some gynecologic cancers have not improved to the same degree as some common cancers during the decline in federal funding. Using her specialty of uterine cancer as an example, Gehrig noted that disease-specific mortality for uterine cancer increased 2% annually from 2010 to 2014.

Borrowing a statement from Spencer's presentation, Gehrig concluded, "Without a correction, gynecologic cancers will continue to be underfunded and risk lagging behind other cancer sites in critical discoveries for cure and life prolongation, in this important era of immunotherapy, molecular targeting, and personalized medicine."

The study had its origin in what Spencer described as a crisis in enrollment in gynecologic cancer clinical trials. From 2011 to 2016, enrollment in gyn cancer trials decreased by 90%, and the number of available trials declined by 68%. The objective was to determine the equability of NCI funding distributions across different types of cancer.

Data for the analyses came from the NCI registry program and the and funding statistics for the years 2007-2014.

Investigators calculated a "funding-to-lethality" score for uterine, ovarian, and cervical cancer, as well as for 10 other types of cancer. The comparators included a mix of common diseases (breast, lung, prostate, colon), cancers with incidences similar to the gyn cancers, and cancers that affect only men (prostate, testicular).

To achieve a balance among cancer incidence, mortality, and burden of YLL, investigators determined YLL for each of the 13 cancers included in the analysis and then used federal funding for each of the cancers to calculate funding-to-lethality values.

In the overall analysis, prostate and breast cancer came out far ahead of all the other types of cancer. From 2007-2014, prostate cancer had a funding-to-lethality score of 1.811, which translated into $1,811,000 per YLL per 100 new cases. Breast cancer followed close behind with a score of 1.803 and $1,803,000 per YLL per 100 cases. Ovarian cancer ranked 9th (0.97, $97,000), cervical cancer ranked 10th (0.87, $87,000), and uterine cancer ranked 12th (0.057, $57,000). Testicular cancer came in last (0.044, $44,000).

Using the data for 2014, Spencer's group compared ovarian and prostate cancers. Ovarian cancer had a mortality of 7.0191 deaths/100,000, versus 19.1189/100,000 for prostate cancer, and an incidence of 11,3496/100,000 versus 99.6716/100,000. Dividing mortality by incidence resulted in 0.618 deaths per new cancer for ovarian cancer and 0.192 for prostate cancer.

Multiplying the deaths per new cancer by 17.5 years of life lost to death by ovarian cancer and 9.9 years of life lost with each prostate cancer death yielded 1,282 YLL per 100 new cases of ovarian cancer and 189.9 YLL/100 for prostate cancer.

Finally, investigators divided the $91.5 million in funding by the YLL to arrive at $85,000/YLL/100 new cases and a funding-to-lethality score of 0.085 for ovarian cancer. The same calculations with $217.8 million in funding for prostate cancer resulted in $1,147,000 per YLL/100 and a funding-to-lethality score of 1.15.

Across the entire study period, the funding-to-lethality scores and funding per YLL per 100 new cases for the other cancers were:

• Melanoma: -0.519 and $519,000
• Colorectal: -0.422 and $442,000
• Lung: -0.3 and $363,000
• Leukemia: -0.353 and $353,000
• Non-Hodgkin's lymphoma: -0.284 and $284,000
• Kidney: -0.112 and $112,000
• Pancreas: -0.074 and $74,000

Spencer acknowledged several limitations of the study. The analysis did not account for funding from sources other than NCI. Funding gaps are likely multifactorial. A "correct" or "appropriate" funding-to-lethality score has not been determined.

Comment