Pancreatic cancer is a paradox. It’s one of the deadliest cancers, yet it has one of the lowest research funding levels of all major cancer types. Scientists and advocates say those funding levels are due for a re-examination.
The American Cancer Society (ACS) estimates that nearly 1.7 million new cases of cancer will be diagnosed in 2016. Almost 600,000 cancer patients will die this year — roughly 1,630 per day. But the mortality figures — while obviously troubling — are even more dire where pancreatic cancer is concerned.
Lung cancer is the No. 1 cause of cancer-related deaths among U.S. men and women, followed by breast cancer in women and prostate cancer in men. Colorectal cancer is the third most common cause of cancer-related deaths in both men and women. However, pancreatic cancer — the fourth-leading cause of cancer-related deaths — is projected to jump to No. 2 by 2030, according to a study published by the Pancreatic Cancer Action Network (PANCAN) in an American Association for Cancer Research journal.
The ACS predicts pancreatic cancer will claim almost 42,000 lives in 2016. Roughly 71 percent of patients die within a year of being diagnosed, and pancreatic cancer’s five-year survival rate is a meager 7 percent — the only cancer with a single-digit five-year survival rate, according to the ACS.
Yet pancreatic cancer research is expected to receive only $127 million for 2016, according to the National Institutes of Health. In contrast, breast cancer, which is expected to cause about 41,000 deaths this year, is projected to receive $704 million. While the prevalence of breast cancer far exceeds that of pancreatic cancer — the 12th most common cancer — death rates for breast cancer decreased by 36 percent between 1989 and 2012, whereas pancreatic cancer deaths have been on the rise.
A Complex Calculus
The National Cancer Institute (NCI), a key federal funder of cancer research, spells out its funding priorities on its website.
“In the grant-making process, NCI does not use predetermined targets for a specific disease area or research category,” the website states. “Rather, the institute relies heavily on scientific peer review, in which highly trained outside scientists review research proposals and judge them on factors such as scientific merit, potential impact, and likelihood of success.”
That does not suggest that a given cancer’s mortality rate is automatically the primary factor in funding decisions.
However, even advocates for pancreatic cancer research say it is unwise to treat funding as a competition. For one thing, research on one cancer can yield advances in treating others, notes Lynn Matrisian, PhD, MBA, Chief Research Officer at PANCAN, a California-based organization focused on advancing research and supporting patients who have the disease. A bigger pie — not a bigger piece of the pie — is the answer, she believes.
“I’d like to see [cancer in general] receive more funding,” Matrisian says. “I would rather not think of it as a zero-sum game.”
Government funding has been rather flat, she adds.
“When you consider inflation has gone down, in terms of buying power that’s invested into [research] over the last decade or so, we have not kept up not only with inflation, but with the remarkable scientific advances that have occurred that give us so much opportunity to make advances in pancreatic cancer or any cancers,” she says. “As a whole, [the government is] not investing enough in cancer research.”
Nevertheless, she acknowledges the complexity of decisions regarding funding of clinical trials and other research.
“When you think about cancer burden, you of course want to think about it multidimensionally — how many people get it, how long they live and how many people die from it,” Matrisian says. “It can be very different among cancer types. Some have very high incidence but long survival and low death rates. [Others] have low incidence rates and very high death rates. I don’t think there’s one formula for comparing.”
Perils of Inaction
Congress and the NCI have taken steps to enhance the focus on pancreatic cancer. In 2012, Congress passed the Recalcitrant Cancer Research Act, requiring the NCI to develop scientific research frameworks for the deadliest cancers, beginning with pancreatic and lung cancers.
While observers say these measures are helpful, they still see a need to substantially increase funding for pancreatic cancer research. They point, for instance, to the lack of reliable methods of early detection of the disease, which leads to higher mortality rates.
Kirsten Bryant, PhD, post-doctoral researcher at the University of North Carolina at Chapel Hill, secured a five-year grant from PANCAN in fall 2015. She is examining whether the altered metabolism of pancreatic cancer cells can be exploited to improve treatment. Grants funding such complex goals are hard to come by, she says.
“I’m already stressed about where I’m going to find funding after that,” Bryant says. “[The lack of funding] actually makes researchers want to tackle simpler questions so that you have more results you can include in your next grant proposal. The problem with pancreatic cancer is there aren’t very many simple questions to answer, and I think this discourages people from joining the field because you need to be generating results to get grants.”
“One of the biggest issues affecting the perception of pancreatic cancer is the lack of survivors to advocate for the disease or for change. The time is so short before they’re gone.”
— Kirsten Bryant, PhD, post-doctoral researcher, University of North Carolina at Chapel Hill
While there are multiple private networks such as PANCAN and the Lustgarten Foundation — which recently teamed with Stand Up To Cancer and Cancer Research UK to provide $12 million to fight the disease — securing adequate federal funding is vital to enhancing outcomes.
“The hopeful thing is, we’ve been able to turn that curve for these other cancers,” Matrisian says. “Now let’s turn it for this one as well.”