Using the National Cancer Plan to Drive Innovation in Cancer Research

Since the signing of the National Cancer Act of 1971 (1) that empowered the NCI to take broad and bold steps to carry out the national effort against cancer through the creation of a National Cancer Program (2), we have seen a tremendous rise in the innovative approaches with which we treat cancer and the depth of knowledge we have about cancer. We have amassed an astonishing array of tools to help us achieve earlier diagnoses, less toxic treatments, better quality of life in survivorship, and more equitable distribution of benefits of research. Importantly, this progress has led to meaningful improvements in the outcomes faced by many people diagnosed with cancer; cancer mortality has declined by a third in just the past three decades (3). This trend must continue and accelerate (4) if the cancer community is going to collectively achieve the goals of the President and First Lady's Cancer Moonshot, (5) – reduce the cancer mortality rate by 50% by 2047 in the United States and improve the experience of those living with cancer. We are also at a critical inflection point in this effort – we can reach more patients, apply technologies to a broader array of cancers, and achieve both scientific and cultural shifts needed to accomplish the sea change we so urgently need. Yet, cancer remains a top fear of many, and virtually everyone can easily name a loved one or friend who lost their life to cancer. To change what it means to face a cancer diagnosis, we have more work to do as a community.

It is against this backdrop that I joined the NCI as director in December 2023. During the first few weeks of my new role, one thing quickly became clear: the NCI and the cancer research ecosystem are larger and more complex than I even anticipated. To me, the NCI comprises the organization itself, as well the important work it supports throughout the nation and around the world to reduce the burden that cancer wreaks on families and communities. I bring to this position more than two decades of experience as a laboratory-based basic scientist and cancer-focused clinician, management expertise running a large and academically robust department of medicine, and leadership roles in major professional organizations. Still, the incredible depth and breadth of the NCI – and the unique vantage point that my new position affords me to view the vast cancer landscape more holistically – has impressed and inspired me beyond my expectations.

Thankfully, we have a National Cancer Plan (6) to serve as a roadmap to guide our work and that of the broader cancer community.

The National Cancer Plan (available at http://nationalcancerplan.cancer.gov) is a broad and inclusive framework designed to capitalize on our progress and foster collaboration to accelerate progress against cancer. The current director of the NIH Dr. Monica Bertagnolli developed the plan in her former role as the NCI director in collaboration with the President's Cancer Panel (7) and with input from across the cancer community. The NCI director leads the broad implementation of the plan to advance the National Cancer Program, and the President's Cancer Panel is charged with monitoring progress toward the plan's goals. The goals reinforce and are aligned with other important national-level cancer priority areas (8–10).

Using the National Cancer Plan to unite the cancer community in coordinated action requires assembling its components (eight goals) to create synergies, leaning into opportunities to apply data-driven solutions, and breaking down barriers that stand in the way of progress. A year after its launch in April 2023, the National Cancer Plan continues to be a catalyst for organizing priorities, communicating about achievements, and identifying gaps and areas of opportunity. But there is so much more we can – and must – do with the opportunities outlined in the plan, to drive innovation for faster progress.

In this commentary, I present my perspective on the National Cancer Plan – seeing it in a new light. I first discuss the importance of the eight goals, then I present three examples that illustrate the power within the plan to drive more innovation in cancer research. My main message is this: the National Cancer Plan represents a whole that is greater than the sum of its parts, and the full potential of the plan is found in the spaces in between the goals, and where the goals intersect, interconnect, and come together to accelerate research through innovation. This is where we need to focus our energy in this new era of cancer research.

Eight goals form the centerpiece of the plan (Fig. 1). I interpret the goals as domains of work that encompass all the efforts that can contribute to progress toward the ideal future states as described in the National Cancer Plan (11). For example, to achieve the ideal future state of Prevent Cancer (all people and society adopt proven strategies that reduce the incidence of cancer), it will take everyone from vaccine researchers, statisticians, family physicians, nurses, health educators, healthy people, dieticians, tobacco control advocates, policymakers, and the list goes on. My examples in this commentary focus on research, but everyone has a unique role in realizing the potential of the plan—including many who do not identify as researchers.

To meaningfully put the whole together, we first need to focus on the individual parts (the goals). Four of the eight goals follow the arc of the patient experience – from cancer risk assessment, to mitigation, management, experience, survivorship, and health outcome. I think of these as the “health-centric” goals: Prevent Cancer, Detect Cancers Early, Develop Effective Treatments, and Deliver Optimal Care. They are directly geared toward health outcomes, which can be assessed by measures such as cancer incidence, cancer mortality, robust survivorship, and life expectancy. These health-centric goals exist mainly in the health and research ecosystem, although achieving them requires efforts from across society. Research – of all kinds – is an essential feature of each of these goals. Discovery science is the critical fuel that powers progress in these health-centric goals, from basic science as the building block to population science, epidemiology, translational studies, clinical research, implementation science and health policy research; our work is not complete until the benefits of research reach everyone.

The next set of four goals, as I think about them, are “empowering” goals: Maximize Data Utility; Eliminate Inequities, Optimize the Workforce, and Engage Every Person. These goals span all aspects of the cancer continuum and operate in the societal ecosystem. We must use all the resources, knowledge, and perspectives available throughout society to improve cancer outcomes. These goals should also be approached from multiple angles: research, program implementation, policy change, and individual behaviors.

Each goal has a value on its own, but when combined, they fuel a culture of innovation, creativity, and collaboration that represents a paradigm shift from an establishment that has historically been marked by narrow approaches to cancer research and care. This new era is in our immediate future, one that utilizes the National Cancer Plan to build on our progress and drive further innovation in cancer research. In other words, the key to the accelerated progress we need to see in cancer research lies in creative partnerships across the entire cancer community – and society – that blend unique perspectives, experiences, and expertise, that will unleash novel, nontraditional solutions that would not be possible when focusing on any one goal by itself. We need to do more of this, and the National Cancer Plan empowers us do that. The NCI has a role, along with other federal agencies, foundations, and industry partners that are dedicated to progress against cancer. We must work together especially because while opportunities are unlimited, time and resources are not.

To illustrate what these “new era” partnerships look like practically – and to encourage everyone to use the National Cancer Plan to identify and engage in more opportunities like these – I present three examples below. These stories show how the National Cancer Plan can help us align efforts, commit to shared goals, and identify novel methods of working across siloes and domains to chart the course to a more innovative, collaborative future. Relevant goals from the National Cancer Plan are shown in italics.