Transforming the Capacity of Centers, Networks, and Consortia

Goal

Integrate research infrastructures and collaborations that enable multiple scientific disciplines to address large problems in human cancer that cannot be solved by individual investigators. Promote networks, partnerships, and coalitions that increase the pace of translational research and the rate at which the results of research are translated into clinical practice and public health benefit.

Introduction

• Embracing an Evolving Paradigm in Cancer Research

The interdisciplinary nature of today's cancer research requires new infrastructures that support team science and enable the sharing of a multitude of resources. The centers, networks, and consortia created and supported by NCI over the past 10 years comprise a model framework in which investigators can work effectively in teams, collaborate for progress, and ensure that results advance from discovery to intervention development and delivery.

• NCI-designated Cancer Centers are highly effective platforms that span the discovery-development-delivery continuum. These Centers organize and integrate multidisciplinary research across departments and schools within a single institution or consortium of local institutions. Emphasizing the cancers that represent the greatest health threat to their communities, NCI-designated Cancer Centers:

• Provide scientists with the most advanced technologies and promote new research opportunities.
• Work collaboratively with industry.
• Perform state-of-the-art translational research.
• Conduct education, outreach, and information programs.

NCI-designated Cancer Centers are highly effective at leveraging additional resources for cancer research and education from organizations in the public as well as private sectors.

• NCI Centers of Excellence, usually evolving within Cancer Centers, connect specialized groups of scientists in collaborative, interdisciplinary research. Projects are closely integrated with the efforts of other centers of excellence, research networks and consortia, and institutions throughout the Nation. NCI Centers of Research Excellence are usually devoted to discovery and development of new interventions and are often linked to private industry.

• Networks and consortia are geographically dispersed multidisciplinary groups whose goals require inter-institutional collaborations. Networks and consortia usually focus on the development or validation of new interventions, ranging from new therapies to genetic risk counseling to outreach.

Embracing an Evolving Paradigm in Cancer Research

This infrastructure is now poised to exploit an evolving paradigm in cancer research that will help attain NCI's challenge goal of eliminating the suffering and death due to cancer. The new research paradigm hinges on interdisciplinary science, strategic partnerships, immediate application of new technologies, optimal information sharing, and close links to health delivery systems. To move forward, by realigning existing resources and incorporate new ones, NCI must:

• Employ progressive bioinformatics and communication systems.
• Encourage collaborative, multidisciplinary research, and require integration and sharing of results.
• Realize economies of scale, avoid duplications, and exercise regional sharing.
• Promote growth in strategic areas of research and technology development.
• Strategically broaden the geographic impact of the centers, networks, and consortia.
• Improve the access of minority and underserved populations to state-of-the-art research and resources.
• Create and strengthen partnerships with government agencies and community organizations.
• Broadly provide expertise, facilities, and other resources to caregivers, patients and families, and appropriate health agencies.

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Progress In Pursuit of Our Goal

Strategic Expansion of NCI's Centers, Networks, and Consortia

NCI-designated Cancer Centers are now present in 31 states and the District of Columbia, and NCI has planning grants in place for developing Cancer Centers in another five states. NCI is actively working with institutions in five additional states that have the capability to develop strong research and outreach programs, with the goal of creating a Cancer Centers program that benefits the entire Nation.

NCI is also creating new Cancer Center models to serve states that do not have the institutional infrastructure to sustain a more traditional NCI Cancer Center. These innovative models will address:

• Geographic expansion
• Education and outreach activities
• Partnerships for research and delivery
• Aids for underserved populations

For example, Cancer Centers are now engaged in a unique partnership, Overcoming Barriers to Early Phase Clinical Trials, with several major pharmaceutical companies.

NCI is also strengthening the capacity of NCI-designated Cancer Centers to audit research, ensure data safety, and monitor human research. A broad new NCI bioinformatics initiative will pave the way for investigators at NCI-designated Cancer Centers to participate in a national network for collaborative research and sharing of research results, while ensuring the safety of patients and populations. (See Developing New Bioinformatics Tools and Infrastructure.)

Specialized Programs of Research Excellence (SPOREs), the original Centers of Excellence created by NCI in 1992, focus entirely on discovery-to-delivery research dedicated to specific cancers. There are now 50 SPOREs in place across t4he Nation, with all major cancer sites represented. These SPOREs are poised to rapidly conduct early-phase clinical studies, sharing information via a protected Web-based system. The SPOREs effectively work together across institutional boundaries and have begun productive collaborations with NCI networks and consortia, as well as through public-private partnerships. For example:

• A partnership with the Avon Foundation has generated over 15 early-phase clinical trials in breast cancer.
• A new supplement program for early-phase trials in all cancer sites is also working well.
• Fifteen new early-phase clinical trials are ongoing in the longest-standing SPOREs, focusing on prostate, gastrointestinal, and lung cancers.

These achievements mark the end of the rapid expansion phase of the SPOREs and a transition to strategic growth.

Other Centers of Excellence founded on the SPOREs model are spearheading interdisciplinary research in a number of specialty areas. For example:

• The Transdisciplinary Tobacco Use Research Centers (TTURCs) support a broad array of studies related to tobacco use, including genetic and behavioral research. (See Research on Tobacco and Tobacco-Related Cancers, Progress in Pursuit of Our Goals.)
• In Vivo Cellular and Molecular Imaging Centers bring together experts from diverse scientific and technological backgrounds to conduct research on cellular and molecular imaging in cancer. (See Cancer Imaging and Molecular Sensing, Progress in Pursuit of Our Goals.)
• Interdisciplinary Teams for Molecular Target Assessment study critical biological processes to uncover high-priority targets for cancer intervention strategies. (See, The Interdisciplinary Research Teams for Molecular Target Assessment (IRTMTA) is....)
• Centers of Excellence in Cancer Communications Research focus on advancement of cancer communication science. (See Cancer Communications, Increasing Knowledge Through Discovery.)
• Centers for Population Health and Health Disparities research the interaction of social, cultural, and physical environmental determinants of cancer incidence and outcomes, and the behavioral and biologic factors that contribute to them. (See, ...establish Centers for Population and Health Disparities.)

The Cancer Genetics Network is a nationwide system of research sites located within NCI-designated Cancer Centers. The CGN specializes in the study of inherited predispositions to cancer. This ambitious program now has its essential databases in place and has achieved adequate participation from patients. Poised as a major research arm in genetics, the CGN has begun collaborating on several projects with the SPOREs and with individual investigators. (See, Cancer Genetics Network, Discovering and Characterizing Cancer Predisposing Genes in High-Risk Families.)

The Mouse Models of Human Cancers Consortium is a powerful system for engaging researchers in a wide spectrum of basic, translational, clinical, and epidemiological investigations. (See also, Using Molecular Signatures to Study Models of Human Cancer.) For the first time, a resource is available to the scientific community that documents the characteristics of mouse models and supplies the most valuable cancer models to the scientific community. MMHCC investigators are collaborating with independent investigators supported by traditional research grants and with SPORE and Early Detection Research Network investigators. Interactions among the Early Detection Research Network, SPOREs, and other interdisciplinary groups are facilitating the discovery and development of molecular markers and assays that detect early signs of cancer.

Through its Minority Institution/Cancer Center Partnership Program (MICCP), NCI is helping to increase the competitive research grants obtained by minority institutions. All major U.S. minority institutions with medical schools now participate in the program. Over 30 other institutions that have never been involved in cancer research are also participating. New inter-institutional models are emerging that provide direction for minorities as they develop their skills in cancer research. (See also, Encouraging Minority Investigator Involvement in Cancer and Cancer-Related Disparities Research).

In another NCI effort, Special Populations Networks for Cancer Awareness and Training are building relationships between minority communities, NCI-designated Cancer Centers, and NCI Cooperative Groups to address cancer health disparities in specific populations. (See also, Bridging the Gap between Discovery and Delivery to Address Disparities.)

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Objectives and Fiscal Year 2005 Milestones and Required Funding Increase

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Cancer Centers Speed the Delivery of Research Benefits to Cancer Patients and to Populations at Risk for Cancer

NCI-supported Cancer Centers, networks, and consortia are natural hubs for national leadership in the war against cancer. They also provide a means for fostering coalitions and partnerships with other cancer funding organizations, professional societies, businesses, industry, communities, and local and state governments. NCI's leadership will accelerate the pace of delivery of effective cancer interventions to the public.

NCI-designated Cancer Centers will be particularly important in future strategies to improve the delivery of new state-of-the-art interventions to the public. In the last 5 years, more than 40 of the 60 Cancer Centers have received the "comprehensive" designation. This includes most medical institutions in the United States with major biomedical research programs. Directors and investigators at these Comprehensive Cancer Centers participate with NCI in outreach activities in order to speed the benefits of research to patients, physicians and other caregivers, and communities, especially to those in underrepresented geographic regions of the Nation.

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National Cancer Advisory Board Working Group Confirms Central Role of Cancer Centers and SPOREs in Delivery of Cancer Interventions

In 2003, the National Cancer Advisory Board completed a report of an ad hoc working group charged with establishing a blueprint for NCI-designated Cancer Centers and Specialized Programs of Research Excellence (SPOREs). The report confirmed the central role of Cancer Centers and SPOREs in future strategies for improving the delivery of cancer interventions. The report lists recommended strategies for balancing the breadth and depth of these programs, maximizing translation of research discoveries, developing objectives for a national cancer agenda focused on reducing the cancer burden, and facilitating partnerships with other governmental, private, philanthropic, and business entities. Specific recommendations include the following:

• Consolidate shared resources in Cancer Centers to create greater economies of scale.
• Look to Cancer Centers for piloting new research, education, dissemination, and delivery strategies.
• Provide greater support for critical activities such as tissue banks, clinical data management and safety, and conformance to regulatory requirements.
• Encourage greater geographic distribution of Cancer Centers by creating programs for institutions that cannot currently meet all the requirements of the more research-intensive institutions that are currently supported by NCI.
• Provide the means for Cancer Centers to actively establish strategic, programmatic links with state health departments, other state agencies, local governments, and Federal agencies such as the Centers for Disease Control and Prevention.
• Encourage Centers to develop the infrastructure to test and implement novel methods for disseminating new knowledge in clinical, cancer control, and early detection research.
• Adopt as a top priority an integrated clinical research informatics system that will serve Centers and industry.
• Work with the Federal Office of Human Research Protections to engage Institutional Review Boards to develop a centralized review of multicenter trials.

Many of these recommendations are reflected in NCI's ongoing programs and plans for centers, networks, and consortia. The report will be a valuable resource to NCI in its continued strategic planning.

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