There is a long history of national commitment to a system of integrated, multidisciplinary cancer research aimed at rapid translation of findings into coordinated cancer care. In 1960, the National Institutes of Health established the General Clinical Research Center Grants Program to provide an opportunity for universities to establish clinical research facilities. The purpose of this program was to provide a resource to enhance the quality of clinical investigation in a medical institution apart from general hospital care. A year later, in 1961, NCI announced three new grant programs that were to have a direct bearing on broadening the base of cancer research activity in the United States: the Cancer Research Facilities Grant (CRFG); the Program Project Grants (P01) for cancer research; and Cancer Clinical Research Center Grant (P02 or CCRCG). The intent of these funding mechanisms was to provide support for broadly based, multidisciplinary cancer research efforts.
By 1963, there was a fairly well-defined cancer centers program of approximately $6 million at 12 institutions. The activities at these centers were diverse, including research in radiation therapy, medical oncology, and surgery, as well as basic science. Except as a category within the NCI budget, little effort was made to define or organize the cancer centers until 1968 when the National Cancer Advisory Board (NCAB) provided guidelines and the concept of the planning, or exploratory grant. Congress envisioned a regional focus for the centers program and in 1968 the House Appropriations Committee recommended that geography be considered in the establishment of new cancer centers; this has continued to be an issue of congressional interest over the years. The Cancer Centers Branch of the NCI was formally conceived and established as a result of the National Cancer Act of 1971; the Act gave a broad mandate to the centers that includes research, excellence in patient care, training and education, demonstration of technologies, and cancer control. The initial model for a cancer center was drawn from several of the older, free-standing institutions: Roswell Park, Memorial Sloan-Kettering, M.D. Anderson, and Fox Chase (formerly, the Institute for Cancer Research).
In June 1973, NCI published information and guidelines for the Cancer Center Support Grant (CCSG), which had been approved in principle by the NCAB. At that time, two classes of centers were described: comprehensive and specialized. Comprehensive cancer centers were described as those conducting long-term, multidisciplinary cancer programs in biomedical research, clinical investigation, training, demonstration, and community-oriented programs in detection, diagnosis, education, epidemiology, rehabilitation, and information exchange. Specialized cancer centers were described as those which had programs in one or more, but not all, of the above areas in which research efforts, specialized study, or a form of patient treatment resulted in well-defined areas of emphasis. By the mid 1980's, cancer centers were classified as basic, clinical, and comprehensive, but in 1997 this was changed to a system of classification which included cancer centers, clinical cancer centers and comprehensive cancer centers. In 2004, the classification was simplified to include cancer centers and comprehensive cancer centers. The unmodified term cancer center refers to a cancer center having a scientific agenda that is primarily focused on laboratory, population science, or clinical research, or some combination of these three components. A comprehensive cancer center has demonstrated reasonable depth and breadth of research activities in each of three major areas: laboratory, clinical, and population-based research, with substantial transdisciplinary research that bridges these scientific areas. An NCI-designated Comprehensive Cancer Center must also demonstrate professional and public education and dissemination of clinical and public health advances into the community it serves.
In 1992, a major conceptual change in the cancer centers program was implemented when all cancer centers were required to become “institutional,” and include and integrate all of the relevant research of the institution across all organizational boundaries (e.g., departments, schools). This resulted in the consolidation of multiple CCSGs at the same institution into one center grant and placed much greater emphasis on the commitment of the institution to the cancer center concept and the authority of the cancer center director to implement that concept. In 2004, the concept was expanded to include consortia and affiliations, with the understanding that these partnerships would both potentially extend the benefits of cancer research to previously underserved populations and enrich the research opportunities available to centers.
The Cancer Centers Program has undergone several evaluations since its formal establishment in 1971, including one by the Institute of Medicine in 1989 and by several ad hoc working groups. In response to these, and to the ever-changing landscape of cancer research, the Program has continued to evolve over time.
Cancer Center versus Cancer Research Center
The great majority of NCI’s direct support to cancer centers is for the furtherance of research; most of the other activities critical to a center’s service mission are supported by other means, such as patient revenues, philanthropic donations, and monies from state or local governments. NCI has therefore considered whether the term “cancer research center” might not be a more accurate descriptor of the activities that NCI actually reviews and funds through the CCSG. NCI’s decision to retain “cancer center” as its designation emphasizes the close association within NCI-funded institutions of research and other critical components, such as clinical care, education, and outreach; indeed it is this intimate association that distinguishes these centers as a group from other “cancer centers,” which, whatever their credentials as dispensers of medical care, lack the strong research base that will drive progress in the years ahead. Institutions lacking their own research base can quickly follow and adopt advances developed elsewhere, but they cannot lead, as can those centers that integrate research with service.