Cooperative groups say NCI trials funding inadequate; some turn to industry.

To calculate total funding for a given trial, investigators multiply the number of patients by the $2,000 reimbursement. The resulting value represents the bulk of what NCI will pay for a trial, including long-term follow-up. Faced with a stagnant budget, NCI hasn't raised the reimbursement rate for 7 years, while median costs per subject have reached $6,000 and beyond, according to the Lewin Group, a health care consulting fi rm in Falls Church, Va. That means NCI funding covers at best a third of what the trial actually costs. To perform NCI trials, investigators require supplemental funds from hospitals, philan-thropies, and other sources. Industry trials, meanwhile, pay at least $9,000 per patient and often more, the Lewin Group reports. Because of this shortfall, some cash-strapped investigators have already begun to select industry studies over their publicly funded counterparts, a trend that will probably continue, says Robert Comis, M.D., president and chairman of the Coalition of Cancer Cooperative Groups, an organization that represents the cooperative groups. Industry studies account for a growing share of clinical trials research, Comis says. " A lot of the publicly funded work we do looks for new ways to use existing medicines , and that's not the kind of thing that drives the pharmaceutical industry, " Comis says. " The same goes for rare cancers — industry's not as motivated to focus on them. With the erosion of the public system , you're likely to see a tremendous impact on the next levels of treatment for cancer patients. " Several NCI-funded investigators interviewed for this article acknowledge that budget pressures have made industry trials more compelling. Most were reluctant to say so on record, however, to avoid jeopardizing their relationships with NCI. Still, recent incidents show that budget pressures have put NCI trials at a competitive disadvantage. The University of Michigan Comprehensive Cancer Center, for example, recently refused to open a trial by the American College of Surgeons Oncology Group unless the group could provide its own supplemental funding. And citing fi scal policy, the University of California at Los Angeles no longer participates in NCI trials coordinated by the Southwest Oncology Group, according to an anonymous source. UCLA offi cials refused to comment. Results from an investigation by the Coalition of Cancer Cooperative Groups, released in September 2006, found that the modest growth in clinical trial activity from 2004 to 2005 was due mainly to …