Research
Each country and locality needs cancer research tailored to local disease burdens and knowledge gaps to improve population health.
For national or regional cancer control programs, research is an essential component of planning, implementation, and monitoring the program’s effectiveness. In addition, research improves patient outcomes and creates national wealth through innovation. However, bibliometrics reveal a large disparity in research activities across countries. (Figure 1, 2) The United States and a few wealthy European countries account for the majority of publications.
Figure 1. Cancer publication trends by number of papers, 2010 vs. 2017, select countries. Cancer publications in United States increased from 35870 in 2010 to 46701 in 2017. Cancer publications in United Kingdom increased from 7427 in 2010 to 9800 in 2017. Cancer publications in China increased from 10399 in 2010 to 33150 in 2017. Cancer publications in Japan increased from 8545 in 2010 to 10653 in 2017. Cancer publications in Nigeria increased from 104 in 2010 to 231 in 2017. Cancer publications in Kenya increased from 26 in 2010 to 72 in 2017. Cancer publications in South Africa increased from 217 in 2010 to 509 in 2017. Cancer publications in Mexico increased from 472 in 2010 to 998 in 2017. Cancer publications in Chile increased from 158 in 2010 to 382 in 2017. Cancer publications in Brazil increased from 1379 in 2010 to 2700 in 2017.
Figure 2. Cancer publications (2002–2013) compared with gross domestic product (GDP) for 31 European countries.
In Malta, GDP is 8.5 billion US dollars and 22 cancer papers were published between 2002 and 2013. In Iceland, GDP is 14.6 billion US dollars and 208 cancer papers were published between 2002 and 2013. In Estonia, GDP is 23 billion US dollars and 97 cancer papers were published between 2002 and 2013. In Cyprus, GDP is 25.2 billion US dollars and 79 cancer papers were published between 2002 and 2013. In Latvia, GDP is 29.4 billion US dollars and 86 cancer papers were published between 2002 and 2013. In Lithuania, GDP is 42.3 billion US dollars and 265 cancer papers were published between 2002 and 2013. In Bulgaria, GDP is 50.3 billion US dollars and 453 cancer papers were published between 2002 and 2013. In Slovenia, GDP is 50.6 billion US dollars and 898 cancer papers were published between 2002 and 2013. In Luxembourg, GDP is 53.4 billion US dollars and 116 cancer papers were published between 2002 and 2013. In Croatia, GDP is 64.9 billion US dollars and 1429 cancer papers were published between 2002 and 2013. In Slovakia, GDP is 87.7 billion US dollars and 755 cancer papers were published between 2002 and 2013. In Hungary, GDP is 138.6 billion US dollars and 1897 cancer papers were published between 2002 and 2013. In Romania, GDP is 175.3 billion US dollars and 1248 cancer papers were published between 2002 and 2013. In Czech Republic, GDP is 210.3 billion US dollars and 3005 cancer papers were published between 2002 and 2013. In Ireland, GDP is 233.3 billion US dollars and 2247 cancer papers were published between 2002 and 2013. In Portugal, GDP is 240.8 billion US dollars and 2079 cancer papers were published between 2002 and 2013. In Finland, GDP is 261.4 billion US dollars and 3721 cancer papers were published between 2002 and 2013. In Greece, GDP is 331.5 billion US dollars and 7243 cancer papers were published between 2002 and 2013. In Denmark, GDP is 333.2 billion US dollars and 4713 cancer papers were published between 2002 and 2013. In Austria, GDP is 397 billion US dollars and 5563 cancer papers were published between 2002 and 2013. In Norway, GDP is 432.5 billion US dollars and 4054 cancer papers were published between 2002 and 2013. In Poland, GDP is 440.8 billion US dollars and 7543 cancer papers were published between 2002 and 2013. In Belgium, GDP is 479.6 billion US dollars and 6253 cancer papers were published between 2002 and 2013. In Sweden, GDP is 487.3 billion US dollars and 9205 cancer papers were published between 2002 and 2013. In Switzerland, GDP is 573.5 billion US dollars and 6837 cancer papers were published between 2002 and 2013. In Netherlands, GDP is 850 billion US dollars and 16068 cancer papers were published between 2002 and 2013. In Spain, GDP is 1476.3 billion US dollars and 15654 cancer papers were published between 2002 and 2013. In Italy, GDP is 2222.8 billion US dollars and 37876 cancer papers were published between 2002 and 2013. In United Kingdom, GDP is 2511.4 billion US dollars and 37541 cancer papers were published between 2002 and 2013. In France, GDP is 2667.6 billion US dollars and 30127 cancer papers were published between 2002 and 2013. In Germany, GDP is 3460 billion US dollars and 45436 cancer papers were published between 2002 and 2013.
Barriers to development of strong, sustainable cancer research output in low-income countries include lack of funds, competing disease priorities, weak infrastructure, and work load and protected time to do research. For example, expenditure on science and technology research represents less than 1% of gross domestic product in many low-income countries, compared to over 2.5% in several high-income countries. (Figure 3) However, there is renewed commitment from private and public institutions in high-income countries to help build sustainable research capacity in low-income countries through north-south partnerships.
ACCESS CREATES PROGRESS
International research collaborations such as the African Research Group for Oncology, a partnership between hospitals and universities in Nigeria, the United States, and the United Kingdom, can advance cancer knowledge and provide evidence and data for making health policy decisions.
Figure 3. Percent (%) of gross domestic product (GDP) spent on research, 2016 estimates, select countries. In Peru, 0.1% of GDP was spent on research. In Paraguay, 0.2% of GDP was spent on research. In Oman, 0.3% of GDP was spent on research. In Jordan, 0.3% of GDP was spent on research. In Chile, 0.4% of GDP was spent on research. In Costa Rica, 0.5% of GDP was spent on research. In Mexico, 0.5% of GDP was spent on research. In Egypt, 0.7% of GDP was spent on research. In Croatia, 0.8% of GDP was spent on research. In Greece, 1% of GDP was spent on research. In Spain, 1.2% of GDP was spent on research. In Brazil, 1.3% of GDP was spent on research. In Canada, 1.6% of GDP was spent on research. In Norway, 2% of GDP was spent on research. In Iceland, 2.1% of GDP was spent on research. In France, 2.2% of GDP was spent on research. In United States of America, 2.7% of GDP was spent on research. In Denmark, 2.9% of GDP was spent on research. In Sweden, 3.3% of GDP was spent on research. In Israel, 4.3% of GDP was spent on research.
In addition to regional variation in publication output, there is a mismatch between cancer research output/funding and societal cancer burden. Some common cancer sites, such as pancreas and lung in the United States and Europe, are under-funded and under-studied compared to less common cancers. (Figure 4) Further, in many countries the bulk of research funding is allotted to basic science, with very little to cancer prevention and control research.
Figure 4. Research priorities by cancer site in number of publications, proportion of US National Cancer Institute (NCI) funding* (2012), and disability-adjusted life years (DALYs, 2011). Lung cancer received 6% of NCI funding, had 5,382 publications, and accounted for 24% of DALYs. Breast cancer received 12% of NCI funding, had 7,833 publications, and accounted for 10% of DALYs. Colorectal cancer received 5% of NCI funding, had 2,498 publications, and accounted for 9% of DALYs. Prostate cancer received 6% of NCI funding, had 4,318 publications, and accounted for 5% of DALYs. Leukemia received 5% of NCI funding, had 4,384 publications, and accounted for 4% of DALYs. Brain and central nervous system cancers received 3% of NCI funding, had 3,009 publications, and accounted for 3% of DALYs. Liver cancer received 1% of NCI funding, had 2,924 publications, and accounted for 4% of DALYs. Pancreatic cancer received 2% of NCI funding, had 1,158 publications, and accounted for 6% of DALYs. Ovarian cancer received 2% of NCI funding, had 1,384 publications, and accounted for 3% of DALYs. Non-Hodgkin lymphoma received 3% of NCI funding, had 677 publications, and accounted for 3% of DALYs.
Increased cancer research tailored to local disease burdens and knowledge gaps is needed for continuous improvement of population health in each country and locality. In low- and middle-income countries, research should focus on identifying local, common risk factors (for example, local alcoholic brews), evaluating preventive interventions, and conducting implementation and operational research. Research in high-income countries should also focus on implementation research as well as biological markers and precision medicine.
All nations should be producers andusers of research.
Quote:
Dye C, Boerma T, Evans D, et al. The World Health Report 2013: Research for universal health coverage. Geneva: World Health Organization, 2013.
Access creates progress:
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Text:
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Unesco Institute for Statistics. Available at: http://data.uis.unesco.org/Index.aspx?DataSetCode=SCN_DS&lang=en. Accessed April 1, 2019.
Figure 1:
Digital Science. (2018-) Dimensions [Software] available from https://app.dimensions.ai. Accessed on 10/25/2018, under licence agreement. For more information see www.dimensions.ai or Hook et al. 2018 – “Dimensions: Building Context for Search and Evaluation”, https://doi.org/10.3389/ frma.2018.00023. Accessed October 21, 2018.
Figure 2:
Begum M, Lewison G, Lawler M, et al. Mapping the European cancer research landscape: An evidence base for national and Pan-European research and funding. Eur J Cancer. 2018;100:75–84.
Figure 3:
Unesco Institute for Statistics. Available at: http://data.uis.unesco.org/Index.aspx?DataSetCode=SCN_DS&lang=en. Accessed April 1, 2019.
Figure 4:
Lortet-Tieulent J, Soerjomataram I, Lin CC, et al. US Burden of Cancer by Race and Ethnicity According to Disability-Adjusted Life Years. Am J Prev Med. 2016; 51(5):673–681.
Digital Science. (2018-) Dimensions [Software] available from https://app.dimensions.ai. Accessed on 10/25/2018, under licence agreement. For more information see www.dimensions.ai or Hook et al. 2018 – “Dimensions: Building Context for Search and Evaluation”, https://doi.org/10.3389/frma.2018.00023. Accessed October 21, 2018.
[United States] National Cancer Institute. Funding for Research Area. Available at https://www.cancer.gov/about-nci/budget/fact-book/data/research-funding. Accessed June 28, 2019.