Comparing National Institutes of Health funding for cancer survivorship: a spotlight on breast and gynecologic cancer

Cancer survivorship in the United States is rapidly rising, with a projected 50% increase by 2050, driven by improvements in treatment and increased incidence of cancers such as endometrial cancer. Along with this growth, long-term side effects create significant burdens, yet survivorship research, particularly for female-organ cancers, remains limited and imbalanced - with breast cancer studies far outnumber those for gynecologic cancers. To understand these disparities, funding patterns for survivorship research between disease sites, while accounting for differences in disease prevalence were undertaken.

To evaluate the distribution of National Institutes of Health funding for breast and gynecologic cancer survivorship research in relation to survivor populations.

A retrospective cohort study was conducted on National Institutes of Health funded grants for breast and gynecologic cancer survivorship from fiscal years 2017 to 2021 using an existing dataset from the National Institutes of Health Office of Cancer Survivorship. Grant characteristics, including funding amount, study design, and research focus, were extracted from National Institutes of Health Reporter and ClinicalTrials.gov. Total funding and per-survivor funding were calculated using prevalence data from the Surveillance, Epidemiology, and End Results program. Descriptive statistics were applied to compare breast and gynecologic cancer survivorship research.

Among 160 National Institutes of Health-funded grants for female organ-related cancer survivorship, 144 (90%) focused on breast cancer and 16 (10%) on gynecologic cancers. Breast cancer survivorship research received more funding ($188.35 million for 4,100,000 survivors) compared to gynecologic cancer survivorship research ($15.41 million for 796,000 survivors). Per-survivor funding was also higher for breast cancer ($9.69 per survivor) than for gynecologic cancers ($2.15 per survivor). Overall, most survivorship studies were interventional (60%), with randomized controlled trials as the predominant design. The primary study focus was on late and long-term effects of cancer treatment (53%), followed by health promotion (21%) and care delivery (16%).

National Institutes of Health funding for gynecologic cancer survivorship research is substantially lower than that for breast cancer, even when accounting for survivor prevalence. The findings highlight the need for equitable resource allocation to ensure comprehensive survivorship support for gynecologic cancer survivors. Increased funding and gynecology-related research efforts are necessary to address the unique challenges faced by this population and to optimize long-term outcomes.