Funding impact of the National Cancer Act and beyond.

During the seven years following passage of the National Cancer Act of 1971, the appropriation for the National Cancer Institute (NCI) was increased by nearly $700 million. A major effect of the Act has been increased funding for grants-in-aid, which rose from $93 million in fiscal year (FY) 1970 to over $416 million in FY 1978. Grants programs account for over 60% of the total N. CI extramural research budget and are divided into four broad categories; research; training (including fellowships); cancer control; and construction. For the first 4 years following passage of the Act, funding for all grants programs increased dramatically. However, growth began to slow in 1976, and the deceleration is continuing. Total NCI obligations for FY 1978 increased at a rate of 7% (as opposed to an increase of 20.3% in FY 1975), which merely managed to keep pace with the estimated Biomedical Inflation Factor of 6.8%. Traditional grants have more than doubled in average cost over the past 10 years, a growth attributable to inflation, more sophisticated and expensive equipment and supplies, and, in some cases, more ambitious projects. The principal types of research grants include: traditional, investigator-initiated research; program projects, a team approach directed toward a common goal; and "core" support used to fund administrative and shared equipment costs of cancer centers. In FY 1977, the actual number of traditional grants awarded declined for the first time in 7 years, while the number of applications for both new and renewal grants increased at an unprecedented rate. Coincidentally, the number of traditional grants awarded this fiscal year increased by 4%, enabling the figure to exactly match that in 1978. While support for traditional grants has remained in the forefront of NCI funding, money for program projects and core support has increased at a greater rate in recent years. However, unlike the years immediately following the Act, emphasis is now being placed on core support (which increased by 9.4% in FY 1978) and program project grants (up 5.1%), as opposed to the exploratory grants necessary to initiate cancer centers. Funds allocated for construction in the wake of the Act are now being reduced, as the pace of development of new centers begins to slow. Although the number of grant awards has decreased, young investigators (35 years old or younger) continued to receiving a significant share of NCI funds, and, in fact, are faring better than older investigators in terms of recommendation, previously referred to as "approval," and award rates. Awards to foreign scientists increased steadily after the Act, achieving their greatest dollar increase ever in FY 1977; in FY 1978, however, they declined by more than 6%. As part of the NCI reorganization plan instituted by NCI Director Arthur C...