Impacts of the CIHR Institute of Cancer Research 2001-2009

A Report prepared for the CIHR Institute of Cancer Research
by Mark Bisby and Michelle Campbell

Ottawa, February 2010

Table of Contents

Key Messages

The CIHR Institute of Cancer Research (ICR) was launched in 2000 into a uniquely well-established and well-funded research community. Canadian cancer research funding has since grown from some $150M per year to perhaps as much as $600M per year. With an inaugural annual budget of $500,000, now $11M, ICR was challenged to make a noticeable impact in this environment where many other agencies and organizations have far larger research budgets.

Nonetheless, the forty respondents identified two major ICR achievements:

  1. The creation of a coherent and coordinated funding community, ultimately resulting in the Canadian Cancer Research Alliance (CCRA) and a strategy for how research can best support Canada's cancer control agenda
  2. The strategic initiative in Palliative and End-of-Life Care, which created substantial new research capacity and is viewed as a model of effective, integrated, knowledge translation.

ICR was able to achieve these significant impacts because of its determined focus on serving the common good, and its conviction that funders could achieve more working together than separately. Instead of being resented as an interloper, ICR became regarded as an excellent partner, and was able to have an influence and impact which far exceeded its small budget.

ICR's investments, with partners, in the Canadian Tobacco Control Research Initiative and training programs (STIHRs) have also had significant impact, and respondents also strongly supported the Institute's investment in the NCIC's Clinical Trials Group. The more recently launched Access to Care initiative also has good potential for future impact.

Respondents are concerned, however, about the sustainability of new capacity and KT relationships built through ICR's initiatives, given their poor fit with CIHR's standard funding and review mechanisms. There is concern that this tenuous path to sustainability is driving new teams towards short-term activity rather than longer-term infrastructure and translational relationship building, which would realise the full potential of ICR's investment in teams.

Overall, there is significant scope for CIHR to enhance team and training program outcomes by providing them with advice and mentoring about best practices. In the same way, CIHR could enhance strategic initiative outcomes by collecting experiences and best practices in strategic planning, and the creation and delivery of strategic initiatives, and sharing these among the thirteen Institutes.

Canada's increases in cancer research funding are mirrored in other leading nations, supporting Canada's prolific international collaborations. Despite the competition, over the last ten years Canada has managed to increase its share of global cancer research publications, while maintaining a high quality standard, as measured by citation rates.

Executive Summary

The CIHR Institute of Cancer Research (ICR) has now completed its inaugural Strategic Plan. ICR seeks to assess the successes, challenges and lessons learned, to incorporate its best practices into its second Strategic Plan and address the challenges which remain.

Canadian cancer research funding: then and now

ICR was launched into a well-funded and mature research community, supported by many provincial and charitable funders and led by the National Cancer Institute of Canada (NCIC) whose ~$40M budget was on scale with CIHR's investment in cancer research. Total Canadian cancer research funding in 2001 was probably in the vicinity of $100M-$150M per year, making ICR a small player in a richly-funded area, challenged to have real and distinct impact.

Since then, the already-large cancer research community has grown at an astounding pace. CIHR's investment has grown to about $150M, and the whole enterprise now spends $500M-$600M annually. The other biggest changes have come from the creation of major new provincial agencies and investments, particularly the Ontario Institute of Cancer Research, and the rapid rise of charity fund-raising, especially in breast cancer.

Funding is no longer concentrated in two large, traditional granting agencies, but directed by many large players across the country, most of them with a stronger orientation towards health outcomes and systems improvement, rather than academic research. Much of the new funding is thus more applied and translational, and more likely to be invested in large blocks in single organizations and/or mega-projects.

Changes in Canadian cancer research performance

Although other countries have also seen large increases in their cancer research investment over the last decade, it's impressive that Canada has grown its share of global publications from 3% to almost 4% (Canada's average in all fields of research). Overall, the approximate quadrupling of funding over the past decade has resulted in about 2.6-fold more Canadian cancer publications per year. These publications are also high quality: Canada produces more than 3x its "fair share" of the world's 100 most-cited papers.

Canada produces a particularly large portion of the global research literature in non-biomedical aspects of cancer research such as social sciences; health services and policy; public, environmental and occupational health; and psychology. Canada is under-specialized in surgery and its sub-specialities (except for urology); and in some of the disciplines and approaches that bear directly on commercialization, and on the physical sciences applied to cancer.

Canadian oncology researchers are among the most likely to collaborate internationally, and to good effect: cancer research publications from international collaborations are cited on average about twice as often as publications with only Canadian authors.

ICR's role in building a national research community

The potential for ICR to be viewed by existing funders as a competitor and interloper was high, but instead, respondents repeatedly lauded the way ICR always worked collaboratively, was willing to share leadership and credit, and contribute towards and build on what others were doing. As a result, "its accomplishments are way larger than the budget allowed for."

ICR's founding Scientific Director was able to use its neutral status to both lead and support the cancer community in creating a coordinated national approach to research funding, which ultimately evolved into the Canadian Cancer Research Alliance (CCRA) under the auspices of the independent Canadian Partnership Against Cancer (CPAC). Respondents identified as a top achievement ICR's success in bringing funders together and enabling them to focus their collective efforts on identifying how research could further Canada's cancer control agenda.

Delivering ICR's initiatives and activities

Priorities

ICR's inaugural priority-setting process was appropriate and fair, and identified important – and unexpectedly non-traditional – priorities. The broadly-composed and active Institute Advisory Board (IAB) was seen as a great benefit to strategic planning; respondents hoped that enthusiasm can be re-captured to address the different challenges of today's mature organization, now without significant new funds to invest.

Like most of CIHR's Institutes, ICR had too many initial priorities, which resulted in few grants per initiative, diluted their impact, and created disproportional cost overheads. Nonetheless, ICR quickly learned to focus its resources, and ultimately concentrated the bulk of its early investment in one initiative, Palliative and End-of-Life Care. While as a consequence ICR had to limit its investment in several other priorities, it was able to have major impact in this area, making an important contribution to research in a critical area of health care. Unquestionably, this would not have happened in the absence of ICR.

Initiatives

The Palliative and End-of-Life Care initiative was highly successful, and is seen as a model for effective translational research investments for CIHR and other funders. Respondents are concerned, however, about the sustainability of the new capacity and KT relationships, given their poor fit with CIHR's standard funding and review mechanisms.

ICR also invested in the Canadian Tobacco Control Research Initiative, with significant impact, helping Canada has become a world leader in the field of tobacco control research. ICR's support for STIHRs (training programs) is highly-regarded, as is the Institute's extraordinarily effective efforts to engage partnered funding, and increase the original number of funded cancer STIHRs from 6 to twenty-two. Many respondents also strongly supported ongoing investment in clinical trials infrastructure, and ICR's support for NCIC's CTG in particular.

Respondents have high hopes for the more recently launched Access to Care initiative, though they are concerned that the limited term of the program, without prospect of renewed funding, has led the funded new emerging teams (NETs) to become focused on short-term outcomes rather than the kind of long-term activities necessary for capacity building and effective KT. The NETs also are unsure of how to address CIHR's team-building and KT expectations, and need better guidance and information about best practices from CIHR. In the same way, at the organizational level, CIHR could collect experiences and best practices in Institute strategic planning, and the creation and delivery of strategic initiatives, and share these across Institutes.

Building partnerships

Respondents reported uniformly excellent experiences working with the Institute, whether as a formal partner, or more generally as a collaborator in the cancer funding community. Partners saw the Institute as clearly focused on serving the greater good, regardless of who got the credit. This trust was underscored by opinions about the ICR staff, who were seen as extremely helpful, knowledgeable, and focused on meeting partners' needs.

Partners did note the need to be engaged earlier, when ideas are incubating and not when programs need additional funding. Partners were also concerned about the extent to which ICR's small budget limits its relevance as a partner, and CIHR's extensive red tape and inflexibility, especially its recently-imposed inability to contribute funds to external organizations.

Translating knowledge into health improvements

The Palliative and End-of-Life Care initiative stands out as a model of effective KT not just for the Institute but for CIHR as a whole. It demonstrates the importance of KT as part of problem-oriented research, and not a separate activity to be pursued in isolation.

CIHR needs reconsider its funding mechanisms, and the extent to which it should provide training and support which will allow funded researchers and knowledge users to contribute more effectively to CIHR's KT mandate, particularly in the application of research findings to improved standards of care outside the academic health science centre setting. It would also be timely for CIHR to help the Institutes examine successful experiences like the Palliative and End-of-Life Care initiative, to share best practices in initiative design and effective KT.

Conclusions and building blocks for the future

Overwhelmingly, respondents identified two key achievements for ICR:

  1. The creation of a coherent and coordinated funding community, ultimately resulting in the Canadian Cancer Research Alliance (CCRA) and the Canadian Partnership for Tomorrow Project (a cancer cohort study).
  2. The strategic initiative in Palliative and End-of-Life Care.

As CIHR completes its first decade, it is clear that it has tackled many major new challenges with creativity and innovation. Nonetheless, the road to achieving the knowledge transfer half of its mandate remains elusive. Our assessment of ICR has highlighted two useful next steps which we believe would help ICR, and CIHR as a whole, deliver on its ambitious strategic plan.

First, CIHR should capture, share and build training opportunities using the many lessons it has learned to date. Both its Institutes and funded teams have a wealth of experience which could be helping new initiatives and teams operate effectively from the start, rather than repeating past difficulties with the launch of new RFAs and team grants.

Second, it is time for CIHR to reassess the fit between the types of goals it is trying to achieve, and the traditional review and funding mechanisms with which it is trying to achieve them. Strategic goals and strategic investments require equally strategic review and active, strategic management to achieve their objectives. As one respondent asks, "If we keep using the old mechanisms and the old metrics, we'll get the old results. How innovative is that?"

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