1.0 History of the NCI Cancer Centers

There is a long history of national commitment to a system of integrated, multidisciplinary cancer research aimed at rapid translation of research findings into coordinated care for cancer patients.  In 1960, the National Institutes of Health established the General Clinical Research Center Grants Program to provide an opportunity for universities to establish clinical research facilities.  The purpose of this program was to provide a resource to enhance the quality of clinical investigation in a medical institution apart from general hospital care.  A year later, in 1961, NCI announced three new grant programs that were to have a direct bearing on broadening the base of cancer research activity in the United States:  the Cancer Research Facilities Grant (CRFG); Program Project Grants (PO1s) for cancer research; and Cancer Clinical Research Center Grants (PO2s or CCRCG).  The intent of these funding mechanisms was to provide support for broadly based, multidisciplinary cancer research efforts.

By 1963, there was a fairly well-defined cancer centers program of approximately $6 million at 12 institutions.  The activities at these centers were diverse, including research in radiation therapy, medical oncology, and surgery, as well as basic science. Little effort was made to define or organize the cancer centers, except as a category within the NCI budget, until 1968 when the National Cancer Advisory Board (NCAB) provided guidelines and the concept of the planning, or exploratory grant. Congress envisioned a regional focus for the centers program and in 1968 the House Appropriations Committee recommended that geography be considered in the establishment of new cancer centers; this has continued to be an issue of congressional interest over the years. The Cancer Centers Branch of the NCI was formally conceived and established as a result of the National Cancer Act of 1971; the Act gave a broad mandate to the centers that includes research, excellence in patient care, training and education, demonstration of technologies, and cancer control. The initial model for a cancer center was drawn from several of the older, free-standing institutions:  Roswell Park, Memorial Sloan-Kettering, M.D. Anderson, and Fox Chase (formerly, the Institute for Cancer Research).

In June 1973, NCI published information and guidelines for the Cancer Center Support Grant (CCSG), which had been approved in principle by the NCAB. At that time, two classes of centers were described: comprehensive and specialized. Comprehensive cancer centers were described as those conducting long-term, multidisciplinary cancer programs in biomedical research, clinical investigation, training, demonstration, and community-oriented programs in detection, diagnosis, education, epidemiology, rehabilitation, and information exchange. Specialized cancer centers were described as those which had programs in one or more, but not all, of the above areas in which research efforts, specialized study, or a form of patient treatment resulted in well-defined areas of emphasis. By the mid 1980's, cancer centers were classified as basic, clinical, and comprehensive, but in 1997 this was changed to the current system of classification, which includes cancer centers, clinical cancer centers and comprehensive cancer centers. The generic term “cancer center” is intended to include all basic laboratory and other types of highly specialized centers, while the term “comprehensive cancer center” is meant to include centers with highly interactive basic, clinical, and population sciences, as well as significant non-research activities in cancer outreach, education and information. While conceptually “clinical cancer centers” could include only clinical research, in reality nearly all clinical cancer centers supported by the NCI have a critical mass of basic research, as well as developing population science based programs, and are striving to become comprehensive.

In 1992, a major conceptual change in the cancer centers program was implemented when all cancer centers were required to become “institutional,” and include and integrate all of the relevant research of the institution across all organizational boundaries (e.g., departments, schools). This resulted in the consolidation of multiple CCSGs at the same institution into one center grant and placed much greater emphasis on the commitment of the institution to the cancer center concept and the authority of the cancer center director to implement that concept.
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2.0 Cancer Center versus Cancer Research Center

The great majority of NCI’s direct support to cancer centers is for the furtherance of research; most of the other activities critical to a center’s service mission are supported by other means, such as patient revenues, philanthropic donations, and monies from state or local governments. NCI has therefore considered whether the term “cancer research center” might not be a more accurate descriptor of the activities that NCI actually reviews and funds through the CCSG. NCI’s decision to retain “cancer center” as its designation emphasizes the close association within NCI-funded institutions of research and other critical components, such as clinical care, education, and outreach; indeed it is this intimate association that distinguishes these centers as a group from other “cancer centers,” which, whatever their credentials as dispensers of medical care, lack the strong research base that will drive progress in the years ahead. Institutions lacking their own research base can quickly follow and adopt advances developed elsewhere, but they cannot lead, as can those centers that integrate research with service.¹

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