# Funding follows fashion, not burden

Source: https://onco.cc/bottlenecks/b-funding-allocation/  
OnCo record `b-funding-allocation` (Bottleneck). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Research money follows visibility, not burden: breast, prostate and leukaemia receive far more funding per death or year of life lost than lung, pancreatic, liver, oesophageal, gastric, bladder and uterine cancers, and metastasis research gets an estimated 5% of funding despite causing most deaths. Advocacy strength and peer review that rewards mechanism explain the skew.

## Summary

Research funding across cancers correlates poorly with burden: breast cancer, leukaemia and prostate cancer receive far more NCI and charity funding per death or per year of life lost than lung, pancreatic, liver, oesophageal, gastric, bladder and uterine cancers, and the pattern is similar in the UK and Europe. Across research types the skew is stronger: metastasis, prevention, implementation, surgery, radiotherapy, supportive care and research in low-income settings are all under-funded relative to their share of deaths or their potential to prevent them, while cell-intrinsic biology and drug discovery are over-represented. The causes are the visibility and advocacy strength of some cancers, peer review that rewards mechanistic novelty, the absence of a burden-weighted portfolio strategy at most funders, and a commercial sector that follows patentability. Transparent portfolio mapping, burden-weighted funding targets, and mission-oriented programmes are the corrective levers.

## Fields

- Kind: Bottleneck
- Last checked: 2026-09-08
- Stage: funding-incentives
- Severity: major
- Metrics: Cancers under-funded relative to incidence, mortality and years of life lost in an analysis of NCI, charity and industry funding: Lung, pancreas, liver, oesophagus, stomach, bladder and uterine cancers under-funded; breast, prostate and leukaemia over-funded (Carter & Nguyen, BMC Cancer 2012); Estimated share of cancer research funding directed at metastasis, which causes most deaths: ~5% (estimate) (Sleeman & Steeg, European Journal of Cancer 2010); Share of cancer deaths occurring in low- and middle-income countries, where a small fraction of research is conducted: ~70% (WHO fact sheet, Cancer)
- Causes: Advocacy strength and public visibility differ enormously between cancers.; Peer review rewards mechanistic novelty and feasibility over expected health gain.; Most funders have no explicit burden- or impact-weighted portfolio strategy.; Industry funding follows patentable, high-price opportunities, which excludes prevention, surgery and repurposing.; Investigator supply is self-reinforcing: fields with money train the next generation, which applies for more.

## Sources

- Carter & Nguyen, A comparison of cancer burden and research spending (BMC Cancer 2012): https://doi.org/10.1186/1471-2407-12-526
- NCI Funded Research Portfolio: https://fundedresearch.cancer.gov/
- International Cancer Research Partnership: https://www.icrpartnership.org/
- Cancer Grand Challenges: https://cancergrandchallenges.org/

## Connected records

- collections: [GLOBOCAN / Global Cancer Observatory](https://onco.cc/collections/globocan/), [SEER (Surveillance, Epidemiology, and End Results)](https://onco.cc/collections/seer/)
- ideas: [A burden-to-funding audit for gallbladder cancer and a dedicated research call](https://onco.cc/ideas/idea-gbc-burden-to-funding-audit-and-dedicated-call/), [A dedicated global financing window for cancer, modelled on the Global Fund](https://onco.cc/ideas/idea-acc-global-cancer-financing-window/), [A dedicated programme for cachexia and treatment toxicity research](https://onco.cc/ideas/idea-fund-cachexia-programme/), [A delivery-science moonshot for prevention we already own](https://onco.cc/ideas/idea-fund-prevention-moonshot/), [A fixed share of trial-group funding for getting proven care to patients](https://onco.cc/ideas/idea-fund-implementation-quota/), [A formal patient-burden score in grant peer review](https://onco.cc/ideas/idea-fund-patient-burden-review-criterion/), [A Global Fund for cancer care in low- and middle-income countries](https://onco.cc/ideas/idea-fund-global-cancer-fund/), [A guaranteed purchase prize for the first drug against a named hard target](https://onco.cc/ideas/idea-bio1-undruggable-market-commitment/), [A precompetitive consortium for the twenty hardest cancer targets](https://onco.cc/ideas/idea-bio1-undruggable-open-consortium/), [A public dashboard of research money per death for every cancer](https://onco.cc/ideas/idea-fund-dollars-per-death-dashboard/), [A public fund that pays for phase 3 trials of cheap, off-patent drugs against cancer](https://onco.cc/ideas/idea-reg-global-repurposing-fund/), [A public registry of unanswered clinical questions linked to funding calls](https://onco.cc/ideas/idea-data-unanswered-questions-registry/), [A public-benefit phase 1 factory that takes academic discoveries into first-in-human trials](https://onco.cc/ideas/idea-moon-public-phase1-factory/), [A ring-fenced metastasis programme with metastasis-specific endpoints](https://onco.cc/ideas/idea-fund-metastasis-moonshot/), [A social impact bond: investors fund a repurposing trial, payers repay from savings](https://onco.cc/ideas/idea-reg-repurposing-social-impact-bond/), [A statutory minimum share of public trial money for surgery and radiotherapy](https://onco.cc/ideas/idea-fund-non-drug-trial-quota/), [A survivorship research endowment funded by a levy on curative therapy prices](https://onco.cc/ideas/idea-fund-survivorship-endowment-levy/), [A trials fund reserved for older and multimorbid patients](https://onco.cc/ideas/idea-fund-older-patients-trial-fund/), [An annual map of high-burden questions that nobody is funding](https://onco.cc/ideas/idea-fund-white-space-map/), [An open forecasting tournament on which combination trials will succeed](https://onco.cc/ideas/idea-tr2-combination-forecast-tournament/), [Burden-matched funding for trials led in low- and middle-income countries](https://onco.cc/ideas/idea-fund-lmic-burden-match/), [Burden-weighted portfolio targets for every major cancer funder](https://onco.cc/ideas/idea-fund-burden-weighted-portfolio/), [Cure-focused prizes: pay for verified long-term cures, not for drugs](https://onco.cc/ideas/idea-moon-cure-prizes/), [Earmark a fixed share of every national cancer budget for palliative care](https://onco.cc/ideas/idea-acc-earmarked-palliative-budget-share/), [Emulate the trial in real-world data first to decide which trials to run](https://onco.cc/ideas/idea-tr1-target-trial-emulation-to-prioritise-rcts/), [Forty-eight-hour small grants for bold experiments in neglected cancers](https://onco.cc/ideas/idea-fund-fast-grants-oncology/), [Fund structured exercise after colon cancer surgery as a treatment, because a randomised trial says it works as well as a drug](https://onco.cc/ideas/idea-crc-exercise-as-a-funded-treatment/), [Funders set aside a fixed share of budget for independent replication](https://onco.cc/ideas/idea-tr2-replication-set-aside/), [Give survivorship interventions a shared control arm](https://onco.cc/ideas/idea-rejuv-survivorship-platform-trial/), [GLP-1 receptor agonists as adjuvant weight-loss therapy in HR-positive breast cancer](https://onco.cc/ideas/idea-nl-glp1-adjuvant-hr-breast/), [Judge funding programme officers on burden alignment and trials completed](https://onco.cc/ideas/idea-fund-programme-officer-incentives/), [Mandatory machine-readable portfolio reporting for all large cancer funders](https://onco.cc/ideas/idea-fund-cross-funder-portfolio-registry/), [One definitive ketogenic diet trial in glioblastoma, then stop](https://onco.cc/ideas/idea-nl-ketogenic-gbm-definitive-trial/), [Open-source drug discovery to clinical proof of concept for neglected cancers](https://onco.cc/ideas/idea-moon-open-source-oncology-drug-discovery/), [Partial lottery funding for good proposals in under-funded cancers](https://onco.cc/ideas/idea-fund-neglected-cancer-lottery/), [Pay a prize for rare cancer drugs instead of hoping for a market](https://onco.cc/ideas/idea-bio2-rare-cancer-prize-fund/), [Publish per-patient trial cost benchmarks and target halving them](https://onco.cc/ideas/idea-tr1-public-trial-cost-benchmarks/), [Put the essential palliative care package into every universal health coverage benefit list](https://onco.cc/ideas/idea-acc-essential-palliative-package-in-uhc/), [Randomise the order of treatment, not only the drugs: a strategy platform for metastatic prostate cancer](https://onco.cc/ideas/idea-prostate-randomise-the-sequence-not-only-the-drugs/), [Randomised trials of how to spread proven cancer treatments, not just what works](https://onco.cc/ideas/idea-data-implementation-trials-programme/), [Ring-fence a fifth of national cancer research money for metastasis](https://onco.cc/ideas/idea-bio2-metastasis-funding-floor/), [Set aside 3% of grant budgets to replicate findings before translation](https://onco.cc/ideas/idea-fund-replication-set-aside/), [Small grants that pay scientists to write up abandoned projects](https://onco.cc/ideas/idea-tr2-writeup-grants/), [Social impact bonds that fund biosimilar switching, repaid from payer savings](https://onco.cc/ideas/idea-reg-social-impact-bond-switching/), [Stop failing trials earlier with pre-registered aggressive futility rules](https://onco.cc/ideas/idea-tr1-aggressive-futility-boundaries/), [Ten-year awards for scientists who commit to one hard problem](https://onco.cc/ideas/idea-fund-ten-year-hard-problem-awards/), [Treat brain metastases as a disease with its own trials programme](https://onco.cc/ideas/idea-fund-brain-metastases-programme/)
- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/), [Endometrial cancer](https://onco.cc/cancers/endometrial/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Glioma & glioblastoma](https://onco.cc/cancers/glioblastoma/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- fronts: [Prevention & Risk](https://onco.cc/fronts/prevention/), [Radiation Therapy](https://onco.cc/fronts/radiation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- institutions: [Advanced Research Projects Agency for Health](https://onco.cc/institutions/arpa-h/), [Alex's Lemonade Stand Foundation](https://onco.cc/institutions/alsf/), [American Association for Cancer Research (AACR)](https://onco.cc/institutions/aacr/), [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [Cancer Grand Challenges](https://onco.cc/institutions/cancer-grand-challenges/), [Cancer Prevention and Research Institute of Texas](https://onco.cc/institutions/cprit/), [Cancer Research UK](https://onco.cc/institutions/cruk/), [Damon Runyon Cancer Research Foundation](https://onco.cc/institutions/damon-runyon/), [Deutsche Krebshilfe](https://onco.cc/institutions/deutsche-krebshilfe/), [Ellison Institute of Technology](https://onco.cc/institutions/ellison-institute/), [Emerson Collective](https://onco.cc/institutions/emerson-collective/), [Fondation ARC pour la recherche sur le cancer](https://onco.cc/institutions/fondation-arc/), [Fondazione AIRC per la ricerca sul cancro](https://onco.cc/institutions/airc/), [Howard Hughes Medical Institute](https://onco.cc/institutions/hhmi/), [Indian Council of Medical Research](https://onco.cc/institutions/icmr/), [Institut National du Cancer](https://onco.cc/institutions/inca/), [International Agency for Research on Cancer (IARC / WHO)](https://onco.cc/institutions/iarc/), [Lasker Foundation](https://onco.cc/institutions/lasker-foundation/), [Li Ka Shing Foundation](https://onco.cc/institutions/li-ka-shing-foundation/), [Ludwig Cancer Research](https://onco.cc/institutions/ludwig-cancer-research/), [Melanoma Research Alliance](https://onco.cc/institutions/mra/), [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/), [Pan-Mass Challenge](https://onco.cc/institutions/pan-mass-challenge/), [Parker Institute for Cancer Immunotherapy](https://onco.cc/institutions/parker-institute/), [Prostate Cancer Foundation](https://onco.cc/institutions/pcf/), [St. Baldrick's Foundation](https://onco.cc/institutions/st-baldricks-foundation/), [Terry Fox Foundation](https://onco.cc/institutions/terry-fox-foundation/), [The Jimmy Fund](https://onco.cc/institutions/jimmy-fund/), [Worldwide Cancer Research](https://onco.cc/institutions/worldwide-cancer-research/)
- key papers: [Benefits of hyperthermic intraperitoneal chemotherapy for patients with serosal invasion in gastric cancer: a meta-analysis of the randomized controlled trials](https://onco.cc/key-papers/paper-sun-bmc-cancer/), [CHALLENGE: a structured exercise programme after chemotherapy improves survival in colon cancer](https://onco.cc/key-papers/paper-challenge-exercise-nejm-2025/), [Estimated Projection of US Cancer Incidence and Death to 2040](https://onco.cc/key-papers/paper-rahib-projection-us-cancer-2040-jama-netw-open-2021/), [Gallbladder cancer: lessons from a rare tumour](https://onco.cc/key-papers/paper-wistuba-gazdar-gallbladder-cancer-lessons-nat-rev-cancer-2004/), [IARC verdict: excess body fat causes 13 cancers](https://onco.cc/key-papers/paper-body-fatness-iarc-nejm-2016/), [Rohaas 2022: the first randomised trial of TIL therapy, against ipilimumab, in advanced melanoma](https://onco.cc/key-papers/paper-rohaas-til-vs-ipilimumab-nejm-2022/)
- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/), [Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment](https://onco.cc/roadmaps/nutrition-lifestyle-roadmap/), [Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials](https://onco.cc/roadmaps/gallbladder-cancer-roadmap/), [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/), [Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it](https://onco.cc/roadmaps/rejuvenation-roadmap/), [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)
- people: [Albert Lasker](https://onco.cc/people/albert-lasker/), [Alexandra "Alex" Scott](https://onco.cc/people/alex-scott/), [Alfred P. Sloan Jr.](https://onco.cc/people/alfred-sloan/), [Ann Lurie](https://onco.cc/people/ann-lurie/), [Billy Starr](https://onco.cc/people/billy-starr/), [Charles F. Kettering](https://onco.cc/people/charles-kettering/), [Dame Deborah James](https://onco.cc/people/deborah-james/), [Daniel K. Ludwig](https://onco.cc/people/daniel-ludwig/), [David H. Koch](https://onco.cc/people/david-koch/), [Debra Black](https://onco.cc/people/debra-black/), [Einar "Jimmy" Gustafson](https://onco.cc/people/einar-gustafson/), [Eli Broad](https://onco.cc/people/eli-broad/), [Evelyn Lauder](https://onco.cc/people/evelyn-lauder/), [Fran Visco](https://onco.cc/people/fran-visco/), [Gert Boyle](https://onco.cc/people/gert-boyle/), [Helen Diller](https://onco.cc/people/helen-diller/), [Herbert Irving](https://onco.cc/people/herbert-irving/), [Jim Valvano](https://onco.cc/people/jim-valvano/), [John D. Rockefeller Jr.](https://onco.cc/people/john-d-rockefeller-jr/), [John Jacob Astor III](https://onco.cc/people/john-jacob-astor-iii/), [Jon M. Huntsman Sr.](https://onco.cc/people/jon-huntsman/), [Judah Folkman](https://onco.cc/people/judah-folkman/), [Larry Ellison](https://onco.cc/people/larry-ellison/), [Leon Black](https://onco.cc/people/leon-black/), [Leonard Abramson](https://onco.cc/people/leonard-abramson/), [Li Ka-shing](https://onco.cc/people/li-ka-shing/), [Lucille P. Markey](https://onco.cc/people/lucille-markey/), [Marc Lustgarten](https://onco.cc/people/marc-lustgarten/), [Martha Rivers Ingram](https://onco.cc/people/martha-ingram/), [Mary Lasker](https://onco.cc/people/mary-lasker/), [Michael Bloomberg](https://onco.cc/people/michael-bloomberg/), [Michael Milken](https://onco.cc/people/michael-milken/), [Monroe Dunaway Anderson](https://onco.cc/people/monroe-anderson/), [Mortimer Zuckerman](https://onco.cc/people/mortimer-zuckerman/), [Nancy Brinker](https://onco.cc/people/nancy-brinker/), [Phil Knight](https://onco.cc/people/phil-knight/), [Priscilla Chan](https://onco.cc/people/priscilla-chan/), [Randy Pausch](https://onco.cc/people/randy-pausch/), [Richard Rogel](https://onco.cc/people/richard-rogel/), [Robert W. Woodruff](https://onco.cc/people/robert-woodruff/), [Sanford I. Weill](https://onco.cc/people/sanford-weill/), [Sean Parker](https://onco.cc/people/sean-parker/), [Sherry Lansing](https://onco.cc/people/sherry-lansing/), [Sidney Farber](https://onco.cc/people/sidney-farber/), [Sidney Kimmel](https://onco.cc/people/sidney-kimmel/), [Sir Dorabji Tata](https://onco.cc/people/dorabji-tata/), [Ted Williams](https://onco.cc/people/ted-williams/), [Terry Fox](https://onco.cc/people/terry-fox/), [Walter Winchell](https://onco.cc/people/walter-winchell/)
- technologies: [Aspirin for cancer prevention and adjuvant therapy](https://onco.cc/technologies/aspirin-cancer-prevention/), [Fasting and fasting-mimicking diets around chemotherapy](https://onco.cc/technologies/fasting-mimicking-diet/), [GLP-1 receptor agonists and obesity-related cancer risk](https://onco.cc/technologies/glp1-agonists-cancer-risk/)
- trials: [Add-Aspirin](https://onco.cc/trials/add-aspirin/)
- terms: [21st Century Cures Act](https://onco.cc/terms/21st-century-cures-act/)

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