Fueling Research to Solve the Problems

Research is essential. Cancer is the second leading cause of death in the United States after heart disease.

If you happen to be in the DHMC parking lots in the wee hours, you'll see lights beaming out of the Norris Cotton Cancer Center and Borwell research labs. Lab science is not a 9-to-5 operation, and lead investigators are not salaried, either.

Focus article photo

Jason Moore, PhD, is part of the eagle-I Consortium, a team of bioinformatics experts creating a database of research resources that can be shared by scientists across the country.

In large measure, basic scientists and population-based researchers fund their own efforts, seeking grant support each year to cover their lab expenses, equipment, and salaries while moving innovative ideas forward. The college and the medical center provide space and keep the lights on, but the science itself is fueled by grants. These grants are highly competitive and won only after intensive peer review.

Scores of Federal agencies offer grants to stimulate research at the frontiers of cancer science, and Federal funding is the engine that drives research by established scientists at Norris Cotton Cancer Center: 130 scientists currently hold more than $65 million in Federal funding. As director Dr. Mark Israel explains, "That's $65M in, and $65M out, each year." Indeed, Dartmouth's Cancer Center is a national leader in the amount of grant funding obtained from the National Cancer Institute (NCI). In 2009, the Cancer Center ranked in the top five percent of institutions nationwide in total dollars of research funding from the NCI—78 grants totaling $34.6 million—for a ranking of 31st among 757 institutions in the U.S.

Dr. Israel notes, "Our success in competing for NCI funding demonstrates the nationally recognized excellence of research scientists at Norris Cotton Cancer Center. Our ranking is surprising only in that other top-ranking centers have far more expansive facilities and many more cancer research scientists."

In February 2009, the U.S. Congress passed the American Recovery and Reinvestment Act (ARRA) to stimulate economic growth and create new jobs, in part by providing funding for research. ARRA grants—mostly awarded through NCI—have been given to 37 Dartmouth cancer investigators, bringing more than $17 million to new research directions, technologies, hires, and programs. Grant-funding is focused in cancer biology, biochemistry, pathology, immunology, genetics, and chemoprevention.

Signal successes include $2 million to Risto Kauppinen, MD, PhD, for purchase of a 9.4 Tesla magnetic resonance imaging scanner to investigate the molecular identity of cancer; $3 million to James Sargent, MD, and colleagues to explore visual media influences on smoking behavior among adolescents; and a $3.5 million grant to Lynn Butterly, MD, from the Centers for Disease Control and Prevention (CDC) to increase colorectal cancer screening, for New Hampshire residents age 50 and older, to 80% over the next five years.

Building an Electronic Network for Sharing Research Resources

Cancer Center scientists Jason Moore, PhD, and Steven Fiering, PhD, are leading the Dartmouth component of a $15 million ARRA grant from the National Center for Research Resources to create a multi-institutional scientific database. Called the eagle-i Consortium, after the eagle's characteristic acute vision, the database project aims to make a wealth of currently "invisible" information available to scientists nationwide. Eagle-i is based at Harvard and initially will bridge nine institutions, aiming to create a searchable database to network far-flung research laboratories. The goal is to increase collaboration and share scientific resources such as laboratory equipment, cells and tissue banks, chemical reagents, and model organisms. Once the data infrastructure is completed, its capabilities will be tested in the area of obesity research. In addition to Dartmouth and Harvard, the eagle-i Consortium includes Jackson State University, Morehouse School of Medicine, Montana State University, Oregon Health and Science University, and the Universities of Alaska, Hawaii, and Puerto Rico.

Evaluating Cancer Detection and Treatment Approaches
Photo: Anna Tosteson, ScD

Anna Tosteson, ScD, is working with the Cancer Center and The Dartmouth Institute to apply research tools that evaluate the effectiveness of health care delivery to specific problems in cancer.

The U.S. spends more on health care than any other nation in the world. Not only is the pace of health care expenditure unsustainable, but the quality of U.S. health care lags well behind that of most developed countries. A new tool to encourage clinically effective, efficient health care is called comparative effectiveness research (CER), and a $2 million National Cancer Institute ARRA grant to Anna Tosteson, ScD, a faculty member of both the Cancer Center and The Dartmouth Institute, will establish Dartmouth as a national leader in cancer CER. New imaging technologies for finding cancer and determining treatment are intended to improve the health of the U.S. population. Research is needed to see whether these technologies actually improve clinical care. Dr. Tosteson and colleagues are launching a multi-institutional Center for Comparative Effectiveness Research in Cancer Imaging, collaborating with the American College of Radiology Imaging Network at Brown University and the Tufts Evidence-Based Practice Center. Researchers at these institutions will combine their unique resources to develop new studies of the effectiveness of advanced imaging in cancer, with the goal of identifying and validating best approaches.

The Dartmouth team also will apply CER to study use of positron emission tomography (PET), drawing on the National Oncologic PET Registry and Medicare administrative claims data, and will work to validate lung imaging approaches through an existing NCI-funded National Lung Screening Trial. A second ARRA grant to Dr. Tosteson will fund a new Office of Cancer CER at Norris Cotton Cancer Center to support application of comparative effectiveness research to specific problems in cancer.

By rapidly advancing comparative effectiveness research for advanced imaging technologies in cancer, the Tosteson team will develop the evidence that health care providers need to make better decisions and achieve better results for patients. They will also pay attention to the consequences of incidental diagnostic findings that can result from the use of these technologies.

April 27, 2010