Report to the NHS Central Research & Development Committee
Introduction

1. Cancer places a major burden of disease on the community. The disease is common, affecting one in three people, and accounts for one in four deaths. Its multiple sites, presentations and complications and the complexity of its treatment represent a major challenge to the NHS. In addition, the individual consequences of the diagnosis of a malignant disease for patients are far reaching and profound. The reputation of cancer is especially threatening and it stands as a metaphor for evil within our society. The potential for reducing deaths from cancer by pre-malignant or early malignant diagnosis was identified in the Health of the Nation White Paper and has been the subject of considerable service commitment. Many health carers are especially concerned with the early clinical diagnosis of cancer and its management at first presentation, usually by surgery. Subsequent treatments may be time-consuming and unpleasant for patients and not always effective. If cancer is advanced at presentation or recurs after initial therapy the outcome is often poor and the burden of palliative care upon the health care system is substantial.
2. The economic losses resulting from cancer are huge. The cost of cancer care to the NHS is estimated to be between £1.5 - £2 billion per annum but the consequences to the economy extend far beyond this to include substantial financial burdens upon families and carers resulting from the disabilities and deaths of people during their productive middle years.
3. Research in cancer covers a wide spectrum including basic biomedical sciences, applied laboratory research, epidemiology, clinical research and treatment development, health services research including the evaluation of symptom control and palliative care. A characteristic of this field is the involvement of many major agencies. The Medical Research Council and the major cancer research charities, the Imperial Cancer Research Fund, Cancer Research Campaign, Cancer Relief Macmillan Fund, Leukaemia Research Fund and others, all have research programmes of considerable scale and value. The remit of the Advisory Group on Cancer in setting R&D priorities was to focus especially on the needs of the National Health Service. In doing so it was necessary to identify the important work being done by other agencies in this field and to ensure that the priorities set were complementary to those being pursued by other agencies.
4. The initiative to advise the CRDC on NHS R&D priorities relating to cancer began in February 1993. Compared with the work of other similar Advisory Groups this Group was the first to have the benefit of a lengthy preparatory period allowing a more considered approach to planning and the gathering of information. After wide and extensive consultations and after one workshop had taken place, the Advisory Group met for the first time in November 1993. The Group members were drawn from the NHS and academia from the disciplines of clinical oncology, diagnostic radiology, epidemiology, health economics, nursing, palliative care, pathology, primary care, psychological medicine, screening and surgery - and included carers and health service managers. The list of members and their affiliations are given at Annex 1.
5. The priorities identified are described in this report and cover a wide spectrum from the investigation of the early natural history of disease through to its palliative management. They cover the activities of the Health Service and represent the results of very extensive consultation with the service itself. In recognition of the substantial and vital work of other agencies in this area, basic biomedical sciences and drug development do not figure prominently although the Advisory Group recognised the importance of work in this field in the long term. The priorities identified are areas for research for which proposals will be invited by a Commissioning Group which begins its work in September 1994. It is hoped that the outcome of the research projects funded will improve the knowledge base upon which the provision of effective cancer care within the NHS depends.

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