As NCI paylines drop to 4%, cancer centers are tapping into their institutional funds to provide “bridge funding,” typically in $50,000 to $100,000 increments, to enable investigators to keep their labs open until better times return—next year God willing.
“It’s sort of starvation wages in terms of the grant funding,” said Ramon E. Parsons, director of the Mount Sinai Tisch Cancer Center. “And so, how do we pay for salaries for research scientists like postdoctoral scientists or graduate students? Those efforts are going to have to be sort of reduced.”
The paylines raise questions about sustainability of cancer research in the United States.
“I do worry about the next generation of scientists, I mean, the frustration level is pretty high over the funding levels,” said Gary K. Schwartz, director of The Case Comprehensive Cancer Center. “And this may result in people with really innovative ideas to establish their careers, deciding that it’s just not worth developing a career in cancer medicine or basic science. And what happens then? We lose the whole cadre of people who are going to be the future of this whole program.”
On the first 2026 episode of The Directors Podcast, Parsons and Schwartz spoke with The Cancer Letter’s Paul Goldberg about the challenges facing their cancer centers, how they’re navigating funding difficulties, and their hopes for the future.
This episode is available exclusively on The Cancer Letter Podcast—on Spotify, Apple Podcasts, and YouTube.
Both Parsons and Schwartz said they were grateful to Congress and the American public for coming to the defense of biomedical research and heading off the White House’s plans to cut NIH appropriations by 40%, cap indirect costs at 15%, and switch all grants to multi-year funding. Three-year funding is the principal reason the NCI payline has dropped dramatically from 7% to 4%. (No such numbers exist for other NIH institutes and centers.)
“Despite the headwinds, we should not neglect the fact that the papers are coming out constantly. There’s all sorts of really exciting new findings from all of our institutions that we have a lot to be proud of,” Parsons said. “And so, yes, there was a storm that went through in 2025 and hopefully it’ll be over in 2026, but I’d say it looks like we’re going to be making progress and continue to make headway.”
Schwartz, too, is optimistic about riding out the storm.
“As a group of 54 NCI-designated Cancer Centers, we bring to the country unparalleled research,” Schwartz said. “We bring a passion for discovery that’s going to greatly advance the field of cancer medicine. That, to me, is the most exciting thing we can offer the world and the country and our value is immeasurable. And I think that’s what we come together on, and that’s my great hope through these cancer centers.
“We can do unbelievable things and I see great hope for the future around the discovery, around the science and around the medicine, that comes out of the things we do together as cancer centers throughout the country.”
Both Parsons and Schwartz focused on recent changes in the way the Cancer Center Support Grants are reviewed.
Until last year, the review of CCSG applications was managed by NCI and required in-person site visits. Last year, the review of the CCSG program was transferred to the NIH Center for Scientific Review. In another change, NIH eliminated the requirement for in-person site visits, which some directors of cancer centers find useful while others regard it as unnecessary.
“Without the right peer review, the value of our cancer centers might decline,” Parsons said. “Meaning that their quality might not be as strong.” The peer review system is a well-oiled machine, one that allows for a “fabric of cancer centers” all with different strengths and weaknesses, Parsons said. Ultimately, peer review permits cancer centers to be diverse and distinct.
“I think it is kind of unique and very important—we truly do let our peers check under the hood,” Parsons said. “We have almost no secrets between our peers. And that allows for the true experts in the field to analyze us and give us advice.”
Schwartz agrees. “The peer review system works. It has worked. I don’t know why we need to be tinkering around with it to change it,” he said. “I would support the continuation of the way we do the cancer center grants now.”
For Case, a cancer center that unites researchers from Case Western Reserve University, University Hospitals, and the Cleveland Clinic, CCSG is the backbone of the program, Schwartz said.
“It does unify disparate parts of this community under one major goal to find ways to treat and cure cancer. So it’s a very powerful force,” Schwartz said. “And with the additional support of the hospitals and the university, it does lead to a rich environment for cancer medicine and cancer research. But without that designation, without that core grant, there wouldn’t be support that exists now to bring everybody together.”
The relationship between the government and CCSG serves to benefit both parties, Parsons said.
“The government is able to leverage not only their own resources, but the resources of the institution by having the Cancer Center Support Grant,” Parsons said. “It’s a really brilliant example of where there’s joint investment being made. It’s not just the government investing. It’s a joint common investment.”
“Cancer centers need a reliable partnership with the government,” said Parsons.
Though the funding landscape may appear bleak, this is a time of unprecedented scientific progress in cancer research—it’s a storm worth the weathering.
The American Society of Clinical Oncology sponsored this episode. ASCO plays no part in the editorial direction of this podcast.
Explore previous episodes of The Directors.
Some highlights:
On site visits
In 2025, NIH consolidated the initial level of review at the Center for Scientific Review, arguably making the Cancer Center Support Grant, the P-30, into just another funding mechanism (The Cancer Letter, Oct. 31, 2025).
Site visits have been a part of the culture of NCI-designated cancer centers for decades, shaping the process for admitting members to the elite club and influencing internal politics within institutions.
“Luckily, we had our cancer center site visit before the government change, but we had a really pleasant exchange with the NCI site visit panel,” Schwartz said. “I think it did help our ultimate ranking and score. We were able to answer questions, interact with them in a fashion that addressed concerns that were raised, or reinforce the positive.”
Schwartz said he believes the elimination of the site visit will have a negative impact.
“I’m hoping that’s reconsidered going forward. We spend a lot of time preparing for that site visit, a lot of time writing the ground,” he said. “I think the site visit does rally people together. It gave us really a commonality and a desire to work closely in a fashion that was only partly there before. And I think for me as a new cancer center director, it did help me understand who the people were, the science better, and also future initiatives the cancer [center] should undertake.”
He acknowledges that not everyone agrees that site visits are necessary.
“Some people feel it takes a lot of time and effort to put these together, but for me, it really was, as a new director, a very important part of my learning about cancer centers, what they do and how to bring people together for a final presentation and present the cancer research in a very positive light in Cleveland,” he said.
Mount Sinai was reviewed in March of 2025.
“To be honest with you, I think it went quite smoothly,” Parsons said. “The review was remote. We were among the first cancer centers to have a virtual site visit.”
And then the NIH and NCI worked together to get the review process completed in time so that the center was funded at the end of September with a comprehensive cancer center designation.
Having had experiences with both an on-site and remote site visit, Parsons said the in-person visit makes a big difference.
“One way to really galvanize the troops and make sure everybody’s rowing in the same direction is to have the site visit,” he said. “And I think it makes a big difference that it’s an in-person visit of your peers because the leadership of the institution, meaning the CEO and the dean, they take this extremely seriously. Cancer center designation is very, very important to any medical school dean and to any health system CEO.”
“And then also the feedback and criticism is shared, and this allows us to adapt and develop our strategic plan based on a peer review,” Parsons said. “So, it’s a wonderful thing.”
Said Parsons:
Now, I’m a little concerned about this idea that we’ll put in a written document that will be critiqued, will receive feedback from the critique of course, and then it will then be renewed or not.
But my concern is that it will inevitably lead to, I would say, a shallowing of the depth of the analysis that we’re doing, the self-analysis and the peer review analysis that we’re doing to identify strengths and weaknesses.
Some of the things that come out of these reviews that I think are sometimes underappreciated is that your peers recognize the excellence that you have and they say, well, you need to focus on that. That’s where your leverage is. Sometimes we’re here working on a cancer center and we see a lot of people, we need to treat them all the same equally. But it’s good.
Sometimes someone says, this is really cutting edge. This is something that you need to invest in. That’s very important because taking risks, institutional risks is part of how we make progress. And collectively, all of us, all of the cancer centers around the country are basically making calculated decisions where to invest their limited resources to advance the cause of cancer.
On funding and paylines
“We are facing a major crisis in funding of grants where the payline is now up to 4%, making it super competitive to get funded,” Schwartz said.
Said Schwartz:
If you look at all the grants in 2025 that were awarded, there were literally 4,000 fewer grants awarded by the NIH [than] for any other prior four years.
11,123 new NIH grants were approved, which also included the competing awards.
The prior year was on the average of 15,259.
That’s a substantial decrease in funded grants. So, it’s going to impact all of our programs, and I think it’s just going forward. And that does keep me up at night: how to do our research programs, maintain funding with that type of payline and the competition that now exists to get NCI and NIH grants in the current funding environment.
I think we all are really struggling with this. I don’t think I’m alone, but it does impact how we’re going to fund our research programs going forward. Where’s the money going to come from?
It makes us more dependent on foundation grants and philanthropy, and we’re trying to identify those funding sources so we can keep the research programs going and also initiate new programs that we think will help advance cancer medicine.
Parsons said his cancer center is facing the same challenge.
“We have several investigators within the last cycle, with scores in 5th percentile, 6th percentile, and even one at the 4th percentile that did not get funding. Ultimately, you can imagine how this affects the morale of scientists,” he said. “It’s really hard to do better than that, a top percentile score.”
The new policies capping the limit of grants one can receive from NIH, as well as the multi-year funding of grants, which recently passed in the House, is also concerning, Parsons said.
Said Parsons:
There’s quite a bit of headwinds in my opinion, in terms of policy changes coming out of NIH and NCI that we’re having to adapt to on the fly. And as you all know, we’re very dependent on federal funding because it comes with full indirect costs, it helps support the institution.
We’re capped at 39% of dollars I believe can go to multi-year funding. I think this is contributing to the very low payline. And I think perhaps this change in policy came about without understanding the consequences to literally a generation of investigators. If you’re so unlucky to be having your grant cycle in last year, this year or next year, the chances of your success are very low.
I will not mention the institution I was visiting, but not too long ago, I was visiting an institution where one investigator had three or ones and they all terminated. Just so happened last year and they did really well, but not one of them was renewed in terms of public. When I say they did well, the publication record was great. Their productivity was tremendous. The payline was three to 4% and they got 5, 8, 9 percentile. So I think that in addition to what Gary’s saying, I would just also add that there is a real risk that a real cohort of affected, through just timing, bad timing or bad luck, about when their grants were cycling, that could be severely impacted based on this change in policy.
A few months ago, things were looking especially bleak in terms of funding, Schwartz said. But that perspective has shifted.
“I think we can look forward and see some light at the end of this tunnel, and hopefully it’ll be sustainable going forward,” he said.
Schwartz agrees that the multiyear or “forward funding” is problematic.
“It does accelerate money going out of the NCI, and that leaves less money for grants to follow,” he said. “I’m hoping that that approach to funding grants is reconsidered. I think there’s some debate still on the budget on how that will be handled. I haven’t seen how that’s being exactly addressed, but to me that does is I find that disruptive in terms of sustaining cancer funding on a continual basis for the community.”
Parsons said that in a meeting with NCI Director Letai last year, he felt a sense of unity.
“I got the sense that we’re all in this together,” he said. “And so the leadership at the federal level is aligned, and frankly, getting this budget through is just going to be the key step really in getting things back on track. So it looks very promising.”
On internal grants and bridge funds
Both directors said they are trying to shore up funding gaps through internal grants for investigators.
“We’re focused on giving out internal grants,” Schwartz said. “We have funding for pilot funds to support new initiatives. We have bridging money up investigators who maybe did not get funding to coax them over that funding hump, so they can reapply and keep their laboratories open.”
Case CCC is trying to use internal money as much as possible to help keep up the funding efforts, he said.
We can do unbelievable things and I see great hope for the future around the discovery, around the science and around the medicine, comes out of the things we do together as cancer centers throughout the country.
Gary Schwartz
“We can help morale, giving out as much money as we can, but there are limitations, what we can do, where the money comes from, to support these efforts,” he said. “So, we haven’t cut back in this effort. In fact, we’ve increased the number of grants that we’re giving out from the pilots and with these collaborative efforts.”
Open communication with the faculty is a priority, he said.
“We try to be open about where things are and try to help them over these difficult times,” he said “I think that’s one thing we’re trying to do here is at least try to find funding within the institution to help bridge it.”
But, he points out that this bridge funding will never be enough to replace the anticipated loss of funding.
“It’s not going to be enough physical help. Some of the pain is that it won’t be enough to replace the lost funding that inevitably is going to take place as these paylines are maintained at such a high level,” Schwartz said. “And I guess some of the hope, the [NCI] director, there is a part of this where even though it’s 4%, I think the director does have some discretionary ability to fund those that are below 4%.”
Schwartz said he hasn’t seen how that discretionary ability is going to apply yet, or how it works, but that mechanism does exist.
“So, I’m hopeful that with some of these grants, the 4% can be rescued by the director or by the cancer center at the NCI to pull some of those into the funding area.”
Parsons said his cancer center is also giving out pilot awards.
“We are also giving out pilot awards where the institution is still supporting… Fortunately, this is only… We’re talking about one year, and most people here have different grants and different sources of funding,” Parsons said. “So, we’ve been able to sort of weather this storm, I think fairly well.”
But bridge funding and pilot awards would not be sustainable over multiple years, he agrees.
Said Parsons:
We work with a budgetary process at our institution, so it’s not as though there’s Draconian responses, but the point would be is that as we’re planning for the future, if there’s no source of funding to plan for, it’s very hard for us to go ahead and plan to hire people we won’t be able to pay, et cetera.
So, I think my issue isn’t so much managing the problem now, it’s more about how do we project for the future. And so, this is distressing, in my opinion. I don’t think the nation frankly wants to go in this direction. Given that there’s so many positive initiatives at Gary’s cancer center, at our cancer center, around the nation, working in pharma, it’s just, this is a real time of opportunity for new treatments and new approaches for cancer.
So, it is disappointing that in this really great time where there’s a lot of technological advancement, where we really have witnessed a sea change in how we even approach the analysis of cancer in the last five years with single cell sequencing, and spatial sequencing, and high depth sequencing, circling tumor DNA analysis, all these different modalities, some of them in the clinic, some of them in the laboratory, really have advanced our understanding and are leading to new insights in the disease that we’re all studying and trying to make a difference in.
So, it’s kind of one of those things, “Tale of Two Cities” type of thing, best of times and the worst of times, honestly. It’s an old saw there, but it really does feel that way.
Bridge funding is only $50,000-$100,000, not even up to an R01 level, Schwartz said. It functions only as a short term bridge.
“Fill in the gap, keep things in motion, but it’s not the long-term solution to the problem,” he said.
“I worry about—talk about what keeps me up at night—not only the funding, but who’s going to be doing the research, who’s going to be leading the field, how many great ideas will be lost and how many of them are coming out of creative young people are going to be the basic, the foundation of the future.”
Schwartz said he doesn’t know yet how to address those concerns.
“I don’t have a solution. I don’t. And how do we fund PhD programs, postops, postdocs and things that Ramon was saying, where’s the money going to come from from all these parts of our research program? I am not sure. And it’s a struggle we’re all facing and I don’t have solutions. I wish I did. And we try to find donors and foundations to help support us. And we spend more time as cancer directors looking at those opportunities,” he said.’
He tries to be positive, he said. The proposed NCI budget looks more hopeful than other budgets.
“If the budget goes through, it’ll be positive for the cancer community,” he said. “I mean, there are certain issues now whether the budget will be approved or issues that are well beyond the scientific efforts, but we’ll see what happens at the end of the month. But I think that reflects the fact that Congress does understand that cancer research is critical for the future of this country.”
On the future of NCI funding
Last week a then-promising legislative package was passed by the U.S. House of Representatives Jan. 22. At the time, the package was expected to pass in the Senate, provide funding for the federal government through fiscal year 2026, and prevent a government shutdown that looms Jan. 30.
But the shooting of 37-year-old ICU nurse Alex Pretti in Minneapolis on Jan. 24 derailed that funding, dissolving the FY26 spending package as lawmakers refuse to move forward without changes to the U.S. Immigration and Customs Enforcement and Department of Homeland Security.
A story about the status of the FY26 budget appears in this issue.
Parsons is optimistic that the bipartisan support for NIH and NCI will prevail.
“Regarding the new legislation that was just passed with the budget for NIH and NCI. I think clearly it looks like, God willing, that knock on wood, everything crossed my fingers that we are going to have a better year in 2026 than 2025,” Parsons said. “And it looks like this bill is going to eventually be hopefully be signed by the president and will have this new funding period. I think it’s going to really help.
I worry about—talk about what keeps me up at night—not only the funding, but who’s going to be doing the research, who’s going to be leading the field, how many great ideas will be lost and how many of them are coming out of creative young people are going to be the basic, the foundation of the future.
Ramon Parsons
“And I’m actually even hopeful that with the right management and with Tony Letai at the head of NCI, that we’ll be able to have a better payline this upcoming year. That’s my hope.”
Schwartz attributes the bipartisan congressional support of NCI to strong lobbying on the part of cancer centers and advocates.
“There’s not a person in the country who hasn’t been affected by cancer. That’s a very huge political force,” Schwartz said. “I think once the public became aware of the impact, then it was a rallying point for the cancer centers to come together and to promote the fact that the cutbacks were just untenable and would have a devastating impact on the future for cancer medicine.”
After the uncertainty of last year, Schwartz is also optimistic about increased funding and stability in 2026.
“I think we were on a pathway to severe negative impact on what we do. And I do believe we’re back on track for hopefully future success,” he said. “We’ll have to see how it all goes.”
A second government shutdown, however, could put a dent in their optimism.
“When I knock on wood and cross my fingers for this future is that we actually don’t have another government shutdown because if we keep on having these kinds of disruptions in research, these are real distractions,” Parsons said. “And many of us, as I was saying before, when our budget changes, we have to adjust our spending. We don’t have an unlimited checkbook, bank account that we can draw on and we prioritize, we economize, we do our best to adapt.”
Schwartz agrees that these disruptions have an impact.
“We are at the mercy of budgets. And, as Ramon was saying, government shutdowns and how that affects us,” Schwartz said. “But at the end of the day, we will have a budget, I think, that’ll look very positive for the cancer community. And I’m hopeful about that.”
Listen to the full episode on Spotify, Apple Podcasts, and YouTube.
A transcript of the podcast is available below:
Claire Marie Porter: Welcome back to the Directors, a special segment of The Cancer Letter podcast.
The directors is sponsored by ASCO, the American society of clinical oncology.
This time, Ramon Parsons, director of the Mount Sinai Tisch Cancer Center, and Gary Schwartz, director of The Case Comprehensive Cancer Center, talk about weathering budget battles, policy shakeups, and government shutdowns, at a time when science is bringing cancer care and research to new levels.
Let’s get started.
Paul Goldberg: Well, Dr. Parsons and Dr. Schwartz, thank you so much for agreeing to appear on The Directors, the first episode of 2026. And on The Directors, the first question is always the same, which is what’s keeping you up at night as you are running your cancer centers? And I guess I’m going to decide… Dr. Parsons?
Ramon Parsons: Oh, goodness. Many different things can keep me up at night. I would say the most challenging thing we’re facing here at Mount Sinai right now is our nurses strike… I think we’re doing a good job trying to balance the staffing challenges with taking care of cancer patients.
We’re now in week three of our strike. And as you can imagine, having new nursing staff that have come in temporarily, with our nursing leadership to take over very complex case care is challenging, but we’re able to really have had to dampen our volume, but still are open for business in the sense that we’re seeing patients and are able to do that.
But it’s a bit of a challenge, because we’re now in week three. One week of a strike—no problem, but it starts to become… I really hope that both parties are aligned soon, really, for the best of the patients.
Paul Goldberg: Dr. Schwartz?
Gary Schwartz: So, we don’t have a nursing strike in Cleveland, but I can speak to the fact that we’ve had a lot of snow in Cleveland, and 18 inches of snow has been definitely a challenge getting to the cancer center, but we’ve been open.
We’re open for business, and we’re seeing patients. We’re doing our basic research and our translational medicine, and it’s been not a major hindrance. So, we have had the university closed yesterday completely for the snow. It was so bad here in the city.
I guess the real issue for me, though, is on a cancer center level—funding keeps me up at night. We are facing a major crisis in funding of grants where the payline is now up to 4%, making it super competitive to get funded grants awarded.
And if you look at last year on congress.gov, this is not… It’s open public knowledge. If you look at all the grants in 2025, that were awarded, there were literally 4,000 fewer grants awarded by the NIH [than] for any other prior four years. The numbers actually have in front of me, 11,123 new NIH grants were approved, that also included the competing awards.
The prior years was on the average of 15,259.
That’s a substantial decrease in funded grants. So, it’s going to impact all of our programs, and I think it’s just going forward. And that does keep me up at night: how to do our research programs, maintain funding with that type of payline and the competition that now exists to get NCI and NIH grants in the current funding environment.
I think we all are really struggling with this. I don’t think I’m alone, but it does impact how we’re going to fund our research programs going forward. Where’s the money going to come from?
It makes us more dependent on foundation grants and philanthropy, and we’re trying to identify those funding sources so we can keep the research programs going and also initiate new programs that we think will help advance cancer medicine.
Paul Goldberg: Is this also occurring at Mount Sinai?
Ramon Parsons: Yes, we’re facing the same challenge.
We have several investigators, in the last cycle, like last fall, with scores in fifth percentile, sixth percentile, and even one at the fourth percentile that did not get funding ultimately. You can imagine how this affects the morale of scientists. It’s really hard to do better than that, like a top percentile score.
And so, I agree with Gary 100% that this is keeping us up at night. Certainly, we’re seeing this. The other thing that I think we’re also concerned about is the new policies around the number of grants one can get from NIH, receive from NIH, and that also is concerning.
So, there’s quite a bit of headwinds, in my opinion, in terms of policy changing coming out of NIH and NCI that we’re having to adapt to on the fly. And as you all know, we’re very dependent on federal funding because it comes with full indirect costs. It helps support the institution.
Certainly, it could be very difficult for us to remain as active as we are with a substantial cut in federal funding going forward. So, it is really quite concerning.
And I would agree with Gary, this keeps me up at night, outside of what the local environment that we’re here adapting to and issues that we face locally. At the national issue, I think this is really a challenge.
I think the other area that I’m concerned about is the multi-year funding of grants, which recently just passed the House. And with that number, if I’m not mistaken, I read in The Cancer Letter this morning, Paul—
Paul Goldberg: Must be true…
Ramon Parsons: … that 39% of… We’re capped at 39% of dollars, I believe, can go to multi-year funding. I think this is contributing to the very low payline, and I think perhaps this change in policy came about without understanding the consequences to literally a generation of investigators.
If you’re so unlucky to be having your grant cycle, last year, this year or next year, the chances of your success are very low. I will not mention the institution I was visiting, but not too long ago, I was visiting an institution where when an investigator had three R01s, and they all terminated, just so happened last year, and they did really well, but not one of them was renewed in terms of…
When I say they did well, the publication record was great, their productivity was tremendous. The payline was 3% to 4%, and they got five, eight, nine percentiles.
So, I think that in addition to what Gary’s saying, I would just also add that there is a real risk that a real cohort of affected through just timing, bad timing or bad luck about when their grants were cycling could be severely impacted based on this change in policy.
Paul Goldberg: The multi-year funding… Well, OMB wanted to go full multi-year funding, and NCI is actually the only place where we know we are at 4% payline. All the other parts of NIH, we just don’t know.
Is there anything you can do to boost morale, to boost funding? What can you do?
Gary Schwartz: Well, at Case, we’re focused on giving out internal grants. We have funding for pilot funds to support new initiatives. We have bridging money up investigators who maybe did not get funding to coax them over that funding hump, so they can reapply and keep their laboratories open.
We’re promoting bicampus—and we have both two hospital systems and Case is part of a consortium, University Hospital and Cleveland Clinic—and we’re promoting bicampus collaboration by funding those efforts, too.
So, we’re trying to use internal money as much as we can to help keep up the funding efforts. And we think that does promote a positive… The best we can help morale, giving out as much money as we can, but there are limitations, what we can do where that money comes from to support these efforts.
So, we haven’t cut back in this effort. In fact, we’ve increased the number of grants that we’re giving out from the pilots with these collaborative efforts, and I think that does help.
We try to keep up communication with all the faculty, try to be open about where things are and try to help them over these difficult times. I think it’s one thing we’re trying to do here is at least try to find funding within the institution to help bridge it, but it’s never going to be enough, Paul. It’s not going to be enough.
It’ll help for some of the pain, but it won’t be enough to replace the lost funding that inevitably is going to take place as these paylines maintain at such a high level.
And I guess some of the hope, the [NCI] director, there is a part of this where even though it’s 4%, I think the director does have some discretionary ability to fund those that are below 4%.
I haven’t seen how that’s going to apply yet and how that’s going to work, but that mechanism does exist. So, I’m hopeful that some of these grants, like the ones Ramon mentioned below the 4% can be rescued by the director or by the cancer center at the NCI to pull some of those into the funding area.
Paul Goldberg: Ramon, is there anything you’re doing?
Ramon Parsons: I guess what we’re doing is we are also giving out pilot awards where the institution is still supporting… Fortunately, this is only… We’re talking about one year, and most people here have different grants and different sources of funding.
So, we’ve been able to sort of weather this storm, I think, fairly well. However, as Gary points out, this is not something that over multiple years is something that we can potentially… It’s sort of starvation wages in terms of the grant funding.
And so, how do we pay for salaries for research scientists like postdoctoral scientists or graduate students?
Those efforts are going to have to be sort of reduced. I mean, we work with a budgetary process at our institution, so it’s not as though there’s Draconian responses, but the point would be is that as we’re planning for the future, if there’s no source of funding to plan for, it’s very hard for us to go ahead and plan to hire people we won’t be able to pay, et cetera.
So, I think my issue isn’t so much managing the problem now, it’s more about how do we project for the future. And so, this is distressing, in my opinion. I don’t think the nation frankly wants to go in this direction. Given that there’s so many positive initiatives at Gary’s cancer center, at our cancer center, around the nation, working in pharma, it’s just, this is a real time of opportunity for new treatments and new approaches for cancer.
So, it is disappointing that in this really great time where there’s a lot of technological advancement, where we really have witnessed a sea change in how we even approach the analysis of cancer in the last five years with single cell sequencing, and spatial sequencing, and high depth sequencing, circling tumor DNA analysis, all these different modalities, some of them in the clinic, some of them in the laboratory, really have advanced our understanding and are leading to new insights in the disease that we’re all studying and trying to make a difference in.
So, it’s kind of one of those things, “Tale of Two Cities” type of thing, best of times and the worst of times, honestly. It’s an old saw there, but it really does feel that way.
Paul Goldberg: Well, if I’m an investigator to put some numbers on this, let’s say, what does bridge funding look like? How much do I get or how much can you afford? How many can you give out? Just kind of like cool-your-heels-and-don’t-quit kind of money.
Gary Schwartz: Right. It’s $100,000, $50,000. It’s not even up to an R01 level grant. It’s just enough to kind of bridge it for the short term. And it’s not sustainable long-term.
I think that’s what Ramon was saying. It’s sort of a short-term gap, filling the gap, keep things in motion, but it’s not the long-term solution to the problem. I mean, I do worry about the next generation of scientists, I mean, the frustration level is pretty high in the funding levels.
And this may result in people with really innovative ideas to establish their careers, decide that it’s just not worth developing a career in cancer medicine or basic science.
And what happens then?
We lose the whole cadre of people who are going to be the future of this whole program. And I worry about, talk about what keeps me up at night, not only the funding, but who’s going to be doing the research, who’s going to be leading the field, how many great ideas will be lost and how many of them are coming out of creative young people who are going to be the foundation of the future?
And that does lead to also one of my concerns, how we’re going to address that. And I don’t have a solution, I don’t. How do we fund PhD programs, postdocs and things that Ramon was saying? Where’s the money going to come from from all these parts of our research program? I’m not sure. And it’s a struggle we’re all facing, and I don’t have solutions. I wish I did. And we try to find donors and foundations to help support us, and we spend more time as cancer directors looking at those opportunities.
And is it time well spent? Yes, absolutely. If it means more dollars to the institution. So, we’ll see. We’ll see. I’m trying to be positive. I think the NCI budget that’s been proposed by Congress looks more positive than any of us have anticipated three months ago, that can increase in NCI dollars, not by much, but by a little—which is much more than the 40% cutbacks that we first talked about.
Indirects are holding themselves. So, I mean, if the budget goes through, it’ll be positive for the cancer community. I mean, there’s certain issues now whether budget will be approved or issues that are well beyond the scientific efforts, but we’ll see what happens at the end of the month.
But I think that reflects the fact that Congress does understand that cancer research is critical for the future of this country. There are enough Congressmen and women who understand that we must be leaders, and this only can come about by funding investigators doing this type of research and through their credit, they’ve rallied together across the aisle to support an NCI budget that’ll not just…—to increase dollars.
And I have to applaud Congress for those efforts.
Ramon Parsons: I just want to also chime in regarding the new legislation that was just passed with the budget for NIH and NCI.
I think it is really good news. I think, clearly, it looks like, Godwilling, knock on wood, everything crossed my fingers that we are going to have a better year in 2026 than 2025.
The fact that a lot of the different things that were ideas that were brought up this year by the new administration have really worked their way through the legislative process. And it looks like this bill is going to eventually be hopefully be signed by the president and will have this new funding period. I think it’s going to really help.
And I’m actually even hopeful that with the right management and with Tony Letai at the head of NCI, that we’ll be able to have a better payline this upcoming year. That’s my hope.
So, I am still, I think, cautiously optimistic that this coming year will be better, but I do think that good management is going to be required at the federal level to really keep things getting on a healthy track.
And I don’t want to go back to being negative, Paul, but I had a former MD-PhD student call me, who’s now at a very top place out on the West Coast, who just called me this week saying he’s not sure if he wants to go into academic research.
And I wonder why, why is he calling me? He’s finishing a clinical fellowship. And so, there’s a lot of people who are going to be affected by the research climate. So, coming up with a climate where it’s like, as you mentioned, good news, positive…
People, when they dedicate themselves to a life in science and medicine, they’re not necessarily looking to make a ton of money, right?
They really want to make an impact, but I do think they need a stable environment to nurture their career. And if they don’t have that stability, the problem, as we know in a soft money institution, is that we’re only able to fund ourselves based on the grant portfolio that we have, right?
We don’t have large endowments that pay our salaries and our staff and the research scientists that work with us separately. This is basically a rolling effort to raise money from the government that then leads to advances, and we have to provide reports on our productivity, and those grants don’t get renewed if we are not able to demonstrate that we’ve made some kind of impact.
Obviously, it depends on the topic of the research, but the impact that was intended basically through publications and other ways of spreading the word on our science. So, this is, I think a good system. It forces the discipline of always having your feet held to the fire. You’re always disciplined, because you always have to renew your next grant. You always have to stay on top of your game, otherwise you won’t renew your grant portfolio.
But the danger is, if the environment that sustains that is, basically, the air is taken out of that balloon completely, there’s not enough money really to keep it going, because philanthropy really, despite a lot of people… We always like to talk about the philanthropy that we receive, and we’re always very proud of it, but it really just supplements the federal investment. It’s not a replacement.
Paul Goldberg: Go ahead.
Gary Schwartz: Yes. It can never replace the NCI money. As you said, it’s a supplement and it’s nice to have it, but without the NCI support, we couldn’t exist as as cancer center.
Paul Goldberg: But looking back a year, just turning the clock back, we were talking about 40% cuts in NIH appropriations, 15% indirect costs and three-year multi-year funding. Okay, nothing left! You might as well just napalm the whole system…That’s not where we are right now.
Ramon Parsons: That’s good.
Paul Goldberg: Yes. So, how long do you think can the system keep trying to get through this bump, through this speed bump?
Ramon Parsons: Yes. Again, I think my personal opinion is it’s about having a reliable partner with the government, partnership with the government, because as you know, we had the disruption last spring with all these new policies that were announced.
And then, if that had been the only disruption, I would say maybe… But the fact that we had that long government shutdown, which affected the review process, actually delayed the review of many grants. This also is a real problem, right?
And so, when I knock on wood and cross my fingers for this future is that we actually don’t have another government shutdown, because if we keep on having these kinds of disruptions in research, these are real distractions. These are real distractions. And many of us, as I was saying before, when our budget changes, we have to adjust our spending. We don’t have an unlimited checkbook, bank account that we can draw on and we prioritize, we economize, we do our best to adapt.
I’m not trying to sound like I’m complaining, but I’m just trying to give you the reality of the situation. We can’t print money.
Paul Goldberg: How much time do you have, you think, in terms of the system starting to collapse if we were staying at the present level?
Ramon Parsons: You want to answer that, Gary?
Gary Schwartz: I’m not sure what the question is exactly. I mean, if we-
Paul Goldberg: How long do you think you can keep on doing the best you can with what you’ve got until the system starts to collapse, as it almost did last year?
Gary Schwartz: Yes, but it didn’t collapse, Paul.
Paul Goldberg: No.
Gary Schwartz: I mean, if the system collapsed, and we’re down to 40% coverage and 15% indirects, there was an imminent sense of true disaster in the cancer community, and the future was pretty bleak.
But for reasons that I think people understand the importance of cancer research and the impact of cancer research on clinical care, and everybody knows about cancer. There’s not a person in the country who hasn’t been affected by cancer. That’s a very huge political force. You put all those people together, that’s a major political force.
And I think once the public became aware of the impact, then it was a rallying point for the cancer centers to come together and to promote the fact that the cutbacks were just untenable and would have a devastating impact on the future for cancer medicine. So, it was a rallying point. And I think Congress heard that we needed to correct that plan of a 40% cutback, restore the cuts. And in fact, looks like there’ll even be an increase in the budget once it’s approved hopefully in the next couple of weeks.
So, to answer your question, Paul, I think we were on a pathway to severe negative impact on what we do. And I do believe we’re back on track for, hopefully, future success. We’ll have to see how it all goes.
Paul Goldberg: Is that what you see, Ramon, as well?
Ramon Parsons: Yes. Like I said, we had a nice meeting with the new NCI director. He asked us all the cancer center directors to meet with him late last year.
And I got the sense that we’re all in this together. And so, the leadership at the federal level is aligned and that frankly, getting this budget through is just going to be the key step really in getting things back on track.
So, it looks very promising.
Gary Schwartz: Yes, I agree with Ramon. I mean, that’s my point, that a few months ago, things looked pretty bad.
Today, I think we can look forward and see hopefully some light at the end of this tunnel, and hopefully it’ll be sustainable going forward.
We are at the mercy of budgets. And as Ramon was saying, government shutdowns and how that affects us. But at the end of the day, we will have a budget, I think, that’ll look very positive for the cancer community. And I’m hopeful about that.
And it won’t change how it impact on the payline. We’ll have to see. Will the four percentile change? I think the funding forward is an issue. It does accelerate money going out of the NCI and that leaves less money for grants to follow.
And I’m hoping that that approach to funding grants is reconsidered. I think there’s some debate still on the budget, how that will be handled. I haven’t seen how that’s being exactly addressed, but to me I find that disruptive in terms of sustaining cancer funding on a continual basis for the community.
Paul Goldberg: But the review of cancer centers was another concern that turned out to be quite fine. I mean, there was… What was your experience with the way center grants are reviewed?
Gary Schwartz: Well, luckily, we had our cancer center site visit. We had an onsite visit before the government changed, but we had a really pleasant exchange with the NCI site visit panel, and I think it did help our ultimate ranking and score.
We were able to answer questions, interact with them in a fashion that addressed concerns that were raised, or reinforced the positives. I think taking away the site visit is a negative, and I’m hoping that’s reconsidered going forward.
We spent a lot of time preparing for that site visit. We spent a lot of time writing the grant, of course. I think the site visit does rally people together. Again, it gave us, really, a commonality and a desire to work closely in a fashion that was only partly there before. And I think, for me, as a new cancer center director, it did help me understand who the people were, the science better, and also future initiatives the cancer center should undertake.
And I think that’s what came out of the site visit and the preparation, which we went over many, many months. I’ll be sad to see the site visits go away, frankly, Paul. I’m hoping that’s reconsidered. To me, it was real positive. Not everybody feels that way.
Some people feel it takes a lot of time and effort to put these together, but for me, it really was, as a new director, a very important part of my learning about cancer centers, what they do, and how to bring people together for a final presentation and present the cancer research in a very positive light in Cleveland and the community.
Ramon Parsons: So, Paul, as you know, we were reviewed in March of 2025, after the new administration took over. So, to be honest with you, I think it went quite smoothly.
The review was remote. We were among the first cancer centers to have a virtual site visit. It had been originally scheduled to be an in person site visit, so that we delayed it about a month. And then the NIH and NCI worked together to get the review process completed in time so that we were funded at the end of September with a Comprehensive Cancer Center designation, so we were really proud of it.
So, I would say, having been someone who actually was at a virtual site visit that we just experienced versus prior site visit, which I was at here at… I was the director at that point in 2020, when we had an in-person site visit…
I would say that I would agree with Gary.
As a matrix cancer center director, one way to really galvanize the troops and make sure everybody’s rowing in the same direction is to have the site visit. And I think it makes a big difference that it’s an in-person visit of your peers, because the leadership of the institution, meaning the CEO and the dean, they take it as extremely seriously.
Cancer Center designation is very, very important to any medical school dean and to any health system CEO. And again, it’s a chance to really work together and get everybody working in the right direction.
And then, also, the feedback and criticism is shared, and this allows us to adapt and develop our strategic plan based on a peer review, right? So, it’s a wonderful thing. Now, I’m a little concerned about this idea that we’ll put in a written document that will be critiqued, will receive feedback from the critique, of course, and then it will then be renewed or not.
But my concern is that it will, I think, inevitably lead to, I would say, a shallowing of the depth of the analysis that we’re doing, the self-analysis and the peer review analysis that we’re doing to identify strengths and weaknesses.
Some of the things that come out of these reviews that I think are sometimes underappreciated is that your peers recognize the excellence that you have. And they say, “Well, you need to focus on that. That’s where your leverage is.” Sometimes we’re here working on a cancer center and we see a lot of people, we need to treat them all the same equally, but it’s good sometimes someone says, “This is really cutting edge. This is something that you need to invest in.” That’s very important because taking institutional risks is part of how we make progress.
And collectively, all of us, all of the cancer centers around the country are basically making calculated decisions where to invest their limited resources to advance the cause of cancer.
And I think part of the reason why we have done so well as a nation is we have this fabric of cancer centers that have their own strengths and weaknesses, and they use those strengths.
So, the peer review, I think ultimately allows us to be different and distinct. The other thing I will just say about peer review that’s really, I think, kind of unique and very important is we truly do let our peers check under the hood. We have almost no secrets between our peers and what we do. And that allows for really, really the true experts in the field are analyzing us and giving us advice.
And then, in order to be ready for that, we have our external advisory boards who are also full of peers and peer reviewers who are also giving us similar advice.
So, we’re getting feedback constantly on what we’re doing and with the notion that if you’re not innovative, you’re not doing a very good job, right? So, we have this…
And so, the problem with the paper review, Paul, is that I’m not sure those messages will come out as clearly, in my opinion.
Gary Schwartz: And I think they’re planning some sort of site visit, but it won’t impact the overall score.
It’s mainly going to be an abbreviated site visit, and it’s mainly to have the CEOs and the CMOs come together, affirm their commitment to the cancer center. It’s not going to be really an evaluation of the science and the directions we’re taking.
So, it may be something as a compromise, but I’m not sure how impactful that’s going to be for the cancer centers themselves, other than to reinforce the additional commitment for each of these cancer center programs.
Ramon Parsons: To me, honestly, unless that site visit actually has a scoring, it just seems like… It feels like, to me, Gary, when I heard that, it sounds like they’re trying to do what they can do with the current administration guidelines, but I don’t think that’s going to… I agree. I don’t think it’s going to be very effective. We’ll see.
Gary Schwartz: Yes. I don’t see the value, compared to where we are now, but I do see the value of a site visit, and I think, as you say, Ramon, listen, for matrix cancer center, rally the troops to get everybody in place to present a vision, telling science, that was the best experience I’ve ever had, and I learned so much from it.
And we’re four years away from our next renewal as well, but now with how do you continue that energy at a site visit and how do you keep people together and thinking creatively and mobilizing people. And that’s also what the cancer centers directors have to do between site visits also. But site visit was a hugely valuable tool for this cancer center.
Paul Goldberg: It’s interesting, because, looking back at last year, this time last year, one of the concerns was that the NCI had a vacuum of leadership, but what didn’t happen…
Doug Lowy is terrific, but he was not the presidentially appointed NCI director… But now, thank God, there’s somebody who actually is a part of this culture who is running the NCI, and it’s Tony Letai.
One of the things he told me in the Q&A was that his goal is to make it easier, or less onerous, for designated cancer centers to get renewals. Have you heard more on this? He hasn’t shown me anything yet. He hasn’t shown anybody anything as far as I know.
As center directors, have you seen anything on his vision?
Gary Schwartz: I’ve heard it discussed for quite a while, but I have not heard anything in that regard, Paul. I don’t have any details.
Ramon Parsons: I mean, other than the meeting that we had with him, he did mention that cancer centers are high priority and are not something that to be concerned about.
I think he [sees] their value, and so, I think we’ve had to prove our value over and over again. So, it’s a pretty well-oiled machine at this point. My only point earlier is that without the right peer review, the value of our cancer centers might decline, meaning that their quality might not be as strong.
Because, remember, the thing about cancer centers, Paul, that you know, is that they are not sustained by the dollars from the Cancer Center grant. The dollars from the cancer center grant are really a small part of the whole enterprise.
And it’s really a fabric of the grant, federal grants for specific projects and program projects and boards. And then, you combine that with institutional support for recruitment and seed funding for new investigators and pilot awards, and then you combine that with philanthropy. And then also in our institution, we get support from both the school and also the hospital and the health system.
So, it’s all part of a greater overall equation with the Cancer Center grant basically being the quarterback for this very complex team. But the point is that the government, in my opinion, is able to leverage not only their own resources, but the resources of the institution by having the Cancer Center Support Grant.
It’s a really brilliant, actually, leveraging, and it’s an example of where there’s joint investment being made. It’s not just the government investing, it’s a joint common investment. So, it’s frankly a wonderful thing to have these cancer centers in our country, as I was mentioning earlier, and I feel that we’re…
And on a positive note, is that we’re really blessed to have them, and we just should try to make sure we don’t… If we do make changes in how they’re reviewed, that we make sure that…
And this is for Anthony: If you’re listening out there, Tony, we want you to be able to sort of use a metric to measure whether things are improving or getting worse or getting better, whatever, so that you can refine this new review system and hone it so that we’re on track.
Paul Goldberg: That’s an inspired idea, to speak to Tony through this. Gary, would you like to say something to Tony?
Gary Schwartz: Yes, I would say the peer review system works. It has worked. I don’t know why we need to be tinkering around with it to change it. So, I would support continuation of the way we do the cancer grants now. I mean, I think the NCI gives us a backbone for the program.
In Cleveland, at Case Western Reserve, it’s been a unifying factor that brings two hospital systems, Cleveland Clinic, University Hospital, and a university, Case Western, under one umbrella.
Without the NCI-designated Cancer Center in Cleveland, we would not exist. It does unify disparate parts of this community under one major goal to find ways of treating, cure cancer. So, it’s a very powerful force, and with the additional supports of the hospitals and the university, it does lead to a rich environment for cancer medicine and cancer research.
But without that designation, without that core grant, there wouldn’t be support that exists now to bring everybody together.
So, I’m a big supporter of the cancer centers. Listen, I left New York, Paul, as you know, after a whole career in New York, I went to Mount Sinai as a fellow, and I was in Memorial Sloan Kettering for many years, and, of course, Columbia as the head of oncology, but this experience has surpassed anything I’ve done in my life and it was worth the move to do something really extraordinary.
So, it works—the peer review. So, I just would be concerned about too much tinkering and I think we should try to sustain the way it’s been done.
Listen, I’m open to change. Listen, I’m a scientist, a physician scientist, and we do experiments all the time. I want to see how it goes and see how it works. But I do have my concerns with changing the peer review process for the cancer centers.
Paul Goldberg: Well, I guess one last question. What is the most positive thing you can say right now in January 2026?
Gary Schwartz: We’re close to a budget that may give us the cancer center dollars we need to continue to succeed. It is the hope that we’re really close. And hopefully we’ll soon be over the finish line.
Ramon Parsons: For me, really, what can I say that’s positive? I would say there’s a lot of different positive things happening. So, first of all, I would say the appointment of Tony Letai is a really great positive accomplishment. I think the administration is showing a real intention to move the cancer ball forward with his appointment.
The second thing, I would agree with Gary wholeheartedly that where we’re at now with the likely passage of this new funding bill for NCI and NIH is really a real tremendous victory, really exciting.
And then, the last thing, I’m excited about is just the science. I mean, despite the headwinds, we should not neglect the fact that the papers are coming out constantly. There’s all sorts of really exciting new findings from all of our institutions that we have a lot to be proud of. And so, yes, there was a storm that went through in 2025 and hopefully it’ll be over in 2026, but I’d say it looks like we’re going to be making progress and continue to make headway.
So, I’m optimistic overall.
Gary Schwartz: As a group of 54 NCI-designated Cancer Centers, we bring to the country unparalleled research.
We bring a passion for discovery that’s going to greatly advance the field of cancer medicine. That to me is the most exciting thing we can offer the world and the country and our value is immeasurable. And I think that’s what we come together on, and that’s my great hope through these cancer centers.
We can do unbelievable things and I see great hope for the future around the discovery, around the science and around the medicine, comes out of the things we do together as cancer centers throughout the country.
Paul Goldberg: Well, thank you both very much.
