Cancer research has unquestionably resulted in disease cures and behavior changes in those of us in treatment for the disease, those of us who want to avoid having the disease, and those of us wanting to eradicate the disease. The life-saving and life-changing outcomes of cancer research cost dollars. Producing, testing, and validating these outcomes using highly regarded methods such that the findings are trustworthy enough to use with humans require considerable upfront and sustained resources, including substantial financial investment. A greater number of cancer research proposals are being submitted to traditional funders of research but these funders now have smaller budgets.1 The very worthy ideas to be studied exceed the number of dollars available to support them. The distribution of available cancer research dollars reflects more funding opportunities for basic scientists as compared with clinical investigators,2 a factor that further diminishes the amount of financial support for clinician-initiated research proposals. The reduced ability of the traditional research funders to fund important cancer research ideas propels us to reflect on the following: (1) What makes the processes used by these funders credible? And (2) can we take those processes to a different source of research funding, such as, philanthropy?

Although diverse terms exist regarding types of philanthropy (eg, private, exceptional, venture), philanthropy is generally viewed as a formal giving of significant resources-most typically in currency-to a chosen cause that has the potential to benefit the welfare of others at a future time. Philanthropy in healthcare, such as the financial gift from "a grateful patient," tends to occur when a donor's favored patient care, educational, or research initiative is funded in appreciation for best care efforts having been given.3,4 In some instances, philanthropy has been directly linked to a donor's desire to influence certain policy or political outcomes.5 If research funded by philanthropy is to be viewed as credible enough for academic promotion of the researchers involved and the findings as trustworthy enough to apply to patient care, this perception or chance of funding for personal or political gain must be addressed and prevented.

Adding credence to philanthropy-supported cancer research will likely require extracting the highly regarded rigorous research review processes from established scientific review entities and applying those to funding processes linked to philanthropic funding. This means establishing a strategic approach to apply highly regarded research review processes first and then matching the most highly rated outcomes of the review processes with the philanthropic support. The strategic approach would begin with the generation of the research idea from a scientifically strong investigator and team and their development of a highly significant and feasible study in a well-written proposal. The developed proposal would then be reviewed by a team of highly regarded scientists and, we suggest, 1 or more cancer community representatives.

The successfully reviewed proposals would comprise a portfolio for use by development officers with potential donors so that donors are selecting from already scientifically reviewed, highly rated proposals. The strategic approach should not include any method that appears to be transactional fundraising, meaning this form of research funding does not involve a personal relationship with the donor. In the same way as with traditional research funders, all possible risks of conflict of interest such as in "grateful patient" philanthropy must be avoided.6 The donor would most certainly be provided with scheduled reports on the progress of the funded research in the manner similar to those required by traditional funders of cancer research.

In this approach, the development office is the sole connection to the donor. This approach removes the likelihood of a personal relationship between the researcher and the donor, removes the scientific reviewers from the funding decision, and removes the likelihood of a researcher adapting a research project to match a donor's preference when that preference may not be the needed scientific advance. Importantly, a benefit of this approach is that the community representatives being part of the review process means that even disadvantaged patient populations who can't afford to fund "grateful patient" projects will have the opportunity to offer and to shape innovative research ideas.

We have much gratitude for philanthropists and much appreciation for the research teams who create well-thought-through cancer research proposals. Bringing the philanthropists and the proposals together in ways that give credence to the actual research and the study team will yield the highly desirable outcomes sought by all.

Our very best to you,

-

Pamela S. Hinds, PhD, RN, FAAN

Department of Nursing

Research and Quality Outcomes

Children's National Health System;

School of Medicine & Health Sciences

Department of Pediatrics

The George Washington University

Washington, DC

-Meaghann Shaw Weaver, MD

Hematology/Oncology Fellow

Division of Hematology/Oncology

Children's National Health System, Washington, DC;

St. Jude Children's Research Hospital

Memphis, Tennessee

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