Leadership corner: FAANs and the National Cancer Advisory Board

Deborah Watkins Bruner, PhD, RN, FAAN

Dr. Bruner is a force for change with her research knowledge and expertise as an internationally renowned researcher focused on patient reported outcomes. At the time of this writing, she is the first and only nurse to ever lead the NCI National Clinical Trials Network National Community Oncology Research Program (NCORP) which focuses cancer prevention, control and cancer care delivery research, and ranks among the top 5% of all NIH-funded investigators in the world since 2012. Dr. Bruner had a long-standing history on NCI committees and was familiar with NCAB. Her experience on these committees ultimately led to her selection as a member of NCAB and is instrumental to her success in her role. In our interview discussing her past 6 years on the NCAB, Dr. Bruner was focused, direct, and clearly communicated what needs to come next for cancer control and cancer care delivery. While addressing the scarcity of funding in cancer control research, she also acknowledged the absurd reality of limited amounts of funding being allocated to study the human experience in cancer. We share a condensed version of our interview below.

Dr. Bruner described how intensely focused the meetings with NCAB are, and in-between meetings there have been opportunities and invitations to meet with other institutes. When asked to describe an accomplishment she was most proud of during her time on the board, Dr. Bruner described several important contributions. Three years after being appointed to the NCAB ad hoc committee on global research, she cochaired the ad hoc working group to review the Office of Global Health which led to a restructuring of the NCI Center for Global Health and a strategic and thoughtful plan focused on new technologies, implementation science, cancer care delivery, clinical trials, and cancer etiology designed to make impact. Second, since 2018, she has served on the ad hoc budget subcommittee, where she believes “we have made tremendous inroads in working with the Director of the NCI to increase funding in the Research Project Grants pool.” Dr. Bruner commented that, “We are a victim of our own success,” and pointed out although the number of applications going to NCI has dramatically increased, it has been a struggle to see comparable adjustments to the NCI budget, and pay lines have dropped as low as 8%. “With extensive conversation at NCAB, the NCI is committed to raising the pay line to 15% by 2025.” Third, she also serves on an ad hoc subcommittee on Population Sciences, Epidemiology and Disparities, and emphasized how, as a nurse, she is continuously asking, “Where is the health disparities focus?” in every new funding opportunity.

When asked about the one step that would make the biggest difference with cancer care delivery, Dr. Bruner genuinely responded, “That’s easy” and described how adjusting the NCI budget would result in the biggest impact, ensuring appropriations for both cancer control, and cancer care delivery. Dr. Bruner further explained that funding for cancer care delivery falls under the cancer control portion of the NCI budget, and while about 70% of the budget goes to basic and translational research, only 5.8% is directed to cancer control. Of this 5.8%, only 21.5% goes to cancer care delivery. Dr. Bruner described this as “an uphill battle” to do something significant with this very small amount of funding. This includes proposals that include everything from prevention and human behaviors to the human experience of cancer and survival.

Christopher Friese, PhD, RN, AOCN, FAAN

Dr. Friese is a connector and mentor whose research career and leadership experience across oncology nursing and health services research brought him to the NCAB. He shared how he received word of the appointment on the heels of another disappointment and his desire to use the role to try to shorten the research-to-practice pipeline timeline. He offered suggestions for how others can support appointees in this role. Overall, his responses amplify his commitment to mentoring.

Dr. Friese was first contacted by the White House, as he reports, “completely out the blue” to inquire about his interest in the position. Incredibly humbled by the request, he also acknowledges the appointment came at a challenging period of time both personally, and amid the COVID-19 pandemic. The invitation occurred at the same time he found out he would not be moving forward with another opportunity, and he noted that other good and even better opportunities usually follow disappointments. This is a perfect example for early-career nurse scientists, and others, who struggle to persist following rejections, and challenging events.

When asked what is the one step that would make the biggest difference with cancer care delivery, Dr. Friese focused on the large time gap from discovery research to actual implementation in routine clinical care or service delivery. Dr. Friese spoke with excitement about the opportunity to accelerate learning, allowing those on the discovery paradigm to work closely with interventionists, and implementation scientists so that the actual targetable intervention can be implemented sooner. While he spoke about the robust pipeline of cancer (etiology to survivorship and supportive care), he also illuminated what he sees as a problem. He said the portfolio remains boxed-in to very specific areas of inquiry, and from what he has observed, some cancers (such as pancreatic) have failed to see improvements in survival. Moreover, certain populations in the United States have been historically excluded from cancer research and have failed to reap equitable benefits from investments in cancer research. He added that to reduce the societal burden of cancer, we must concentrate our efforts in those cancer conditions for where progress has been slow, and assure that all populations have the opportunity to participate.

And while there still may remain some mystery surrounding presidential appointments, Dr. Friese shared a few possible strategies for other nurses to position themselves for similar opportunities by using networks, leveraging expertise, and connections in professional organizations. For example, those spearheading appointment efforts may put “feelers” out to professional organizations and key opinion leaders in the field to inquire as to who might be good for these kinds of opportunities. His advice is to stay actively engaged with professional organizations that might be tapped for these kinds of conversations, let others know you are open and interested in service opportunities outside of your institution, and consider joining the Nurses on Boards Coalition (Nurses on Boards Coalition, 2021). He shared advice on using these networks to learn—further adding that if you are interested in an opportunity, contact those who are currently in those roles. He encouraged colleagues to “put themselves out there” and not be afraid to indicate their interest, expertise, and what they can bring to a particular position or organization. While nurses have the knowledge, skills, expertise, and inherent problem-solving skills to excel in these opportunities, he acknowledged nursing as a profession has struggled in this area, and he has found sometimes the only thing getting in our way as a profession is our own inertia.

Dr. Friese further urged nurse scientists to look beyond fighting for a seat at the table, but to fully take advantage of opportunities and ensure those appointed have as many resources and information as possible to be most impactful and influential, and influence policy. So, what can we do to best support Dr. Friese, and others appointed to similar positions? Dr. Friese welcomes opportunities to hear from his colleagues about what they see as gaps and opportunities and how he can best help. He also encouraged AAN members to stay updated on NCAB meeting agendas to gain a sense of where policy and strategic initiatives are headed.

Conclusion

It was our pleasure to conduct these interviews. We ended our interview with Dr. Bruner by asking what advice she had for Dr. Friese coming into this role. Her advice was to “Get involved. Be vocal about patientcentered priorities, policies, the disparities in funding for cancer control and cancer care delivery, for behavioral science, for prevention.” When we shared this with Dr. Friese, he rightfully reminded us of the importance of a handoff from a leadership perspective. Dr. Friese reminds us that we have the knowledge, the skills, and the expertise to lend to institutions. Dr. Bruner engages us with the realities of competing priorities and acknowledges struggles with funding and securing budgets. Both Drs. Bruner and Friese possess a balanced view of their career and are shaped by their background as nurses in how they have and will present on the NCAB: focusing on the human experience—an integral component of nursing care.