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If you work in a research or research-adjacent setting, do you remember the first grant you ever received? Do you remember the project it funded? Do you remember how it felt when someone was willing to invest in the value and potential of your idea? I can picture the heads nodding. It’s a pivotal, memorable moment, no matter how far you’ve advanced in your career. 

I’ve been thinking lately about how one of the most important things we can “buy,” especially in the clinical research realm, with grant funding is also our most finite resource: time.  

As we focus more and more on counting RVUs, there is less and less protected time for clinical research. Grant funds don’t just pay for equipment, lab facilities, and statisticians; they pay for the investigator’s time. The discoveries that are going to transform cancer care in the future are not the work of a moment—not a year, or three years, or even a decade. This work will take the career-long investment of large and diverse groups of people all over the world, and it is only possible when those people have funded time to set aside expectations of clinical productivity and focus their intelligence, creativity, and persistence on their research questions.  

I worry that we’re approaching a tenuous moment in clinical research. Simply put, clinical research is expensive. Clinical researchers, with our unique skills and expertise, are expensive, and this is especially true in academic medicine settings. Academic institutions cannot pay our research staff as much as they can make in industry; the shortage of clinical research coordinators and other specialized staff, for example, is a huge problem that we are dealing with across the country. I worry about the future of conducting clinical research in academic centers here in the United States, a high-income country with well-funded institutions and a well-established research infrastructure, and I worry about it in low- and middle-income countries where the research enterprise is still developing

While I really hope that we do not see a future where clinical research is not feasible within an academic or even a community setting, I’m certain that things are going to look different 10 years from now. We need to continue to be nimble in our response. We need to think together and work together so we can maintain the integrity of clinical research. In particular, if we want diversity in clinical trial accrual, we need to take action now, today, to foster diversity in our clinical research teams. 

With all this in mind, investing in the next generation of investigators is hugely important, and the first grant is critical. No one can apply for more substantial funding without preliminary data—but how do you get the preliminary data? That first grant allows the opportunity to begin generating data and ideas that will ultimately lead to a research career. 

As you’ll see throughout this issue, Conquer Cancer, the ASCO Foundation, is deeply invested in helping investigators build and sustain their research careers, starting with that first crucial grant. Their Grants and Awards program supports clinical researchers as they develop preliminary data, establish labs and long-term projects of their own, and pass their knowledge and experience on to future generations. The researchers highlighted in these pages are hugely inspiring, and they give me hope that our uncertain future is in capable hands. 
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