Strategic Plan 2015-2020
Capturing innovation to prevent cancer and improve cancer control for Canadians

Table of Contents

• Executive Summary
• ICR's Mission
• Setting the Stage
• ICR Strategic Planning Process
• ICR Strategic Research Priorities 2015-2020
  • Strategic Priority 1: Targeting High Fatality Cancers
    • Background/Rationale
    • Goal
    • Objectives
    • Approach
  • Strategic Priority 2: Health Economics & Health Services Research in Cancer Control
    • Background
    • Goal
    • Objectives
    • Approach
  • Strategic Priority 3: Redressing Cancer Risk Factors Disparities & Prevention Service Inequities
    • Background
    • Goal
    • Objectives
    • Approach
• Leadership in Action
  • Community Engagement
  • Training/Capacity Building
  • Knowledge Mobilization, and Ethics
  • Development of a pan-Canadian Cancer Research Asset Map
  • Performance Measurement Framework
• Canadian Cancer Research Funding Landscape
• ICR and CIHR's Signature Initiatives
• Partnerships
• Summary
• Appendix
  • Figures and Tables

Executive Summary

Cancer is the leading cause of death in Canada. Approximately 2 in 5 Canadians will develop cancer during their lifetime and 1 in 4 will die of their disease. Cancer is also the leading cause of potential years of life lost. Globally, cancer remains a leading cause of death. Each year over 14 million people are diagnosed with cancer. This number is expected to increase to 22 million in the next two decades. At the same time an alarming 8.2 million die of the disease each year. Without significant improvement, in the year 2030 more than 17 million people are expected to succumb to this disease worldwide^{Note 1}.

Although significant progress has been made in treating many cancers over the past 25 years, there is still much to be done. A number of cancers, or cancer subtypes, continue to have high case fatality rates after diagnosis^{Note 2} (i.e. pancreatic, liver, non-small cell lung cancer, gastric and glioblastoma). Evidence suggests that many of these cancers are on the rise and their relative burden is going to increase^{Note 3}. Moreover, the development of resistance to current therapies remains a significant challenge in managing this disease. Cancer control costs continue to rise. Sustainability of the health system and cancer control services (prevention, screening, diagnosis, clinical care, survivorship and end-of-life care) is critical to ensuring the best cancer outcomes. Specifically, we must support research that deciphers why current treatments fail and provide novel treatment strategies when this occurs. We must also ensure that the appropriate providers, deliver the correct care to the right patients at the right time and cost. We know that over half of all cancer deaths continue to be related to modifiable risk factors such as tobacco, diet, and physical activity, as well as alcohol consumption, infectious agents, ultraviolet/ionizing radiation, and exposures to occupational and environmental carcinogens. It is estimated that about one third of the cancer burden could be decreased if cancer was detected early, accurately diagnosed and treated with therapies tailored to the disease^{Note 4}. Furthermore, it is often our most vulnerable populations who bear the greatest burden.

The mandate of the Institute of Cancer Research (ICR) is "to support research that reduces the burden of cancer on individuals and families through prevention strategies, screening, diagnosis, effective treatments, psychosocial support systems, and palliation". ICR activities are linked to CIHR Strategic Plan for 2014-15 to 2018-19- Roadmap II: Capturing Innovation to Produce Better Health and Health Care for Canadians (Figure 1). ICR's 2015-2020 Strategic Plan: Capturing innovation to prevent cancer and improve cancer control for Canadians has identified new strategic research priorities:

1. Targeting High Fatality Cancers
2. Health Economics and Health Services Research in Cancer Control
3. Redressing Cancer Risk Factor Disparities and Prevention Service Inequities

The focus of our first priority High Fatality Cancers is to support innovative discovery research targeting high mortality cancers including advanced stage (metastatic) disease. We will support research that will enable a better understanding of the molecular and biological features of certain cancers, which are associated with high fatality rates, and to identify strategies to best manage these cancers, with the long-term goal of increasing patient survival.

The focus of our second priority Health Economics and Health Services Research in Cancer Control is to support decision making when it comes to policies, programs and practices related to cancer care (including screening and prevention). Through new research we will better understand how best to provide health services (including health economics) to improve disease management across the cancer control continuum (from prevention to palliation), as well as the development of mechanisms for timely adoption and implementation of research findings.

The focus of our third priority Redressing Cancer Risk Factor Disparities and Prevention Service Inequities is to support intervention research to prevent cancer, including the translation of that research knowledge into evidence-based practices and policies, with a focus on cancer prevention to redress disparities among vulnerable populations within Canada.

This Strategic Plan will guide ICR activities during the next five years toward a vision of a Canada where cancer is no longer a major health concern. Programs will be developed that best help turn these priorities into action. These programs will be built in concert with a thoughtful community engagement strategy to address these important cancer challenges. ICR will also facilitate collaboration and interaction between researchers and decision makers to support the sharing and use of information.

RESEARCH PRIORITY A:
Enhanced patient experiences and outcomes through health innovation

1. Targeting High Fatality Cancers
2. Health Economics & Health Services in Cancer Control

RESEARCH PRIORITY B:
Health and wellness for Aboriginal peoples

1. Redressing Cancer Risk Factor Disparities & Prevention Service Inequities

RESEARCH PRIORITY C:
A healthier future through preventive action

1. Targeting High Fatality Cancers
2. Health Economics & Health Services in Cancer Control
3. Redressing Cancer Risk Factor Disparities & Prevention Service Inequities

RESEARCH PRIORITY D:
Improved quality of life for persons living with chronic conditions

1. Targeting High Fatality Cancers
2. Health Economics & Health Services in Cancer Control

ICR's Mission

The mission of the Institute of Cancer Research (ICR) is "to foster research based on internationally accepted standards of excellence, which bears on preventing and treating cancer, and improving the health and quality of life of cancer patients and survivors." ICR has an important role in creating and maintaining a robust cancer research environment in Canada that attracts and sustains world-class researchers by providing leadership and collaborating to develop Canada's cancer research agenda. In order to mobilize our community to address complex problems ICR is guided by a number of foundational principles:

1. Ensure engagement/involvement of patients and those with lived experience in all we do
2. Mobilize research and research capacity to increase impact
3. Build on ICR's past –leverage what has been done
4. Encourage and foster trans-disciplinary research across pillars
5. Collaborate with the other CIHR Institutes to develop and support cross-cutting research initiatives
6. Collaborate, cultivate and create partnerships early on to engage other cancer research funding organizations
7. Include Sex and Gender considerations
8. Foster collaborations with federal, provincial and non-governmental organizations, international agencies and patient and citizen groups to support research and the implementation of research outcomes across the cancer control continuum
9. Focus on ongoing impact evaluation
10. Leverage resources in Canada (ie. CPTP, ARC, SPOR SUPPORT units, 3CTN, C17)

Setting the Stage

Cancer remains a leading cause of death in the world. Each year over 14 million people are diagnosed with cancer. This number is expected to increase to 22 million in the next two decades. At the same time an alarming 8.2 million die of the disease. Without significant improvement, in the year 2030 more than 17 million people are expected to succumb to this disease worldwide ^{Footnote 1}. In Canada, cancer is the leading cause of death. Approximately 2 in 5 Canadians will develop cancer during their lifetime and 1 in 4 will die of their disease; however, we know that key risk factors can impact more than 30% of cancers^{Footnote 2}. Prevention and the development of novel treatments will continue to improve cancer outcomes for all Canadians when they are translated into practice and policy.

ICR Strategic Planning Process

ICR activities are guided by the Canadian Institutes of Health Research (CIHR) mandate to "excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system". CIHR's Strategic Plan, Roadmap II, continues CIHR's vision to capture excellence and accelerate health innovation. CIHR has identified three strategic directions and four research priority areas within Roadmap II, which ICR will use to guide and focus our efforts over the next five years.

• Priority A: Enhanced patient experiences and outcomes through health innovation
• Priority B: Health and Wellness for Aboriginal peoples
• Priority C: A healthier future through preventive action
• Priority D: Improved quality of life for persons living with chronic conditions

Further, ICR's new strategic plan builds on our Institute's prior strategic research priorities that have informed our activities and strategic investments since the Institute's inception in 2000 (Appendix -Table 1). This is the foundation upon which ICR's new Strategic Plan is built.

To create its new strategic plan, Capturing Innovation to Prevent Cancer and Improve Cancer Control for Canadians, ICR conducted an internal and external consultation process. Initial discussions were held with ICR's Institute Advisory Board (IAB) in the fall of 2013 and spring of 2014 to identify new priority areas. Following these discussions, ICR held a consultation workshop in September 2014. This workshop, attended by 60 participants, allowed further information gathering and vetting and was attended by IAB members from several CIHR Institutes, members of CIHR Governing Council, researchers, cancer funding agencies, and decision and policy-makers (Appendix -Table 2a). Members of ICR's IAB championed individual research priority areas and led detailed discussions with attendees to help identify, prioritize and define important research questions in their respective areas. This workshop was also an opportunity to look at feasibility, impact, challenges and barriers for each proposed new research priority area. Additional face-to-face consultation occurred in the spring of 2015, with the ICR's IAB members, funding partners and patient representatives to help focus priorities and refine the goals, objectives and approaches of each priority area resulting in this document (Appendix -Table 2b). Through this process, criteria for selecting research priority areas included:

• Alignment with CIHR's Roadmap II
• Addresses identified research gaps and has potential for impact on disease burden – includes cost benefit and economic impact
• Potential for national and international partnerships and alignment with national research strategies; i.e. working within Canadian Cancer Research Alliance (CCRA) (alignment with CCRA Target 2020 Framework)
• Continuity and alignment with current and past priorities led by ICR and others – sustainability of research
• Competitive or research advantage in Canada and potential for global excellence (capacity within Canada)
• Ability to translate research results into improvements in clinical outcomes
• Lack or limited funding/investment to date

ICR Strategic Research Priorities 2015-2020

Cancer continues to be a significant burden in Canada. The ICR, with a desire to make an impact and ensure a focus on providing effective and cost-effective cancer care and decreasing mortality from cancer, recognized the need to focus on hard to treat high fatality cancers, and to investigate models that ensure that the right care is delivered to the right person, by the right provider, at the right time and cost, with the right partners. Further, to realize the vision of a Canada where cancer is no longer a major health concern (i.e., significantly reduced cancer incidence and mortality rates), we also need to focus on cancer prevention, with special attention to vulnerable populations who often bear the greatest disease burden with the fewest individual and community resources; and to ensure that ultimately this research turns into appropriate practice and policy.

As a result of these considerations, and building on ICR's previous priorities, ICR has identified new strategic research priorities for the five-year period 2015-2020:

1. Targeting High Fatality Cancers
2. Health Economics and Health Services Research in Cancer Control
3. Redressing Cancer Risk Factor Disparities and Prevention Service Inequities

Strategic Priority 1: Targeting High Fatality Cancers

Background/Rationale

Although significant progress has been made in treating many cancers over the past 25 years, a number of cancers, or cancer subtypes, continue to have high case fatality rates after diagnosis ^{Footnote 3}. These are cancers with a mortality rate/incidence rate of >75%. They fall into two broad categories: those where little progress has been made (i.e. pancreatic, liver, non-small cell lung cancer, gastric and glioblastoma) and high fatality subtypes (bad cancers among the "good" i.e. triple negative breast cancer (TNBC) or castrate resistant prostate cancer (CRPC)). Alarmingly, evidence suggests that many of these cancers are on the rise and their relative burden is going to increase^{Footnote 4}. For instance, lung cancer will remain the leading cause of cancer-related deaths in 2030, and pancreatic and liver cancers are projected to surpass prostate breast and colorectal cancer with respect to cancer mortality^{Footnote 5}. Further, cancer site-specific investment has been low in certain indications, with funding under represented relative to mortality for these cancers (Appendix - Figure 2). These devastating cancers share many common features. They are hard to detect, hard to resect, metastasize early and quickly develop resistance to current treatments. As well there is a lack of identified risk factors, sensitive screening technologies, validated clinical targets and effective treatment strategies for these cancers. Many of these cancers have common biological attributes that include: functional heterogeneity (subpopulations that are metastatic or possess tumour-initiating capacity), cellular plasticity (ability to phenotypically change in response to factors within the tumour microenvironment) and the capacity to engage mechanisms of therapeutic resistance. The paediatric cancer experience has taught us that when researchers are focused, work together and have the required resources, profound changes can happen in relatively short timeframes. If we want to change the death rate for these diseases, it is imperative to increase the investment in understanding, the underlying biology that governs their initiation, growth and spread; and identify early detection strategies and novel therapeutic targets or interventions that can be translated and tested in clinical trials.

This priority area aligns with Roadmap priority areas A, C and D through a focus on innovative discovery research targeting high mortality cancers including advanced stage disease. This research priority builds on prior strategic investments in molecular profiling of tumours, imaging, cancer initiation and progression, diagnosis and guided therapy, focusing on a subset of cancers that pose the greatest challenge to detect and treat.

Goal

To support research that will provide a better understanding of high fatality cancers with respect to how they first initiate, the molecular and biological processes that drives their growth and dissemination. It is anticipated that research programs will not only be focused on the cancer cells themselves, but the unique tumour microenvironments that characterize these high fatality cancers. Ultimately, this new depth of knowledge regarding such cancers will be exploited to determine strategies to best address problems associated with treating these cancers (detection, tumour heterogeneity, therapeutic response, resistance, metastatic disease) as an important step toward the long-term goal of increasing patient survival (or reducing mortality rates).

Objectives

• Develop new research capacity in high fatality cancers
• Support discovery research to:
  • Understand what are the signatures of high fatality cancers
  • Understand the biological processes that makes these cancer "hard-to-treat"
  • Understand therapeutic resistance, tumour heterogeneity, cellular plasticity, tumour microenvironment, metastatic disease, tumour dormancy
• Support research to develop techniques for earlier/more sensitive detection
• Improve and develop earlier detection tools (image guided treatment)
• Develop novel therapeutics/interventions/approaches that will impact fatality
• Support development and linkage of research platforms

Approach

This priority addresses an important research gap and clearly supports three of CIHR's research priority areas: (1) Enhanced patient experiences and outcomes through health innovation; (2) A healthier future through preventative action (3) Improved quality of life for persons living with chronic conditions with a focus on identifying new targets and technologies. By focusing on heath innovation for hard to treat/high case fatality cancers with the ultimate goal of improving quality of life for individuals living with these cancers, ICR's approach also aligns with the CCRA Target 2020 Framework in the areas of Discovery – (i) hard-to-treat cancers ii) metastatic disease iii) mechanisms of resistance iv) cancer stem cells) and Patient Experience (improve daily experience and outcome of cancer patients and their families). Leveraging Canadian expertise in areas like genomics, cancer stem cells, immunotherapy, imaging and radiation therapy, and resources like CTRNet (Canadian Tumour Repository Network) and initiatives such as 3CTN (Canadian Cancer Clinical Trials Network) will position us to have a maximal impact in these cancers.

Strategic Priority 2: Health Economics & Health Services Research in Cancer Control

Background

Cancer care is costly and these costs continue to rise. Although current data is not available, in 2002 Cancer care was reported to cost $17.9 billion (up from $16.4 billion in 1998) in Canada^{Footnote 6}. As an example, in Ontario the mean costs in initial treatment doubled between 1997 and 2007 for breast cancer and tripled for melanoma patients^{Footnote 7}. Better understanding what factors limit or support the ability to translate research findings is needed for timely spread of effective and cost-effective models throughout the health care system. This is the foundation to allow for the sustainability of the health system and cancer control services (prevention, screening, diagnosis, clinical care, survivorship and end-of-life care). The best cancer outcomes are achieved when the right care is delivered to the right person, by the right provider, at the right time and cost, with the right partners. Collaboration amongst health service policy makers and practitioners, researchers, and patients and caregivers is necessary to develop and test promising models of care across the cancer control continuum. Despite the recognized importance of this area (scientific model systems), current investment is lacking (Appendix - Figure 3). Funding opportunities and methods to enhance research capacity and identify mechanisms that will improve knowledge translation and exchange between researchers and adopters within the health care system is required. As medical decisions practices and products become more personalized unique expectations and challenges emerge. A pan-Canadian approach is needed for effectively translating medical breakthroughs based on personalized medicine approaches into standard of care.

The focus of this priority is to support evidence informed decision making when it comes to policies, programs and practices related to cancer care (including screening and prevention). Through new research (including health economics) we will better understand how best to provide health services to improve disease management across the cancer control continuum (from prevention to palliation), as well as the development of mechanisms for timely adoption and implementation of research findings.

Goal

1. Develop and test optimal models to improve cancer care at the population level across the cancer control continuum, from prevention to survivorship and end-of-life care.
2. Determine public and patient preferences and perceptions of value to inform policy decision making about cancer care services.
3. Develop methods to measure quality of care at the population level including comparisons to stratified populations (ie vulnerable, high-risk populations)
4. Building on our investment in Personalized Medicine, facilitate uptake, integration, and implementation of personalized medicine.

Objectives

• Conduct intervention research that test models of care delivery along the cancer control continuum.
• Create a decision making framework for health care policy makers that incorporates evidence of effective and cost-effective models of care, is based on public and patient engagement, and is relevant to health care policy makers
• Standardize and validate metrics to measure quality and safety of cancer care, from different perspectives (i.e., patients/public, providers, policy makers)
• Develop a data linkage research platform
• Advance and apply implementation science to improve quality of cancer care including how new technologies are used and communicated to patients
• Standardize processes and procedures to improve safety and access to chemotherapy, with a special focus on oral chemotherapy, which is now being more widely used throughout Canada

Approach

Focus in this area will support Roadmap II priority areas specifically focused on enhancing patient experience and outcomes through health innovation and developing a healthier future through preventive actions. Specifically accelerating the discovery, development, evaluation and integration of healthcare innovations into practice so that patients can receive the right treatments at the right time, and ensuring the creation of appropriate frameworks for transfer of research into practice and for policy decision-making. This effort is also consistent with the overall vision of the Strategy for Patient Oriented Research (SPOR). This area also aligns with CCRA 2020 Framework in the areas of Clinical Innovation – "To improve and expedite the translational pipeline and advance personalized medicine research and its application through collaboration" - and Health Services - "Develop funding opportunities and methods to enhance research capacity and identify mechanisms that will improve the interface between researchers and adopters within health care system; as well as new models of financing, funding and delivery".

Strategic Priority 3: Redressing Cancer Risk Factors Disparities & Prevention Service Inequities

Background

Despite near universal access to health care in all provinces and territories, significant disparities in income (Appendix - Figure 4), rural/urban environments, and immigration status have been observed across the cancer control continuum. Differences can be found in risk factor and screening utilization behaviours through diagnostic and treatment service access and utilization measures^{Footnote 8}. Many of these disparities are magnified in Canada's aboriginal populations.

Some cancers are linked to certain risk factors such as smoking and alcohol consumption, of which aboriginals are participating more frequently comparative to the average non-aboriginal population.^{Footnote 9}. First Nations on-reserve have significantly higher rates of smoking, binge drinking, obesity and diabetes, and less leisure-time physical activity, and consumption of fruits and vegetables than the rest of Canadians.^{Footnote 10} Aboriginals are reported to smoke at twice the rate of non-aboriginals in Canada (39% vs 20.5%). This rate is even higher looking at Inuit populations separately (49%).^{Footnote 11} These differences are also observed in Official Language Minorities where Francophone Canadians smoke at an increased rate compared with Anglophones^{Footnote 12}. Between 1991–2001, cancer was the third leading cause of death for First Nations males and the second leading cause for First Nations females.^{Footnote 13} It is estimated that about one third of the cancer burden could be decreased if cancer was detected early, accurately diagnosed and treated with therapies tailored to the disease ^{Footnote 14}. Although the current mortality and incidence rate of cancer among Aboriginals appears to be less prevalent than the non-aboriginal population, rates of common cancers, treatable cancers are increasing, diagnosed at later stages^{Footnote 15Footnote 16}. The life expectancy of Aboriginals has been 12 years lower than the national average, which could be contributing to the current rate of cancer^{Footnote 17}. Furthermore, cancer mortality in First Nations women is at a higher rate than non-Aboriginal women of the same age^{Footnote 7}.

Over half of all cancer deaths are related to modifiable risk factors including tobacco, diet, and physical activity, alcohol consumption, infectious agents, ultraviolet/ionizing radiation, and exposures to occupational and environmental carcinogens. Cancer is also influenced by geography. More than 60% of First Nations communities are remote or are fly-in with no road access, some of these communities have less than 500 inhabitants^{Footnote 7}. Cancer research investment focused on FNMI is limited (Appendix – Figure 5), with very few funded prevention/intervention research projects in Canada are focused on redressing disparities in cancer risk factors (or access to preventive services) for vulnerable populations. There is a great need to better understand the nature of these disparities and how to address them as well as conducting prevention intervention research that contributes to reducing the risk of all Canadians equitably (including those who have least resources, bear the greatest risk factor and disease burden, and need the most service support) for developing, suffering, or dying from cancer.

The focus of this priority is to support intervention research to prevent cancer, including the translation of that research knowledge into evidence-based practices and policies, with a focus on cancer prevention to redress disparities among vulnerable populations within Canada. Cancer prevention research has been a strategic priority for ICR since the Institute's inception. However, support for prevention research remains a small proportion of the total cancer research investment in Canada

Goal

Support the development and implementation of evidence-based interventions, specifically to redress cancer risk factor disparities and prevention service inequities within vulnerable populations. Ultimately, the implementation of evidence-based cancer prevention strategies will decrease health care costs by reducing the burden of cancer in the Canadian population and expanding access to interventions to those who bear an excess burden of cancer risk.

Objectives

• Increase prevention intervention research capacity within Canada
• Support research to determine to what extent generic interventions need to be tailored for diverse vulnerable populations to reduce cancer risk factor prevalence within vulnerable populations
• Support research to identify the most effective knowledge translation (KT) strategies to engage research, practice, and policy partners to ensure uptake and utilisation in disseminating and implementing evidence-based interventions focused on vulnerable populations
• Refine funding strategies to support collaborative and multi-disciplinary research directed to understanding why evidence-based prevention interventions benefit some, but not all people/populations.
• Develop partnerships with key knowledge user audiences with whom innovative intervention research ideas could be co-developed.
• Develop partnerships to help increase public awareness of risk factors in vulnerable populations

Approach

CIHR has identified preventive action and health and wellness for Aboriginal peoples as priorities. Many of the factors that contribute to disparities in health and wellness for Aboriginal peoples are common to other vulnerable populations (poverty, lack of access to care, cultural issues, linguistics etc.)^{Footnote 18 Footnote 19}. In this strategic priority, ICR will be working on increasing prevention intervention research with a specific focus on vulnerable populations such as Aboriginal peoples, individuals from low socio-economic backgrounds, individuals in rural communities and new immigrants. This approach is also in alignment with the CCRA 2012 prevention research framework, which also has a focus on vulnerable populations. Several different areas should be targeted including:

1. Collaborative funding for cancer and chronic disease prevention research that will identify opportunities to increase funding for risk factor reduction intervention studies.
2. Inclusion of health economic research in cancer intervention prevention and delivery research to identify the most cost-effective approaches to preventing cancer in resource limited jurisdictions and service settings.
3. Knowledge synthesis support: Expand collaborative funding for a shared resource to synthesize systematic reviews on current and emerging research questions of interest to inform the genesis of future intervention research funding initiatives focused on vulnerable populations, as well the translation of intervention research findings redressing health disparities into culturally appropriate practices (e.g., indigenous ways of knowing) and broad policies that demonstrate the perturbation of the social determinants of health.

Leadership in Action

ICR will remain open and accessible to the cancer research community at large and will continue to support cancer research across the continuum from prevention to palliation. Emphasis will be placed on the continued support of research excellence, and the continuing collaboration with our many partners to align priorities and reduce duplication, and to ensure that research outcomes are captured and used to improve the health of Canadians. ICR will continue to play a leadership role within the CCRA and support the implementation of the pan-Canadian Cancer Research Strategy (CCRA Target 2020 Framework) with a focus on Discovery, Clinical Innovation, Prevention and Health Services. We will continue to support and facilitate innovative clinical trial design and infrastructure, which focuses on improving the efficiency and impact of cancer clinical trials in Canada.

Community Engagement

ICR will remain engaged with its cancer research community by providing timely, relevant and accessible information through in person, virtual and written means, including a dynamic and informative on-line presence. ICR will support financially and in-kind workshops, meetings and conferences to support the dissemination and exchange of relevant information with the cancer research and stakeholder community relevant to the cancer research community. ICR will also engage the public and media through Café Scientifique events and journalist workshops on pressing issues related to cancer research.

Training/Capacity Building

Enhancing and sustaining research excellence in Canada is the critical foundation upon which success is built. We must foster our next generation of Cancer Researchers. ICR will actively support the training, networking and mentoring of emerging researchers and trainees within the cancer community. ICR will continue to develop and support cancer research training programs in multidisciplinary and collaborative settings and develop strategies to increase their awareness and utilization of platforms and resources.

Knowledge Mobilization, and Ethics

The translation of new and existing knowledge is integral to all of ICR activities. Towards this end, ICR will continue to stimulate research required to facilitate dissemination, exchange and application of knowledge from research findings into policies, interventions, services and products. ICR will also establish and maintain ongoing communications with cancer researchers, health professionals, public decision-makers and representatives of various professional, scientific and community organizations (including NGOs and Charities) involved in cancer control. ICR will facilitate the transfer and translation of knowledge resulting from cancer research to the research and medical community, and facilitate the dissemination of plain language information on cancer research, its findings and potential applications to the general public and groups interested in cancer research. It is also imperative that with new innovations we keep aware of new ethical challenges and help the research community develop skills for such understanding and scrutiny. ICR is promoting an integrated approach to KT that encourages the participation of relevant stakeholders (knowledge users and partners) at appropriate stages of the research process.

Development of a pan-Canadian Cancer Research Asset Map

Understanding the cancer research landscape, including the gaps and opportunities and outcomes is key to optimizing research investments. Over the next 5 years ICR will create a cancer funding asset map to provide visual information to track where research funding is going and what the impacts are from specific investments. Outcomes will provide information to researchers, funders and government to better understand the impact of research investments.

Performance Measurement Framework

A performance measurement framework for CIHR's Roadmap II has been established to report on actual progress made towards implementing this plan over the next five years. ICR will leverage this framework to ensure we are evaluating our progress with appropriate metrics and standards. .

Canadian Cancer Research Funding Landscape

Funding for strategic cancer research by charitable organizations and the provinces has been expanding over the last decade. The Canadian Partnership Against Cancer (CPAC), a federally funded independent organization, was created in 2007, to work with cancer experts, charitable organizations, governments, cancer agencies, national health organizations, patients, survivors and others to implement Canada's cancer control strategy. In the changing cancer research funding landscape, the need for communication and collaboration between parties led to the creation of the Canadian Cancer Research Alliance (CCRA). The CCRA serves as the coordinating voice for cancer research in Canada and promotes the development of national cancer research priorities and strategies. ICR, through its inaugural Scientific Director, Dr. Philip Branton, played a pivotal role in building CCRA. Today, ICR continues to maintain a leadership role in the CCRA, through its Scientific Director Dr. Stephen Robbins.

CCRA publishes an annual document reporting on cancer research investment in Canada. In the 2014 release (2011 data), an overall Canadian investment of $548.3M in cancer research was reported^{Footnote 20}. CIHR remains the leading funding agency investing in cancer research (Appendix - Figures 6, 7a and 7b) with investment in open and strategic areas. Investment in cancer biology and treatment each represent 30% of the 2011 investment. This investment is nearly a doubling of investment in treatment research since 2005. Etiology research and early detection, diagnosis and prognosis research each represent 14% of investments. 10% of investments were made in the area of cancer control, survivorship and outcomes. Finally, investment in cancer prevention, though doubling since 2005, accounts for only 2% of the total research investment^{Footnote 21}.

ICR and CIHR's Signature Initiatives

ICR focuses on the identification of research areas that would benefit from strategic investment stemming from a broad-based, partnered approach, encompassing the four health research domains of biomedical, clinical, health systems and services, and the social, cultural, and environmental factors that affect the health of populations.

Roadmap Signature Initiatives

CIHR identified eight Signature Initiatives that align with the vision of its 2009-2014 strategic plan: Health Research Roadmap: Creating innovative research for better health and health care. ICR will continue to be a strong supporter of CIHR Signature Initiatives (SI) especially as they align with our new Strategic Plan and Research Priorities (Appendix –Figure 8, Table 3). As CIHR transitions to a strategic multi-institute, multi disciplinary investment model, ICR is well positioned. ICR anticipates continuing our historic ability to embrace such initiatives and work with other institutes towards common goals (historically >50% of ICRs investments have been part of such multi institute activities) summarized below.

Personalized Medicine (PM)

ICR co-leads this SI supporting translational research for prevention, diagnosis, and treatment of cancer with the goal of stratifying patients based on disease susceptibility or response to a specific treatment, and to promote health services research to integrate innovations into policy and practice.

Canadian Epigenetics, Environment and Health Research Consortium (CEEHRC)

ICR is a co-lead on the CEEHRC, whose goal is to position Canada for the rapid translation of epigenetic discoveries into diagnostic procedures and the development of new therapeutics.

Community-Based Primary Healthcare (CBPHC)

This transformative SI aims to improve health and chronic disease management and reduce inequities in access to care with new approaches to patient and family-centered CBPHC through interdisciplinary, inter-professional and community-based partnerships. Through this SI, ICR is supporting a research team that is developing an approach to help primary healthcare providers, cancer specialists, and patients and their families work together to improve continuity and coordination of care throughout the cancer journey.

Inflammation in Chronic Disease

Chronic inflammation has been linked to the etiology of many diseases, including cancer. This SI will support research that focuses on the relationship between chronic inflammation and disease and the common pathways that exist between different health conditions. ICR is collaborating on this SI to build capacity in this area and engage cancer researchers in multidisciplinary studies probing the role of inflammation in cancer initiation and progression.

Pathways to Health Equity for Aboriginal Peoples

This SI focuses on four exemplar areas: suicide, tuberculosis, diabetes/obesity and oral health. Knowledge gained from researching these themes will be useful in reducing inequities in other areas that affect Aboriginal peoples, including cancer, which is increasing in this population and is likely linked to environmental factors such as obesity and smoking^{Footnote 22}. As this SI develops, ICR will explore future collaborative opportunities that align with our strategic priorities.

Environments and Health

The physical, social, cultural and built environments in which we live, work, and play are critical to our health, development and wellbeing over the course of our lives. These environmental factors intersect and contribute both positively and negatively to our health. This strategic initiative aligns with ICR's focus on prevention.

Canada's Strategy for Patient-Oriented Research (SPOR)

SPOR is about ensuring that the right patient receives the right intervention at the right time. The objective of SPOR is "to foster evidence-informed health care by bringing innovative diagnostic and therapeutic approaches to the point of care, so as to ensure greater quality, accountability, and accessibility of care". SPOR and the SPOR SUPPORT units offer a unique opportunity to help ICR achieve its goals. ICR will continue to champion CIHR's patient/citizen engagement initiatives. With our Scientific Director championing the SPOR Patient Engagement Framework we are integrally involved in the implementation of key cross-cutting mechanisms that will bring about active collaborations between patients, researchers, health care professionals and decision-makers.

Key Initiatives spearheaded or supported by ICR

Prior and current initiatives led and supported by ICR include the following areas:

• Palliative Care
• Personalized Cancer Medicine
• Imaging
• Cancer Stem Cells

Specific initiatives are: Quantitative Imaging Network (QIN), Breast Cancer in Young Women Research Program (through CBCF), CSCC-CIRM Research program, Cancer Prevention Research Grants (with CCSRI), Childhood Cancer – Late effect of treatment team grants. ICR has also supported CIHR's Strategic Training Initiative in Health Research (STIHR), which aim to increase the capacity of the Canadian health research community through mentoring and training and development of researchers and by fostering collaborative research across disciplines.

Partnerships

The ability to establish and maintain valuable partnerships has been an important competent in allowing ICR to continue to have a significant impact. ICR has a very strong history of partnerships, including internal collaborations through SI. In 2013-14 52% of ICR's base budget allocation went towards these large-scale transformative initiatives. In the next period, ICR will continue to leverage our funds with investments from various partners. Critical is our partnership and leadership role within the Canadian Cancer Research Alliance (CCRA), a group that involves over 30 of the top cancer research funders in Canada. ICR has begun to embark on some exciting non-traditional partnerships that will continue to evolve, such as with the entertainment industry, pharma and the biotech sector. These relationships will allow us to better address our new priorities.

Summary

This Strategic Plan will guide ICR activities during the next five years. ICR will develop an Operational Plan in parallel to this Strategic Plan to guide its priorities. Emphasis will be placed on ensuring the continued support of research excellence, collaborating with our many partners in the cancer field by aligning priorities and reduce duplication and ensure that research outcomes are captured and used to improve the health of Canadians. Ongoing ICR-led initiatives, which deliver on prior ICR strategic research priorities, will be monitored and evaluated and efforts will be made to assist the research community in engaging end-user groups and moving their results into practice. This Strategic Plan will be reviewed annually to ensure that it continues to be responsive to emerging health challenges and priorities and remains particularly aligned with the CCRA's vision for cancer research and CIHR's vision for health research in Canada. New initiatives addressing the three priority areas will be developed in consultation and partnership with a wide variety of public, private and voluntary sector organizations. These initiatives will be developed to include anticipated outcomes, milestones and deliverables. Working with our community, fellow CIHR institutes and our broader stakeholders we will use all available opportunities, resources and platforms to deliver on our new strategic plan.

Appendix

Figures and Tables

Figure 1: See Executive Summary

Figure 2: Cancer Research Investment in Canada, 2012^{Footnote 23}

Figure 3: Cancer Research Investment in Canada, 2010^{Footnote 24}

Figure 4: Survival rates by neighbourhood income quintiles.^{Footnote 25}

Figure 5: Cancer-related Investment for projects focused (in whole or in part) on FNIM^{Footnote 26}

Figure 6: Total ICR area expenditures 2013-2014

Figure 7a: Federal Cancer Research Funding 2013^{Footnote 27}

Figure 7b: Distribution of Cancer Research Funding 2009 and 2013 by sector^{Footnote 28}

Figure 8: Initiatives Alignment with Roadmap II Research Priority areas

Date modified:

2016-08-22