By Rachana Pradhan and Arthur Allen for KFF Health News The Trump administration’s broadsides against scientific research have caused unprecedented upheaval at the National Cancer Institute, the storied federal government research hub that has spearheaded advances against the disease for decades. NCI, which has long benefited from enthusiastic bipartisan support, now faces an exodus of clinicians, scientists, and other staffers — some fired, others leaving in exasperation. After years of accelerating progress that has reduced cancer deaths by a third since the 1990s, the institute has terminated funds nationwide for research to fight the disease, expand care, and train new oncologists. “We use the word ‘drone attack’ now regularly,” one worker said of grant terminations. “It just happens from above.” The assault could well result in a perceptible slowing of progress in the fight against cancer. Nearly 2 million Americans are diagnosed with malignancies every year. In 2023, cancer killed more than 613,000 people, making it the second-leading cause of death after heart disease. But the cancer fight has also made enormous progress. Cancer mortality in the U.S. has fallen by 34% since 1991, according to the American Cancer Society. There are roughly 18 million cancer survivors in the country. That trend “we can very, very closely tie to the enhanced investment in cancer science by the U.S. government,” said Karen Knudsen, CEO of the Parker Institute for Cancer Immunotherapy and a globally recognized expert on prostate cancer. “We’re winning,” Knudsen said. “Why we would let up, I really don’t understand.” Related | Trump is playing a deadly game with cuts to medical research This article is based on interviews with nearly two dozen current and former NCI employees, academic researchers, scientists, and patients. KFF Health News agreed not to name some government workers because they are not authorized to speak to the news media and fear retaliation. “It’s horrible. It’s a crap show. It really, really is,” said an NCI laboratory chief who has worked at the institute for three decades. He’s lost six of the 30 people in his lab this year: four scientists, a secretary, and an administrator. “If we survive I will be somewhat surprised,” he said. After a mandate by the Department of Health and Human Services and the Department of Government Efficiency to slash contract spending by more than a third, the cancer institute is cutting contracts to maintain precious biological specimens used in its research, according to three scientists. “The required contract cuts are going to be devastating,” a senior scientist said. Secretary of Health and Human Services Robert F. Kennedy Jr. at a House subcommittee budget hearing on May 14. On the NCI campus in Bethesda, Maryland, scientists describe delays in getting essential supplies — “literally anything that goes into a test tube or a petri dish,” a recently departed clinician said — because of staffing cuts and constant changes in policies about what they can order. Even the websites that publish new evidence on cancer treatment and diagnosis aren’t being updated, because HHS fired workers who managed them. And when NCI scientists do communicate with outsiders, what they say has been severely restricted, according to documents viewed by KFF Health News. Forbidden topics include mass firings, President Donald Trump’s executive orders, and “DEIA” – diversity, equity, inclusion, and accessibility. The turmoil at the National Institutes of Health’s largest arm could haunt the country and the world for years to come. “I really, really don’t understand what they’re trying to achieve,” said Sarah Kobrin, chief of NCI’s health systems and interventions research branch. “It just doesn’t make sense.” “Efforts that are lifesaving now are being curtailed,” one scientist said. “People will die.” Years of Bipartisan Support Initially, some workers said, they thought the cancer institute might be spared. HHS Secretary Robert F. Kennedy Jr. has called chronic disease — cancer is one — “an existential threat” to the country. Cancer research, with multiple NCI-funded breakthroughs in genetics and immunotherapy, has sidestepped the political minefields around other public health issues, like vaccination. “People who care about cancer might be the biggest lobby in the country,” said Paul Goldberg, editor and publisher of The Cancer Letter, which has monitored oncology science and policy since 1973. Count Mike Etchamendy, 69, of Big Bear Lake, California, as part of that lobby. Since 2013 he’s flown to the East Coast scores of times to participate in five clinical trials at the cancer wing of NIH’s Clinical Center. “They call it the House of Hope,” Etchamendy said. Between drugs, therapeutic vaccines, and expert treatment for his rare bone cancer, called chordoma, he said, he believes he’s gained at least 10 years of life. He’s proud to have served as a “lab rat for science” and worries about NCI’s future. “People come from all over the world to learn there,” Etchamendy said. “You cut funding there, you’re going to cut major research on cancer.” Related | Beyond Ivy League, RFK Jr.’s NIH slashed science funding across states that backed Trump In response to a list of detailed questions from KFF Health News about the cuts and chaos at NCI, HHS spokesperson Andrew Nixon said the reporting amounted to a “biased narrative” that “misrepresents a necessary transformation at the National Cancer Institute.” Nixon declined to elaborate but said research into cancer and other health conditions continues to be a high priority “for both NIH and HHS.” “We are refocusing resources on high-impact, evidence-based research — free from ideological bias or institutional complacency. While change can be uncomfortable for those invested in the status quo, it is essential to ensure that NCI delivers on its core mission,” he said. Much of NCI’s work is authorized by the National Cancer Act of 1971, which expanded its mandate as part of President Richard Nixon’s “War on Cancer.” Three of four of the cancer institute’s research dollars go to outside scientists, with most of the remainder funding more than 300 scientists on campus. And Congress was generous. Harold Varmus, one of more than 40 Nobel laureates whose work was funded by NCI, said