# A survivorship research endowment funded by a levy on curative therapy prices

Source: https://onco.cc/ideas/idea-fund-survivorship-endowment-levy/  
OnCo record `idea-fund-survivorship-endowment-levy` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Tens of millions of people live after cancer with heart damage, infertility and second cancers. A tiny levy on the price of curative treatments would build a permanent fund to study and treat late effects.

## Summary

Health systems and payers negotiate a 0.5% levy on reimbursed prices of curative-intent oncology drugs and radiotherapy into an independent endowment for late-effects research and survivorship services: long-term cohort follow-up, cardio-oncology and fertility-preservation trials, second-cancer surveillance and return-to-work interventions. The logic is that the cost of cure includes the cost of living with its consequences, and that no manufacturer has an incentive to fund it.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: An endowment of this kind funds long-term cohort follow-up for more than 80% of paediatric and young-adult survivors in its jurisdiction within five years and produces at least three practice-changing late-effects interventions within ten.
- Rationale: Earmarked levies have built sustainable research funds elsewhere: France's tobacco tax allocation, the US vaccine injury compensation excise tax, and blood-product and pharmaceutical sector levies in several European countries. Survivorship research currently competes poorly in general peer review because it lacks novelty appeal.
- Proposed test: Model the levy yield against reimbursed spend in one country, then negotiate a three-year pilot with one national payer and one manufacturer group, tracking funded cohort coverage and cost.
- Maturity: speculative
- Actor: payer

## Sources

- Bottleneck evidence (Funding follows fashion, not burden): Carter & Nguyen, A comparison of cancer burden and research spending (BMC Cancer 2012): https://doi.org/10.1186/1471-2407-12-526

## Connected records

- ideas: [Structured exercise prescribed like a drug in all curative-intent cancer care](https://onco.cc/ideas/idea-exercise-as-adjuvant/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/)
- technologies: [Cardio-oncology](https://onco.cc/technologies/cardio-oncology/), [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/)
- bottlenecks: [Funding follows fashion, not burden](https://onco.cc/bottlenecks/b-funding-allocation/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)
- key papers: [Benefits of hyperthermic intraperitoneal chemotherapy for patients with serosal invasion in gastric cancer: a meta-analysis of the randomized controlled trials](https://onco.cc/key-papers/paper-sun-bmc-cancer/)
- roadmaps: [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)

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