{"entity":{"id":"idea-fund-survivorship-endowment-levy","kind":"idea","name":"A survivorship research endowment funded by a levy on curative therapy prices","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Funding follows fashion, not burden): Carter & Nguyen, A comparison of cancer burden and research spending (BMC Cancer 2012)","url":"https://doi.org/10.1186/1471-2407-12-526"}],"tags":[],"related":["idea-exercise-as-adjuvant"],"cancers":["hodgkin-lymphoma","all-leukemia","breast-hr-positive"],"sections":[],"technologies":["cardio-oncology","exercise-oncology"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-funding-allocation","b-survivorship"],"keyPapers":["paper-sun-bmc-cancer"],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"large","horizonYears":5},"route":"/ideas/idea-fund-survivorship-endowment-levy/","neighbours":{"idea":[{"id":"idea-exercise-as-adjuvant","kind":"idea","name":"Structured exercise prescribed like a drug in all curative-intent cancer care","route":"/ideas/idea-exercise-as-adjuvant/"}],"cancer":[{"id":"all-leukemia","kind":"cancer","name":"Acute lymphoblastic leukaemia","route":"/cancers/all-leukemia/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"technology":[{"id":"cardio-oncology","kind":"technology","name":"Cardio-oncology","route":"/technologies/cardio-oncology/"},{"id":"exercise-oncology","kind":"technology","name":"Exercise & lifestyle oncology","route":"/technologies/exercise-oncology/"}],"bottleneck":[{"id":"b-funding-allocation","kind":"bottleneck","name":"Funding follows fashion, not burden","route":"/bottlenecks/b-funding-allocation/"},{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}],"paper":[{"id":"paper-sun-bmc-cancer","kind":"paper","name":"Benefits of hyperthermic intraperitoneal chemotherapy for patients with serosal invasion in gastric cancer: a meta-analysis of the randomized controlled trials","route":"/key-papers/paper-sun-bmc-cancer/"}],"roadmap":[{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"}]}}