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Setting research priorities for cancer in India: Findings from a CHNRI exercise by ICMR & AIIMS-NCI
#ICMR-NCI CHNRI Exercise Group: Assam- Ravi Kannan (Cachar Cancer Hospital and Research Centre, Cachar); Chandigarh- Amit Bahl, Navneet Singh (Postgraduate Institute of Medical Education and Research); Karnataka- Bengaluru- Anita Nath, Gokul S, Jayasankar, Sathish Kumar K, R. Thilagavathi (National Centre for Disease Informatics and Research), Praveen Birur (Karnataka Lingayat Education Society Institute of Dental Science), Manipal- Naveen Salins (Kasturba Medical College Manipal, Manipal Academy of Higher Education; Kerala- Sunil Kumar MM (Pallium India, Trivandrum); Maharashtra- Mumbai- Gaurav Narula (Tata Memorial Centre), Kumar Prabhash (Tata Memorial Hospital), Sorab Dalal, Syed Hasan (Advanced Centre for Treatment, Research and Education in Cancer); New Delhi- Abhishek Kunwar (NPC, WHO Country Office for India), Nisha K Jose (Indian Council of Medical Research Hqrs); Ahitagni Biswas, Aman Sharma, Anant Mohan, Anita Dhar, Anurag Srivastava, Ashutosh Mishra, Atul Batra, Deepam Pushpam, Jyoti Meena, Krithika Rangarajan, Pallavi Shukla, Prabhat S Malik, Raja Pramanik, Ritu Gupta, Seema Mishra, Seema Singhal, Sunil Kumar, Supriya Mallick, Chandrashekhar (All India Institute of Medical Sciences Delhi); Akash Kumar, Aparna Sharma, Babita Kataria, Hari Sagiraju, Jyoti Sharma, Prashant Sirohiya, Smriti Panda (National Cancer Institute- All India Institute of Medical Sciences); Shantanu Chowdhury, Shantanu Sengupta (Council of Scientific and Industrial Research - Institute of Genomics and Integrative Biology); Anubha Gupta, Ranjan K Choudhury, Tavpritesh Sethi (Indraprastha Institute of Information Technology Delhi); Prakamya Gupta, Himanshu Bhushan (National Health Systems Resource Centre); Punjab- Bathinda- Ankita Kankaria, Mayank Gupta (All India Institute of Medical Sciences); Puducherry-Prasanth Ganesan (Jawaharlal Institute of Postgraduate Medical Education & Research); Tamil Nadu- Jerard Selvam (National Health Mission);Vellore- Jenifer Jeba Sundararaj (Christian Medical College); Chennai- R Swaminathan [Cancer Institute Adyar (WIA-Women’s Indian Association)]; Uttar Pradesh- Noida- BC Das (Amity University), CP Yadav, Ekta Gupta, Pramod Kumar, Ruchika Gupta, Sandeep Kumar (National Institute of Cancer Prevention and Research)
For correspondence: Dr Tanvir Kaur, Division of Non Communicable Diseases, Indian Council of Medical Research, New Delhi110 029, India e-mail: kaurtanvir.hq@icmr.gov.in
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Received: ,
Accepted: ,
Abstract
Background & objectives
With limited funding and vast array of research ideas, setting priorities becomes essential to ensure effective and efficient use of resources. This study aims to systematically identify key research questions in cancer through stakeholder engagement using the Child Health and Nutrition Research Initiative method which is a new concept in the Indian context.
Methods
The Indian Council of Medical Research held a research priority-setting exercise on May 7-8, 2024 at All India Institute of Medical Sciences-National Cancer Institute, Jhajjar, Haryana, engaging 84 participants across India using CHNRI methodology. Experts were divided into four thematic groups. In Step I, each group proposed research questions, which were scored based on five predefined criteria (answerability, efficacy, relevance, deliverability, equity) and arranged in descending order. In Step II, the highest-scoring questions were further validated through full-house voting. Questions receiving a consensus of more than two-third were finalised as priorities.
Results
In Step I, 99 questions were generated which covered descriptive (n=10), development (n=65), discovery (n=14), and delivery research (n=10). Development group questions were subcategorised as Technologies (diagnostics/devices/digital) (n=17), Therapeutics (n=16), Prevention and screening (n=20), and Palliative care and survivorship (n=12). During validation (Step II), 36 questions across all domains received >66 per cent scores, resulting in research priorities.
Interpretation & conclusions
The priority setting exercise helped in short listing research questions in area of cancer in India and provided actionable guidance to policymakers and funders enabling appropriate usage of limited funds.
Keywords
Cancer
CHNRI
ICMR
research priority setting
NCI Jhajjar
Globally, formal priority-setting exercises have emerged as compelling tools to guide research agendas and allocate funding. Such exercises bring together diverse stakeholders — clinicians, researchers, policymakers, and patient representatives — to identify research gaps and rank them based on predefined criteria. While various methods exist for priority setting, the three most common methods in practice are: (i) the Child Health and Nutrition Research Initiative (CHNRI), (ii) the James Lind Alliance (JLA), and (iii) the Delphi-based consensus approach1. The Child Health and Nutrition Research Initiative (CHNRI) method has emerged as a widely adopted, transparent, and systematic approach for setting health research priorities1-4. This method enables systematic alignment of health priorities having potential research impact through ‘crowdsourcing’2,5.
In India, formal prioritisation of cancer research has not been widely implemented. Indian Council of Medical Research (ICMR) as the apex body of research regularly allocates funds for cancer research, covering both small and large-budget projects limited to specific cancers. Feedback was given by researchers, clinicians, and policymakers (through both formal and informal channels), highlighting the necessity to broaden the scope and reassess the priorities within the Indian cancer research landscape. The core management team of ICMR acknowledged this gap and initiated a collaboration with the National Cancer Institute at All India Institute of Medical Sciences (AIIMS) Jhajjar, Haryana aiming to systematically prioritise cancer research and revisit existing priorities through a scientific approach. The objective was to identify the most critical and feasible cancer research questions that could inform future funding and strategic planning of ICMR.
Materials & Methods
Pre-workshop planning
The exercise was conceptualised in internal meetings of core management team of ICMR chaired by the Secretary, Department of Health Research (DHR) and Director-General, Indian Council of Medical Research (DG-ICMR) and subsequent meetings with the Head, Division of Non Communicable Diseases, ICMR, Programme Officer dealing with Cancer, Director, ICMR- National Institute of Cancer Prevention and Research (ICMR-NICPR), Director, ICMR-National Centre for Disease Informatics and Research (NCDIR)and Head, All India Institute of Medical Sciences- National Cancer Institute (AIIMS-NCI) in the months of March-April 2024. A two-day workshop on May 7-8, 2024 was planned at AIIMS-NCI-Jhajjar Campus for crowd sourcing. Four working groups were created (Descriptive group, Development group, Discovery group and Delivery group). Group composition ensured representation across multiple domains of cancer research-public health, basic biology, clinical oncology, diagnostics, preventive oncology, and palliative care. The experts were selected from national research institutions/medical colleges across the country at varying stages of their careers based on their publication record (H-index/data available in public domain/research experience), research funding record and working directly/indirectly on cancer. Experts’ list was expanded through snowballing. List of experts and their allocation to working groups was reviewed by core team of ICMR and finalised. Each group was assigned 7-14 members based on thematic expertise. Invitations were sent to 76 non-ICMR/NCI experts to attend the workshop. Of these, 66 experts attended the workshop. Representatives from Ministry of Health (policymakers/programme officers) were also invited to participate. Participants from ICMR institutions and NCI were not sent formal invitations but some of them were members of working groups (as coordinators or rapporteurs) and participated in voting. The distribution of stakeholders who participated in the workshop by organisation, area of expertise is given in table I.
| Group name | No. of experts in each group* (Total n=84) | Organisations | Domain expertise (1-2 members from each domain) |
|---|---|---|---|
| 1. Descriptive group | n= 7 (8.3%) | NCI, Jhajjar; NCDIR, Bengaluru; Cancer Institute Adyar Chennai; NPC-WHO, Delhi | Cancer Registries, Biostatistics, Health Policy/Programme, Epidemiologists, Preventive Oncology, Radiotherapy, Surgical Oncology, Public health, WHO-NCD representatives |
| 2. Development Group | n=51 (60.7%) | ||
| 2a) Technologies (Diagnostics/Devices/Digital) | n=14 (16.6%) | AIIMS-Delhi; ICMR, New Delhi, ACTREC, Mumbai; IGIB, Delhi; IIIT, Hyderabad; NHSRC, Delhi; NICPR, Noida; NCDIR Bengaluru | Cell &Tumour Biology, Biotechnology, Gynae-Oncology, Health Technology, Medical Equipment Procurement, Supply Chain Management, Genomics, Proteomics, Biomedical Engineering, Computational Biology, Deep Learning, AI, Medical Oncology, Onco-radiology |
| 2b) Therapeutics | n=14 (16.6%) | AIIMS-Delhi; NCI Jhajjar; TMH, Mumbai; ICMR, Delhi; PGI, Chandigarh; NCDIR, Bengaluru; NICPR-Noida | Radiotherapy, Immunotherapy, Medical Oncology, Chemotherapy, Metronomic Therapy, Onco-Surgery, Paediatric Oncology, Genetic Counselling, Pharmacology |
| 2c) Prevention & Screening | n=11 (13%) | ICMR, Delhi; TMC, Kolkata; NICPR, Noida; CCHRC Silchar, AIIMS Delhi; AIIMS Bathinda, NHM Chennai, NHSRC, Delhi, NCDIR Bengaluru; NCI Jhajjar | Surgical Oncology, Public Health, Preventive Oncology, Community & Family Medicine, State Program Managers, WHO-NCD representatives, Radiation Oncology, Medical Oncology |
| 2d) Palliative care & Survivorship | n=12 (14.2%) | CMC Vellore; AIIMS Delhi, NICPR, Noida; AIIMS Bathinda; JIPMER Puducherry; KMC Manipal; Pallium India Trivandrum; NCDIR, Bengaluru; NCI Jhajjar | Onco-anaesthesia, Palliative & Supportive Care, Pain Management, Community health, Palliative Medicine, Medical Oncology |
| 3. Discovery Group | n=13 (15.4%) | ACTREC, Mumbai; IGIB Delhi; AIIMS Delhi; Amity Noida; NCI Jhajjar; NICPR, Noida; NCDIR, Bengaluru; ICMR Delhi | Cancer Genetics, Genomics, Cancer Cell Biology, Structural Biology, Molecular Biology, Cancer Genetics, Haemato-oncology, Medical Oncology, Diagnostic Pathology, Molecular Medicine & Stem Cell research |
| 4. Delivery Group | n=13 (15.4%) | Safdarjung Hospital Delhi; AIIMS, Delhi; PGI, Chandigarh; KLES IDS Bengaluru, NCI, Jhajjar; NICPR, Noida; ICMR Delhi | Medical Oncology, Pulmonary Medicine, Oral Cancer Diagnostics, Gynae-oncology, Cancer Surgery, Radiation Oncology, Cancer Immunology, Public Health |
For priority setting, a two-step approach was followed in the workshop described below and in figure.
- Sequence of activities for research priority setting exercise in cancer.
Step I: CHNRI Process
Stakeholders proposing priority research questions: A total of 84 stakeholders from pre-assigned groups attended the workshop on May 7-8, 2024 at NCI-Jhajjar. On day 1 of the workshop, the Child Health and Nutrition Research Initiative (CHNRI) exercise was conducted. The seven working groups were informed about the scoring criteria, followed by meetings for discussion within their respective teams. These discussions led to emergence of multiple ideas. After the discussions, voting was done and the participants were asked to rank questions based on the criteria given in table II. Each criterion was given equal weight, with novelty being considered as understood:
| Criterion | Weight | Description |
|---|---|---|
| Answerability | 1 | Is it possible to design an appropriate, ethical research study that can provide the required answer? |
| Efficacious | 1 | Will the research result be expected to reach an efficacious intervention? |
| Possibility of impact | 1 | What is the likelihood of the research outputs leading to a substantial impact on an important health problem? |
| Deliverable | 1 | Are the proposed research results possible to scale up? |
| Equity | 1 | Will the proposed research results eventually improve equity and preferentially improve the health of the most vulnerable and disadvantaged people? |
Response of “yes” was assigned a value of 1, and a response of “no” was assigned a value of 0. Every member scored each question on a scale of 1 to 5. Maximum score that could be given to a question by one member was 5. The average score was calculated for each question, by taking arithmetic mean of the scores of all members. Questions were arranged in descending order of scores. All of these questions were subjected to voting and validation by full house on day 2 of workshop.
Step II: Validation
All research questions identified in Step I (arranged in descending order) were subjected to voting from full house. These stakeholders comprised researchers, scientists, clinicians, working in cancer research from all the working groups (Table I). If >2/3 of the members voted “yes” group response=yes=1; else, No=0. Maximum possible score for a question was 84. Thus, those questions with more than or equal to 2/3rd (66.6%) voting in favour were given ranks. Although all question were scored, individual scores were not retained as it would not have provided accurate figures (due to factors, such as inconstant denominator, non-response of participants). The final prioritised list was generated based on consensus ranking during the validation step. Duplicate questions (if any) from different groups were removed as and when identified.
Post workshop refinement of research questions
Final selection of questions was done internally by ICMR core team based on ranks and national relevance. The questions were further split/combined/reshuffled/rephrased carefully after the workshop for refinement without changing the core idea of the questions (Table III). The original lists of research questions (from Step I and Step II) were kept intact as separate files for future reference.
| Group | Prioritised research questions | |
|---|---|---|
| 1. | Descriptive |
1. Among workers from industries commonly associated with cancer or the general population, what is the estimated risk of developing cancers due to exposure to known environmental carcinogens? 2. Among high-risk groups, what is the cost-effectiveness of alternative strategies as compared to the existing standard of care in reducing morbidity due to cancers? 3. What factors contribute to successful cancer care pathways from screening to diagnosis and treatment? 4. Recommendations for including in the ongoing DHR-DIAMONDS project: a. Are there regional differences in the pattern of distribution of common oncogenic driver alterations in non-small cell lung cancer and other cancer types? b. What is the percentage of patients with an identified targetable oncogenic driver alteration able to access the appropriate targeted therapy? |
| 2a. | Development Technologies -(Diagnostics/Devices/Digital) |
1. How effective can digital twins of Indian cancer patients (generated using clinical and genomic data) be in improving early detection, diagnosis, & prognosis of cancers? 2. How effective are point-of-care tests (such as surrogate onco-metabolites in bio fluids, the CRISPR-CAS system, liquid biopsy-based mutation identification assays) in early diagnosis & prognosis of cancers? |
| 2b. | Development-Therapeutics |
1. In patients with head and neck cancer, how effective is hypo-fractionated radiotherapy compared to standard treatment in improving overall survival? 2. In cancer patients, how effective are new therapies (such as personalized radiotherapy/personalized chemotherapy based on indigenous biomarker expression/reduced dose of chemotherapy/calibrated adjuvant treatment based on tumor micro-environment and circulating biomarkers)? 3. In women above 30 years with gynaecological cancers, how effective is oral metronomic therapy as compared to standard treatment in improving survival? |
| 2c. | Development-Prevention and Screening | 1. What will be the effectiveness of integrated models engaging NGOs/SHGs with the health system in improving screening uptake of priority cancers? |
| 2d. | Development-Palliative care and Survivorship |
1. In cancer survivors of five common cancers, how effectively can early palliative care integration ensure appropriate treatment and improve survival rates? 2. What will be the effectiveness of rehabilitation interventions in cancer survivors in improving quality of life? |
| 3. | Discovery |
1. What are the new targeted therapy approaches effective in killing cancer cells without side effects? (for e.g., identifying novel targets/using tumour micro-environment like hypoxia, acidic pH or by using tumour-specific surface molecules OR immunotherapy such as CAR T cell, neoantigen-based therapeutic vaccines) 2. Are new minimally/non-invasive biomarker-based tests (blood/saliva/urine-based) helpful in early detection and bio-monitoring of cancer patients? 3. Are Indian patient-derived organoid (PDO) cultures & patient-derived xenografts (PDX) models better alternatives for evaluating drug/radiation sensitivity and development of novel therapeutics for cancers unique to India? |
| 4. | Delivery |
1. How can point-of-care technology-enabled screening be scaled up for early detection of cervical cancer? 2. How can data generated from currently ongoing and recently completed low-dose immunotherapy trials be used for testing & implementation of the regimens tested therein to generate larger real-world data? |
Results
Overall, 99 research questions were identified from all groups in Step I (Supplementary material I) and 36 non-duplicate questions received more than 66 per cent voting during Step II (Supplementary material II) which were termed research priorities. The Group-wise details are given below:
Descriptive research group
In the descriptive theme, a total of 10 research questions were identified in Step I (Supplementary material I) that focused on epidemiological research, health system assessments, cancer care pathways and pattern of care and survivorship. During full house voting, five questions received >=66 per cent voting in favour (Supplementary material II), which were considered research priorities.
Development research group
In the development group, 65 research questions were generated in all the four subgroups in Step I viz (a) Technologies (diagnostics/devices/digital); (b) Therapeutics; (c) Prevention and screening; (d) Palliative care and survivorship (Supplementary material I). The identified priority topics in these subcategories primarily focused on new diagnostic markers, Artificial intelligence (AI) based cancer diagnosis and methods of cancer detection, personalised therapy and other newer therapeutic modes of cancer treatment (hypo fractionated radiotherapy, metronomic therapy, immunotherapy, CAR T cell therapy, NK based therapy, etc.) and immune checkpoint inhibitors. Other ideas focused on prevention strategies and palliative care- promoting healthy lifestyle, tobacco cessation, community-based screening, strengthening care pathways and referral mechanism for cancer screening and diagnosis, improving quality of life, survivorship and support services for cancer patients. During full house voting, 20 questions from all subgroups of Development group received >=66 per cent voting in favour (Supplementary material II), which were considered research priorities under Development theme.
Discovery research group
A total of 14 research questions were generated in Step I (Supplementary material I). The identified priority topics focused primarily on identification of new biomarkers and agents for cancer detection and treatment, applications of genomic data in cancer treatment, DNA based therapeutic agents/vaccines. During full house voting, five questions from all subgroups received >=66 per cent voting in favour (Supplementary material II), which were considered research priorities under the Discovery theme.
Delivery research group
10 research questions were generated (Supplementary material I). The identified priority topics focused primarily on new point of care devices and tests for screening and treating cancers. During full house voting, six questions received >=66 per cent voting in favour (Supplementary material II), which were considered research priorities under Delivery theme.
Discussion
This exercise represents India’s first national-level cancer research priority setting using the CHNRI method. In collaboration with key stakeholders, 99 research questions were identified through this exercise that were aimed at addressing components of cancer research under the identified themes. The questions are prioritised as public health concerns in the country. The four research domains encompasses 360 degree view into the potential cancer research landscape. The description research will generate epidemiological estimates on distribution of disease and potential risk factors, while discovery research will lead to identifying novel molecules for interventions. Development research will generate evidence on efficacy of newer diagnostics or therapeutics and reduction of cost of care of cancer; Delivery research will provide the evidence on how to scale up effective interventions in the community.
Several priority-setting exercises have been done in the past for multiple domains across the globe6. A scoping review reveals that nearly all priority-setting projects (93%), focused on identifying research priorities within the health sector, particularly in areas such as cancer, paediatrics, nursing, and mental, behavioural, and neurodevelopmental disorders. A mere six per cent of projects focus on non-health-related areas, while only one per cent highlight priorities that bridge health and non-health sectors6. The US-NCI did similar exercise in 2012 (16 day-long workshops on the National Institutes of Health (NIH) campus in Bethesda, Maryland, and at several other locations throughout the United States) to guide allocation of its funds to neglected areas of oncology7. This innovative initiative in the United States involved consultations with scientific experts, which were followed by internal curations that led to themed funding announcements. In contrast, the ICMR-NCI initiative adopted the CHNRI methodology (a formal scoring framework). Rather than focusing on neglected areas, the ICMR exercise focused on domain-specific working groups and identified translational gaps and research needs across the cancer continuum—from early detection to survivorship. The results of this exercise lean towards development-related questions compared to Description and Discovery, particularly in new diagnostics, point of care tests, new therapeutics, and palliative care models. This focus reflects India’s growing capabilities in technological innovation and the urgent need for scalable cancer care solutions. There is also emphasis on health system needs and addressing program implementation challenges to improve screening uptake, ensuring contextual relevance to India’s resource-constrained settings. While both models aimed to guide research investments strategically, the U.S. NCI’s initiative emphasised more on creativity and scientific provocation, whereas ICMR-NCI’s CHNRI exercise emphasised consensus-driven public health relevance.
The ICMR, in collaboration with the INCLEN Trust International, also used the CHNRI method to set research priorities for maternal, neonatal, child health, and nutrition issues from 2016-20258 Similar exercise for setting priority areas in cancer was done in Iran9. Recognising the value of involving patients and caregivers, a James Lind Alliance (JLA) based priority setting exercise was conducted for kidney cancer across Canada by surveying patients, caregivers, along with expert clinicians10. These approaches highlight the diverse methods available to align national research funding.
This exercise had some limitations. The CHNRI method relies heavily on the subjective judgments of the selected stakeholders leaving scope for expert bias and may not offer a fully replicable and comprehensive approach to establishing priorities5,11. It was challenging to obtain a perfect mix of stakeholders, thereby leading to a risk of bias in the selection of experts. As the domain expertise of scientists was diverse, there could be bias while scoring based on the knowledge and experience of the scorer. While efforts were made to keep broad spectrum of expertise, there was limited representation from some domains—such as surgical oncology, diagnostic imaging, geriatric oncology, and health systems management. As a result, some aspects of areas, such as surgical innovation, patient education, cancer related societal and familial economics, systematic health systems planning and evaluation, preventive and health promotion aspects, may have been underrepresented. Moreover, patient groups/caregivers were not invited to the workshop. Future rounds of such exercise should ensure broader inclusion of stakeholders addressing the underrepresented /missed areas.
Despite these limitations, the exercise successfully identified actionable priorities that are specifically tailored to India’s needs. ICMR/DHR, as funding organisations, can adopt some of these ideas to enhance their intramural and extramural initiatives. The primary beneficiaries of this initiative will be medical and non-medical research students working towards their doctorate or postgraduate degrees. Based on these research questions, multiple projects will emerge with specific objectives. Because research is continual, dynamic, and time-sensitive, the results from this prioritisation exercise will only hold relevance for a period of 3-5 yr, necessitating a reassessment after five years as new research concepts will arise from the data produced through this endeavour. Additionally, advancements in technology over time will create new research opportunities.
Thus, it is important to recognise that while availability of funding affects the direction of research, priority-setting exercises such as this one help ensure that these funds are allocated to areas of highest consensus at a given time and relevance to public health.
The 36 questions identified through this CHNRI exercise provide a fairly balanced set of priorities across the cancer care continuum in India, which will guide future expenditure of funds of ICMR (both intramural and extramural), policy formulation, and collaborative efforts in the near future, which in turn will strengthen India’s cancer control strategies.
Financial support & sponsorship
None.
Conflicts of Interest
None.
Use of Artificial Intelligence (AI)-Assisted Technology for manuscript preparation
The authors confirm that there was no use of AI-assisted technology for assisting in the writing of the manuscript and no images were manipulated using AI.
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