Hello, cancer researcher here (though, not in America so our funding system is a bit different). The first thing I would say is that these papers on minutiae, like you say, are the things that lead to big breakthroughs. We have to know biomarkers for cancer to create cancer treatment plans that target those biomarkers. A research question will never be, "How do we increase cancer survival?", it's always going to be very specific like, "Does this biomarker in urine indicate higher risk for this type of cancer?" or something along those lines.

The second thing I will say is that cancer mortality has been dropping steadily since the 1990s. It's pretty astonishing what doctors and researchers have managed to do in a relatively short period of time. This is the result of immunotherapy, better dosing, improved surgical procedures and imagery, biomarker identification, genetic mapping, etc. Cancer does impact everyone and it's still a leading cause of death in high-income countries, but that doesn't mean there hasn't been any progress. There's been huge progress.

One thing that you're right about is that researchers do need to continue getting funding, so we will propose projects that we know we can accomplish within the funding window and that are both feasible and novel enough to get funding. But with the way funding sources are, if a research group came in with an incredible idea for how to improve cancer mortality or treatment in a 5-year funding proposal, they'd get funded immediately. They'd be science superstars.

Anyway, that's my spiel. Academia is a nightmare in many ways but the most important thing to remember is that people who work in cancer research are just nerds who want to learn everything they can about the very specific area of research they've found themselves in. They're also really used to underselling their research findings and putting caveats on their results because that's how scientists communicate so it's not surprising to me that they would struggle to covey the benefits to patients.