Full Text CA-93-06


NIH GUIDE, Volume 21, Number 40, November 6, 1992

RFA:  CA-93-06

P.T. 34, FB

  Disease Control+ 
  Disease Prevention+ 

National Cancer Institute

Letter of Intent Receipt Date:  December 4, 1992
Application Receipt Date:  January 25, 1993


The National Cancer Program is mandated to address the unique cancer
prevention, early detection, and treatment needs of all populations
within the U.S. and its territories.  An excerpt from the FY 1992
Committee on Appropriations to the U.S. Department of Health and Human
Services stated:

"The Committee also urges NCI to expand its efforts to develop an
appropriate response to the needs of American Samoans.  Access to
timely treatment intervention is especially important for this native
American population...."   (Senate Report No. 102-104, page 86)

Therefore, the Division of Cancer Prevention and Control (DCPC) of the
National Cancer Institute (NCI) invites applications from various
organizations for developmental studies that:  (1) assess cancer
control need, (2) determine barriers to cancer control, and/or (3)
validate intervention methods and assessment instruments in native
Pacific populations; i.e., American Samoans, Guamanians (Chamorros),
Palauians, and Northern Marianians.  This initiative will define the
cancer prevention and control needs of native Pacific populations and
those of similar ancestry located in the Pacific as well as the U.S.


The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  This Request
for Applications (RFA), Developmental Research in Native Pacific
Populations, is related to the priority area of cancer.  Potential
applicants may obtain a copy of Healthy People 2000 (Full Report:
Stock No. 017-001-00474-0) or Healthy People 2000 (Summary Report:
Stock No. 017-001- 00473-1) through the Superintendent of Documents,
Government Printing Office, Washington, DC 20402-9325 (telephone


Applications may be submitted by domestic (including U.S. Territorial
possessions) public and private, for-profit and non-profit
organizations serving native Pacific populations such as universities,
public health departments, voluntary organizations, research centers,
hospitals, consortia of health providers, units of State and local
governments and eligible agencies of the Federal government.  Teams of
applicants are encouraged.  Among a team of applicants, one institution
must be proposed as the lead institution to serve as the applicant and
to assume responsibility for the conduct and administration of the
project.  Note that awards will not be made to foreign institutions and
that applications from domestic organizations may not include
international components.


The mechanism of support for this RFA will be the National Institutes
of Health (NIH) research project grant (R01).  Responsibility for the
planning, direction, and execution of the proposed research will be
solely that of the applicant.  In addition to the requirements stated
in this RFA, awards will be administered under PHS grants policy as
stated in the Public Health Service Grants Policy Statement, DHHS
Publication No. (OASH) 90-50,000, revised October 1, 1991.  This RFA is
a one-time solicitation.  Future unsolicited competing continuation
applications will compete with all investigator-initiated applications
and be reviewed according to the customary peer review procedures.  It
is anticipated that four awards will be made at approximately $300,000
total costs per year.


Approximately $1.2 million in total costs per year for three years will
be set-aside to specifically fund applications that are submitted in
response to this RFA.  It is anticipated that up to four awards will be
made.  The total project period of these awards may not exceed three
years.  This level of support is dependent on the receipt of a
sufficient number of applications of high scientific merit.  Although
this program is provided for in the financial plans of the NCI, the
award of a grant pursuant to this RFA is also contingent upon the
availability of funds for this purpose.



The National Cancer Program is mandated to address the unique cancer
prevention, early detection, and treatment needs of all populations
within the U.S. and its territories.  The cancer control objectives for
the nation are aimed at (1) reducing the cancer death rates for all
Americans and (2) eliminating differentials in cancer rates between
population segments.  The means to obtain these objectives include the
development and implementation of cancer control and prevention
strategies directed at the general U.S. population and targeted
initiatives directed at minority and medically underserved populations
that are differentially affected by cancer.  These populations include
those who experience high cancer incidence/mortality rates or low
survival rates, or who are underserved in terms of cancer prevention
and control programs that include the native Pacific populations.

The paucity of data on effective cancer prevention and control
intervention methods in the target populations reflect both a dearth of
such programs and of validated instruments to evaluate their
effectiveness.  The need for the development of sensitive intervention
methods and assessment instruments has to be established in many areas
of health (e.g., mental health, cardiovascular diseases) and other
sectors (e.g., education).

In recent years, the Division of Cancer Prevention and Control (DCPC)
has carried out intervention research initiatives directed at the
American Indian/Alaska Native, Black, Native Hawaiian, and Hispanic
populations.  These experiences, combined with information gathered
through external working groups and experts in the cancer prevention
and control needs of minority and medically underserved populations and
extensive conversations with experienced investigators, has clarified
the need for Phase I and Phase II cancer control studies for native
Pacific populations.  It is clear that the concepts of health and
healing vary significantly, and this diversity is not captured by a
single design, method, or instrument.

Studies conducted under this RFA will seek to define cancer prevention
and control needs/services of the native Pacific population segments
(Phase I). Studies to test ways in which existing intervention methods
can be used or adapted for the target populations (Phase II); studies
of new methods designed to be sensitive to the needs of the target
populations (Phase II); and methodologic research on validation of
assessment instruments in target populations (Phase II) are eligible
for consideration under the RFA.  This "developmental cancer control
research" (Phase I and Phase II) is absolutely essential to future
development of cancer prevention and control research for native
Pacific populations.

The following definitions apply to this RFA:

1.  Native Pacific Populations -- The term "native Pacific populations"
refers to those population segments indigenous to the Pacific region
and/or populations of similar ancestry located within the U.S.
mainland, such as American Samoan populations.

2.  Cancer Control -- Cancer control is defined as the reduction of
cancer incidence, morbidity, and mortality through an orderly sequence
from research on interventions and their impact in defined populations
to the broad, systematic application of the research results.

3.  Phases of Cancer Control -- Cancer control research studies are
classified in the five phases that represent the orderly progression
noted in the above definition:  (I) Hypothesis development; (II)
Intervention methods development and testing; (III) Controlled
intervention trials to establish cause and effect relationships; (IV)
Research in defined human populations; and (V) Demonstration and
implementation studies.

The research of interest in this RFA falls into either Phase I or Phase
II studies.  Hypothesis development (Phase I) studies should focus on
the assessment of cancer prevention and control needs in communities or
organizations within native Pacific populations, or studies that
identify barriers to cancer prevention and control within these
indigenous populations.  Methods development and testing studies, Phase
II, should focus on:  (1) validating the use of existing intervention
methods (e.g., dietary modification, health services, tobacco
cessation) as applied in the target populations described above; (2)
developing and pilot testing unique methods that are sensitive to the
needs of the target populations described above, or (3) developing and
validating assessment instruments to measure the cancer control related
needs of the target populations or for use in evaluating the
effectiveness of intervention methods in the target populations.

It is the interest of this RFA that the projects should be
multidisciplinary in design.  Applicable disciplines may include
epidemiology, oncology, public health, pathology, health services
research, behavioral, and social sciences.  The research team should
include individuals with knowledge of the culture and language of the
native Pacific populations.

Because validation and intervention studies may depend on the review of
case records, investigators should assure in the application that a
mechanism to access pertinent records has been identified.

A.  Goals and Objectives

The goals of this program initiative are to identify cancer control
needs, to determine barriers to cancer control, and to validate
intervention methods and assessment instruments.  The objectives
relating to Phases I and II are described below:

Phase I Studies

1.  Assess cancer prevention and control needs/services in communities
with native Pacific populations.

2.  Identify barriers to cancer prevention and control in native
Pacific population communities.

Phase II Studies

1.  Validate the use of existing intervention methods (e.g., dietary
modification, health services, tobacco cessation) applied in the target

2.  Develop and pilot test unique intervention methods sensitive to the
needs of the target populations.

3.  Develop and validate assessment instruments (e.g., dietary intake,
risk factor surveys) to measure the cancer control related needs of the
target populations and to evaluate the effectiveness of intervention
methods in the target populations.

B.  Project Approach

It is important that applicants describe fully and in detail all
aspects of the proposed project in the application, including cancer
sites to be studied, the target population for which the research is
being conducted, available population data bases, hypotheses to be
considered, the planned intervention approaches, methods of assessment
and validation, and the overall research design approach to the
proposed study.  It is essential to select and justify in the
application, cancer sites on the basis of the significance in the
target population and the potential for reduction of mortality rates.
It is also essential that the population for which the study(ies) will
be carried out be specified and characterized using population-based
estimates of the demographic characteristics of the target population.
All collaborative arrangements that are planned should be described in
detail, including areas of responsibility, coordinating, decision-
making authority, and financial relationships.  Letters of commitment
from each participating organization should be included in the

C.  Research Plan

The applicant should include a detailed protocol outlining the proposed
project methods for determining outcome effects.  The protocol should
detail the research project as conceived and should provide the
complete methodological approach to the problem under investigation.
The design for the project should provide enough information to
determine an adequate "test" of the concepts, whether validation or
intervention outcomes.  It is important that the design permits
statistically valid results to be achieved within the period of award.

D.  Options in Project Design

Applicants must choose from the three types of projects described

o  Type One - Validation study of an existing intervention method for
use in a native Pacific population group.

o  Type Two - Develop and pilot test a "unique" intervention method
that is sensitive to the needs of the target population.

o  Type Three - Develop and validate needs assessment instruments or
assessment instruments that could be used to measure effectiveness of
cancer control methods in the target population.

Applicants must specify which type they have selected in the first line
of section 2(a), "Specific Aims", in the application.

E.  Time Schedule

A detailed time schedule should be presented in the application.  This
schedule is important because it will provide the milestones against
which progress will be validated.


Awardees should include in the proposed budgets travel to the NCI for
up to two persons to attend two meetings of Principal Investigators and
NCI program staff to discuss such issues as the validation of stated
hypotheses, determination of population characteristics/size relative
to the intervention specified, research progress, and results.  These
meetings will be held approximately three months prior to the scheduled
completion of years 01 and 03, respectively.

Awardees should anticipate that NCI staff may conduct a site visit as
a part of program management in order to assure that projects are
proceeding according to the plans specified in the application.  This
anticipated site visit is not intended to reduce the requirements for
the customary detailed progress report in accordance with the
instructions appearing in form PHS 2590.


The targeted population intended under this RFA is the native Pacific
populations and those of similar ancestry located in the Pacific as
well as the U.S. mainland; i.e., American Samoans, Guamanians
(Chamorros), Palauians, and North Marianians.  Applicants responding to
this RFA are expected to successfully access a significant portion of
this population to decrease cancer incidence and mortality, increase
cancer survival, and increase the diagnosis of cancers at earlier


NIH policy is that applicants for NIH clinical research grants and
cooperative agreements will be required to include minorities and women
in study populations so that research findings can be of benefit to all
persons at risk of the disease, disorder or condition under study;
special emphasis should be placed on the need for inclusion of
minorities and women in studies of diseases, disorders, and conditions
which disproportionately affect them.  This policy is intended to apply
to males and females of all ages.  If women or minorities are excluded
or inadequately represented in clinical research, particularly in
proposed population-based studies, a clear compelling rationale should
be provided.

The composition of the proposed study population must be described in
terms of gender and racial/ethnic group.  In addition, gender and
racial/ethnic issues should be addressed in developing a research
design and sample size appropriate for the scientific objectives of the
study.  This information should be included in the form PHS 398 in
Sections 1-4 of the Research Plan AND summarized in Section 5, Human
Subjects.  Applicants are urged to assess carefully the feasibility of
including the broadest possible representation of minority groups.
However, NIH recognizes that it may not be feasible or appropriate in
all research projects to include representation of the full array of
United States racial/ethnic minority populations (i.e., Native
Americans [including American Indians or Alaska Natives], Asian/Pacific
Islanders, Blacks, Hispanics).

The rationale for studies on single minority population groups should
be provided.

For the purpose of this policy, clinical research includes biomedical
and behavioral studies of etiology, epidemiology, prevention (and
preventive strategies), diagnosis, or treatment of diseases, disorders
or conditions, including but not limited to clinical trials.

The usual policies concerning research on human subjects also apply.
Basic research or clinical studies in which human tissues cannot be
identified or linked to individuals are excluded.  However, every
effort should be made to include human tissues from women and
racial/ethnic minorities when it is important to apply the results of
the study broadly, and this should be addressed by applicants.

If the required information is not contained within the application,
the application will be returned.

Peer reviewers will address specifically whether the research plan in
the application conforms to these policies.  If the representation of
women or minorities in a study design is inadequate to answer the
scientific question(s) addressed AND the justification for the selected
study population is inadequate, it will be considered a scientific
weakness or deficiency in the study design and reflected in assigning
the priority score to the application.

All applications for clinical research submitted to NIH are required to
address these policies.  NIH funding components will not award grants
or cooperative agreements that do not comply with these policies.


Prospective applicants are asked to submit, by December 4, 1992, a
letter of intent that includes a descriptive title of the proposed
research, the name and address of the Principal Investigator, the
identities of other key personnel and participating institutions, and
the number and title of the RFA in response to which the application
may be submitted.

Although a letter of intent is not required, is not binding, and does
not enter into the review of subsequent applications, the information
that it contains is extremely helpful in planning for the review of
applications.  It allows NCI staff to estimate the potential review
workload and to avoid possible conflict of interest in the review.

In addition, if it appears that the potential applicant has
misunderstood the objectives of the RFA or opted for an inappropriate
funding mechanism, NCI staff will respond to such letters.  The NCI
would like to emphasize the benefits to the applicant and to staff of
having a Principal Investigator submit a letter of intent.  The letter
establishes communication between the potential applicant and program
staff initiating the RFA.  Program staff may be able to assist
prospective applicants in several areas, i.e., scientific content and
objectives of an application, size and focus of a research program,
organization of an application, and appropriate use of core components
and consultants.

The letter of intent is to be sent to:

George A. Alexander, M.D.
Chief, Special Populations Studies Branch
Division of Cancer Prevention and Control
National Cancer Institute
Executive Plaza North, Room 240
Bethesda, MD  20892-4200
Telephone:  (301) 496-8589
FAX:  (301) 496-8675


The research grant application form PHS 398 (rev. 9/91) is to be used
in applying for these grants.  These forms are available at most
institutional offices of sponsored research and from the Office of
Grants Inquiries, Division of Research Grants, National Institutes of
Health, 5333 Westbard Avenue, Room 449, Bethesda, Maryland 20892;
telephone 301/496-7441.

The RFA label available in the application form PHS 398 must be affixed
to the bottom of the face page.  Failure to use this label could result
in delayed processing of the application such that it may not reach the
review committee in time for review.  In addition, the RFA title and
number should be typed on line 2a of the face page of the application
form and the YES box must be marked.

Submit a signed, typewritten original of the application, including the
Checklist, and three signed, exact photocopies in one package to the
Division of Research Grants at the address below.  The photocopies must
be clear and single-sided.

Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**

At the time of submission, two additional copies of the application
must also be sent to:

Ms. Toby Friedberg, Referral Officer
Division of Extramural Activities
National Cancer Institute
Westwood Building, Room 838
5333 Westbard Avenue
Bethesda, MD  20892

Applications must be received by January 25, 1993.  If an application
is received after that date, it will be returned to the applicant
without review. The Division of Research Grants (DRG) will not accept
any application in response to this announcement that is essentially
the same as one currently pending initial review, unless the applicant
withdraws the pending application.  The DRG will not accept any
application that is essentially the same as one already reviewed.  This
does not preclude the submission of a substantial revision of an
application already reviewed, but the revised application must include
an introduction addressing the previous critique.


Review Procedures

Upon receipt, applications will be reviewed (initially) by the DRG for
completeness.  Incomplete applications will be returned to the
applicant without further consideration.  Evaluation for responsiveness
to the RFA is an NCI program staff function.  If an application is
judged to be non-responsive, the applicant will be contacted and given
an opportunity to withdraw the application or have it considered with
other unsolicited applications received by NIH in the next review
cycle.  Questions concerning responsiveness to the RFA may be directed
to NCI program staff listed under INQUIRIES.

If the number of applications submitted is large compared to the number
of awards to be made, the NCI may conduct a preliminary scientific peer
review to eliminate those that are clearly not competitive.  The NCI
will remove from competition those applications judged to be
noncompetitive for award and notify the applicant and institutional
business official.

Those applications that are complete and responsive will be initially
evaluated in accordance with the review criteria stated below for
scientific/technical merit by an ad hoc review committee convened by
the Division of Extramural Activities, NCI.  The second level of review
will be provided by the National Cancer Advisory Board.

Responsiveness Criteria

Applicants must be responsive to this RFA in the sense of being
directed towards the attainment of the stated programmatic goals.  Five
considerations are of paramount importance to this RFA:

1.  Descriptions of the cancer problem with justification for the
selection of specific cancer site(s) in terms of potential for
reduction of mortality rates, cancer control intervention strategy,
research method, procedures, analysis plans, and time schedule must be
clearly delineated.

2.  Studies must be limited to Phase I and/or Phase II only.

3.  Assurance of access to a community with characteristics appropriate
for the proposed intervention: written documentation must be included.

4.  The target population must be a native Pacific population
indigenous to the U.S. Pacific territorial region, i.e., American
Samoa, Guam, Palau, Northern Marianas; or of similar ancestry located
in Hawaii and the U.S. mainland, i.e., American Samoans.

5.  Agreements with communities, organizations, agencies, or
institutions that are critical to ensure access to appropriate records
and to the implementation of the research plan must be included.

Review Criteria

Each application will be reviewed on its own merit.  All applicants
must clearly define the target population and geographic location where
the program efforts will be demonstrated as well as the project team's
ability to access the target population.  All applicants should include
in the application a succinct discussion of previous relevant efforts
and plans to meet the terms of award.

Applicants are encouraged to submit and describe the approach that they
think would best meet the goals of this RFA and to identify in-kind
contributions and/or co-sponsors for specific personnel, activities,
and facilities.  Each application will be reviewed according to the
following criteria:

1.  Scientific merit of the research approach, design, and methodology.

2.  Scientific and technical significance and originality of the
proposed research.

3.  Experience (research or clinical or service) and/or competence of
the Principal Investigator and staff.

4.  Adequacy of time (effort) that the Principal Investigator and staff
would devote to the proposed project.

5.  Characterization of the native Pacific population to be used
(cultural, spiritual or language considerations) in the proposed project.

6.  Adequacy of the approaches to produce valid assessment instruments
for use in larger community intervention studies for cancer control.

7.  Likelihood of intervention (Phase II studies) to be readily
accepted and feasible in terms of cost.

8.  Potential for generalizability of the findings and adaptability of
the intervention approaches and assessment instruments in other
communities with similar cancer control problems.

9.  Adequacy of the plans for inclusion of women.

The ad hoc review group will recommend an appropriate budget for each
approved application.


The anticipated date of award is July 1, 1993.  Applicants will compete
for funding based on the quality and merit of the proposed research
study as determined by peer review, availability of funds, and
programmatic priorities, as well as geographic location.


Written and telephone inquiries concerning this RFA are encouraged.
opportunity to clarify any issues or questions from potential
applicants is

Direct inquiries regarding programmatic issues to:

George A. Alexander, M.D.
Chief, Special Populations Studies Branch
Division of Cancer Prevention and Control
National Cancer Institute
Executive Plaza North, Room 240
Bethesda, MD  20892-4200
Telephone:  (301) 496-8589

Direct inquiries regarding fiscal issues to:

Crystal Elliott
Grants Administration Branch
National Cancer Institute
Executive Plaza South, Room 243
Bethesda, MD  20892
Telephone:  (301) 496-7800 Ext. 19


This program is described in the Catalog of Federal Domestic Assistance
No. 93.399, Cancer Control Science Program.  Awards are made under
authorization of the Public Health Service Act, Title IV, Part A.
(Public Law 78-410, as amended by Public Law 99-158, 42 USC 285) and
administered under PHS grants policies and Federal Regulations 42 CFR
52 and 45 CFR part 74.  This program is not subject to the
intergovernmental review requirements of Executive Order 12372 or
Health Systems Agency review.


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