The purpose of this Notice is to inform potential applicants of the interest of the National Cancer Institute (NCI) in supporting implementation research related to cancer prevention and control in low- and middle-income countries (LMICs) and in low resource settings. This Notice also aligns with the Global Alliance for Chronic Diseases (GACD) 2020 Cancer Call.

Background

Cancer is a leading cause of premature death worldwide. In 2018, an estimated 18.1 million new cancer cases were diagnosed and there were 9.6 million deaths from cancer. Predictions suggest that 30 million people will die from cancer each year by 2030, of whom 75% will be in low- and middle-income countries (LMICs). This increase may be attributed to the aging of societies, the 'epidemiologic transition' in many LMICs, the high prevalence of behavior that increase the risk of developing cancer, as well as the socioeconomic inequalities that result in delayed diagnosis or care provision and poor-quality care in many LMIC settings.

It is estimated that 30-50% of all cancers are preventable. Specifically, one-third of global cancer deaths are attributable to behavioral risk factors, such as tobacco and alcohol use, low fruit and vegetable intake, obesity, and lack of physical activity. Tobacco use alone accounts for around 22% of the cancer mortality. Around 20-25% of cancer incidence in LMICs is attributable to chronic infections, including human papillomavirus (HPV), hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), Epstein Barr virus (EBV), human T-cell leukemia virus 1 (HTLV1), helicobacter pylori, and other pathogens. Increasingly, in LMICs, exposure of humans to environmental risk factors, such as air pollution, poses an increasing challenge to health. Within high-income countries, similar patterns are seen in populations experiencing health disparities and greater exposure to cancer risk factors.

A key challenge to reducing the global burden of cancer, particularly among people in LMICs and in other populations experiencing disparities, is the poor implementation of cancer prevention and control strategies that are known to work. Implementation of effective, evidence-based interventions has been central to cancer control in many high-income countries (HICs). Yet, in LMICs and other low-resource environments, such interventions are under-used or have limited impact because of implementation challenges that have yet to be identified, researched, and addressed.

Research Objectives

NCI encourages applications that pursue innovative approaches to identifying, understanding, and developing strategies for overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions, tools, policies, and guidelines in low-resource settings. The research projects on which these applications will be based should be focused on dissemination and implementation research for the primary and secondary prevention of cancer in LMICs and/or in populations facing conditions of vulnerability in HICs. The projects described in grant applications must be built on evidence-based interventions (including cost-effectiveness) for the respective population groups under defined contextual circumstances. For promising interventions, a limited validation period can be envisaged. However, the core of the research activities should focus on their implementation in real-life settings.

NCI is interested in proposed studies to adapt and scale-up the implementation of these interventions in accessible, affordable, and equitable ways in order to improve the prevention and early diagnosis of cancer in real-life settings. Interventions should meet conditions and requirements of the local health and social system context and address any other contextual factors identified as possible barriers.

Research topics in the context of LMICs and other low-resource environments include, but are not limited, to the following:

• Strategies to implement health promotion, prevention, screening, early detection, and diagnostic interventions, as well as effective treatments, clinical procedures, and/or guidelines, into existing care systems.
• Implementation of multiple evidence-based practices within community or clinical settings to meet the needs of cancer patients.
• Local adaptation of evidence-based practices in the context of implementation.
• Longitudinal and follow-up studies on the factors that contribute to the sustainability of evidence-based interventions in public health and clinical practice.
• Testing the effectiveness and cost-effectiveness of dissemination or implementation strategies to reduce health disparities and improve quality of care among cancer patients.
• Reducing or stopping ("de-implementing") the use of clinical and community practices that are ineffective, unproven, low-value, and/or harmful.
• Relationship of context and local capacity of clinical and community settings to adoption, implementation, and sustainability of evidence-based practices.
• Prospective or retrospective studies of the adoption, implementation, and sustainability of health policies and their interaction with programs and contextual factors.
• Influences on the creation, packaging, transmission, and reception of evidence for effective health interventions.
• Strategies to impact organizational structure, climate, culture, and processes to enable dissemination and implementation of clinical/public health information and effective clinical/public health interventions.
• Studies that focus on the testing of theories, models, and frameworks for dissemination and/or implementation processes.
• Studies of policies and other contextual factors that influence the success of dissemination and/or implementation efforts.

NOTE: Applications proposing/describing projects involving and/or conducting research on animals are not appropriate for this funding opportunity.

Funded researchers will be invited to participate in the GACD network through its Annual Scientific Meeting and related activities. For more information about GACD, see https://www.gacd.org

Application and Submission Information

This Notice applies to application due dates on or after June 5, 2020, and subsequent receipt dates through May 8, 2022.

Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcements through the expiration date of this Notice.

PAR-19-274: Dissemination and Implementation Research in Health (R01 Clinical Trial Optional)

PAR-19-275: Dissemination and Implementation Research in Health (R21 Clinical Trial Optional)

PAR-19-276: Dissemination and Implementation Research in Health (R03 Clinical Trial Not Allowed)

All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions:

• For funding consideration, applicants must include NOT-CA-20-025 (without quotation marks) in the Agency Routing Identifier field (box 4b) of the SF424 R&R form. Applications without this information in box 4b will not be considered for this initiative.

Note: Investigators planning to submit an application in response to this NOSI are strongly encouraged to contact and discuss their proposed research (aims) with an NCI program officer listed on this NOSI and/or on the listed funding opportunity announcements well in advance of the chosen application receipt date.

Applications nonresponsive to terms of this NOSI will be not be considered for the NOSI initiative.

Please direct all inquiries to the contacts in Section VII of the listed funding opportunity announcements with the following additions/substitutions:

Scientific/Research Contacts:

Marie D Ricciardone, Ph.D.
National Cancer Institute (NCI)
Telephone: 240-276-5151
Email: marie.ricciardone@nih.gov

Gila Neta, Ph.D.
National Cancer Institute (NCI)
Telephone: 240-276-6785
Email: gila.neta@nih.gov