Notice of Intent to Publish a Funding Opportunity Announcement for Advancing Cancer Control Equity Research Through Transformative Solutions (U19 Clinical Trial Optional)

Key Dates

None

National Cancer Institute (NCI)

The National Cancer Institute (NCI) intends to publish a Notice of Funding Opportunity (NOFO) to solicit applications to the Advancing Cancer Control Equity Research through Transformative Solutions (ACCERT) initiative. Up to four (4) Research Centers and one (1) Coordination Center will be funded as part of the ACCERT Consortium’s effort to address the impact of social determinants of health (SDOH) on adverse cancer control outcomes.

Each Research Center will: 1) develop interventions that target the multilevel pathways by which SDOH impact adverse cancer outcomes; 2) develop measures, methods, and assess community-level SDOH, community engagement and cancer control equity processes and outcomes; and 3) build capacity among diverse scholars and community partners to implement interventions that incorporate the lived experiences of those who face cancer inequities.

The NOFO will utilize the U19 Research Program - Cooperative Agreements activity code.

The NOFO is expected to be published in Summer 2023 with an expected application due date in early Fall 2023. Details of a pre-application webinar will be announced after the publication of the NOFO. The NOFO is expected to use the U19 mechanism; clinical trial is optional. This Notice is being provided to allow potential applicants with meaningful community collaborations time to develop responsive projects, and with relevant expertise and insights to consider applying for this new NOFO.

Potential applicants are encouraged to view the presentation of this initiative to the Joint Virtual Meeting of the NCI Board of Scientific Advisors (BSA) and the National Cancer Advisory Board (NCAB), available at: (https://videocast.nih.gov/watch=48653) beginning at 1 hour, 8 minutes. Presentation slides are downloadable at https://deainfo.nci.nih.gov/advisory/joint/1222/Oh.pdf.

Recent data indicate that while cancer mortality has declined overall, not all populations have benefited from such progress. Cancer disparities are often the result of historical, social, and structural inequities with implications across the cancer control continuum. Specifically, SDOH are the unfair and avoidable factors that influence health. This includes the conditions of the environment in which people are born, grow, live, learn, work, play, and age that impact health outcomes, and operate at multiple levels of influence (e.g., individual, family, community, systems, and population levels). Examples of SDOH with the potential to adversely affect cancer prevention and control across individual and community levels include housing instability, transportation barriers, structural racism and discrimination, language accessibility, health literacy, food access and insecurity, limited physical activity opportunities, and poor air and water quality. Cancer control equity means that everyone has a fair and just opportunity to prevent and detect cancer, receive quality care, and survive cancer with optimal quality of life.

Achieving cancer control equity requires a concurrent emphasis on developing interventions that address the multilevel influences of SDOH on adverse cancer outcomes; collaboration across multiple sectors and partners to leverage community insights and assets; and fostering meaningful community engagement with and building capacity among those disproportionately affected by cancer. In this manner, health equity is not only the goal or outcome, but the approach, process, and methods by which the research is conducted. Community engagement, as an approach to addressing health equity, is well-documented and effective in addressing historical power imbalance, building trust, improving participation in research, as well as enhancing acceptability, feasibility, and uptake of interventions both within and beyond the health care system. This NOFO requires meaningful community engagement in the development and testing of multilevel SDOH interventions.

Objectives and Scope

This initiative requires each ACCERT Center to conduct at least one signature community-engaged, multilevel SDOH intervention research project and related pilot studies over the course of the grant period. Each ACCERT Center must propose an overarching research theme related to addressing health equity by intervening on multilevel SDOH influences on cancer control outcomes. Themes may focus on addressing inequities related to health promotion, cancer prevention, screening, care delivery, and/or survivorship for individuals, families, neighborhoods, and communities from underserved groups. The proposed theme should inform the overall scientific agenda of each ACCERT Center, including study design, methodological approaches, and dissemination activities. The research theme should be identified in collaboration with community partners and transdisciplinary researchers, as well as guide the selection and participation of relevant sectors and stakeholders. Lastly, the research theme should be synergistic, with projects and cores connected by the common theme, and describe anticipated scientific gains beyond those achievable if each project were pursued independently.

Examples of research areas of interest include, but are not limited to:

• Development of multilevel interventions that address pathways by which SDOH impact community and/or individual level cancer risks or outcomes (e.g., cancer-related health behaviors, exposure to carcinogens, psychological distress, financial toxicity, and related cancer decision-making and family cancer caregiving).
• Interventions to modify the effects of historical and contemporary injustices on receipt of cancer prevention, detection, or treatment services (e.g., historical trauma, immigration policies, criminal justice, and others), and/or chronic experiences of structural racism and discrimination, and related individual level experiences with bias and discrimination on cancer control inequities.
• Interventions that combine community and individual approaches to healthy lifestyles by integrating behavioral interventions with interventions that modify related SDOH at community, clinic, and/or policy levels (e.g., combining food environment or built environment with related behavior change interventions).
• Development and testing of SDOH interventions that address historical and contemporary inequities and structural barriers to receipt of cancer-related health services (e.g., staff training, service delivery settings, health care and service utilization, health literacy, cost, and financial toxicity) and individual outcomes to reduce inequalities.
• Interventions to mitigate the effects of community social risks on cancer preventive behaviors, screening, care delivery and follow up for medically underserved populations, including individuals experiencing homelessness, incarcerated or formally incarcerated populations and their families.
• Develop and test strategies that collect and use community level SDOH data (e.g., food access, transportation, housing, interpersonal safety, utilities) to rapidly communicate and inform the delivery of targeted and tailored interventions to reduce disparities in cancer control outcomes.

Key considerations:

• Community partners are a critical part of this funding opportunity and must be integrated in every aspect of the program, including direct involvement in the study planning, conduct, and evaluation.
• Studies must be designed to be relevant to local community needs and context. Consequently, the studies may not be generalizable, thus common data elements will be required to capture the diversity of studies and outcomes.
• The intervention studies included in the research projects must include a cancer-related primary endpoint (e.g., screening, cancer-related preventive behaviors, access to cancer care, adherence to guideline concordant treatment, health-related quality of life, etc.).
• All intervention studies must have component(s) that target and assess mechanisms of intervention effectiveness at multiple levels of influence.

ACCERT Center Components: To support the objectives of the ACCERT Consortium, each ACCERT Center must apply community-engaged approaches and consider the feasibility, acceptability, and sustainability of the proposed methods in the design of multilevel SDOH interventions. Research teams within each ACCERT Center may be composed of investigators located at one institution or may be formed through a collaboration of investigators located at different institutions. Community partners within each ACCERT Center should demonstrate collaborative history with the research team(s) as evidenced by community-partnered activities with relevant outcomes (e.g., study design and implementation, communication and dissemination efforts, community education and outreach program development, etc.)

Each Center will include the following components:

Administrative Core: The Administrative Core should manage and coordinate all ACCERT Center operational and scientific activities, within a cohesive organizing framework, including fiscal management, evaluation, communication, and dissemination. The Administrative Core should also manage and support coordination of efforts for integration, responsiveness, and interaction within the ACCERT Consortium in collaboration with the ACCERT Coordination Center to promote synergistic research efforts. Each ACCERT Center is required to participate in consortium-wide collaborative activities, including pilot studies that will facilitate synergy and address unmet scientific priorities across the ACCERT Consortium.

Research Methods, Measures, and Data Management (RMMDM) Core: The RMMDM Core will meet the ACCERT Center's goal of developing methods, measures, and assessing community-level SDOH, community engagement and cancer control equity processes and outcomes.  The RMMDM Core will be responsible for applying or developing measures to assess the impact of the multilevel SDOH intervention on cancer control outcomes from at least two levels of influence (e.g., individual, community). The following two required elements of the RMMDM Core are also described below:

Community Engagement: Each ACCERT Center must track and evaluate community engagement processes, approaches, and outcomes as they relate to the multilevel cancer control outcomes and disseminate results.
Community and Developmental Pilot Projects: Each ACCERT Center will be expected to detail a process by which they will employ community feedback and engagement for rapid and responsive pilot studies on the following topics to advance and compliment the proposed SDOH intervention: to adapt or develop multilevel equity outcome measures, consider evolving community policies, needs, or community multi-sector change impacting equity outcomes, or dissemination and communication tools to enhance community engagement.

Capacity Building Core: This core will build capacity among diverse scholars and community partners on community engagement, cancer research, and development and testing of SDOH interventions that incorporate the lived experiences of those who face cancer inequities.  The Core must support capacity building efforts that include community partners as active research team members, assist with the development of research questions for pilot studies, and the translation of scientific findings into accessible formats and practice, as aligned with the ACCERT Center themes.

Social Determinants of Health (SDOH) Research Project: The Center must develop and test at least one large scale multilevel SDOH intervention(s) that is informed by a conceptual model to guide hypotheses and mechanisms by which the intervention components will impact cancer control equity outcomes across multiple levels. To assess the impact of the multilevel intervention, measures of health equity and related outcomes will be required at two or more levels included in the study design, with an assessment and analytical plan that evaluates the cumulative effects as well as individual effects of the interventions at and across each level. 

Funding Information

Public/State Controlled Institution of Higher Education
Private Institution of Higher Education
Nonprofit with 501(c)(3) IRS Status (Other than Institution of Higher Education)
Small Business
For-Profit Organization (Other than Small Business)
State Government
Indian/Native American Tribal Government (Federally Recognized)
County governments
Independent school districts
Public housing authorities/Indian housing authorities
Indian/Native American Tribally Designated Organization (Native American tribal organizations (other than Federally recognized tribal governments)
U.S. Territory or Possession
Indian/Native American Tribal Government (Other than Federally Recognized)
Regional Organization
Eligible Agencies of the Federal Government

Applications are not being solicited at this time. 

Inquiries

April Y. Oh, PhD. MPH
National Cancer Institute (NCI)
Telephone: 240-753-3154
Email: [email protected]

Brenda Adjei, M.P.A., Ed.D.
National Cancer Institute (NCI)
Telephone: 240-753-3154
Email:[email protected]