Key Dates

Related Announcements

• April 25, 2024 - Notice of Preapplication Webinar for NOSI NOT-CA-24-033: Telehealth Research in Cancer Care. See Notice NOT-CA-24-025
• January 18, 2024   - Modular R01s in Cancer Control and Population Sciences (R01 Clinical Trial Optional). See NOFO PAR-24-122
• December 15, 2023  - Cancer Prevention and Control Clinical Trials Grant Program (R01 Clinical Trial Required). See NOFO PAR-24-072
• December 05, 2022  - NCI Small Grants Program for Cancer Research for Years 2023, 2024, and 2025 (NCI Omnibus) (R03 Clinical Trial Optional). See NOFO PAR-23-058
• June 13, 2022  - Innovative Approaches to Studying Cancer Communication in the New Information Ecosystem (R01 Clinical Trial Optional). See NOFO PAR-22-164
• June 13, 2022 - Innovative Approaches to Studying Cancer Communication in the New Information Ecosystem (R21 Clinical Trial Optional). See NOFO PAR-22-165
• March 31, 2022  - Leveraging Health Information Technology (Health IT) to Address and Reduce Health Care Disparities (R01 Clinical Trial Optional). See NOFO PAR-22-145
• November 16, 2021  - Patient-Clinician Relationship: Improving Health Outcomes in Populations that Experience Health Care Disparities (R01 Clinical Trial Optional). See NOFO PAR-22-064
• October 12, 2021  - Exploratory Grants in Cancer Control (R21 Clinical Trial Optional). See NOFO PAR-21-341

Issued by

National Cancer Institute (NCI)

Purpose

The purpose of this Notice of Special Interest (NOSI) is to highlight the interest of NCI’s Division of Cancer Control and Population Sciences in receiving investigator-initiated applications for proposing research on the use and impact of telehealth in cancer-related care, and the implications of telehealth policy changes on cancer care access, outcomes, and health equity.

Background

Telehealth encompasses a variety of clinical interactions and communication modalities. As defined by the Centers for Medicare and Medicaid Services (CMS), “telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health.” The Health Resources and Services Administration (HRSA) extends this definition to include the use of telecommunications technologies to support distant clinical health care, patient and professional health-related education, public health, and health administration.

Telehealth interactions can occur between clinicians (i.e., provider-provider interactions) or between clinicians and patients (including interactions with family members or other caregivers of patients). Telehealth interactions can also be categorized as synchronous (real-time) or asynchronous (sequential). Synchronous telehealth examples include telephone calls and videoconferencing; asynchronous telehealth examples include the capture and forwarding of medical images and secure messaging. The technology used for telehealth includes hardware (such as computers, cameras, mobile phones, wearable devices, and sensors) and software (such as electronic health records [EHRs], patient portals, image processing software, digital aids to support cognition and behavior change, and clinical decision support systems).

The use of telehealth has grown in recent years, and the rapid and widespread adoption of virtual visits has been facilitated by changes in coverage and reimbursement for telehealth. Over the past three years, there has been a substantial increase in the use of telehealth as a care modality for cancer patients. Concurrently, several state and federal policy restrictions related to delivering and reimbursing telehealth care were relaxed during the COVID-19 pandemic. As a result, there have been many state and federal policy changes related to provision and coverage of telehealth. Examples include restrictions in telehealth visits across state lines that were previously enabled by relaxing the state-specific provider licensing requirements, and restrictions on use of telehealth visits for prescriptions of controlled substances such as for pain management. These policy changes may affect populations covered by Medicare, Medicaid, and private insurers. Such changes may have differential effects on vulnerable populations based on cancer type, geography, socioeconomic status, race or ethnicity, disability, sexual or gender minority status, and other characteristics. The shifts in state and federal policy offer an opportunity to examine the effects of changes in telehealth policies on cancer care outcomes and examine effects on health equity.

Research Objectives

The scope of telehealth research encompassed by this NOSI includes (a) synchronous and asynchronous communications and other digital interactions between clinicians and patients (including family members and other caregivers), (b) communications and other digital interactions between and among clinicians, and (c) the evaluation of telehealth policy changes on cancer care access, outcomes, and health equity. The proposed telehealth research can focus on any part of the cancer care continuum (ranging from cancer prevention to end-of-life care) for patients of all age groups in all types of care settings. This research may use a natural experiment, observational, or interventional study design, or a combination of study designs.

This NOSI encourages research focused on patient-provider interactions including, but not limited to, studies that:

• Examine the utilization and effectiveness of telehealth for primary and secondary cancer prevention such as counseling for tobacco, alcohol, physical activity, diet, HPV vaccination, and mental health; providing genetic counseling for germline mutations; shared decision making for preference-sensitive cancer screening tests; and improving adherence to cancer screening.
• Evaluate the effectiveness of telehealth interventions aiming to increase cancer screening rates, improve the accuracy and timeliness of cancer diagnoses and resultant staging, and initiate appropriate cancer treatment.
• Evaluate the effectiveness of telehealth in improving treatment and management of cancer and/or the provision of palliative care.
• Evaluate the use of telehealth to support cancer survivors, including psychosocial care, surveillance for adverse effects of cancer treatments, recurrence of cancer, and treatment of co-morbidities.
• Evaluate the impact of telehealth on patient, family, and caregiver experiences with care and quality of life in the context of cancer care.
• Evaluate the quality and effectiveness of telehealth interactions in promoting patient-centered communication.
• Understand the tasks, and the time and cognitive burden of performing the tasks, imposed by the telehealth interactions on patients and their caregivers.

This NOSI encourages research focused on provider-provider telehealth interactions including, but not limited to, studies that:

• Evaluate the effectiveness of telehealth in improving communication and coordination of oncology care, including communication and coordination between oncology care and primary care providers.
• Evaluate the effectiveness of telehealth for precision oncology, including the use and interpretation of tests for genomic or other molecular markers.
• Evaluate the effectiveness of telehealth for recruitment, enrollment, monitoring, and retention of patients in clinical trials.
• Understand the clinical workflow and the cognitive and other burdens imposed by current clinical information technology (IT) systems on providers in their telehealth-related interactions.
• Understand how organizational policies, billing practices, clinical team interactions, and the configuration of IT systems influence the clinical workflow and delivery of telehealth.
• Examine the cost effectiveness of telehealth in cancer-related care.

This NOSI encourages research focused on evaluating the impact of changes in telehealth policy on cancer care access, patient outcomes, and health equity, including, but not limited to, studies that:

• Examine the impact of changes in state policy related to geographic differences in licensing requirements for use of telehealth services across state lines.
• Examine the effects of potential changes in federal (i.e., CMS) telehealth policies related to access and coverage that are set to expire January 1, 2025.
• Examine the effects of potential changes in federal (i.e., Drug Enforcement Administration and Health and Human Services) requirements for in-person visits related to prescriptions of controlled substances for cancer-related pain management, which are in place through December 2024.
• Generate baseline data to track potential changes in telehealth policy.

Studies that examine interactions at multiple levels (i.e. patient, provider, and care delivery system-level) or intervene at multiple levels are also of interest.  In addition, it is important that studies use best practices for interoperability across IT systems and devices and ensure that patient privacy and confidentiality are protected as required by applicable laws and regulations.

NCI encourages research on populations that experience inequities in access to care, have limited access to broadband and digital technologies, have low health and/or digital literacy, and have worse cancer outcomes compared to the general population, especially those accessing care in community and rural primary care and oncology practices. NCI also strongly encourages research that examines how telehealth can be implemented without creating or exacerbating health disparities, as well as research that examines how telehealth can be used to address health disparities and promote health equity.  Applications in response to this NOSI should strive to advance actionable knowledge on the optimal use of telehealth in support of patient and clinician interactions during the course of cancer care delivery.

R21s and R03s may support formative work to develop telehealth interventions or examine their impact in pilot studies. R01s may support projects that integrate and evaluate telehealth interventions in a cancer care delivery context. Applicants are encouraged to identify the aspects of telehealth that are being tested in order to isolate their effects on variability in specified patient outcomes.

Applications Not Responsive to this NOSI

Studies that are outside the scope of this NOSI include stand-alone mHealth, Web-based interventions, or decision support tools that do not have an explicit connection with cancer care delivery. In addition, development of new drugs or devices is outside the scope of the NOSI.

Application and Submission Information

This Notice applies to due dates on or after June 5, 2024, and subsequent receipt dates through March 16, 2026. This NOSI expires March 17, 2026.

Submit applications for this initiative using one of the following Notices of Funding Opportunity (NOFOs) or any reissuances of these announcements through the expiration date of this notice. 

For other NCI funding opportunities relevant to healthcare delivery research and behavioral research, please visit the NCI Healthcare Delivery Research Program’s Funding Opportunities page (https://healthcaredelivery.cancer.gov/funding/) and the NCI Behavioral Research Program’s Funding Opportunities page (https://cancercontrol.cancer.gov/brp/funding). 

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

• For funding consideration, applicants must include “NOT-CA-24-033" (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.

Applications nonresponsive to terms of this NOSI will be withdrawn from consideration for this initiative.

Inquiries

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

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

Gurvaneet Randhawa, MD, MPH
National Cancer Institute (NCI)
Telephone: (240) 276-6940
Email: [email protected]

Kelly Blake, ScD
National Cancer Institute (NCI)
Telephone: (240) 281-5934
Email: [email protected]