Key Dates

Related Announcements

• November 12, 2024 - Cancer Prevention and Control Clinical Trials Grant Program (R01 Clinical Trial Required). See PAR-25-167
• November 08, 2024 - Exploratory Grants in Cancer Control (R21 Clinical Trial Optional). See PA-25-253
• November 7, 2024 - Modular R01s in Cancer Control and Population Sciences (R01 Clinical Trial Optional). See PA-25-172
• November 5, 2024 - Cancer Prevention and Control Clinical Trials Planning Grant Program (U34 Clinical Trials Optional). See PAR-25-103
• November 5, 2024 - Cancer Prevention and Control Clinical Trials Planning Grant Program (R34 Clinical Trials Optional). See PAR-25-104
• October 31, 2024 - Dissemination and Implementation Research in Health (DIRH)  (R21 Clinical Trial Optional). See PAR-25-143 
• October 30, 2024 - Dissemination and Implementation Research in Health (DIRH) (R01 Clinical Trial Optional). See PAR-25-144
• October 18, 2024 - NCI Small Grants Program for Cancer Research (NCI Omnibus) (R03 Clinical Trial Optional). See PAR-25-078
• December 14, 2022 - National Cancer Institute Program Project Applications (P01 Clinical Trial Optional). See PAR-23-059

Issued by

National Cancer Institute (NCI)

Purpose

The purpose of this Notice of Special Interest (NOSI) is to promote intervention research through investigator-initiated applications that aim to study ways to mitigate financial hardship for individuals impacted by a cancer diagnosis, including patients receiving cancer treatment, survivors, and caregivers.

Background

The 2021 Annual Report to the Nation on the Status of Cancer estimated the annual patient economic burden of cancer care to be $21 billion in 2019. Part of that burden is felt as financial hardship for patients. Financial hardship refers to the collective impact of out-of-pocket costs and lost income, psychological worry about finances, and behavioral coping responses that include delaying or foregoing recommended care and other necessities to save money. Cancer-related financial hardship is the product of varied risk factors, including high prescription drug prices, private health insurance benefits that shift healthcare costs to patients through higher co-pays and deductibles, high out-of-pocket costs, increasingly multimodal treatments, and supportive care therapies delivered by an array of providers. Recent national data indicate that more than half of cancer survivors report material and/or psychological financial hardship. The consequences of financial hardship are wide-ranging and can result in diminished quality of life for patients and their families and, in extreme cases, premature death.

Patients with fewer financial resources to buffer the high cost of cancer care are especially vulnerable to cancer-related financial hardship. Further, those patients most at risk for financial hardship are also less likely to have access to paid sick leave, flexible work schedules, and other accommodations, leading to higher rates of job loss. Thus, the growing financial burden associated with cancer care will likely exacerbate existing disparities in both care and health outcomes.

Although there is a growing body of literature that has established the impact of financial hardship on select patient outcomes, development, and testing of interventions to mitigate patient financial hardship is needed. Additionally, there remain noteworthy barriers to addressing patient economic concerns for individuals treated both in academic cancer centers and the community. These multilevel barriers include a lack of transparency regarding the cost of treatment, unclear pathways or workflows to connect patients with financial services, and substantial time and resources required to provide financial services for patients. Continued research is needed to advance interventions to address these important challenges and mitigate poor patient health outcomes due to cancer-related financial hardship.

Research Objectives

This notice invites research applications that propose to develop and/or test interventional approaches to prevent and/or mitigate financial hardship in individuals diagnosed with cancer. Intervention targets may include the patient, caregiver, clinician, healthcare team, and/or healthcare delivery system, with multi-level research encouraged. Proof of concept and studies testing the efficacy of interventions are acceptable; however, proposed studies should address the potential for intervention sustainability and scalability. Research studies that integrate expertise from diverse scientific and clinical areas (e.g., health services, health economics, outcomes research, health communications, social work, pharmacy, nursing, and oncology) are of particular interest. Studies that target populations identified to be at risk for health disparities are strongly encouraged.

Areas of research interest include, but are not limited to:

• Develop and test interventions to facilitate systematic financial hardship screening in cancer-related care delivery settings.
• Develop and test interventions to innovate the workflow linking patients to financial services, and/or reduce resource burden in providing financial services.
• Implement and evaluate evidence-based strategies to mitigate out-of-pocket costs and their influence on cancer-related care during diagnosis, treatment, follow-up, and/or survivorship.
• Implement and evaluate patient, provider, healthcare system, and/or community-level interventions to mitigate the impact of financial hardship and employment disruption and enhance health equity.
• Develop and test tools that enhance patient and clinician communication related to the direct medical or non-medical costs of cancer-related care and supportive care or communication about financial hardship more broadly.
• Develop and test interventions with populations at increased risk for cancer-related financial hardship and who experience health disparities (e.g. racial/ethnic minorities, rural residents, sexual and gender minorities, socioeconomically disadvantaged individuals).
• Implement and evaluate interventions to improve cost transparency of treatments and healthcare services delivered to cancer patients and survivors.

Application and Submission Information

This notice applies to due dates on or after February 05, 2025, and subsequent receipt dates through January 08, 2028.

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

All instructions in the How to Apply - 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-25-035” (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.

Inquiries

Scientific/Research Contact(s)

Kate Castro, MS, RN, AOCN
National Cancer Institute
Telephone: (240) 276-6834
Email: castrok@mail.nih.gov 

Peer Review Contact(s)

Examine your eRA Commons account for review assignment and contact information (information appears two weeks after the submission due date).

Financial/Grants Management Contact(s)

Crystal Wolfrey 
National Cancer Institute (NCI)
Telephone: 240-276-6277 
Email: wolfreyc@mail.nih.gov