We understand the need to remain nimble so that we can adjust priorities as new opportunities to accelerate progress emerge in rapidly changing scientific and health care contexts.
As we move into 2016, we in the Division of Cancer Control and Population Sciences (DCCPS) at NCI look back on 2015 as a year in which we began pivotal work on the goals we’ve set for shaping our nation’s cancer control strategy for the coming decade.
In 2015, we took many important strides in that direction, most notably reorganizing the structure of our division to address new and emerging priorities. For example, we formed the Healthcare Delivery Research Program to serve as the foundation around which health services work throughout the division is organized, with the goal of improving survival and enhancing the patient experience across the cancer control continuum. In our Epidemiology and Genomics Research Program, Dr. Kathy Helzlsouer accepted the role of Associate Director, bringing with her a valuable blend of medical and scientific perspectives — critically necessary to leading an area of science that is increasingly inter- and multidisciplinary. Meanwhile, other DCCPS programs and branches convened working groups, comprising internal and external experts, to identify the most important scientific questions and objectives to be addressed in the coming decade.
Based in large part on those strategic planning efforts, as well as on NCI priorities and those highlighted in the Vice President’s cancer initiative, we have selected specific research opportunities on which we plan to focus our greatest efforts in DCCPS. In this issue of our annual Overview and Highlights, we lay out those priorities, briefly describing the challenge for the research community and providing examples of ways in which the division is currently responding to those challenges.
Even as we identify those areas of research in which we hope to have the greatest and most immediate impact, we understand the need to remain nimble so that we can adjust priorities as new opportunities to accelerate progress emerge in rapidly changing scientific and health care contexts.
We are grateful to our partners and to the many experts in our research and advocacy community who have contributed recommendations and advice over the past year as we set our strategic agenda for cancer control. We hope that you will find this issue of Overview and Highlights a valuable source for identifying areas of interest and collaboration and that you will continue to share your perspectives as we work together to make progress against cancer.
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In this Overview and Highlights, DCCPS features six priorities that are listed “for immediate action and continued progress” and an additional five priorities “to revisit, revitalize, and develop.” The six priorities for immediate action and continued activity include tobacco control research; health disparities; revitalizing Surveillance, Epidemiology, and End Results (SEER) for research use; precision medicine; HPV vaccination uptake; and observational outcomes research. The five priorities to revisit, revitalize, and develop include survivorship; diet, weight, and physical activity; behavioral science methods; colorectal cancer screening; and geospatial research.
These 11 division-wide priorities reflect ongoing, concerted investments that are responsive to NIH and NCI priorities, such as health disparities and precision medicine. They address behaviors that continue to take an enormous toll on public health, such as tobacco use. And they reflect immense opportunities for advancement, such as increasing uptake of HPV vaccination. However, DCCPS is not focusing on these priorities to the exclusion of other important areas of work. The division continues to invest in research across the cancer control continuum.
For each priority below, we include examples of DCCPS initiatives and activities that illustrate ways in which the division is addressing that priority.
Tobacco use is still the leading cause of preventable death in the US. Despite half a century of progress in tobacco control and prevention, the devastating health and economic effects of tobacco use continue. In order to bring this epidemic to an end, innovative research is needed to address a myriad of factors, including a changing population of users, evolving patterns of initiation and use, new and modified tobacco products, and a complex and changing policy environment. We must implement what we already know, while not being “limited” by past strategies in tobacco control, supporting cross-cutting research that accelerates progress in behavioral science relevant to tobacco use; treatment development and delivery; policy, system, and environmental changes; and public health interventions.
In the United States, rates of preventable and detectable cancers are falling for the general population, but for some cancers, minority communities are still suffering at disproportionate rates. NCI’s research priorities in the area of cancer disparities encompass the entire cancer control continuum, from identifying and understanding the role of biology in disparities, to cancer prevention, treatment, and survivorship. A variety of research efforts is needed to better understand and address the disparities that exist in cancer incidence, treatment access, and outcomes. In addition, research is needed to improve methodologies and selection of appropriate research sample sizes that will allow for generalization of findings to racial and ethnic subpopulations across the US.
The SEER Program has been supporting research on the diagnosis, treatment, and outcomes of cancer since 1973. SEER’s timely, complete, and accurate surveillance data, statistical methodologies and tools, and surveillance infrastructure all support cancer research in health care, technology, and scientific environments that continue to change. In December 2015, Lynne Penberthy, Associate Director for the division’s Surveillance Research Program, presented a comprehensive update on the SEER Program to NCI’s Board of Scientific Advisors and National Cancer Advisory Board. The presentation provided an overview of the program and also focused on new projects designed to expand SEER’s capacity to support research.
After decades of research, we are poised to enter a new era of cancer prevention and treatment that takes into account people’s individual variations in genes, environment, and lifestyle. The President’s Budget for NCI for fiscal year (FY) 2016 contains funding increases for priority research to advance the field of precision medicine. Under the Precision Medicine Initiative (PMI), NIH will create a research cohort of more than 1 million American volunteers who will share genetic data, biological samples, and diet/lifestyle information, all linked to their electronic health records if they choose. Research based upon the cohort data will advance pharmacogenomics, the right drug for the right patient at the right dose; identify new targets for treatment and prevention; test whether mobile devices can encourage healthy behaviors; and lay scientific foundation for precision medicine for many diseases.
In 2014, the President’s Cancer Panel released a report calling for a coordinated effort to increase the rates of vaccinations against human papillomavirus (HPV). The report, Accelerating HPV Vaccine Uptake: Urgency for Action to Prevent Cancer, calls increasing the rate of HPV vaccinations one of the most profound opportunities in cancer prevention today. The two HPV vaccines – Cervarix and Gardasil – both prevent the two types of HPV that cause 70% of all cervical cancers. Despite this, only 33% of adolescent girls and less than 7% of boys in the US have completed the 3-dose series of either vaccine. DCCPS is pursuing areas of research that could potentially lead to higher vaccination rates.
Despite the significant advances in cancer research over the past decade, many patients with cancer do not receive optimum care. In addition, the economic burden associated with cancer is staggering, with costs expected to only increase as the population ages and more expensive screening, diagnostic, and therapeutic strategies are adopted as standards of care. The complexity of research on the quality and economic impact of cancer care requires more comprehensive sources of meaningful data and scientifically sound methods to enhance the linkages of traditional databases and cancer registries. Moreover, outcomes research must increasingly consider not only traditional biomedical endpoints, such as survival and disease-free survival, but also patient-reported outcomes that reflect the perspective of the individual with cancer.
In 2015, there were an estimated 14.5 million cancer survivors in the United States, and that number is projected to increase to almost 19 million by 2024.
In 2015, there were an estimated 14.5 million cancer survivors in the United States, and that number is projected to increase to almost 19 million by 2024. These exponential increases underscore the growing need to better understand and improve survivorship care and the survivorship experience, including possible physical and financial changes, risks of persistent or late-occurring effects – and interventions to prevent or mitigate them – the psychosocial needs of cancer survivors and their caregivers, the role of physical activity, and the need to develop and integrate effective and efficient models of care.
Over the past few decades, the incidence of obesity has risen markedly in the United States and in many other countries around the world. The so-called obesity epidemic has substantial implications for cancer research and cancer control, given that obesity is associated with increased risks of developing cancer at many sites. In recent years, researchers have been focusing on energy balance, or the integrated effects of diet, physical activity, and genetics on growth and body weight over an individual’s lifetime, and on how those factors may influence cancer risk. Further interdisciplinary research is needed to refine our understanding of the associations between obesity and specific cancers, the mechanisms underlying these associations and their potential reversibility, and to support behavioral research to help overcome obesity at the individual and population levels.
Cancer morbidity and mortality are greatly influenced by behaviors such as tobacco use, physical activity, vaccination, and sun exposure, and by psychological and behavioral processes including stress, cognition, emotion, and communication. Changes in the health and scientific landscape are posing many important new demands on behavioral research. Fortunately, new data sources, technological innovations, and methodologies have created novel ways to address the changing paradigm in health behavior research, offering the opportunity to adopt a multilevel approach to understanding behavior and the downstream effects of behavior on cancer incidence, progression, and quality of life.
Colorectal cancer is one of only a few cancers that can be prevented, and deaths from colorectal cancer have decreased with the use of colonoscopies and fecal occult blood tests. But racial and ethnic disparities in colorectal death rates persist, and the reasons for these differences have not been entirely elucidated. Transdisciplinary research in cancer screening has helped us to better understand how to improve the screening process, including recruitment, diagnosis, and referral for treatment. However, effective messaging is still needed to reach the unscreened, and barriers to health care access must be removed. Successful models are needed for coordinated, high-quality colorectal cancer screening and follow-up care that engages patients and empowers them to complete needed care from screening through treatment and long-term follow-up.
Spatial context is a key factor in health, as it can influence the risk of getting a disease, the ability to adopt a healthy lifestyle, and the ease of access to medical services for disease diagnosis and treatment and for preventive care. Geospatial data and tools, therefore, play an important role in cancer research by integrating data on exposure, neighborhood characteristics, and access to health services. Robust geographic information systems are critical to answering key questions about cancer incidence, morbidity, mortality, cancer-related health status, and health disparities in diverse regions and populations, as well as the impact of cancer control interventions on the cancer burden in the United States.
In addition to encouraging the best scientific ideas for researchers through investigator-initiated applications and omnibus solicitations, DCCPS develops and participates in NIH funding opportunities aimed at stimulating new directions in specific research to examine, discover, and test methodologies to improve public health. The following are examples of recent Funding Opportunity Announcements to encourage research projects in emerging or priority areas:
Researchers funded by DCCPS have advanced the science to improve public health for nearly two decades, and we celebrate their scientific advances and research accomplishments in cancer control and population sciences. Major programmatic areas include epidemiology and genomics research, behavioral research, health care delivery research, surveillance research, and survivorship research.
In fiscal year 2015, DCCPS funded 726 grants valued at more than $423 million, with work in the United States and internationally aimed to reduce risk, incidence, and deaths from cancer, and to enhance the quality of life for cancer survivors. While the majority of DCCPS funding is for investigator-initiated research project grants, the division also uses a variety of strategies to support and stimulate research such as multi-component specialized research centers and cancer epidemiology cohorts.
Learn more about the DCCPS grant portfolio and funding trends at cancercontrol.cancer.gov/current_research.html.
As a window into the many ways DCCPS provides return on investment, we highlight here just a few snapshots of progress from the past year.
The DCCPS 2015 New Grantee Workshop brought together approximately 40 new investigators who received their first R01 in 2012 and 2013 to help them successfully manage their grants and advance their careers.
In 2015, the Team Science Toolkit included nearly 2,300 resources drawn from the range of fields and disciplines creating the evidence-base for effective team science.
As of FY 2015, 264 peer-reviewed publications had used data from the Health Information National Trends Survey (HINTS), which monitors changes in the rapidly involving fields of health communication and health information technology.
More than 90 common genetic variations are associated with breast cancer risk. The Breast Cancer Genetic Epidemiology Challenge is stimulating innovation in breast cancer research by giving participants access to genetic data from thousands of ethnically diverse research participants for the first time.
In July 2015, more than 450 patients, researchers, practitioners, and advocates participated in a “Coping with Cancer” Twitter chat about caregiving. The division’s Office of Cancer Survivorship, in collaboration with NIMH, led the chat with an expert group of more than 25 cancer centers and advocates. NCI and NIMH coined the hashtag #CopingCancer, which appeared more than 93 million times in a little over an hour as part of the chat.
DCCPS co-hosted the Annual Conference on the Science of Dissemination and Implementation in Health in 2015. The number of abstract submissions nearly tripled — increasing by more than 137% (from 217 in 2012 to 515 in 2015).
The SEER-Medicare Health Outcomes Survey (SEER-MHOS) was updated in FY 2015 to include data on more than 126,000 patients with cancer. Sponsored by NCI and the Centers for Medicare & Medicaid Services, the SEER-MHOS is a major data source for studies of cancer care.
DCCPS and CDC’s Office on Smoking and Health released Smokeless Tobacco and Public Health: A Global Perspective in 2015, the first-ever report to provide a global estimate of the number of smokeless tobacco users worldwide. Smokeless tobacco is used in a variety of forms in at least 70 countries and by more than 300 million people.
The Did You Know? series of short videos from DCCPS explains some of the statistics and trends behind different types of cancer, as well as related topics, such as the link between excess weight and cancer risk. As of 2015, viewers could choose from more than a dozen options by opening the “Choose a video” drop-down menu.
The DCCPS-sponsored International Cancer Screening Network (ICSN) held its annual meeting in Rotterdam, the Netherlands, in June 2015, focusing on global health. The ICSN comprises 23 member countries.
As of FY 2015, the Smokefree.gov initiative had expanded to include 15 smoking cessation and healthy lifestyle text message programs, reaching adult smokers and other audiences such as teens, pregnant women and new mothers, veterans, and Spanish speakers. Subscribers have access to free programs such as SmokefreeTXT, HealthyYouTXT, SmokefreeMOM, and SmokefreeVET.
The Division’s Healthcare Delivery Research Program co-funds the Medical Expenditure Panel Survey (MEPS) Experiences with Cancer Survivorship Supplement, which is used to improve national estimates of the burden of cancer. In 2015, DCCPS researchers published key findings on financial hardship among cancer survivors. Financial hardship was most common (28.4%) for cancer survivors aged 18-64 years (Yabroff et al. J Clin Oncol, Dec 7, 2015).