Future Direction: Digital Health

Establishing Cancer-focused Telehealth Research Centers of Excellence

In the United States, there has been a substantial increase in telehealth use in recent years. Research has shown that telehealth can improve healthcare access and quality, patient-provider communication, and health outcomes. Importantly, many aspects of cancer care can be delivered through telehealth, such as the promotion of positive health behaviors and cancer screening, remote patient monitoring and management of symptoms during cancer treatment, and virtual survivorship follow-up care. In response, DCCPS, supported by the Cancer Moonshot, launched the Telehealth Research Centers of Excellence (TRACE) initiative to ensure cutting-edge findings are quickly adopted into effective and equitable practice.

Over the next 5 years, four centers will focus on improving people’s lives by

• Rapidly developing an evidence base of telehealth approaches to cancer care, spanning prevention to survivorship 
• Identifying and addressing disparities in access to and use of telehealth services for cancer-related care
• Fostering innovations to improve cancer care delivery using new tools, research methods, and technologies
• Evaluating the changing policy, payment, and communication environments and their impact on the delivery of telehealth for cancer care 

Digital Health as a Solution for Patient-Provider Communication

DCCPS continues to diversify the digital health funding landscape through the use of different NCI funding mechanisms. In spring 2023, DCCPS solicited administrative supplements via NOT-CA-23-041 to better understand the effects of digital health tools and interventions on patient-provider communication across the cancer control continuum, with the aim of developing an evidence base to inform future development, modification, and delivery of digital tools/intervention for effective cancer prevention and control. The NOSI received a robust response, with 12 funded projects focused on leveraging diverse digital tools and interventions, including remote symptom monitoring, electronic medical records, mobile applications, and artificial intelligence (AI) to improve patient-provider communication in areas such as cancer survivorship and lung cancer screening.

Exploring Emerging Technology with Government-wide Support

DCCPS is partnering within NCI and across NIH and the federal government to contribute to more than 15 funding opportunities focused on digital health and evolving technologies. For example, as a partner in the NIH-National Science Foundation (NSF) Smart Health initiative, DCCPS aims to accelerate the development and use of innovative approaches that partner technology and data science-based solutions with biomedical and behavioral health research. The program supports high-risk, high-reward research focused on improving fundamental understanding of biomedical and behavioral health-related processes across a variety of areas, including information science, data science, technology, health disparities, behavior, sensors, imaging, and engineering. DCCPS is also currently soliciting applications via NOT-CA-22-037 to validate digital health tools and AI technologies that are currently or have the potential to be adopted and implemented in real-world settings across the cancer control continuum.

Leveraging Collaboration to Move the Digital Health Needle

Digital health innovation requires collaboration throughout the government. DCCPS program staff lead and participate in the Digital Health R&D Interagency Working Group, which aims to improve the health of Americans by advancing digital health technologies that support personalized health screening, monitoring, diagnosis, and treatment.

Additionally, DCCPS staff collaborated with the Office of the National Coordinator for Health Information Technology (ONC) to contribute subject matter expertise to the United States Core Data for Interoperability Version 4 (USCDI v4), published in July 2023 (PDF, 0.5MB), which included physical activity data elements as Core Measures (see page 16 of PDF), alongside other new data elements that focus on improving equity across the healthcare ecosystem. Finally, DCCPS program staff also lead and participate in the NIH Telehealth Interest Group, a collective of institutes and centers dedicated to promoting telehealth research and practice across NIH.

Boosting Innovation in the Fight Against Cancer

Announced by the Cancer Moonshot^SM in February 2023, CancerX is a public-private partnership to boost innovation in the fight against cancer. With a mission to identify, support, grow, and implement world-class digital solutions to reduce the burden of cancer for all people, CancerX aligns with the goals set forth in the National Cancer Plan and DCCPS’s mission.

The inaugural project is developing evidence, best practices, and a toolkit focused on improving equity and reducing financial toxicity in cancer care and research through digital health technologies. Building on this work, CancerX will be launching a demonstration project in 2024 that will combine the implementation and evaluation of a digitally enabled cancer care model with the development of an associated alternative payment model to combine clinical decision support, virtual-first care, and navigation programs at scale to improve patient access and reduce financial toxicity. DCCPS staff represent NCI as inaugural members on this groundbreaking initiative to champion high-quality innovation in cancer care, address methodological gaps where they exist, and define best practices for successful and equitable implementation. 

Planning for the Future

Digital health plays a pivotal role in the future of cancer control research, enabling integration, analysis, and interpretation of patient data. As we think toward the future, it is important to understand how digital health approaches can advance the assessment, monitoring, and understanding of multilevel cancer risk factors and determinants; increase participant reach and engagement in clinical, behavioral, and epidemiological cancer research; and improve the delivery of cancer-related care.

In addition to identifying and addressing multilevel barriers to equitable access to, engagement with, and use of digital health technologies across constituent groups and cancer-related settings, we must also address the need for training and workforce development to foster the dissemination and adoption of digital health research and technology in cancer control.