Story 01
Summary
The NCI Cohort Consortium pools data and biospecimens necessary to conduct a range of cancer studies, including identifying novel risk factors associated with cancer etiology.
Current State
There is a great need for more fundamental and clinical research to understand cancer biology in ways that lead to effective prevention or interception methods.
Strategy
Undertake fundamental and translational research to increase understanding of cancer etiology and the molecular nature of precancer and its relationship to genetic, behavioral, and environmental influences and social determinants of health.
DCCPS Contribution
DCCPS formed the NCI Cohort Consortium to provide a coordinated, interdisciplinary approach to tackling important scientific questions related to cancer etiology, economies of scale, and opportunities to quicken the pace of research. Through its collaborative network, the Cohort Consortium increases the exchange of information and promotes collaborative research, particularly on cancer incidence and outcomes for rare cancers, cancer subtypes, and rare exposures. The consortium currently comprises 74 cancer etiology and cancer survivor cohorts located in North America, Europe, Asia, and Australia, representing approximately 7 million participants. Over 80 collaborative projects have led to scientific discoveries about cancer risk factors and advances in epidemiology methodologies that can be applied in cancer prevention efforts. Through annual meetings and other activities, the Cohort Consortium keeps pace with cutting-edge initiatives in cancer etiology and data collection and utilization methods. Some recent examples include initiatives related to data harmonization, cohort data modernization, and unique uses of cohort data in fields including metabolomics, proteomics, and social and geospatial risk factors for cancer.
Story 02
Summary
Through key partnerships, DCCPS works to increase human papillomavirus (HPV) vaccination uptake and reduce incidence and mortality from cervical cancer.
Current State
Uptake of the HPV vaccine is steadily increasing in the United States, but many more cancers could be prevented if all eligible people received this safe and effective vaccine. Regional variation in vaccine uptake is driven by challenges with access, vaccine hesitancy, and misunderstanding of the value of the vaccine for cancer prevention. Interventions are needed to address each challenge while building on local needs and strengths.
Strategy
Develop, test, and evaluate interventions that incorporate individual-, system-, and societal-level approaches to promote cancer risk-reducing behaviors for people of all ages.
DCCPS Contribution
Every year, thousands of cervical, anal, penile, and other cancers are caused by HPV. Uptake of the HPV vaccine started slowly in the United States. A vaccine was approved by the US Food and Drug Administration in 2006 because of excellent safety profiles and strong evidence of efficacy. However, unlike other vaccines recommended for adolescents, and despite insurance coverage and a strong recommendation from the Centers for Disease Control and Prevention (CDC), by 2013 fewer than 40% of eligible girls and boys were fully vaccinated against these cancers (pmc.ncbi.nlm.nih.gov/articles/PMC5779422).
In 2014, the President’s Cancer Panel Report called underuse of HPV vaccines a “serious but correctable threat to progress against cancer.” Building on the strength of our cancer centers, NCI provided small supplemental sums to jump-start their focus on local uptake of HPV vaccine across the US. These early efforts were quickly joined by state and local health departments focused both on cancer and immunization. The CDC provided state-based expertise and worked with NCI and the American Cancer Society to develop a national effort to increase uptake of the HPV vaccine. Dozens of partners joined a National HPV Vaccination Roundtable (hpvroundtable.org) focused on ensuring all perspectives were included in unified, clear, and accurate health communication messages. These unified messages were shared nationally when all of NCI’s Designated Cancer Centers, for the first time, spoke with one voice to declare the importance of HPV vaccination. NCI collaborated with these partners and focused on research gaps, offering funding to identify how health care providers can work with their staff to increase HPV vaccine uptake and hosting meetings of cancer researchers working to build shared knowledge. Since these collaborative efforts began in 2014, HPV vaccination rates have increased year by year, with current data showing that 76.9% of adolescents received at least 1 dose of the vaccine in 2022, and 61.7% were up to date on the vaccination in 2022. NCI and many partners continue to develop, test, and maintain interventions to support the integration of HPV vaccination into clinical practice, reduce vaccine hesitancy, and address local and national immunization barriers and strengths to continue to accelerate progress toward full uptake of the HPV vaccine.
Story 03
Summary
OPTImize Cancer Survivorship (OPTICS) works to encourage healthy behaviors and optimal behavioral health for cancer survivors.
Current State
Scientists estimate that we could prevent more than half of all cancers by applying the knowledge that we have now. This knowledge includes altering behavior to reduce the risk from modifiable factors, such as tobacco use, alcohol use, obesity, a sedentary lifestyle, and sun exposure. More research in implementation science and targeted interventions could significantly reduce cancer incidence and death from cancer by identifying new ways to increase the uptake of proven prevention approaches.
Strategy
Develop, test, and evaluate interventions that incorporate individual, system, and societal-level approaches to promote cancer risk-reducing behaviors for people of all ages.
DCCPS Contribution
The DCCPS Promoting Healthy Lifestyles to OPTImize Cancer Survivorship (OPTICS) Working Group is conducting foundational activities to better understand the implementation of behavioral health interventions and programs within NCI-Designated Cancer Centers and to identify the unmet needs—and the reasons for these unmet needs—within those settings.
These activities include systematic literature reviews and audits of NCI-Designated Cancer Center web pages to identify programs, resources, and information concerning the following four health behavior/behavioral health (HB/BH) domains: smoking/tobacco cessation, physical activity and exercise, alcohol use, and mental health.
The goal is to survey a broad array of stakeholders to identify clinical, economic, and other outcomes of cancer survivorship care and the barriers to integrating HB/BH interventions within survivorship care. Understanding unmet needs for, and barriers to, these HB/BH services can help researchers and health care providers adopt and implement evidence-based interventions, strategies, and policies that promote healthy behaviors and optimal behavioral health in cancer survivors.
Story 04
Also related to Eliminate Inequities.
Summary
New cohorts expand inclusion of diverse populations understudied in cancer research.
Current State
NCI has a long-standing history of supporting cancer epidemiology cohorts to study both cancer etiology and survivorship. Given the changing composition of the US population, coupled with the emergence of new potential risk factors, as well as new cancer treatments and regimens, it is critical to renew resources to address gaps and balance the cohort characteristics in the current NCI portfolio while optimizing the utility of established resources. Advancing our understanding of how cancer develops will inform intervention and prevention strategies. Likewise, research on determinants that affect recurrence and secondary cancers in survivors is valuable for cancer survivorship research.
Strategy
- Undertake fundamental and translational research to increase the understanding of cancer etiology and the molecular nature of precancer and its relationship to genetic, behavioral, and environmental influences, and social determinants of health.
- Understand and address toxic and environmental exposures that contribute to cancer.
- Conduct research to identify ways to prevent additional cancers among cancer survivors.
- Include measures to overcome health disparities at all levels and in all aspects of cancer prevention research.
DCCPS Contribution
DCCPS Epidemiology and Genomics Research Program (EGRP) currently supports over 45 cancer epidemiology cohorts. Collectively, these survivor and etiology cohorts have enrolled over 1 million participants. Moreover, these cohorts have rich epidemiological data and biospecimens that could be leveraged by researchers worldwide to investigate novel research questions.
More recently, EGRP has enhanced its efforts to increase the diversity of the cohorts in NCI’s portfolio. Three funding opportunities with targeted goals and set-aside funds were recently published: (1) Utilizing Cohort Studies to Address Health Outcomes in Cancer Survivors, (2) New Cohorts for Environmental Exposures and Cancer Risk (CEECR), and (3) Cannabis and Cannabinoid Use in Adult Cancer Patients During Treatment: Assessing Benefits and Harms. Together, these initiatives resulted in the creation of 14 new cancer epidemiology cohorts (four cohorts addressing health outcomes in survivors, five cohorts focused on environmental exposures and cancer risk, and five survivor cohorts focused on cannabis use during treatment) that are currently enrolling targeted populations and establishing prospectively collected resources to be shared and leveraged by the extramural community.
In addition, new epidemiology cohorts can be proposed through the Building the Next Generation of Research Cohort initiative, aimed at establishing future cohorts that address critical scientific gaps related to novel or unique exposures that may influence cancer risk and outcomes. This initiative also emphasizes improving the inclusion of diverse populations who are understudied (extending beyond race and ethnicity) in cancer research. Additionally, NCI seeks to leverage resources from existing cohorts for hypothesis-driven studies through the Research Opportunities in Established Cancer Epidemiology Cohort Studies initiative. Established cohorts—those that have achieved their initial planned recruitment goal—are well- characterized and offer rich exposure data, biospecimens, considerable follow-up time, and cancer information. Through the Research Opportunities in Established Cancer Epidemiology Cohort Studies initiative, researchers can propose studies that leverage existing cohort data and biospecimens to propose novel hypotheses and address gaps in scientific knowledge.
The DCCPS-led cohort initiatives are designed to complement and align with the goals of the National Cancer Plan and DCCPS. Through these efforts, NCI enables progress in addressing current and future scientific priorities important for cancer control and prevention. A diverse and comprehensive portfolio of NCI-supported cohorts would provide an invaluable resource and create a pipeline for downstream generation of critical information to advance cancer prevention and improve the cancer survivorship experience across diverse populations for current and future generations. Ultimately, the vision is to enhance the utility and power of cancer epidemiology cohorts by creating and optimizing investments within the epidemiology cancer research community.
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