RFA: Cancer Health Equity Research Centers

Purpose  

The American Cancer Society (ACS) believes that everyone should have a fair and just opportunity to prevent, find, treat, and survive cancer (Alcaraz et al, 2020).

Background

Addressing the root causes of cancer health disparities in the context of the social determinants of health is needed to accelerate progress in health equity research. This requires addressing obstacles to health caused by poverty and discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care (Alcaraz et al, 2020).

Cancer health disparities largely result from inequities in wealth leading to differences in exposure to risk factors and barriers to high‐quality cancer care (Siegel et al, 2021). Societal factors, such as structural racism, have downstream effects on the ability of some population groups to thrive. Discriminatory practices such as redlining impede access to home ownership and to a quality education, which impacts a person's level of educational attainment and employment, and thus, the degree of wealth. Interrelated factors of racism, discrimination, education, employment, wages, neighborhood, health insurance coverage, and access to care all intersect to impact health outcomes.

Ideally, everyone diagnosed with cancer should be able to receive high-quality cancer care (Yabroff et al, 2020). New cancer technologies and treatments can cause or exacerbate health disparities due to access or affordability barriers (Elmore et al, 2021). For example, being able to access a clinical trial offers the opportunity for people living with cancer to receive new therapies. However, even with access to protocol-directed care in clinical trials, high area-level socioeconomic deprivation is associated with worse survival (Unger et al, 2021). There is a critical need for research addressing tangible, impactful solutions for equitable access to high-quality cancer care and ways in which optimal outcomes can be achieved. 

Scientific Scope 

Due to the complexities associated with social determinants of health and cancer, multi-level and multi-sector research that addresses the interactions of factors responsible for cancer inequalities within communities is required. This RFA is a call for solution-based research addressing cancer health disparities that will contribute to achieving health equity. Thirty percent (30%) of the planned research participants must be racial and ethnic minorities or live in rural or medically underserved areas. Teams may propose collaborations with consortia of community hospitals and/or oncology practices, public hospitals, or other academic institutions or medical centers to accrue study participants. Collectively, the CHERC funds will support innovative research centered on a common goal of achieving sustainable health equity in your community.

Areas of Interest

Research topics could include:

• Integration of social-determinants-of-health screening tools and interventions into practice, to ensure that the revealed needs are addressed and monitored;
• Strategies to prevent diagnostic or treatment delays regardless of health insurance or socioeconomic status, geographic location, age, race, ethnicity, gender, gender identity, or sexual orientation;
• Strategies to increase participation of medically underserved populations in clinical trials;
• Strategies to overcome barriers or promote facilitators of treatment adherence, and interventions to target care planning and coordination between teams of health care professionals caring for people being treated for cancer.

Who Should Apply

All investigators must be at an accredited college, university, or medical school, within the United States (in accordance with ACS grant policies). Applicants from underrepresented groups and from Minority Serving Institutions (MSIs) are encouraged to apply. MSIs are institution of higher learning that serve minority populations, such as Historically Black Colleges and Universities (HBCUs), Hispanic-Serving Institutions (HSIs), Tribal Universities (TCUs), and Asian-American-and-Pacific-Islander-Serving Institutions (AAPISIs), and Alaska Native and Native Hawaiian Serving Institutions (ANNH). For more information see U.S.C. Title 20.

We strongly encourage applications from diverse teams and study participants. All applications should include individuals from underrepresented groups as members of their research team. Applicants who are not from MSIs are encouraged to collaborate with MSIs or health systems providing care to minority or underserved populations within their community to expand the impact and reach of their Center.

The Principal Investigator (PI):

• Must be a full-time faculty member at the rank of Associate or Full Professor at a college, university, or eligible non-profit within the United States or its territories. Assistant Professors who have led large R-level or equivalent grants or have held health leadership positions may apply.            
• Must have a track record addressing cancer healthy disparities or health equity evident by: Extramural cancer research funding, mentoring junior investigators, publications in peer-reviewed journals, and administrative/leadership experience (e.g., deputy director or director of a program, center, or department).

Project Budget and Sub-Award Mechanism(s) 

A total budget of $4.08 M ($3.4 M direct cost plus 20% indirect cost) for a 4-year project period will support research, collaboration among researchers, and community engagement. Subawards include the following ACS research grant mechanisms: Clinician Scientist Development Grant (CSDG), Postdoctoral Fellowship (PF), and Research Scholar Grant (RSG). The PI may propose any combination of subawards that is within the specified budget limits. For example, a PI may propose 2 RSGs, 1 CSDG, and 1 PF or 3 RSGs only or any other combination of subawards that collectively does not exceed the maximum budget allowed.                        

1. Clinician Scientist Development Grants (CSDGs) provide support for protected time to allow faculty who are involved with patient care and who do not lead an independent research program, to be mentored and participate in research training to aid their development as independent clinician scientists. Applicants can request from 3 to 4 years, at $135,000 direct costs per year. If the subaward is at a secondary institution, 8% indirect costs per year may be claimed by the secondary institution.
2. Postdoctoral Fellowships (PFs) provide 2 or 3 years of support for investigators within 4 years of receiving a doctoral degree to receive mentored research and training experiences with the goal of becoming an independent investigator. The award covers annual stipend support of $66,000, $68,000, and $70,000 for the first, second, and third years, respectively. Fellows eligible for only 2 years may request progressive stipends of $68,000 and $70,000, respectively. The award also includes a $4,000 annual fellowship allowance and an additional $1,500 in the final year for travel to a scientific conference.                            
3. Research Scholar Grants (RSGs) fund an independent researcher with a full-time faculty position and a doctoral degree for 4 years at $200,000 per year direct costs. If the  subaward is at a secondary institution, 20% indirect costs may be claimed by the secondary institution. For this RFA, faculty may be at any rank. The research must be multi-level and involve 2 or more social determinants of health.

See CHERC Policies PDF and CHERC Instructions PDF

Letter-of-Intent Process

A letter-of-intent (LOI) process will be used for selecting investigators to submit a full application. LOIs are only required for new submissions. See the LOI Instructions for the required information.

CHERC LOI Instructions

Expectations for Full Applications

Required application components for the CHERC and the subawards can be found in the CHERC Instructions document. The following components are especially unique and integral to the application:

• Inclusion of underrepresented populations and investigators from populations underrepresented in research;
• Establishing a community/stakeholder advisory board;
• Developing strategies that address social determinants of health to translate research findings to the community;
• An action plan for practical, clinical, and public health benefits and community engagement (i.e., an implementation guide for equity).

Application Review

An independent and competitive peer review of grant applications will be conducted. See the CHERC Instructions document for more information on the review criteria. Reviewers will evaluate proposals based on:

• Importance of the cancer health disparity topic and clarity of the hypothesis in the context of at least 2 social determinants of health. The assessed impact will be evaluated on how the proposed center activities and research subawards will contribute to achieving health equity. The Center and all subaward applications will be evaluated.
• Strength of the experimental design, scientific rationale, investigators, innovation, scientific environment, and framing of the Center to address multifactorial, intersecting factors contributing to the cancer health disparity research topic(s) proposed. Where applicable, collaborations with a consortia of community hospitals, oncology practices, public hospitals, primary care practices, and community partners, etc. will also be evaluated.
• Potential for the work, if successful, to positively influence the care of people seeking cancer prevention, screening, and early detection services or receiving cancer treatment and survivorship services.   
• Inclusion of at least 30% of study participants who are medically underserved or part of a population group with known health disparities, such as those characterized by age, race or ethnicity, religion, literacy, socioeconomic status, mental health, disability, gender, sexual orientation, or gender identity, geographic location, or other characteristics historically linked to discrimination or exclusion.

Questions: Please contact kimberly.clarke@cancer.org

See CHERC Policies PDF  and CHERC Instructions PDF

References

Alcaraz, KI, Wiedt T, Daniels ED, Yabroff KR, Guerra C, Wender RC. Understanding and Addressing Social Determinants to Advance Cancer Health Equity in the United States: A Blueprint for Practice, Research, and Policy. CA Cancer J Clin. 2020;70(1):31-46.

Alfano CM, Leach CR, Smith TG, Miller KD, Alcaraz KI; Cannady RS, Wender RC, Brawley OW. Equitably Improving Outcomes for Cancer Survivors and Supporting Caregivers: A Blueprint for Care Delivery, Research, Education, and Policy. CA Cancer J Clin. 2019;69:35–49.

Braveman P. A new definition of health equity to guide future efforts and measure progress. Health Affairs Blog Health Equity. 2017.

Edwards H, Monroe DY, Mullins CD. Six ways to foster community-engaged research during times of societal crises. J Comp Eff Res. 2020;9(16):1101-1104.

Elmore LW, Greer SF, Daniels ECD, Saxe CC, Melner MH, Krawiec GM, Phelps WC. Blueprint for Cancer Research: Critical Gaps and Opportunities. CA Cancer J Clin. 2021 Mar;71(2):107-139.

Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021;71(1):7-33.

Unger J, Moseley AB, Cheung CK, Osarogiagbon RU, Symington B, Ramsey, SD, Hershman, DL. Persistent Disparity: Socioeconomic Deprivation and Cancer Outcomes in Patients Treated in Clinical Trials.  J Clin Oncol. 2021

Yabroff KR, PhD, Gansler T, Wender RC, Cullen KJ, Brawley OW. Minimizing the Burden of Cancer in the United States: Goals for a High-Performing Health Care System. CA Cancer J Clin. 2019; 69(3):166-183.

Other Resources on Minority-Serving Institutions  

United States Department of Education Lists of Postsecondary Institutions Enrolling Populations with Significant Percentages of Undergraduate Minority Students

Minority Serving Institutions Program

College Student Guide to Minority Serving Institutions

2020 NASA List of Minority Serving Institutions

Populations Underrepresented in the Extramural Scientific Workforce