CDC-RFA-DP17-1701Publicationrev.pdf

Centers for Disease Control

National Center for Chronic Disease Prevention and Health Promotion

Cancer Prevention and Control Programs for State, Territorial, and Tribal Organizations

CDC-RFA-DP17-1701

Application Due Date: 02/21/2017

Cancer Prevention and Control Programs for State, Territorial, and Tribal Organizations

CDC-RFA-DP17-1701

TABLE OF CONTENTS

Part I. Overview Information Federal Agency NameA.

Funding Opportunity TitleB.

Announcement TypeC.

Agency Funding Opportunity NumberD.

Catalog of Federal Domestic Assistance (CFDA) NumberE.

Dates F.

Executive Summary G.

Part II. Full Text Funding Opportunity Description A.

Award Information B.

Eligibility Information C.

Required Registrations D.

Review and Selection Process E.

Award Administration Information F.

Agency Contacts G.

Other Information H.

Glossary I.

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-DP17-1701. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC)

B. Funding Opportunity Title:

Cancer Prevention and Control Programs for State, Territorial, and Tribal Organizations

C. Announcement Type: New - Type 1

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42 -vol1-sec52-2.pdf. Guidance on how CDC interprets the definition of research in the context of public health can be found at http ://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf .

D. Agency Funding Opportunity Number:

CDC-RFA-DP17-1701

E. Catalog of Federal Domestic Assistance (CFDA) Number:

93.898

F. Dates:

1. Due Date for Letter of Intent (LOI): 01/12/2017 Is a LOI: Recommended but not Required The purpose of a Letter of Intent (LOI) is to allow CDC program staff to estimate the number of and plan for the review of submitted applications. An LOI is not required, but strongly encouraged for the National Breast and Cervical Cancer Early Detection Program, the National Comprehensive Cancer Control Program and the National Program of Cancer Registries.

The LOI should include the following:

Descriptive title of proposed project Name, address, telephone number, and email address of the Principal Investigator or Project Director, or both Name, address, telephone number, and e-mail address of the primary contact for writing and submitting this application Number and title of this FOA

If an LOI is submitted, it must be emailed or postmarked by January 12, 2017, 11:59 p.m. U.S. Eastern Standard Time

LOIs may be sent via email, U.S. express mail or delivery service to:

Frances Babcock

Department of Health and Human Services

Centers for Disease Control and Prevention

4770 Buford Hwy, NE, MS F-76

Atlanta, GA 30341

Telephone: 770-488-3069

Email: DP171701mailbox@cdc.gov

2. Due Date for Applications: 02/21/2017, 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Date for Informational Conference Call: 01/05/2017

G. Executive Summary:

1. Summary Paragraph:

The CDC, Division of Cancer Prevention and Control (DCPC) announces the availability of Fiscal Year 2017 funds to implement https://foa.grantsolutions.gov/www.grants.gov https://foa.grantsolutions.gov/www.grants.gov https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf http://www.grants.gov

The CDC, Division of Cancer Prevention and Control (DCPC) announces the availability of Fiscal Year 2017 funds to implement DP17-1701, a National Cancer Prevention and Control Program. This FOA supports implementation of a comprehensive and coordinated approach to inform policy, systems, and environmental change strategies to prevent and control cancer. It supports high quality breast and cervical cancer screening services, statewide cancer coalitions to plan and implement cancer control priorities, and surveillance programs to monitor and report cancer burden.

These priorities will be accomplished by funding three national programs:

1) The National Breast and Cervical Cancer Early Detection Program- funds will be awarded up to 75 applicants to include state health departments and the District of Columbia or their Bona Fide Agents; Territories/Pacific Island Jurisdictions; and Federally Recognized American Indian Tribes, Tribal Organizations, Alaska Native Organizations, and Urban Indian Organizations for implementing a program to provide breast and cervical cancer screening services to uninsured and underinsured women and implement key evidence-based strategies to reduce structural barriers to screening within health systems.

Approximately $155 million per year is available.

2) The National Comprehensive Cancer Control Program- funds will be awarded to up to 65 applicants including one award per state and the District of Columbia; U.S Territories; and Federally Recognized American Indian Tribes, Tribal Organizations, Alaska Native Organizations, and Urban Indian Organizations for implementing a program to support cancer coalition efforts that leverage resources to plan and implement evidence-based strategies to promote the primary prevention of cancer; support cancer early detection efforts; address the needs of cancer survivors; and promote health equity. Approximately $22 million per year is available.

3) The National Program of Cancer Registries- funds will be awarded to up to 55 applicants including state health departments, the District of Columbia (or their Bona Fide agent) and U.S Territories for implementing a population-based core Cancer Registry program. Approximately $38 million per year is available.

In addition, optional funding will be awarded to eligible NPCR applicants to pilot public health prevention surveillance projects related to one of 3 focus areas (Collection of cervical cancer precursors, Collection of screening data for breast and cervical cancer cases, and Collection of new or emerging prognostic factors) is submitted. Approximately $1.6 million per year is available.

a. Eligible Applicants: Limited

b. FOA Type: Cooperative Agreement

c. Approximate Number of Awards: 85

d. Total Project Period Funding: $1,075,000,000

e. Average One Year Award Amount: $850,000

f. Number of Years of Award: 5

g. Estimated Award Date: 06/30/2017

h. Cost Sharing and / or Matching Requirements: Y Program 1: NBCCEDP Recipient financial participation is required for this program in accordance with the authorizing legislation. Section 1502(a) and (b)(1), (2), and (3) of the Public Health Services (PHS) Act, as amended, requires matching funds from non-Federal sources in an amount not less than one dollar for every three dollars of Federal funds awarded under this program. However, Title 48 of the U.S.

Code 1469a (d) requires DHHS to waive matching fund requirements up to $200,000 for Guam, U.S. Virgin Islands, American Samoa and the Commonwealth of the Northern Mariana Islands.

Matching funds may be cash, in-kind or donated services or equipment. Contributions may be made directly or through donations from public or private entities. Public Law 93-638 authorizes tribal organizations contracting under the authority of Title I to use funds received under the Indian Self-Determination Act as matching funds.

Applicants may also designate as State/Tribal/Territorial/Pacific Island Jurisdiction matching funds any non-Federal amounts spent pursuant to Title XIX of the Social Security Act for the screening and case management of women for breast and cervical cancers.

Matching funds may not include: (1) payment for treatment services or the donation of treatment services; (2) services assisted or subsidized by the Federal government; or (3) the indirect or overhead costs of an organization. All costs used to satisfy the matching requirements must be documented by the applicant and will be subject to audit.

Program 2: NCCCP Cost sharing is encouraged if it helps to leverage federal and state resources, is responsive to stated CDC recipient activities, supports the National Comprehensive Cancer Control Program priorities, and does not compromise the integrity or the ability of the comprehensive cancer control program to accomplish proposed activities. Matching funds are not required under this cooperative agreement, but are encouraged.

Program 3: NPCR Per PHS Act (42 USC 280e-280e-4), matching funds are required for Program 3, NPCR applicants in an amount not less than 25 percent of such costs or one dollar for every three dollars of Federal funds awarded under this program; [Title 42, Chapter 6A, Subchapter II, Part M, § 280e(b)(1)]. Matching funds may be cash, in-kind, or donated services or equipment. Contributions may be made directly or through donations from public or private entities. However, Title 48 of the U.S. Code 1469a (d) requires DHHS to waive matching fund requirements for Guam, U.S. Virgin Islands, American Samoa and the Commonwealth of the Northern Mariana Islands up to $200,000. Public Law 93-638 authorizes tribal organizations contracting under the authority of Title 1 to use funds received under the Indian Self-Determination Act as matching funds. Non-federal financial contributions in excess of the Maintenance of Effort may be used for matching.

Matching funds may not include: (1) payment for treatment services or the donations of treatment services (2) services assisted or subsidized by the Federal government; or (3) the indirect or overhead costs of an organization. All costs used to satisfy the matching requirement must be documented by the applicant and will be subject to audit. Documentation of appropriate matching is to be provided in the detailed budget and narrative justification.

Part II. Full Text Executive Summary

The CDC, Division of Cancer Prevention and Control (DCPC) announces the availability of Fiscal Year 2017 funds to implement DP17-1701, a National Cancer Prevention and Control Program. This FOA supports implementation of a comprehensive and coordinated approach to inform policy, systems, and environmental change strategies to prevent and control cancer. It supports high quality breast and cervical cancer screening services, statewide cancer coalitions to plan and implement cancer control priorities, and surveillance programs to monitor and report cancer burden.

These priorities will be accomplished by funding three national programs:

1) The National Breast and Cervical Cancer Early Detection Program- funds will be awarded up to 75 applicants to include state health departments and the District of Columbia or their Bona Fide Agents; Territories/Pacific Island Jurisdictions; and Federally Recognized American Indian Tribes, Tribal Organizations, Alaska Native Organizations, and Urban Indian Organizations for implementing a program to provide breast and cervical cancer screening services to uninsured and underinsured women and implement key evidence-based strategies to reduce structural barriers to screening within health systems.

Approximately $155 million per year is available.

2) The National Comprehensive Cancer Control Program- funds will be awarded to up to 65 applicants including one award per state and the District of Columbia; U.S Territories; and Federally Recognized American Indian Tribes, Tribal Organizations, Alaska Native Organizations, and Urban Indian Organizations for implementing a program to support cancer coalition efforts that leverage resources to plan and implement evidence-based strategies to promote the primary prevention of cancer; support cancer early detection efforts; address the needs of cancer survivors; and promote health equity. Approximately $22 million per year is available.

3) The National Program of Cancer Registries- funds will be awarded to up to 55 applicants including state health departments, the District of Columbia (or their Bona Fide agent) and U.S Territories for implementing a population-based core Cancer Registry program. Approximately $38 million per year is available.

In addition, optional funding will be awarded to eligible NPCR applicants to pilot public health prevention surveillance projects related to one of 3 focus areas (Collection of cervical cancer precursors, Collection of screening data for breast and cervical cancer cases, and Collection of new or emerging prognostic factors) is submitted. Approximately $1.6 million per year is available.

A. Funding Opportunity Description

1. Background

a. Overview Cancer remains the second leading cause of death in the United States. In 2013, approximately 1.6 million people were diagnosed with cancer and more than 584,000 people died of cancer, according to the United States Cancer Statistics. There is also an estimated 14 million cancer survivors. According to the National Cancer Institute, medical cost for cancer in the United States could reach an estimated $207 billion by 2020. The cost of cancer extends beyond the people diagnosed with cancer. Caregivers, family members, friends, and employers may face emotional, social, spiritual, and financial challenges.

CDC's Division of Cancer Prevention and Control (DCPC) works with state health agencies, tribes and tribal organizations, territorial health agencies, and other stakeholders to inform a comprehensive and collaborative approach that addresses cancer prevention and control practices. The goal of the FOA is to decrease cancer incidence, morbidity, and mortality by focusing on underserved populations who have increased cancer risk due to health disparities. This FOA will assist awardees by providing resources and comprehensive evidenced-based programs to prevent, detect, and treat cancers and to improve the quality of life of cancer survivors across the United States. These outcomes will be achieved by increasing appropriate cancer screening services through provision of cancer screenings, eliminating barriers, and implementing key evidence-based strategies; supporting state-wide cancer coalitions and cancer plans to inform strategic policy, systems and environmental changes; and collection and dissemination of cancer surveillance data with enhanced use of cancer data for state planning.

Awardees are expected to use a collaborative and coordinated approach to implement cancer prevention and control activities to reduce the burden of cancer in their communities. This collaboration between public health, communities and health care systems provides a framework to improve the scope and quality of efforts by building upon the efforts of the prior FOA DP12-1205.

b. Statutory Authorities Program 1: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is authorized under sections 1501-1510 [42 U.S.C. 300k, 42 U.S.C. 300l, 42 U.S.C. 3001-1, 42 U.S.C. 300m, 42 U.S.C. 300n, 42 U.S.C. 300 n-1, 42 U.S.C.

300 n-2, 42 U.S.C. 300 n-3, 42 U.S.C. 300 n-4, 42.U.S.C. 300-4a, 42 U.S.C. 300 n-5] of the Public Health Service Act, as amended.

Program 2: The National Comprehensive Cancer Control Program (NCCCP) is authorized under sections 317(k)(2) and (e) of the Public Health Service Act, [42 U.S.C. section247b (e) and (k)(2)], as amended.

Program 3: The National Program of Cancer Registries (NPCR) is authorized under the Public Health Service Act, (42 USC 280e-280e-4; Public Law 102-515), as amended

c. Healthy People 2020 In accordance with the Healthy People 2020 objectives for the nation, this FOA focuses on addressing the national cancer burden.

Measurable outcomes for awardees will be in alignment with the following performance objectives:

Reduce the female breast cancer death rate (Healthy People C-3) Reduce the death rate from cancer of the uterine cervix (Healthy People C-4) Reduce invasive uterine cervical cancer (Healthy People C-10) Reduce late-stage female breast cancer (Healthy People C-11) Increase the number of central, population-based registries from the 50 States and the District of Columbia that capture case information on at least 95 percent of the expected number of reportable cancers (C-12) Increase age-appropriate screening prevalence for cervical and breast cancer (Healthy People C-15 and C-17) Increase the proportion of women who were counseled by their providers about mammograms and Pap tests (Healthy People C-18.1 and C-18.2)

More info is available here: https://www.healthypeople.gov/2020/topics-objectives/topic/cancer/objectives

d. Other National Public Health Priorities and Strategies This program supports strategies to increase and improve the quality of cancer screening, community-clinical linkages, and preventive services in the following national plans and guidelines:

The Guide to Community Preventive Services:

http://www.thecommunityguide.org/ The National Partnership for Action to End Health Disparities:

http://minorityhealth.hhs.gov/npa/ The National Prevention Strategy: http://www.cdc.gov/Features/PreventionStrategy/

The National Quality Strategy:

http://www.ahrq.gov/workingforquality/

e. Relevant Work This FOA builds upon the work previously established by funded awards of DP12-1205 http://www.cdc.gov/cancer/ awards supported the coordination and integration of long-standing cancer activities to reduce cancer morbidity and mortality.

This FOA primarily relates to the four National Center for Chronic Disease Prevention and Health domains http://www.cdc.gov /chronicdisease/pdf/four-domains-factsheet-2015.pdf of action to transform the nation’s health and support Americans to take charge of their own health: 1) epidemiology and surveillance, 2) environmental approaches, 3) health care system interventions, and 4) community programs linked to clinical services.

https://www.healthypeople.gov/2020/topics-objectives/topic/cancer/objectives http://www.thecommunityguide.org/ http://minorityhealth.hhs.gov/npa/ http://www.cdc.gov/Features/PreventionStrategy/ http://www.ahrq.gov/workingforquality/ http://www.cdc.gov/cancer/ http://www.cdc.gov/chronicdisease/pdf/four-domains-factsheet-2015.pdf http://www.cdc.gov/chronicdisease/pdf/four-domains-factsheet-2015.pdf

2. CDC Project Description

a. Approach

Bold indicates project period outcome.

i. Purpose The purpose of this non-research FOA is to provide a comprehensive and coordinated approach to inform policy, systems, and environmental changes that decrease cancer burden. This will be achieved through support of high quality breast and cervical cancer screening services, statewide cancer coalitions and implementing cancer plan priorities at state and local levels, and monitoring cancer burden through surveillance. This will be accomplished by funding three national programs: 1) The National Breast and Cervical Cancer Early Detection Program, 2) The National Comprehensive Cancer Control Program, and 3) The National Program of Cancer Registries.

ii. Outcomes Program 1: National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

Program 1: National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

Short-term Outcomes

• Retention of high quality staff and providers

• Established community partnerships that support increased breast and cervical cancer screening

• Established health system partnerships with broad reach to increase breast and cervical cancer screening

• Measurement and use of high quality data

• Improved knowledge about the need for breast and cervical cancer screening among priority populations

• Reduced barriers and increased access to breast and cervical cancer and diagnostic screening for priority populations

• Increased use of and implementation of multiple EBIs & support strategies within health systems

• Improved provider knowledge of breast and cervical cancer screening and diagnostic guidelines

• Increased appropriate provider recommendations for patients to receive breast and cervical cancer screening

• Increased high quality screening

• Increased adherence to timely diagnostic follow-up

• Increased timely cancer treatment referral Increased knowledge of healthy lifestyle behaviors

Intermediate Outcomes

• Decreased disparities in breast and cervical cancer screening

• Breast and cervical cancer is detected at early stage

• Increased rescreening rates

• Increased adherence to timely diagnostic follow-up and cancer treatment referral

• Increased timely cancer treatment referral Increased health seeking and healthy lifestyle behaviors

Long-term Outcomes

• Reduced breast and cervical cancer morbidity and mortality

• Reduced disparities in breast and cervical cancer incidence and mortality

Program 2 : National Comprehensive Cancer Control Program (NCCCP) Short-Term Outcomes:

• Increased awareness, knowledge, and abilities about cancer prevention and screening among target populations.

• Improved healthcare provider practices and systems to support screening.

• Increased health extender services.

• Improved community-clinical linkages.

• Increased chronic disease self-management support among cancer survivors.

• Improved systems to support quality screening.

• Increased environmental supports for prevention through:

New/enhanced school, worksite, adult & child care programs/strategies to support cancer prevention and screening activities Increased evidence-based lifestyle & wellness survivorship programs.

• Increased policies and systems that promote health lifestyle behaviors and support high quality cancer screening.

Intermediate Outcomes:

• Increased appropriate cancer screening, rescreening, and surveillance of priority populations.

• Improved access to health care and preventive services.

• Increased evidenced-based lifestyle programs to increase healthy living.

• Increased use of evidenced-based lifestyle programs, clinical preventive services, and cancer care among cancer survivors.

• Improved delivery of clinical preventive services and cancer care.

Long-Term Outcomes:

• Reduced cancer risk e.g. tobacco, alcohol, UV exposure, HPV.

• Increase in health seeking and healthy lifestyle behaviors; e.g., HPV vaccination, HBV vaccination, improved physical activity, and improved diet.

• Increased early detection.

• Improved survivorship practices.

• Prevent cancer/ recurrence.

• Decreased cancer incidence.

• Increased quality of life among cancer survivors.

• Reduced cancer morbidity and mortality.

• Reduce cancer disparities.

Program 3 : National Program for Cancer Registries (NPCR)– Component 1

The goals of Component 1 are:

The goals of Component 1 are:

• Collection and dissemination of high-quality data on all reportable incident cancer cases in a timely manner for the purpose of public health cancer prevention and control.

• Improved and enhanced electronic reporting to central cancer registries.

Short Term Outcomes

• Increased access to quality and timely cancer data for stakeholders, partners and researchers

• Increased use of electronic reporting of cancer cases to the central cancer registry.

• Meet established NPCR’s National Data Quality and Advanced National Data Quality standards

• Increased use of NPCR cancer data

• Improved access to enhanced cancer surveillance data

Intermediate Outcomes

• Targeted cancer screening for populations at risk

• Utilization of data for evidence-based decisions

• Utilization of data for cancer prevention and tobacco control strategies at state and local levels

• Increase in flexibility and utility of the cancer registry infrastructure to meet new data needs for cancer prevention and control

Long Term Outcomes

• Increased survival for all cancers

• Decreased incidence, morbidity, and mortality for all cancers

• Reduced cancer risk e.g. tobacco, alcohol, UV exposure

• Increased collaboration with Chronic Disease Programs at state and local levels Program 3 : National Program for Cancer Registries (NPCR)– Component 2

The goal for Component 2 are to identify the feasibility of and/or barriers to collection of new information on cancer cases through cancer registries in one of three focus areas:

• Cervical cancer precursor data and outcomes directly related to cervical cancer prevention programs

• Cancer screening and diagnostic follow-up data on breast and cervical cancer cases

• New or emerging cancer prognostic factors or risk assessment models The Short Term, Intermediate, and Long Term Outcomes for Program 3 - Component 2 (CINIII, Screening, Prognostic Factors) are the same as those listed in Component 1.

iii. Strategies and Activities Program 1: National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

Program Management

• Establish and enhance program infrastructure and capacity to increase breast and cervical cancer screening rates and navigation services to priority population(s) over the length of the project period.

• Hire or retain adequate and qualified staff to manage the program. Essential staff, at the minimum, includes a program director, a data manager, and an evaluator.

• Develop and maintain a fiscal system that tracks and monitors program expenditures, ensures the timely reimbursement of services, and provides detailed fiscal reporting on time.

• Develop an evaluation plan with CDC guidance based on program identified strategies; plan should be updated, as needed, throughout the project period. Plan must include stakeholders, program description, evaluation questions, analytic methods, reporting methods, and process/outcome measures.

• Acquire medical professionals to provide clinical consultation throughout the project period.

• Participate in required CDC meetings and trainings to facilitate the accomplishment of proposed objectives.

Strategy 1 - Program Collaboration (see Collaboration section)

• Collaborate with chronic disease programs on prevention and risk reduction activities.

• Collaborate with central cancer registries for reporting and use of cancer data, to include working with cancer registries who collect enhanced screening and other clinical data on women diagnosed with breast and cervical cancer.

• Collaborate with state cancer coalitions for program planning and identification of priority populations.

• Disseminate information and education including referrals to appropriate immunization programs for their children.

Strategy 2 - External partnerships (see Collaboration section)

• Develop strategic partnerships with local health care facilities such as community health centers, hospitals, and Indian Health Service.

• Partner with non-traditional agencies and organizations such as Bureau of Prisons, Department of Transportation and the Housing and Urban Development.

• Establish or continue partnerships with professional organizations such as state and local governments, American Indian/Alaska Native tribal governments and/or tribally designated organizations, primary care associations, employers, not-for-profit organizations (e.g., the American Cancer Society), the National Association of Community Health Centers, Health Center organizations (e.g., the American Cancer Society), the National Association of Community Health Centers, Health Center Controlled Networks, community-based organizations, for-profit organizations, non-governmental organizations, and community advocates.

Strategy 3 - Cancer data and surveillance (Domain 1)

• Use current state and local level survey data with GIS Mapping, or other information systems and data sources, to pre-identify and describe priority populations and/or communities of need.

• Collect, analyze, and report to CDC required patient-level clinical data (Minimal Data Elements (MDE)).

• Collect, analyze, and report to CDC required clinic-level data.

• Link cancers diagnosed for women who received NBCCEDP services to central cancer registry to collect cancer stage data in the MDEs.

Strategy 4 - Environmental Approaches for Sustainable Cancer Control (Domain 2)

• Educate and assist employers with policies that help make screening services available to women as a way to increase screening rate among low-income women.

Strategy 5 - Community-Clinical Linkages to Aid Patient Support (Domain 4)

• Use community and/or clinic-based health workers/lay advisors, native language speakers, or health educators to conduct community outreach, identify eligible women for screening, provide patient education about risk factors and preventive health behaviors, and address barriers to care.

• Navigate women to community resources, medical homes, or health care systems for cancer screening, diagnostic, genomics and/or treatment resources.

• Work with community and national partners to reach disparate populations and use culturally appropriate interventions that are tailored for the communities for which they are intended.

• Facilitate or refer to health insurance enrollment, if applicable

Strategy 6 - Health Systems Changes (Domain 3)

• Provide timely and appropriate breast and cervical cancer screening services to uninsured or underinsured women who meet NBCCEDP eligibility criteria.

• Provide patient navigation services to assist NBCCEDP-eligible women overcome barriers to complete screening, diagnosis and initiation of cancer treatment. A description to expected patient navigation activities can be found at http://www.cdc.gov/cancer /dcpc/about/foa-dp17-1701/

• Provide timely and appropriate patient navigation services to support low-income women screened with other sources (e.g.

insurance, state funds, Medicaid) through assessing and addressing barriers to cancer screening, diagnosis, and initiation of cancer treatment.

• Conduct a comprehensive assessment of each partner health care delivery system. The assessment should include: breast and cervical screening rates, data/electronic health record (EHR) functionality, patient/health system process flow, standing orders/policies for cancer screening, provider/health system adherence to clinical cancer screening guidelines, patient navigation/community health worker/support services, and use of priority evidence-based interventions (EBIs) or other strategies that support cancer screening.

• Improve breast and cervical cancer screening clinic-level rates and/or strengthen the delivery of cancer screening services through partnerships, including: 1) Implementing evidence-based interventions as described in the Community Guide. See recommended Community Guide interventions at http://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/; and 2) Using data to increase cancer screening rates among the priority population and to identify appropriate interventions.

• Enhance provider and health system/clinic EHRs and Health Information Technology (HIT) systems’ capability to monitor clinic level screening rates and, where applicable, clinical tracking of completeness and timeliness of screening services. Establish a system wide chart audit process to periodically validate screening rates.

Strategy 7 - Program Monitoring and Evaluation (Domain 1)

• Establish and maintain a data system to collect and report to CDC required patient-level clinical data (MDEs) to monitor and track clinical care to ensure high quality screening and diagnostic services are delivered and treatment is initiated for women diagnosed with cancer, as needed, according to CDC performance standards

• Use data management systems to monitor whether women navigated receive appropriate screening, follow-up on abnormal screening results, and referral to treatment, as needed, according to CDC performance standards.

• Collect and report to CDC baseline and annual data, including breast and cervical cancer screening rates, from partner health system clinics where the program is implementing evidence-based interventions.

Program 2 : National Comprehensive Cancer Control Program (NCCCP)

Program Management To maintain the infrastructure required to successfully implement program activities, awardees will:

• Use the majority of funding for program implementation to ensure the capacity to achieve the goals of the program. Staffing http://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/ http://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/ should not comprise more than 40% of the award as the program's success is related to capacity to support the implementation of the cancer plan strategies.

• Coordinate implementation of a statewide cancer plan by the coalition.

• Coordinate and support the periodic revision of a statewide cancer plan by the coalition.

Strategy 1: Program Collaboration

• NCCCP Awardees will convene the Leadership Team comprised of the NCCCP, NBCCEDP, and NPCR Program Directors in their state, tribe or jurisdiction. The NCCCP Program Director will be responsible for facilitating Leadership Team activities to coordinate cancer prevention and control activities across the 3 program components. See “Collaborations” section for additional details.

• Collaborate with central cancer registry to ensure that program efforts are informed by cancer surveillance data.

• Collaborate across all DP17-1701 programs to identify populations with relatively higher cancer risks, incidence, and/or mortality to determine strategies to reduce the burden of cancer for these groups.

• Recruit leadership from all DP17-1701 programs to participate in the cancer coalition.

• Collaborate across all DP17-1701 programs to create synergies that facilitate community level interventions and patient support and health systems change.

• Collaborate with other chronic disease or risk factor prevention programs to include cancer prevention and control strategies in coordinated and categorical chronic disease prevention and control plans.

• Collaborate with other chronic disease or risk factor prevention programs to align implementation of evidence based interventions to optimize prevention strategies addressing shared chronic disease risk factors (e.g. tobacco control strategies.)

See Collaboration section for more detailed information

Strategy 2: External Partnerships

• Support an existing state-, tribe-, territorial-, or jurisdiction-wide cancer coalition to achieve cancer plan goals and objectives.

• Leverage community resources to implement evidenced based interventions that are aligned with promoting the primary prevention and early detection of cancer, addressing cancer survivor needs, and promoting cancer-related health equity.

• Foster and sustain relationships with key organizations whose missions align with the reduction of cancer related morbidity and mortality.

See Collaboration section for more detailed information

Strategy 3: Cancer Data and Surveillance (Domain 1)

• Use cancer risk factor and surveillance data to develop burden reports that inform the state cancer plan and other related program documents.

• Use cancer risk factor and surveillance data to set baselines and targets for selected interventions.

• Routinely present to coalition partners on cancer burden trends data.

Strategies 4 – 6 (Domains 2 – 4)

• Environmental Approaches for Sustainable Cancer Control: implement evidence-based interventions to reduce risk and promote healthy behaviors by enhancing social and physical environments

• Community-Clinical Linkages to Aid Patient Support: implement evidence-based interventions to increase availability and use of cancer-related preventive health services or health extender services.

• Health Systems Changes: implement evidence-based interventions that promote efficiency and effectiveness of clinical care.

Evidence-based interventions will be selected from the CDC NCCCP Library of Indicator and Data Sources published at: http ://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/. Awardees should select three (3) evidence-based intervention strategies for each of the following priority areas:

Priority 1: Primary prevention of cancer Priority 2: Screening and early detection of cancer Priority 3: Improving quality of life of cancer survivors

• In addition, applicant must ensure that least one (1) of the selected evidence-based strategies in each priority area address cancer related disparities as evidenced by risk, incidence, and mortality.

Strategy 7: Program Monitoring and Evaluation

Develop and implement a 5 year evaluation plan that defines both process and outcome measures (short-term, intermediate, and long-term) that will be evaluated. See Applicant Evaluation and Performance Measurement Plan section for more detailed information Develop and submit annual evaluation reports summarizing key findings Update the 5 year evaluation plan annually to reflect evaluation findings, current program context and program improvement measures Monitor, track, analyze, and report program data in a CDC-provided management information system Over the five-year period of the cooperative agreement, develop at least 4 dissemination documents that describe the monitoring, assessment, or evaluation of program efforts. These documents may be briefing reports, Success Stories and presentations at local and national conferences(including CDC-sponsored conferences.) At least one peer-reviewed manuscript should be developed.

Program 3 : National Program for Cancer Registries (NPCR)– Component 1 Strategy 1: Program Collaboration

• Promote use of central cancer registry data for planning and evaluation of cancer control objectives and public health practice.

• Collaborate with NCCCP and NBCCEDP programs on activities across the four domains with defined and measureable cancer prevention or control outcomes. See Collaboration Section for additional information.

• Coordinate and collaborate with other chronic disease programs, and with key external organizations and programs, such as, but not limited to, Medicaid, to

a) Identify priority populations

b) Select, implement and evaluate evidence-based interventions

c) Increase screening among priority population

d) Create synergies that facilitate the alignment of implementation and optimize shared priorities.

See Collaboration section for more detailed information

Strategy 2: External Partnerships

• Establish and convene an Advisory Committee to assist in enhancing and utilizing the central cancer registry data for cancer prevention and control and other chronic diseases, and for coordinating and collaborating with other cancer programs.

• Utilize the Advisory Committee to develop and refine quality improvement initiatives.

• Establish and promote greater awareness and utilization of the cancer registry data.

Strategy 3: Cancer Data and Surveillance (Domain 1)

Legislative Authority

• Maintain existing state law/regulations that provide legal authority for a central cancer registry as defined in Public Health Services Act Title 42, Chapter 6A, Sub-Chapter II, Part M, 280e, authorizing the National Program of Cancer Registries. http ://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/

• Update existing state law/regulations as needed to support electronic data exchange

Administration/Operations

• Establish or retain staff sufficient in number and expertise to manage, implement, and evaluate the central cancer registry, as well as utilize and disseminate the data. Core staff must fill the roles of Program Director/Project Director/Principal Investigator, Quality Assurance/ Quality Control Manager, and Education and Training Coordinator. The Quality Assurance/ Quality Control Manager and Education and Training Coordinator positions must be filled by qualified, experienced Certified Tumor Registrars (CTRs).

• Ensure that adequate hardware and software systems are in place to support the central cancer registry activities, including data collection, database management, interstate data exchange, data linkages, quality assurance, data analysis, and management reporting.

• Ensure the confidentiality and security of central cancer registry data through software and hardware security standards. This includes:

• implemented and documented security policies and procedures

• documented data release policies and procedures that include both access and disclosure of information

• documented disaster data recovery plans; annual risk assessments and security audits for registry data tracked ongoing security training for staff. (Details included on the NPCR data security pages http://www.cdc.gov/cancer/npcr/tools/index.htm

Data Collection, Content and Format

• Conduct surveillance for all reportable cancer diagnoses and related data items according to the CDC Program Standards and Data Submission Specifications http://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/ for program standards and data submission specifications).

Electronic Data Exchange

• Develop and implement a plan to enhance timely reporting via the expansion of electronic reporting by one or more means (e.g., Meaningful Use and ePath reporting), and through data exchanges (including interstate data exchange).

Data Completeness/Timeliness/Quality

• Implement procedures to ensure timeliness, quality and completeness of data in accordance with CDC data quality standards.

• To obtain data on residents who have been diagnosed or treated out of catchment area, establish interstate data exchange agreements with out-of-state central cancer registries and perform data exchanges with them at least twice per year. Quarterly data exchange with geographically bordering central cancer registries is strongly encouraged.

• Perform linkages with external data sets to improve data completeness and quality.

Linkages

• Create and employ data linkages as described in the NPCR Program Standards and additional linkages which are necessary for Program functioning. Perform linkages that assist in addressing other public health issues as they relate to cancer, including http://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/ http://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/ http://www.cdc.gov/cancer/npcr/tools/index.htm tobacco use and obesity (e.g., behavioral risk factor data, socio-economic status data). Linkages include, but are not limited to:

State Vital Statistics (at a minimum, death records) annually Indian Health Services Administrative records (as appropriate) Social Security Administration Death Master File recommended annually National Death Index recommended annually Social Security Administration Vital Status Service recommended annually

Data Quality Assurance and Education

• Develop, implement, and maintain an education and training plan for internal staff and reporting facilities with the goal of improving central cancer registry data quality.

• Conduct internal audits and/or quality checks of data collected and processed by central registry staff, participate in national quality assurance studies (e.g., TNM Reliability Study), participate in ad hoc audits in collaboration with CDC to assess data quality, and conduct external audits of reporting sources to assure central cancer registry data quality.

• Complete and submit the Program Evaluation Instrument (PEI) by the stated deadline.

Data Use and Data Monitoring

• Develop a coordination plan to propose innovative ways cancer surveillance data will be used to improve public health in the catchment area.

• Produce or participate in the production of biennial reports of incidence measures appropriate for the cancer and population (e.g., rates, counts, proportions) at geographic levels appropriate for the local populations (e.g., county, city, statistical health area) for screening-amenable cancers (e.g., breast, cervix, colorectal, lung) diagnosed at late stage and cancers associated with obesity, tobacco, and the human papillomavirus (HPV).

• Submit final biennial report to CDC and disseminate to partners as appropriate.

Data Submission

• Submit electronic data files to the NPCR Cancer Surveillance System (CSS);

according to the timeframe and content established by CDC that meets the reporting requirements outlined in the NPCR-CSS Submission Specifications document that meets the criteria for:

publication in the United States Cancer Statistics (USCS) Web-based report, the National Data Quality Standard, and the Advanced National Data Quality Standard. http://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/

• Participate in all CDC-created and hosted analytic datasets and web-based data query systems as outlined in the annual NPCR CSS Data Release Policy.

http://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/

Strategy 4: Community Level Interventions and Patient Support (Domain 4)

• Disseminate cancer surveillance data with NCCCP and NBCCEDP programs, and other organizations/agencies as identified by the registry’s Advisory Committee, to implement community level and patient support interventions

Strategy 5: Health Systems Change (Domain 3)

• Share cancer surveillance data with NCCCP and NBCCEDP programs, and other organizations/agencies as identified by the central cancer registry’s Advisory Committee, to enable implementation of evidence-based interventions for health systems change.

Strategy 6: Program Monitoring and Evaluation

• Conduct program evaluation inclusive of reviewing processes, outputs and outcomes of the central cancer registry and use findings to continuously improve operations, data quality and completeness. (See Evaluation Section for more details)

Program 3 : National Program for Cancer Registries (NPCR)– Component 2: CINIII, Screening, Prognostic Factors

For Component 2, CIN III award recipients:

Strategy 1: Program Collaboration

• Collaborate with appropriate programs/partners to facilitate successful implementation of project and use of the data for program planning, and evaluation.

Strategy 3: Cancer Data and Surveillance (Domain 3)

• Obtain/maintain the legal authority of CCR to collect data electronically on cervical cancer precursors from medical and pathology records.

• Establish/improve infrastructure and partnerships, and develop a plan for CIN III data collection

• Implement CIN III project and collect enhanced data on cervical cancer precursors, using established data collection procedures, automated edits, quality control procedures and data submission specifications

• Link registry data with additional data sources, such as vaccine registry, cervical screening data, comprehensive cancer control activities, or other relevant information. (Additional data may come from the entire population-based area, or from areas within a state, such as data collected for the HPV IMPACT project- http://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/ http://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/ state, such as data collected for the HPV IMPACT project- http://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/

• Submit CIN III data to CDC annually, in November of each year.

• Evaluate data and utilize quality assurance findings to continuously improve data quality and completeness

• Disseminate data and findings to key partners/stakeholders to identify priority areas and populations in need of increased access to HPV vaccines and/or cervical cancer screening and treatment.

For Component 2, SCREENING award recipients:

Strategy 1: Program Collaboration

• Collaborate with NBCCEDP and other appropriate programs/partners to facilitate successful implementation of project and use of the breast and cervical cancer screening and diagnostic follow-up data for program planning, and evaluation.

Strategy 3: Cancer Data and Surveillance (Domain 3)

• Obtain/maintain the legal authority of CCR to collect screening and diagnostic follow-up data on women diagnosed with breast or cervical cancer.

• Establish/improve infrastructure and partnerships and develop a plan to electronically collect breast and cervical cancer screening and diagnostic follow-up data on women diagnosed with breast or cervical cancer.

• Establish data submission specifications, data collection procedures, automated edits, and quality control procedures in collaboration with NPCR and NBCCEDP award recipients in the catchment area.

• Implement project and collect breast and cervical cancer screening and diagnostic follow-up data.

• Link registry data with other relevant data sources (e.g., cervical and breast screening data) to improve quality and completeness of screening and diagnostic follow-up on breast and cervical cancer cases.

• Submit breast and cervical cancer screening and diagnostic follow-up data.to CDC annually, in November of each year.

• Evaluate data and utilize quality assurance findings to continuously improve breast and cervical cancer screening and diagnostic follow-up data quality and completeness.

• Disseminate breast and cervical cancer screening and diagnostic follow-up data and findings to key partners/stakeholders to identify priority areas and populations in need of increased access to cervical and breast cancer screening and treatment.

For Component 2, PROGNOSTIC FACTORS award recipients:

Strategy 1: Program Collaboration

• Collaborate with CDC and other relevant partners (e.g., the American College of Surgeons-American Joint Committee on Cancer, College of American Pathologists, etc.) to establish data submission specifications, data collection procedures, automated edits, and quality control procedures.

Strategy 3: Cancer Data and Surveillance (Domain 3)

• Obtain/maintain the legal authority of CCR to collect the selected new/emerging prognostic factors on persons diagnosed with cancer in the state/territory/district.

• Establish/improve infrastructure and partnerships and develop a plan for prognostic factors data collection.

• Select new or emerging prognostic factors or risk assessment models recommended for clinical care in the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 8th Edition, and not collected prior to 2018 in any national cancer surveillance system http://www.cdc.gov/cancer/dcpc/about/foa-dp17-1701/.

• Link registry data with other relevant data sources to improve quality and completeness of the prognostic factors.

• Submit prognostic…