Foa_Content_of_CDC-RFA-DP22-2202 (7).pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH

PROMOTION

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

CDC-RFA-DP22-2202

01/26/2022

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Required Registrations

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA- DP22-2202. 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. Notice of Funding Opportunity (NOFO) 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 https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr- 46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP22-2202

E. Assistance Listings Number:

93.898 F. Dates:

1. Due Date for Letter of Intent (LOI):

The LOI date will generate once the Synopsis is published if Days or a Date are entered.

Recommended but not Required https://www.grants.gov/ https://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 https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html

The purpose of an LOI is to allow CDC program staff to estimate the number of and plan for the review of submitted applications.

2. Due Date for Applications:

01/26/2022 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

November 18, 2021 CDC will provide three informational conference calls. Each call will provide exactly the same information therefore, applicants need only attend one call. There will not be a question and answer session on the calls. Instead, applicants are asked to submit questions to nofodp22- 2202@cdc.gov

November 18, 2021 at 10:00 a.m. to 12:00 p.m. Eastern Daylight Savings Time - For eligible applicants in the Atlantic, Eastern, and Central time zones. This conference call can be access ed by calling 800-593-8948. The leader for this call is Tanya Hicks and the passcode is 1179165.

November 18, 2021 at 3:30 p.m. to 5:30 p.m. Eastern Daylight Savings Time – For eligible applicants in the Mountain and Western time zones. This conference call can be accessed by calling 800- 593-8948. The leader for this call is Tanya Hicks and the passcode is 1179165.

November 18, 2021 at 7:30 p.m. to 9:30 p.m. Eastern Daylight Savings Time - For eligible applicants in the Pacific Island Jurisdictions. This conference call can be accessed by calling 800-593- 8948. The leader for this call is Tanya Hicks and the passcode is 1179165.

If operator assistance is needed, call 866-865-7014 and the operator will assist you in joining the call.

F. Executive Summary:

Summary Paragraph The CDC, Division of Cancer Prevention and Control (DCPC) announces the availability of Fiscal Year 2022 funds to implement DP22-2202, a National Cancer Prevention and Control Program. This Notice of Funding Opportunity (NOFO) supports the achievement of the following cancer prevention and control goals: eliminate preventable cancers, ensure all people get the right screening at the right time for the best outcome, and support cancer survivors in a manner that allows them to live longer, healthier lives. This program takes a comprehensive, coordinated approach to achieve these goals and advance health equity. It supports breast and cervical cancer screening services, cancer control plan implementation by coalitions, and surveillance programs to monitor and report cancer burden.

These priorities will be accomplished by funding three national programs:

Program 1: National Breast and Cervical Cancer Early Detection Program (NBCCEDP) supports clinical services for women with lower incomes who are uninsured or underinsured and https://www.grants.gov/ mailto:nofodp22-2202@cdc.gov mailto:nofodp22-2202@cdc.gov implementation of evidence-based interventions in the clinics that serve them.

Program 2: National Comprehensive Cancer Control Program (NCCCP) supports cancer coalition efforts that use their individual and collective resources to plan and implement evidence-based strategies as described in jurisdiction-wide cancer plans.

Program 3: National Program of Cancer Registries (NPCR) supports the implementation of a population-based core cancer registry program.

a. Eligible Applicants:

Open Competition

b. NOFO Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards

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

Program 2: The National Comprehensive Cancer Control Program (NCCCP) funds will be awarded to up to 66 applicants to implement 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. Applicant eligibility for these awards is unrestricted.

Program 3: The National Program of Cancer Registries (NPCR) funds will be awarded to up to 55 applicants including;

state health departments, the District of Columbia, Freely Associated States and US Affiliated Pacific Islands; US Virgin Islands: or their Bona Fide Agents for implementing a population-based core cancer registry program.

d. Total Period of Performance Funding:

$1,100,000,000

e. Average One Year Award Amount:

$850,000 Program 1: NBCCEDP Approximately $155 million per year is available.

Program 2: NCCCP Approximately $22 million per year is available.

Program 3: NPCR Approximately $38 million per year is available.

f. Total Period of Performance Length:

g. Estimated Award Date:

June 30, 2022

h. Cost Sharing and / or Matching Requirements:

Yes 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, the Commonwealth of Puerto Rico, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. 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.

Recipients 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 Although there is no cost-sharing requirement, recipients should document and report how funds have been leveraged to increase financial and in-kind support for their NCCCP work plans and coalitions.

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.

Part II. Full Text A. Funding Opportunity Description

1. Background

a. Overview Cancer is the second leading cause of death in the United States for both men and women. In 2017, more than 1.7 million people were diagnosed with cancer and 600,000 people died from this disease. Since 1990, CDC’s Division of Cancer Prevention and Control (DCPC) has been committed to advancing cancer prevention nationwide for everyone through a variety of activities at the national, state, territorial, and tribal levels. The Division's overall goal is to work toward having all people free of cancer while improving health equity through prevention, screening, and health and wellness in cancer survivors. DCPC supports comprehensive cancer control, a philosophical approach that brings together partners and other organizations to collectively address a community’s cancer burden in a much more impactful way than any one organization could accomplish alone. The approach relies heavily upon the willingness of organizations to work together to establish priorities for addressing the community’s cancer burden and strategically present these in a coordinated cancer control plan. The plan is intended to be more than a “document on a shelf”, but rather it is a blueprint for expected action that includes specific partner commitments to plan implementation. These plans prioritize primary prevention, screening and early detection and diagnosis, treatment, cancer survivorship, and palliative care. They also focus heavily on supporting a surveillance infrastructure that is critical to effective program planning and implementation, supporting clinical trials and other research efforts, and identifying specific strategies to focus on the issues that cause some people to be diagnosed with cancer more often or experience poorer health outcomes than others. The Division’s primary prevention, screening, and survivorship priorities are largely addressed through comprehensive cancer control plans and implemented by 3 federally funded national programs. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), federally mandated in 1990, provides breast and cervical cancer screening, diagnostic services, and treatment referrals to women with lower incomes and who are uninsured or underinsured; the National Comprehensive Cancer Control Program (NCCCP) was established in 1998 to support the creation of coalitions and networks that develop and implement cancer control plans across the cancer continuum; and the National Program of Cancer Registries (NPCR) was federally mandated in 1992 to support the management and operations of population-based cancer surveillance systems across the United States.

This NOFO will fund eligible applicants to facilitate collaborative planning and implementation of evidence-based cancer surveillance, prevention, and control strategies in communities that improve the provision of clinical preventive services, and cancer survivorship. Ultimately, a successful implementation of the work described in this NOFO will demonstrate that by the three programs working together through partnerships, leveraging resources, coordinating efforts, consistent communication, and community involvement, we will come that much closer to health equity and “All People Free of Cancer.”

b. Statutory Authorities Program 1: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is authorized under sections 1501-1508 and 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 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, Sections 399B, 399C, 399D, and 399F(a) of the Public Health Service Act (PHS Act) to the authority (Public Law 102-515), as amended.

c. Healthy People 2030 Healthy People 2030: Cancer - Healthy People 2030 | health.gov Reduce the age-adjusted annual rate of cancer mortality per 100,000 population (C-01) Reduce the lung cancer death rate (C-02) Increase the proportion of adults who get screened for lung cancer (C-03) Reduce the female breast cancer death rate (C-04) Increase the proportion of females who get screened for breast cancer (C-05) Reduce the colorectal cancer death rate (C-06) Increase the proportion of adults who get screened for colorectal cancer (C-07) Reduce the prostate cancer death rate (C-08) Increase the proportion of females who get screened for cervical cancer (C-09) Increase the proportion of cancer survivors who are living 5 years or longer after diagnosis (C-11) Increase quality of life for cancer survivors (C-R01)

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

Healthy People 2030: Cancer - Healthy People 2030 | health.gov The Guide to Community Preventive Services: The Guide to Community Preventive Services (The Community Guide) The National Partnership for Action to End Health Disparities: Home Page - Office of Minority Health (OMH) (hhs.gov)

e. Relevant Work During DP17-1701, the current NOFO which ends on June 29, 2022, and over the past 30 years, substantial gains were made by increasing activities to reach and screen women with low-incomes and who are uninsured or underinsured for breast and cervical cancer; expanding state plans and coalitions to improve prevention, screening, and survivorship; and advancing the collection and accessibility of cancer surveillance data to inform and evaluate cancer control activities.

2. CDC Project Description

a. Approach https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer https://www.thecommunityguide.org/ https://www.thecommunityguide.org/ https://www.minorityhealth.hhs.gov/ https://www.minorityhealth.hhs.gov/

Bold indicates period of performance outcome.

Each of the three programs (NBCCEDP, NCCCP, NPCR) in this NOFO have provided programmatic logic models below. An Integrated Programmatic Logic Model is available at https://www.cdc.gov/cancer/dcpc/about/foa-dp22-2202/

CDC-NOFO-DP22-2202 Program 1: National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Logic Model

Strategies and Activities Short-term Outcomes Intermediate Outcomes

Long-Term Outcomes

Strategy 2: Cancer Data and Surveillance

Use state and local data to identify and describe the population who is eligible for the program. Prioritize populations disproportionately burdened by breast or cervical cancer (i.e., populations of focus) for service delivery.

Strategy 3: Support Partnerships for Cancer Control and Prevention

Work with the cancer coalition, Colorectal Cancer Control Program (CRCCP), National Comprehensive Cancer Control Program (NCCCP), National Program of Cancer Registries (NPCR) and other organizations to help set breast and cervical cancer screening and health equity goals within cancer control plans.

Serve on the cancer coalition.

Collaborate with community-based organizations to increase screening among populations of focus.

Collaborate with other chronic disease and public health programs to disseminate information to women served

Increased access to breast and cervical cancer screening among program-eligible women, prioritizing populations of focus.

Increased partnerships with clinics serving women with lower income.

Increased access to health/community/social services among program-eligible women through partnerships.

Increased use of data to inform program planning and improvement.

Increased EBI implementation to improve screening within partner clinics.

Improved provider knowledge of breast and cervical cancer screening recommendations and diagnostic guidelines.

Improved effectiveness of outreach to populations experiencing health inequities for breast and cervical cancer.

Increased number of women receiving NBCCEDP-paid screening and follow-up services.

Increased number of women served who experience higher mortality and late-stage cancer.

Increased early detection of breast and cervical cancer.

Increased adherence to timely diagnostic follow-up.

Increased timely cancer treatment referral.

Increased clinic-level breast and cervical cancer screening rates in partner screening clinics.

Decreased cancer incidence, morbidity, and mortality.

Reduced cancer disparities.

https://www.cdc.gov/cancer/dcpc/about/foa-dp22-2202/ across programs.

Collaborate with other cancer programs, including other NBCCEDP-funded programs, to maximize screening access and share lessons learned.

Strategy 4: Deliver Breast and Cervical Cancer Screening

Set annual and 5-year service delivery projections for breast and cervical cancer.

Establish and maintain a screening delivery system to provide breast and cervical cancer screening and diagnostic services to program-eligible women.

Prioritize populations that experience higher mortality and late-stage cancer.

Conduct outreach to identify program-eligible women and connect them to screening and diagnostic services in partner clinics.

Engage local partners and community health workers to identify women in need of support to access services and monitor through screening completion.

Provide patient navigation to women who receive NBCCEDP-paid clinical services.

Provide patient navigation to women who meet some NBCCEDP eligibility requirements whose clinical services are paid by other sources (OPTIONAL).

Partner with organizations to link program-eligible women to other needed health, community, and social services.

Increased utilization of needed health, community, and social services among program-eligible women.

Decreased inequities in screening and follow-up services among populations of focus.

Establish formal partnerships with organizations that show expertise in and access to populations of focus.

Collaborate with organizations with expertise in providing technical assistance to clinics.

Conduct ongoing quality improvement for timely and appropriate screening and follow-up services.

Collect and report minimum data element (MDE) records for all women receiving NBCCEDP-paid services.

Strategy 4: Implement Evidence-Based Interventions

Work with partner clinics that provide NBCCEDP-paid clinical services to implement evidence-based interventions (EBIs).

Identify an EBI champion in each partner clinic.

Provide ongoing technical assistance to support EBI implementation, adaptation, and data monitoring.

Collect and report baseline and annual clinic-level data.

Strategy 5: Program Monitoring and Evaluation

Participate in CDC-led monitoring, evaluation, and dissemination efforts.

Develop an evaluation plan.

Evaluate processes and outcomes.

Establish and maintain MDE systems to collect and report patient data.

Monitor, report, and use MDE and clinic-level data.

Submit annual evaluation reports to describe program monitoring, effectiveness, and use of findings.

Share evaluation findings with appropriate partners.

CDC-NOFO-DP22-2202 Program 2: National Comprehensive Cancer Control Program (NCCCP) Logic Model

Strategies Short-Term Outcomes Intermediate Outcomes

Long-term Outcomes

Strategy 1: Enhance National Program of Cancer Registries (NPCR) data quality, completeness, use, and dissemination

Use data to monitor cancer risk factors, incidence, and mortality Use cancer incidence and mortality data for program planning (e.g. to revise/update cancer control plans, select program priorities, set program baseline and targets).

Share data to educate policymakers, partners, and the public about the people and places that are most impacted by cancer.

Strategy 2 : Use surveillance systems and population-based surveys to assess cancer burden and inform programmatic efforts

Collaborate with internal and external partners to set and report on annual and five-year objectives

Conduct policy scans to identify facilitators and barriers to cancer prevention, screening, and survivorship

Use data to identify and collaborate with populations and geographic locations

Increased use of USCS data to assess cancer burden, identify priority populations, and monitor incidence, mortality, and survival.

Increased use of surveillance systems and population-based surveys to assess cancer risk, health behaviors, and access to preventive services

Increased use of data to facilitate program planning and evaluation

Improved recruitment and engagement of members from populations of focus, chronic disease programs, traditional and non-traditional public health partners within comprehensive cancer control coalitions

Improved partnership contribution to evidenced-based interventions implemented to address cancer burden

Improved implementation of jurisdiction-specific comprehensive cancer control plans

Improved knowledge, awareness, and attitudes regarding evidenced based interventions and resources that aid with implementation

Improved implementation of EBIs that address primary prevention, Increased health seeking and healthy behaviors among population of focus

Increased early detection of cancer among population of focus

Increased number of eligible women served through the

NBCCEDP

Increased breast and cervical cancer screening rates in

NBCCEDP

partner clinics

Reduced cancer risk

Increased quality of life among cancer survivors

Decreased cancer incidence, morbidity, and mortality

Reduced cancer disparities with the greatest burden

Strategy 3: Support partnerships for cancer control and prevention

Convene and maintain a multisectoral cancer control coalition

Establish formal agreements with the cancer control coalition, partner organizations, and community members assuring their commitment to achieving NCCCP priorities/outcomes

Provide staffing and support for coalition engagement

Strategy 4: Deliver screening and implement evidence-based interventions (EBIs)

Use data to implement a suite of interventions to advance program priorities that expand reach and make the greatest impact

Identify short-, intermediate-, long-term strategies that complement each other and work synergistically to achieve 5-year objectives

Select evidence-based interventions for strategies based on screening, and survivorship with fidelity

Improved awareness, knowledge, and beliefs about cancer prevention, screening, and survivorship among priority populations

Increased access to healthy eating and physical activity opportunities

Increased access to cancer screening/preventive services by priority populations

Increased reporting of high-quality program data to CDC

Increased recipient participation in special studies available research, coalition buy-in, resources for implementation, and promising program practice

Strategy 5: Conduct program monitoring and evaluation

Create a performance measurement plan to report short, intermediate, and long-term outcomes

Develop and implement annual evaluation plans

Use program evaluation results for program improvement by sharing results with evaluation stakeholders, revising program work plans, and revising subsequent annual evaluation plans

Develop dissemination documents to share lessons learned

Participate in evaluation and dissemination implementation science-driven studies to contribute to viable models for sustainable comprehensive cancer control

CDC-NOFO-DP22-2202 Program 3: National Program of Cancer Registries (NPCR) Logic Model

*Strategies and Activities Short-term Outcomes

Intermediate Outcomes

Long-term Outcomes

Strategy 1: Enhance NPCR data quality, completeness, use, and dissemination

Maintain and enhance a population-based central cancer registry (CCR) Maintain and update legislation authorizing the registry Ensure adequate, qualified staff fill critical registry positions Provide relevant, ongoing continuing education and training to CCR staff and reporting partners Convene and maintain an advisory board Collect, format, and manage surveillance data Conduct interstate data exchange annually Implement procedures to ensure timeliness, quality, and completeness of data Maintain data confidentiality and security Perform linkages to improve data completeness and quality Create and implement innovative projects Submit data to CDC annually

Strategy 2 : Use surveillance systems and population-based surveys to assess the cancer burden, examine health disparities, target program

Increased use of

NPCR

data by recipients, partners, collaborators, and researchers

Achievement of data quality standards by the CCR

Successful adoption of data modernization strategies

Improved timeliness, quality, completeness, and confidentiality of NPCR surveillance data

Increased collaboration among chronic disease and other public health programs

Increased access to cancer screening and preventive services among populations of focus

Increased knowledge about cancer prevention, Increased capacity, flexibility, and utility of CCR infrastructure to meet new data needs

Increased data use for cancer prevention and control

Improved health behaviors

More cancer primary prevention resources and screening available for populations of focus

Increased early detection of cancer among populations of focus

Reduced cancer risk

Better quality of life among cancer survivors

Decreased cancer incidence, morbidity, and mortality

Reduced cancer disparities

Increased health equity efforts, and inform efforts to address social determinants of health (SDOH)

Use surveillance systems and population-based surveys to assess risk factors and health behaviors among populations of focus Promote and disseminate data to facilitate program planning and evaluation

Strategy 3: Support partnerships for cancer control and prevention

Engage partners to help achieve program outcomes Work with partners to facilitate access to health care for cancer screening and preventive services among populations of focus Support collaborations and partnerships across cancer, chronic disease, and other programs that increase understanding about the relationship between SDOH and cancer risk in communities Collaborate with traditional and nontraditional public health partners that address

SDOH

Strategy 5: Conduct program monitoring and evaluation

Monitor and evaluate registry processes, data, and outcomes- routinely check the quality of registry data screening, and survivorship among populations of focus

Faster reporting of high-quality program data to

CDC

Increased use of evaluation findings for program improvement

Increased participation in special studies

Conduct NPCR-led and registry-led audits Participate in CDC-led special studies such as cost or surveillance studies Develop and implement program evaluation plans Evaluate innovative projects Translate and disseminate monitoring and evaluation findings

*Please note: NPCR does not require recipients to implement DP22-2202 Strategy 4

i. Purpose Support three national programs working together through the state, tribe, territory, or freely-associated state’s comprehensive cancer control plans, taking advantage of resources, coordinating efforts, and community involvement to decrease cancer burden and health disparities. Achieved through the provision of breast and cervical cancer screening and diagnostic services and the implementation of evidence-based interventions, cancer coalitions and implementing cancer plan priorities at state and local levels (e.g. county, city, township), and monitoring cancer burden through surveillance.

ii. Outcomes Program 1: NBCCEDP Short-term:

Increased access to breast and cervical cancer screening among program-eligible women, with a focus on populations who are disproportionately affected by breast and cervical cancer.

Increased partnerships with clinics serving women with lower income.

Increased access to health/community/social services among program-eligible women through partnerships.

Increased use of data to inform program planning and improvement.

Increased sustainable EBI implementation to improve screening within partner screening clinics.

Improved provider knowledge of breast and cervical cancer screening recommendations and diagnostic guidelines Improved effectiveness of outreach to populations experiencing health inequities for breast and cervical cancer.

Intermediate:

Increased number of women receiving NBCCEDP-paid screening and follow-up services.

Increased number of women from populations disproportionately affected by breast and cervical cancer and who experience higher mortality served through the NBCCEDP Increased early detection of breast and cervical cancer Increased adherence to timely diagnostic follow-up Increased timely cancer treatment referral Increased clinic-level breast and cervical cancer screening rates in partner screening clinics Increased utilization of needed health, community, and social services among program-eligible women Decreased inequities in screening and follow-up services among populations disproportionately affected by breast and cervical cancer

Long-term:

Decreased cancer incidence, morbidity, and mortality Reduced cancer disparities

Program 2: NCCCP Short-term Increased data use Increased use of United States Cancer Statistics (USCS) data to assess cancer burden, identify priority populations, and monitor incidence, mortality, and survival.

Increased use of surveillance systems and population-based surveys to assess cancer risk, health behaviors, and access to preventive services Increased use of data to facilitate program planning and evaluation

Increased collaboration among chronic disease programs Improved recruitment and engagement of members from priority populations , chronic disease programs, traditional and non-traditional public health partners within comprehensive cancer control coalitions Improved partnership contribution to EBIs implemented to address cancer burden Improved implementation of jurisdiction-specific comprehensive cancer control plans Increased access to cancer screening/preventive services by underserved populations Increased social, physical, and economic supports that promote healthy lifestyle behaviors that reduce cancer risk, promote screening, and support the wellness of cancer survivors Improved built environments that shape the living and working conditions known to prevent (or protect against) cancer risk factors, promote healthy behaviors and social connectedness, and improve access to screening and other health services.

Increased chronic disease self-management and wellness programs for cancer survivors Improved connections to health care systems and services, public health agencies, and community-based organizations to improve population health (i.e., community-clinical linkages) Improved access to services that meet the social needs to support healthy behaviors and allow access and utilization of health care services Increased adoption of EBIs among cancer prevention and control plannersImproved knowledge, awareness, and attitudes regarding EBIs and resources that aid with implementation Improved implementation of EBIs that address primary prevention, screening, and survivorship with fidelity Increased access to healthy eating and physical activity opportunities Improved awareness, knowledge, and beliefs about cancer prevention, screening, and survivorship among priority populations Increased reporting of high-quality program data to CDC Increased recipient participation in special studies

Intermediate Increased healthy behaviors among priority populations Increase in healthy behaviors that reduce cancer risk, such as sun-safety practices; reduced tobacco and alcohol use; increased physical activity and healthy eating to keep a healthy weight Increase vaccination uptake among eligible populations to reduce HPV and Hepatitis B infection Increased early detection of cancer among priority populations

Long-Term Reduced cancer risk;

Reduce risk of skin cancer, tobacco-related cancers, HPV-associated cancers, and cancers in which alcohol use, physical inactivity, and poor nutrition are risk factors Increased quality of life among cancer survivors;

Increase overall wellness (i.e. healthy days measures) as reported by cancer survivors among populations or communities experiencing a disproportionate burden of cancer risk factors and outcomes due to inequities Improved healthy behaviors among cancer survivors, such as tobacco cessation, physical activity, nutrition, and mental health among populations or communities experiencing a disproportionate burden of cancer risk factors and poorer outcomes due to inequities Decreased cancer incidence, morbidity, and mortality

Reduced disparities;

Reduced disparities in cancer risk factors and cancer incidence, morbidity, and mortality that are due to social, economic, and geographic inequities that cut across population characteristics, such as gender, race, ethnicity, and other characteristics, historically linked to discrimination or exclusion.

Increased number of local and state-level policies that address the root causes of health inequities, such as racism and discrimination

Program 3: NPCR

Short-term Increased use of NPCR data by recipients, partners, collaborators, and researchers Achievement of data quality standards by the Central Cancer Registry (CCR) Successful adoption of data modernization strategies Improved timeliness, quality, completeness, and confidentiality of NPCR surveillance data Increased collaboration among chronic disease and other public health programs Increased access to cancer screening and preventive services among populations of focus Increased knowledge about cancer prevention, screening, and survivorship among populations of focus Faster reporting of high-quality NPCR program data to CDC Increased use of evaluation findings for program improvement Increased participation in special studies

Intermediate Increased capacity, flexibility, and utility of CCR infrastructure to meet new data needs Increased data use for cancer prevention and control Improved health behaviors More primary prevention resources and screening available for populations of focus Increased early detection of cancer among populations of focus

Long-term Reduced cancer risk Better quality of life among cancer survivors Decreased cancer incidence, morbidity, and mortality Reduced cancer disparities Increased health equity

iii. Strategies and Activities Each of the three programs in this NOFO will implement a unique combination of the five strategies outlined in the specific programmatic logic models as they work together to achieve combined outcomes that are grounded in their jurisdictional comprehensive cancer control plan to which all recipients will contribute and be responsible for implementing via their funded program(s) (i.e., NBCCEDP, NCCCP, and NPCR).

Program 1: NBCCEDP Strategy 2: Use surveillance systems and population-based surveys to assess cancer burden, examine health disparities, focus program efforts, and inform efforts to address social determinants of health (SDOH).

Use state and local level health, disease burden, and demographic data, including CCR data, as well as Geographic Information System (GIS) mapping, Small Area Health Insurance Estimates (SAHIE) data, and/or data from other sources to identify and describe the program- eligible populations in your jurisdiction. Prioritize screening and diagnostic services for populations that are disproportionately burdened by breast or cervical cancer, especially those who experience higher mortality and late stage disease.

Strategy 3: Support partnerships for cancer control and prevention.

Work with cancer coalition partners, CRCCP, NCCCP, NPCR, and other organizations/agencies to develop and implement data-informed, equity-driven state or jurisdictional cancer control plans.

Serve on the state or jurisdictional cancer coalition to set breast and cervical cancer screening and health equity goals in the state or jurisdictional cancer control plan.

Ensure that screening goals are included as a jurisdiction-wide priority and help facilitate coalition collaborations to support implementation.

Use the state or jurisdictional cancer control plan to inform program planning and identification of priority populations.

Collaborate with central cancer registries to report and use cancer data for program planning.

Collaborate with community-based organizations to increase screening among program-identified populations who are disproportionately burdened by breast and cervical cancer, especially those who experience higher mortality and late stage disease. Engage organizations who have demonstrated experience, relationships, and credibility with identified populations.

Collaborate with other chronic disease and public health programs on activities with defined and measurable breast and cervical cancer screening outcomes. Partner to disseminate public health information and education to program-eligible women, including information on Human Papilloma Virus (HPV) immunization for their children to reduce future risk for cervical cancer.

Collaborate with other NBCCEDP-funded programs whose service area overlaps with yours to maximize access to screening and avoid duplication in services.

Engage with other cancer programs to share lessons learned to advance cancer prevention and program service knowledge.

Collaborate with other programs, as appropriate, to achieve breast and cervical cancer screening outcomes and advance health equity.

Strategy 4. Deliver cancer screening and implement EBIs in primary care clinics that serve women impacted by health inequities.

Provide breast and cervical cancer screening, diagnostic testing, and treatment referrals to women who are at or below 250% of the federal poverty level and who are uninsured or underinsured. Prioritize populations that are disproportionately burdened by breast and cervical cancer, especially those who experience higher mortality and late stage disease.

Ensure timely follow-up for all program-eligible women with abnormal screening and diagnostic test results.

Ensure all program-eligible women who are diagnosed with cancer are referred to treatment.

Identify the program-eligible population among women in your jurisdiction. Establish an eligibility determination and enrollment process; assess women for eligibility; and enroll them into the program. Recipients may have more restrictive eligibility criteria but may not expand beyond CDC’s criteria as outlined in program guidance. https://www.cdc.gov/cancer/dcpc/about/foa-dp22-2202/

Set annual and 5-year projections for the number of women who will receive screening and diagnostic services paid by the program. Recipients should increase screening at a minimum of 5% each program year.

Establish and maintain a screening delivery system to provide breast and cervical cancer screening and diagnostic services. Include securing clinical providers; establishing clinic partnerships; establishing billing and reimbursement systems; and implementing processes to report required screening data for women served (i.e., minimum data elements [MDEs]) to CDC.

Conduct outreach in communities to identify program-eligible women who need access to breast and cervical cancer screening and diagnostic services; connect women to services at partner clinics.

Engage local and community-based partners and community health workers to identify women who are underserved and need support to access and complete screening; monitor and report the rate of screening completion to CDC.

Provide patient navigation to assist women who receive NBCCEDP-paid clinical services in overcoming barriers to complete these services, and initiate cancer treatment. In addition, recipients may provide “patient navigation-only” services to women whose screening and diagnostic services are paid by other sources and who reflect NBCCEDP age and income eligibility requirements. All women enrolled in the program for clinical services must be assessed for barriers and provided patient navigation if needed according to CDC guidance. Prioritize delivery of patient navigation-only services in clinics where NBCCEDP-paid clinical services are provided. If delivering patient navigation-only services, recipients must set annual and 5-year projections; track women through screening and diagnostic services; and submit MDE records for women who complete screening and diagnostic services. Delivery of patient navigation-only services is not a required activity. These services may be implemented in addition to screening provision activities, but not in lieu of them. https://www.cdc.gov/cancer/dcpc/about/foa-dp22-2202/

Partner with local, community-based organizations to link program-eligible women to health insurance and other needed health (e.g., diabetes, heart disease, obesity, immunization, other recommended cancer screenings) and community/social (e.g., housing, food) services to reduce barriers to breast and cervical cancer screening.

https://www.cdc.gov/cancer/dcpc/about/foa-dp22-2202/

Develop and maintain a policy requiring participating program providers to implement a tobacco screening protocol to screen every woman for tobacco use and refer women who use tobacco to comprehensive tobacco treatment programs (e.g., state tobacco quit lines).

Track women through screening and diagnostic services and submit MDE records on all women receiving NBCCEDP-paid clinical services.

Work with partner clinics that provide NBCCEDP-paid clinical services to implement EBIs that improve service delivery. Recipients may also partner with clinics that are not providing NBCCEDP-paid clinical services but have low breast and cervical cancer screening rates and are serving women with lower incomes. Efforts should be made to enlist these clinics as clinical providers.

Document EBIs selected for each clinic in the workplan and evaluation plan to assess and track clinic-level screening increases and overall success of EBI implementation. The Guide to Community Preventive Services has established the following EBIs to increase breast and cervical cancer screening: client reminders, reducing structural barriers, provider assessment and feedback, provider reminder and recall systems, engaging community health workers, small media, group education, and one-on-one education. The Guide recommends use of multi-component EBIs that combine strategies which increase community demand for and access to cancer screening.

Identify at least one individual within each partner clinic to serve as a champion for EBI implementation efforts and ensure a cancer screening policy is in place.

Conduct quality assurance and quality improvement (QA/QI) activities that support delivery of timely and appropriate screening and diagnostic services by partnering with NBCCEDP-screening clinics to conduct a comprehensive assessment and audits of their health care delivery system. Assess the clinic’s patient process flow, screening practices, validate the quality of breast and cervical cancer screening data in electronic health record (EHR) or other data systems, identify established and needed EBIs in each clinic and select appropriate interventions for implementation.

Provide clinic partners with technical assistance (TA) to support EBI implementation, adaptation, and data monitoring, including reporting of CDC-required clinic-level data.

Recipients are encouraged to engage organizations with appropriate expertise to assist in providing TA to clinics (e.g., expertise in clinic workflow or process mapping, assessing clinic readiness to implement EBIs, EBI adaptation and implementation, quality improvement, use of EHR data for population management, and data management).

Engage organizations that demonstrate expertise in and access to the identified populations that are disproportionately burdened by breast and cervical cancer; ideally these organizations should be in the communities where women are being served.

Collect and report clinic-level data on clinic characteristics, screening rates, and EBI implementation.

Strategy 5: Conduct program monitoring and evaluation to strengthen program processes and improve equitable outcomes

Participate in CDC-led program monitoring, evaluation, and dissemination activities including periodic data quality reviews (MDEs, clinic data), quarterly program updates, annual program survey, and annual success story submissions.

Develop an evaluation plan according to CDC guidance https://www.cdc.gov/cancer/dcpc/about/foa-dp22-2202/ and submit to CDC within six months of award. This plan should be updated and resubmitted to CDC at the end of PY3.

Conduct process and outcome evaluation to assess all program activities.

Evaluate your program’s activities to connect program-eligible women from the community to completed breast and cervical cancer screening at partner clinics.

Submit an annual evaluation report to CDC summarizing program monitoring and evaluation findings, including your program’s effectiveness at reaching identified populations that are disproportionately burdened by breast and cervical cancer with screening and diagnostic services that contribute to reducing cancer health disparities.

Describe how findings were used for program improvement and to identify and disseminate best practices.

Establish and maintain a patient-level data system to collect and report to CDC the required patient-level data (MDEs) https://www.cdc.gov/cancer/dcpc/about/foa-dp22- 2202/ used to monitor and track screenings, outcomes, and treatment referrals for women served, according to CDC performance standards. An abbreviated MDE record must also be reported for women receiving patient navigation-only services (optional activity). For women diagnosed with cancer, link MDE records with cancer registry records to obtain cancer staging data in the MDE.

Regularly review and use the patient-level data (MDEs) to ensure screening completion and improve the timeliness of diagnostic and treatment referrals.

Collect and report baseline and annual clinic-level data records for clinics implementing EBIs, including clinic level screening rates, according to CDC guidance. https://www.cdc.gov/cancer/dcpc/about/foa-dp22-2202/

Regularly review and use the clinic data, including clinic-level screening rates and EBI implementation data to monitor progress and identify areas for program improvement.

Share monitoring and annual evaluation findings with appropriate partners, including screening providers and clinics where EBIs are implemented, to facilitate program improvement.

Program 2: NCCCP Strategy 1: Enhance National Program of Cancer Registries (NPCR) data quality, completeness, use, and dissemination

Use decision matrix available at https://www.cdc.gov/cancer/dcpc/about/foa-dp22-2202/ to revise or update a five-year cancer plan with goals, objectives (including baselines and targets) and strategies. NCCCP recipients are expected to work with their coalition members to select strategies that prioritize :

o Top ten cancers for males and females (based on crude incidence and death rates).

o Disparities in cancer outcomes among racial and ethnic groups, low-SES groups, rural or other geographically isolated communities, other population-based or geographically determined communities, and large numbers of persons at disproportionate risk for and affected by cancer.

o Use of data to monitor cancer risk factors, incidence, and mortality. Recipients are expected to include cancer registry leadership in coalition efforts to ensure access https://www.cdc.gov/cancer/dcpc/about/foa-dp22-2202/ https://www.cdc.gov/cancer/dcpc/about/foa-dp22-2202/ to data on cancer progress, trends, potential needs to reprioritize cancer, population, or geographic priorities

Data should be…