Notice of Special Interest (NOSI): Disparities Affecting Healthcare Utilization and Health Outcomes Among Childhood Cancer Survivors

Application Due Date
Brief Description

The purpose of this Notice is to highlight the interest of the National Cancer Institute (NCI) Division of Cancer Control and Population Sciences (DCCPS) in receiving applications to understand and address the full spectrum of factors that contribute to disparities in survivorship care, healthcare utilization, and health outcomes among childhood cancer survivors. Studies that focus on factors that extend beyond the individual (e.g., survivor, caregiver, clinician) to include an examination or intervention that involves healthcare teams, healthcare system, community, payer, and/or policy-level factors that contribute to disparities in health outcomes and result in inequitable survivorship care are strongly encouraged.

Key definitions:

  • Childhood cancer survivor: Any individual who was diagnosed with cancer before the age of 19.
  • Health outcomes: Any physical, social, or psychological state that occurs as a result of a health condition or associated treatment. For cancer survivors, health outcomes may result from their cancer, anti-cancer treatments, or other healthcare received.
  • Healthcare utilization: The use of services by individuals to prevent, treat, or improve health problems, promote maintenance of health or well-being, or obtain information about health status and prognosis.
  • Survivorship care: Care delivered to any individual who has been diagnosed with cancer, including one or more of the following components: prevention/surveillance for recurrence and subsequent malignancies, surveillance/management of physical and psychosocial impacts of cancer and its treatment; and health promotion, including the encouragement of positive health behaviors and the cessation or reduction of harmful behaviors (e.g., smoking, alcohol use).
  • Multilevel intervention: An intervention at more than one level of individuals, healthcare teams, healthcare systems, community, payer, or policy settings, and that measures outcomes at two or more of these levels.

Levels include:

  • Individuals: Patients, survivors, caregivers and family members, and clinicians.
  • Healthcare team:Two or more health professionals, social care professionals, and/or staff who identify as a team and work together interdependently to deliver services, coordinate their activities or services, and solve care problems.
  • Healthcare system: Collection of primary and specialty-care clinicians and support staff, medical facilities, and organizational structures. Together, these people, institutions, and resources provide the environment for the comprehensive delivery of healthcare services for childhood cancer survivors.
  • Community setting: nvironments in which the process of delivering survivorship healthcare reflects approaches typically followed by clinicians whose primary responsibilities are patient care (e.g., Federally Qualified Health Centers). Patient populations in these environments tend to be more representative of the local population -- and may be populations with fewer resources -- than those referred to academic medical centers for specialty care, or who are enrolled in clinical trials.
  • Payer: Insurance company or other organization that delivers payment for services.
  • Policy setting: Law, procedure, or rules that govern healthcare delivery or reimbursement.