Limited Competition: NIMHD Initiative for Improving American Indian and Alaska Native Cancer Outcomes (U19 - Clinical Trial Optional)

American Indians and Alaska Natives (AI/AN) experience overall cancer incidence and mortality rates that are strikingly higher than the overall U.S. population.

Specific states and geographic regions show especially high rates of cancer (all sites) among AI/AN populations. For example, between 2016 and 2020, states within the top 10 rates for cancer deaths among AI/AN populations included several in the Northern Plains (South Dakota, North Dakota, and Montana), followed by Kansas, Wyoming, Minnesota, Alaska, Nebraska, Arizona and New Mexico. Between 2015 and 2019, the states with the highest age-adjusted rates of new cancer cases (all sites) were North Dakota, Oklahoma, Minnesota, Montana, Alaska, Wisconsin, Oregon, Iowa, and South Dakota. In addition, there is considerable variation in the types of cancer diagnoses by region. For example, there are relatively higher rates of lung cancer observed in the Northern and Southern Plains, while lower rates occurred among American Indians living in the southwest. Alaska Native communities also face elevated cancer rates, with certain types such as lung and colorectal cancer being especially prevalent. All-cancer incidence rates and mortality rates are also higher among rural AI/AN compared with urban AI/AN.

These disease outcomes in many cases can be traced to structural factors and social and environmental determinants of health such as carcinogen exposure (e.g., uranium in the Southwest), poverty, unemployment, pollution, and poor access to health care in combination with unique factors impacting AI/AN people, such as historical trauma. Access to NCI-designated cancer centers, cancer care specialists, and screening is lower for rural AI/AN compared with urban AI/AN. In the face of these structural challenges, resiliencies and strengths within Native communities and individuals have been drawn upon to improve cancer health outcomes.

In recognition of this significant need the Fiscal Year 2024 Federal appropriations (Public Law 118-47 - Further Consolidated Appropriations Act, 2024) authorized an initiative to support efforts including research, education, outreach, and direct clinical access to improve the screening, diagnosis, treatment, and survivorship care of cancers in culturally respectful and practical ways among AI/AN populations, particularly those living in rural communities. The initiative is to be located at NCI-designated cancer centers with demonstrated partnerships with Tribal Nations, Tribal organizations, and urban Indian organizations to lead innovative and impactful efforts to improve the screening, diagnosis, and treatment of cancers. Interventions that are theoretically grounded and built upon Indigenous Knowledge (see: https://www.whitehouse.gov/ostp/ostps-teams/climate-and-environment/indigenous-knowledge/) and empirical evidence are needed to promote health, to prevent and treat disease, and to support recovery. Given continued disparities in service access and quality, and in disease outcomes, additional efforts are needed to advance dissemination and implementation science relevant to AI/AN communities. There is a need for research to identify, understand, and develop strategies for overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions, tools, policies, and guidelines that can improve cancer outcomes for AI/AN populations.

A particular resource for the initiative is the Tribal Epidemiology Centers (TECs) that contribute significantly to the evidence base and scientific research on AI/AN health. Established in 1996 under the re-authorization of the Indian Health Care Improvement Act (IHCIA) and funded by the Indian Health Service (IHS) and the Centers for Disease Control and Prevention (CDC), TECs serve AI/AN communities and populations through the collection and analysis of health surveillance data, maintenance of patient registries, implementation and evaluation of public health interventions, development of health awareness campaigns, and mobilization of emergency response to public health crises.

Application Instructions

Please submit:

1. A one‐page letter of intent with a description of proposed aims and approach.
2. If the final application requires a diversity statement or statement of broader impacts, please summarize your plans to address the specific requirements on an additional page.
3. CV (not biosketch) of the PI including past grant funding.

to limitedsubs@uw.edu by 5:00 PM Wednesday, July 17, 2024. Proposals are due to the sponsor 8/2/2024, so you will need to have your materials in to the Office of Sponsored Programs by 7/24/2024 if given the go‐ahead by the Limited Submissions review committee.