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Cancer prevention, treatment, and biology

(1) Advance the development and dissemination of effective cancer prevention strategies to California populations that are disproportionately impacted by cancer. (2) Foster and implement evidence-based health care policies and practices that show promise for reducing cancer-related deaths and cancer health disparities in California. (3) Promote high-impact translational research aimed at bringing new therapies and patient care strategies to community clinical settings. (4) Provide continued support for basic research into the molecular genetic mechanisms in cancer pathophysiology.

Despite the overall decline in cancer death rates that was recently announced in the NIH’s “Annual Report to the Nation on the Status of Cancer,” the death rate for patients with tobacco-related cancers remains high. Moreover, disparities in cancer incidence and death rates persist even with greater public knowledge of cancer prevention and recent innovations in cancer screening and treatment. The impact of these cancer health disparities extends beyond the affected communities to all Californians because of increased health care costs and strain on health care resources in the state.

Racial-ethnic minorities such as African Americans, Californians who live in rural areas or have household incomes below the poverty line and members of the LGBT community all smoke at disproportionately high rates and thus have higher rates of cancer diagnoses and mortalities. These facts underscore the need for impactful research on the effective dissemination of community-focused cancer prevention strategies and implementation of evidence-based policy and practice interventions that can reduce the cancer burden in specific communities and in California as a whole. The persistent high rate of cancer incidence and death among tobacco users also underscores the need for continued research into the etiology and cure for tobacco-related cancers.

In recent years, TRDRP focused its limited funding for cancer research on projects related to early diagnosis of tobacco-related cancers to support studies that could have a direct impact on the prognosis and care for California smokers. With the passage of Proposition 56, TRDRP has a new mandate to fund research on all types of cancers and to expand the range of topics beyond early diagnosis. Specifically, Proposition 56 calls for “research into the causes, early detection, and effective treatment, care, prevention, and potential cures of all types of cancer.” Within this broad framework, TRDRP will prioritize funding in the following areas:

Development and dissemination of cancer prevention strategies for California’s diverse communities

In California, African Americans have the highest death rates, followed by non-Hispanic whites, Hispanics and Asian/Pacific Islanders, respectively. Cancer incidence follows a similar trend. These disparities persist despite the overall reduction in cancer incidence and death rates in California over the past few decades. Research is needed to translate new discoveries in cancer biology into cancer prevention strategies for California’s diverse communities. Dissemination research of effective methods for bringing existing prevention programs into the community is also needed. There is a critical need for effective interventions that can be implemented in a community setting or that are targeted to specific cultures and communities that bear a high cancer burden. Behavioral, clinical and pre-clinical studies are all welcome, as well as studies that combine more than one approach.

Implementation of evidence-based policy and/or practice changes within California

Very often, personal health care decisions, such as whether or how often to undergo cancer screening or whether to participate in clinical trials, are influenced by policies governing health care insurance coverage and practice recommendations provided by health care providers. Recent studies have shown that changes in some current policy and practice recommendations may result in improved cancer surveillance and/or survival in underserved communities. Research is needed to determine and overcome the barriers to implementing system change and to design strategies to bring innovative health care solutions to all Californians.

Translational research studies of new treatment strategies

TRDRP will now accept proposals for studies of new agents or methods for treating cancer. These include pre-clinical animal studies to small human clinical trials. Emphasis is on therapeutic strategies that can be implemented in remote, under-resourced clinics that are often found in underserved communities. TRDRP will continue to support innovative research on early detection and diagnosis methods due to the proven survival benefit of identifying, characterizing and tailoring treatment for early-stage cancer. Studies of innovative patient care strategies to improve patient prognosis, response to therapy and/or quality of life also are encouraged. Projects focusing on palliative care interventions for seriously ill cancer patients and their families are particularly needed.

Basic research studies of the molecular genetic mechanisms of cancer pathogenesis, progression and resistance to therapy

Molecular genetics studies of the initiation and malignant progression of cancer in patients are needed to develop effective early detection techniques and precision medicine therapeutic strategies. As new therapies are developed, attention also must be given to understanding the basic mechanisms of drug resistance, which often leads to disease recurrence even with the most effective therapies. While TRDRP will continue to prioritize research of cancers that are directly related to tobacco use, studies of all types of cancers will be accepted, particularly since many cancers have similar molecular mechanisms for growth and progression.

Sub-focus areas

  • Cancer prevention
  • Cancer policy and practice interventions
  • Translational cancer research
  • Basic research on cancer initiation and progression

Examples of relevant research topics

  • Evaluation of technology-driven methods for cancer prevention
  • Multi-county dissemination of an evidence-based cancer prevention program designed for Vietnamese males
  • Evaluation of emergency room intake procedures and their ability to identify patients at risk for cancer and inform those patients of the benefits of cancer screening
  • Development of a combined behavioral and medical health care team approach to increasing the racial and ethnic diversity of clinical trial cohorts
  • Evaluation of the quality/effectiveness of information about lung cancer screening and proximity to low-dose CT services in California’s Central Valley
  • Therapeutic efficacy studies of new biologics in small or large animal models
  • Development of “theranostic” molecular imaging methods for simultaneous diagnosis and treatment of cancer
  • Characterization of newly discovered genetic or epigenetic alterations in oral cancer
  • Pathways in the development of resistance to PD-1/PD-L1 targeted immunotherapies