>>IT IS NOW 1:15 AND TIME TO START THE AD HOC SUBCOMMITTEE MEETING ON LOCAL CANCER RESEARCH. THIS IS A PUBLIC MEETING. IT IS BEING VIDEOCAST AND RECORDED. MEMBERS OF THE PUBLIC WHO MAY WISH TO EXPRESS VIEWS WITH ITEMS DISCUSSED MAY WRITE THE EXECUTIVE SECRETARY OF THE NCAB WITHIN 10 DAYS AFTER THE MEETING. ANY WRITTEN STATEMENTS OR QUESTIONS PRESENT MEMBERS OF THE PUBLIC WILL RECEIVE CAREFUL CONSIDERATION. THE FOLLOWING NCAB SUBCOMMITTEE MEMBERS ARE PARTICIPATING. THE CHAIR ALI-OSMAN. DR. RIORATA. THERE'S A FORUM. ARE THERE ANY QUESTIONS REGARDING PROCESS? DR. ALI-OSMAN YOU MAY NOW BEGIN THE MEETING. I'D LIKE TO WELCOME TO YOU THE MEETING. I'D LIKE TO CONGRATULATE ON THE HISTORIC APPOINTMENT AND WELCOME TO THE FIRST MEETING OF THE SUBCOMMITTEE. I HAVE MET WITH THE OTHERS AND THERE'S ENTHUSIASM FOR THE GLOBAL RESEARCH AT THE NCI. I HAVE NO DOUBT SHE WILL NOT ONLY CONTINUE THE OUTSTANDING SUPPORT THE GLOBAL CANCER RESEARCH HAS ENJOYED FROM OTHER DIRECTORS BUT AS DEMONSTRATED WILL BRING RENEWED ENERGY AND LEADERSHIP TO IMPACT THE NCS GLOBAL COUNCIL RESEARCH. BEFORE I INVITE REMARKS, I'D LIKE TO SUMMARIZE THE CHARGE FOR THE BOARD AND DIRECTOR OF THE STRATEGY APPROACHES AND OPPORTUNITIES TO ENHANCE THE CONTRIBUTION TO GLOBAL CANCER RESEARCH. THE SUBCOMMITTEE WILL PROVIDE LEADERSHIP, EXPERTISE AND INPUT ON PROPOSED INITIATIVES, CONCEPTS AND PARTNERSHIPS AS WELL AS INFORMATION FOR THE PRIORITIZATION OF NEW PROSPECTS OF GLOBAL CANCER RESEARCH FOR THE NCI. IN ADDITION THE SUBCOMMITTEES PROVIDED OPPORTUNITIES WHEREBY THE NCI CAN CONTRIBUTE INTERNATIONALLY. EXAMPLES OF THESE INCLUDE ADVANCED CANCER RESEARCH AND BUILDING AND BRIDGING TECHNOLOGY, DEVELOPING RESEARCH CAPACITY AND PROMOTING TRAINING PROGRAMS. >>I JUST WANT TO A WE'RE ALL CITIZENS OF THE WORLD. WHAT AFFECTS ONE OF US AFFECTS US DEEPLY. WE ONLY NEED TO TURN ON THE TV EVERY SINGLE NIGHT AND TURN TO ANY ASPECT OF THE NEWS TO REALIZE WE'RE TRULY CITIZENS OF THE WORLD AND AS CANCER RESEARCHERS AND CANCER DOCTORS, WE HAVE TO MAKE SURE THAT WE ADDRESS THE NEEDS OF THE WORLDWIDE COMMUNITY AS WELL AS OUR OWN. SO THAT REALLY IS THE MAIN MESSAGE. FINALLY, I WILL SAY THAT AS I'M SURE ALL OF YOU ARE A FIRM BELIEVER THAT ANY SUCCESS FOR ONE NEEDS TO BE A SUCCESS FOR ALL. WE HAVE TO HAVE THAT MENTALITY THROUGHOUT OUR ENTIRE SOCIETY WITHIN OUR BORDERS BUT A VIEW TOWARDS THE REST OF THE WORLD. THANK YOU VERY MUCH. I'M HONORED TO BE HERE AND PARTICIPATE IN THIS DISCUSSION TODAY AND NOW LET ME TURN IT BACK OVER TO FRANCIS. >>THANK YOU, WE HAVE NOT TOO ITEMS BUT A LOT TO HEAR AND DISCUSS. I'LL GO TO THE DIRECTOR OF THE NCS CENTER FOR GLOBAL HEALTH. THE HE TOOK UP THE POSITION AT A VERY CRUCIAL TIME JUST WHEN THE COVID-19 PANDEMIC WAS BEGINNING. HAS DONE A REMARKABLE JOB TRANSITIONING AS YOU'LL HEAR. OVER TO YOU. >>THANK YOU, FRANCIS. WE'VE HAD A RESPIRATORY VIRUS RUNNING THROUGH OUR HOUSE. I'VE ASKED TO PRESENT AND I'M GRATEFUL FOR THE OPPORTUNITY TO PRESENT. FIRST I'LL BRIEFLY REMIND SUBCOMMITTEE MEMBERS LAST YEAR WAS THE 10th ANNIVERSARY OF THE ESTABLISHMENT OF THE CENTER FOR GLOBAL HEALTH AND HAVE A STRATEGY PLAN FOR THE CENTER. THE PLAN IS PUBLICLY AVAILABLE ON OUR WEBSITE AND REFRESHING OUR VISION AND WE WROTE AN ACCOMPANIED VIEW POINT ARTICULATING THEMES HAROLDING BACK TO A PIECE WHEN THE CENTER WAS FIRST ESTABLISHED. I ALWAYS SAY I BELIEVE THEN THE TASK WAS TO ESTABLISH THE CENTER AND INTEGRATE CANCER INTO GLOBAL HEALTH BUT NOW OUR TASK IS TO INVOLVE OUR CENTER AND PRIORITIZE WITHIN GLOBAL HEALTH. ON THE SLIDE ARE SOME OF THE KEY ELEMENTS OF OUR CURRENT WHICH WE ARE NOW IMPLEMENTING IN WHICH SOME MAY REMEMBER WE PRESENTED AT THE BSA MEETING IN FEBRUARY OF LAST YEAR IN MORE DETAIL. WE TRIED TO ORIENT OUR ACTIVITIES AROUND THE PRIMARY GOALS OF RESEARCH, RESEARCH TRAINING, DISSEMINATION AND PARTNERSHIPS AND SOUGHT TO FOCUS OUR RESEARCH EFFORTS IN THE APPLIED AREAS SHOWN AT RIGHT INCLUDING TECHNOLOGY DEVELOPMENT, IMPLEMENTATION SIGN, GLOBAL DISPARITIES, CLINICAL TRIALS THROUGH COLLABORATION ACROSS THE INSTITUTE. I'LL BRIEFLY PROVIDE UPDATES REGARDING RECENT ACTIVITIES IN SEVERAL AREAS SINCE WE LAST MET. WE HAVE A PROGRAM SUPPORTING LATE-STAGE VALIDATION OF TECHNOLOGIES IN LOW AND MIDDLE-INCOME COUNTRIES. IT WAS APPROVED WITH THE FIRST OF THREE NEW COHORTS OF AWARDS MADE SINCE WE LAST MET IN FEBRUARY AND SHOWN IN THE TABLE AT RIGHT. THE SUBCOMMITTEE MAY ALSO REMEMBER AT THE LAST MEETING IN FEBRUARY WE PROVIDED A PROGRAM UPDATE AND INTER VIVIDE -- AND HAVE THE DEVELOPMENT OF A RAPID MOLECULAR DIAGNOSTIC INSTRUMENT AT THE POINT-OF-CARE IN AFRICA OBVIATING THE NEED FOR PATHOLOGY SERVICES WHICH ARE EXTREMELY SCARCE ACROSS THE CONTINENT. WE'RE EXCITED THESE EFFORTS INCLUDING THESE EFFORTS TO THE DIAGNOSIS TO THE SARCOMA WILL BE EXPANDING IN THE NEXT PHASE OF THE PROGRAM. WE'RE EXPANDING SUPPORT AND IN OUR SUBCOMMITTEE IN SEPTEMBER AT LAST YEAR OUR DEPUTY DIRECTOR DESCRIBED THE IMPORTANCE AND POTENTIAL OF IMPLEMENTATION SCIENCE FOR GLOBAL CANCER CONTROL BUILDING ON IMPORTANT INVESTMENTS NCI MADE IN THE FIELD DOMESTICALLY IN RECENT YEARS. SINCE WE LAST MET, WE HAVE FUNDED NEW AWARDS FOR THE PROGRAM DEVELOPED TO SUPPORT IMPLEMENTATION SCIENCE FOR CANCER CONTROL AMONG PEOPLE LIVING WITH HIV LMICs. GIVE ENTHE POPULATION IS EXPERIENCING CANCER RELATED MORBIDITY AND MORTALITY AND GIVEN HIV CARE WHICH CAN BE LEVERAGED TO DELIVER PROVEN INTERVENTIONS. WE HAVE RECEIVED APPLICATIONS FOR NEW COMPANION NON-HIV U54 IMPLEMENTATION SCIENCE CENTERS IN LMICs AND ANTICIPATE MAKING THE AWARDS LATER THIS FISCAL YEAR. WE HAVE INITIATED A NEW GLOBAL CANCER INSTITUTIONAL TRAINING PROGRAM BORROWING IS THE D47 MECHANISM FROM THE FOGARTY CENTER TO ENCOURAGE LMIC INSTITUTION TO PARTNER WITH CANCER CENTERS TO SUPPORT PRE AND POSTDOCTORAL RESEARCHERS IN LMICs. WE HAVE FOUR NEW AWARDS SINCE WE LAST MET IN THE FY22 COHORT TO THE PROGRAMS TO CREATE A NEW RESEARCH TRAINING COMMUNITY. WE HAVE ALSO CONTINUED OUR SUPPORT FOR FOG ART Y PAY AWARD PROGRAMS FOR EARLY CAREER GLOBAL HEALTH RESEARCHERS SEEING INCREASED APPLICATIONS AND WILL BE A NATURAL NEXT CAREER STEP FOR MANY TRAINED IN THE NEW PROGRAM. WE ALSO INITIATE AND AWARDED NEW MENTORED RESEARCH SUPPLEMENTS FOR LMIC RESEARCHERS WORKING WITH ESTABLISHED INVESTIGATORS MODELLED UNDER OUR SUPPLEMENT PROGRAM. WE ALSO WORKED ON MORE INTRAMURALLY FOCUSSED TRAINING OPPORTUNITIES. SINCE WE LAST MET WE RESUMED THE SHORT-TERM SCIENTIST TRAINING PROGRAM WHERE RESEARCHERS FROM LMICs CAN TRAVEL AND MEET WITH COLLABORATORS IN THE NCI INTERIM PROGRAM AND ONE IS LED IN THE SOUTH AFRICA MATCH STUDY LOOKING AT TRENDS RELATED TO CANCER IN THE LARGEST HIV INFECTED POPULATION IN THE WORLD IN SOUTH AFRICA. WITH CGH SUPPORT SHE WAS RECENTLY HOSTED AT NCI TO DISCUSS COLLABORATION OPPORTUNITY IN THE DIVISION OF CANCER EPIDEMIOLOGY AND GENTETIC -- GENETICS. AND WE WORKED WITH INTRAMURAL FELLOWS TO UNDERSTAND HOW TO BETTER SUPPORT THE INTERESTS IN ADDITION TO THE STRONG TRAINING RECEIVING IN RESPECTIVE LABS AND RESEARCH GROUPS. MANY ARE FROM LMICs AND HOPED TO RETURN HOME AT SOME POINT IN THEIR CAREERS AND WE THEREFORE WORK TO SUPPORT THEIR SELF-INITIATION OF A GLOBAL HEALTH INTEREST GROUP TO BETTER CONNECT WITH EACH OTHER AND GLOBAL HEALTH ACTIVITIES ACROSS THE INSTITUTE WITH TRAINING OPPORTUNITIES. AS AN EXAMPLE AT BOTTOM RIGHT IS A GLOBAL HEALTH EQUITY PANEL ORGANIZED IN JULY FOR FELLOWS AT NCI TO MARK NELSON MENDELA DAY. SINCE WE LAST MET WE ALSO HAVE BEEN WORKING TO ADVANCE OUR DISSEMINATION AND PARTNERSHIP GOALS INCLUDING CELEBRATING THE 10th ANNIVERSARY OF THE CANCER CONTROL PARTNERSHIP WHICH WE SUPPORT WITH THE UNION FOR INTERNATIONAL CANCER CONTROL TO PROVIDE MULTILATERAL SUPPORT AT A COUNTRY LEVEL AS THEY'RE EVALUATING AND IMPLEMENTING THE CANCER CONTROL PLANS. WE ORGANIZE ED MEETINGS INCLUDING THE 10th ANNUAL SYMPOSIUM ON CANCER RESEARCH AND A GLOBAL CANCER STIGMA WORKSHOP AND COORDINATED IN OTHER ORGANIZATIONS. WE ALSO RECENTLY HOSTED THE EUROPEAN COMMISSIONER FOREHEALTH AND SAFETY AND THE DIRECTOR EF INTERNATIONAL AGENCY FOR RESEARCH ON CANCER IN ADDITION TO PROVIDING SUPPORT TO THE WHITE HOUSE FOR POSSIBLE UPCOMING SIDE EVENTS AS PART OF NEXT WEEK'S LEADER SUMMIT. THERE'S MAJOR INTERNATIONAL INTEREST IN EXPANDING GLOBAL HATH COLLABORATION FOR CANCER IN LIGHT OF THE CANCER MOON SHOT AND LOOK FORWARD TO MORE AS THESE COME TOGETHER. AND OUR COLLEAGUES WILL BE DISCUSSING RESULTS OF OUR RECENT GLOBAL ONCOLOGY SURVEY AT NCI DESIGNATED CANCER CENTERS IMMEDIATELY FOLLOWING MY PRESENTATION SO I'LL LEAVE THE DISCUSSION IN THEIR CAPABLE HANDS. FINALLY, I'D LIKE TO BRIEFLY HIGHLIGHT OUR UPCOMING ANNUAL SYMPOSIUM ON GLOBAL CANCER RESEARCH WE ORGANIZED TOGETHER WITH MANY PARTNER ORGANIZATIONS SHOWN HERE. WE BELIEVE THIS TO BE THE LARGEST MEETING DEVOTED TO LMICs AND CONCEPTUALIZED THIS AS A VIRTUAL HIGH ENGAGED MEET ALLOWING ANYONE IN THE WORLD TO BE INCLUDED IN THE CANCER RESEARCH ENTERPRISE. PARTICULARLY FOR THOSE WHO MAY LACK TIME AND RESOURCE TO ATTEND MANY OTHER SIGNATURE CANCER MEETINGS CALL FOR ABSTRACTS AND SESSIONS IS NOW OPEN AND A HOPE SOME OF YOU AND YOUR COLLEAGUES WILL CONSIDER SUBMITTING OR ATTENDING. I'LL END THERE. THANK YOU FOR YOUR CONTINUED ADVICE AND SUPPORT. I'LL BE HAPPY TO TAKE ANY QUESTIONS FOR WE MOVE ON TO THE NEXT PRESENTATION ON ACTIVITIES AT THE NCI DESIGNATED CANCER CENTERS. >>WE ARE OPEN FOR QUESTIONS. RAISE YOUR HAND AND I'LL CALL ON YOU. LET ME START. THERE'S BEEN TWO ANNOUNCEMENTS FOR ESTABLISHING PILOT AT THE INITIAL PHASE OF THE CENTERS OF EXCELLENCE FOR RESEARCH IN LMICs AND A NUMBER OF AWARDS WERE GIVEN OUT. CAN YOU GIVE US -- AND THIS IS DIRECTED TOWARDS THE CAPACITY BUILDING COMPONENT AND CENTER FOR GLOBAL HEALTH. CAN YOU GIVE US AN UPDATE ON THAT AND WHAT FUTURE PLANS ARE WITH RESPECT TO THAT? >>YEAH, THANK YOU, FRANCIS. IT'S A GREAT QUESTION. I THINK YOU'RE REFERRING TO THE 2020 PROGRAM FOR NON-COMMUNICABLE DISEASES. WE TRIED TO RECONCEPTUALIZE THE CENTER PROGRAM AROUND MORE SPECIFIC SCIENTIFIC AREAS OF FOCUS. FOR EXAMPLE, AS I MENTIONED WE HAVE A NEW U54 IMPLEMENTATION SCIENCE CENTER PROGRAM WE RECEIVED APPLICATIONS FOR SO NCD FRAMING AND IN SOME WAYS THE LACK OF PARTICIPATION BY OTHER NIH INSTITUTES I THINK LED US TO RECONCEPTUALIZE AROUND SPECIFIC AREAS OF SCIENTIFIC FOCUS LIKE IMPLEMENTATION SCIENCE. OUR IMPLEMENTATION SCIENCE U-54 WILL SIMILARLY INCLUDE CONNECTIONS WITH A LOT OF OTHER CONSORTIA ACTIVITY AT NCI INCLUDING MORE DOMESTICALLY ORIENTED SCIENCE AND DEDICATED CORE FACILITIES FOR CAREER DEVELOPMENT AND FOR STAKEHOLDER ENGAGEMENT. IT'S THE SAME CENTER CONCEPT RECONCEPTUALIZED WITH A SPECIFIC FOCUS IF THAT MAKES SENSE. >>SO CONTINUED AS IT WAS. THOSE THAT WERE AWARDED, WHAT WAS THE OUTCOME? IS THERE AN EVALUATION HOW THEY DID? >>THEY WERE TWO-YEAR PILOT GRANTS THERE WAS A SUBSEQUENT NO-COST EXTENSION AND MANY WERE FINISHING UP THEIR WORK AND WE COLLECTED SOME FROM INFORMATION FROM THE AWARDEES BUT WE NEED TO ANALYZE WHAT THE IMPACT OF THOSE INVESTMENTS WERE. >>ANY OTHER QUESTIONS? >>I HAVE ONE. SO THANK YOU SO MUCH. THAT WAS A NICE PRESENTATION AND VERY EYE-OPENING. I GREW UP IN AN LMIC SO IT'S HARDENING TO SEE. I HAVE A QUESTION. ONE THING I HEAR FROM STUDENTS ALL OVER THE WORLD IS LACK OF ACCESS TO THE MEETINGS LIKE ACR AND SOME OF THE OTHER MEETINGS YOU MENTIONED. WHAT CAN WE DO TO INCREASE THE INFRASTRUCTURE SO THEY HAVE ACCESS VIRTUALLY AS WELL AS ENCOURAGE PARTICIPATION AND TRAVEL TO THESE MEETINGS? >>THAT'S A GREAT QUESTION. SOME ARE HAVE TAKEN STEPS. ASCO RECENTLY WAIVED MEMBERSHIP FOR INVESTIGATORS AND WE WORKED TO STRATEGIZE HOW TO INCREASE ACCESS. OUR MEETING WE HOPE TO HOLD WITH ASPO AND CUGH AND AN AORTIC IS HAS CONTENT DESIGN TO BE FREE AND WE WELCOME ADDITIONAL IDEAS FOR OTHER THINGS WE CAN DO. >>IT'S A TERRIFIC PLATFORM OF WORK. GLOBAL OUTREACH EFFORTS ARE FANTASTIC. I'VE WORKED WITH DIFFERENT REGIONS IN AFRICA ON BREAST CANCER PROGRAMS OVER THE LAST SEVERAL YEARS. IN THE SPIRIT OF CAPACITY BUILDING I SEE A HUGE UNMET NEED IN TRYING TO ATTAIN MORE GENDER BALANCE IN BOTH THE MEDICAL CLINICAL CARE AND RESEARCH ISSUES ADDRESSED IN AFRICA. THAT'S ANOTHER IMPORTANT EFFORT TO ADDRESS. THERE'S A HUGE UNTAPPED POOL OF TALENT AMONG WOMEN WE LOOK TO MOBILIZE. >>GOOD POINT. >>I HOPE YOU FEEL BETTER SOON. I KNOW THERE'S VIRUSES GOING AROUND. CONGRATULATIONS ON THE WORK YOU ARE DOING. I KNOW THE WORK IS DOING IS AMAZING IN TERMS OF SUSTAINABILITY. I JUST WANT TO ASK YOU, I KNOW YOU WANT TO HAVE THE MAXIMUM IMPACT WITH WHAT YOU ARE DOING WITH CGH BUT THE WORLD IS A VERY BIG PLACE. HOW DO YOU STRATEGIZE WHEN YOU AWARD THE GRANTS? AGAIN, THANK YOU FOR THE GREAT WORK. >>THAT'S A GOOD QUESTION. WE'RE AWARE OF THAT AND I REALLY BELIEVE STRATEGIZING AND PRIORITIZE IS AN EXISTENTIAL ISSUE FOR US AT THE CENTER FOR GLOBAL HEALTH. WE TRY TO FOCUS ON LOW AND MIDDLE INCOME COUNTRIES WHICH ARE UNDER REPRESENTED IN THE NCI PORTFOLIO RELATED TO BURDEN AND TARGETING PROGRAMS AND SCIENTIFIC AREAS THAT CAN HAVE DISCREET AND MEASURABLE IMPACT IS SOMETHING WE FOCUS ON AND HOPEFULLY SOME IS REFLECTED IN THE PRESENTATION. WE LOOK AT SCIENTIFIC DEVELOPMENT AND WE LEAVE IT OPEN TO THE BEST APPLICATIONS AROUND THE WORLD. WE KNOW THERE'S NOT AS GOOD REPRESENTATION OF SOME WORLD REGIONS AS OTHERS AND WE'RE THINKING A LOT HOW SOME ARE SYSTEMIC ISSUES. FOR EXAMPLE, PARTS OF THE WORLD WHERE ENGLISH IS NOT SPOKEN AS THE PRIMARY LANGUAGE POSE AS A REAL BARRIER IN SUBMITTING APPLICATIONS IN ENGLISH. WE'RE TRYING TO THINK HOW TO UNLOCK THOSE. IN MANY RESPECTS THEY'RE NOT UNIQUE NCI ISSUES BUT BROADER NIH ISSUES WE'RE THINKING WITHIN OURSELVES AND OTHER GLOBAL HEALTH OFFICES IN HOW WE MIGHT ADDRESS. DEF >>I'M GLAD TO SEE ALL THE MEETINGS HAPPENING AFTER COVID. CAPACITY BUILDING IS A MAJOR AREA OF FOCUS. YOU MAY HAVE MENTIONED THAT ALREADY BUT IN TERMS OF THE PARTNER TRAINING GRANTS, WHAT'S THE VOLUME RIGHT NOW AND WHAT'S THE PROSPECT ABOUT HOW MANY NEW GRANTS YOU ANTICIPATE FUNDING IN THE SPACE? >>THANK YOU FOR THE QUESTION. WE CURRENTLY HAVE EIGHT GRANTS. THAT'S ALL THAT WAS ANTICIPATED TO BE AWARDED IN THE CURRENT RFA. WE'RE JUST STANDING UP THE NEW COMMUNITY. EACH OF THOSE -- AGAIN, THESE ARE NOW INSTITUTIONAL TRAINING PROGRAMS SIMILAR TO A T32 AND THE D ME MECHANISM ALLOWS INTERNATIONAL TRAINING HAS RESIDED AS FOGARTY AND WE CO-FUNDED INTO THE FOGARTY PROGRAMS AND WHAT BECAME CLEAR TO US A FEW YEARS AGO AND YOU'LL SEE THIS IN THE SURVEY, MANY CANCER CENTERS ARE DOING QUITE A LOT BUT RELATIVELY LIMITED TRAINING DESPITE A LOT OF INTEREST FROM PARTICULARLY TRAINEES AND EARLY CAREER FACULTY AND SO WE HAVE TRIED TO ADDRESS THAT WITH THIS INITIAL OFFERING WHICH IS WE'RE STANDING UP NOW AND WHICH IS ALLOWING US TO DEVELOP A TRAINING COMMUNITY OF PRACTICE TO SHARE RESOURCES AND PROVIDE NETWORKING OPPORTUNITIES FOR TRAINEES AND EACH OF THE PROGRAMS WERE ASKED TO ADDRESS THEIR LOCAL TRAINING NEEDS AND EACH ARE ANTICIPATED TO TRAIN COHORTS OF SCORES OF INDIVIDUALS BUT IT'S VERY MUCH SOMETHING THAT WE'D LIKE TO EXPAND BASED ON THE INITIAL EXPERIENCE. THESE ARE AWARDS THAT ARE JUST NOW GETTING INITIATED. WE HAVE A LOT OF LEARNING TO DO I THINK STILL HOW TO OPTIMALLY SUPPORT GLOBAL CANCER RESEARCH TRAINING EFFORTS AT LIMCs. THE OTHER THING TO SAY QUICKLY THERE NEEDS TO BE A PIPELINE AND TRAINEES NEED TO HAVE ADEQUATE K AND OTHER SOURCES OF SUPPORT TO SUSTAIN GLOBAL CANCER RESEARCH CAREERS. ALL ISSUES TRAINEES FACING IN THE U.S. ARE IN SOME WAYS MORE EXTREME IN LIMC AND THIS SAY PIPELINE APPROACH SIMILAR TO REGARD TO UNDER REPRESENTED GROUPS DOMESTICALLY. >>REAL QUICKLY TO ADD TO THAT, YOU KNOW VERY WELL AND THIS AND OTHERS IN THE GROUP KNOW, ONE OF THE BIGGEST CHALLENGES WITH LMICs IS INFRASTRUCTURE. YOU CAN TRAIN THE PEOPLE BUT THEY GO BACK AND SIMPLE THINGS LIKE THERE'S CHEMISTRY. ANY IDEAS MAYBE WORKING WITH THE LOCAL STAKEHOLDERS IN THOSE COUNTRIES OR OTHER ORGANIZATIONS IN ADDITION TO TRAINING PEOPLE AND ENSURE THE INFRASTRUCTURE IS AVAILABLE? >>IT'S SUCH A GOOD POINT. WE PLAY A ROLE AT NCI AT INITIATING CATALYTIC INVESTMENTS THAT LEAD TO INFRASTRUCTURE GROWTH AND WE DO THAT OVER TIME DOMESTICALLY BUT YOU'RE RIGHT THIS HAS TO BE SUSTAINED AND OFTEN IT HAS TO COME FROM OUTSIDE NCI OFTEN. WHEN YOU HAVE RESEARCH THAT DEMONSTRATED VALUE TO PEOPLE AND POPULATIONS AND COMMUNITIES, IT'S EASIER TO ENGENDER THOSE KINDS OF INVESTMENTS AS SUBSEQUENT STEPS. VERY OFTEN MINISTRIES OF HEALTH IN ADDITION TO THE DEVELOPING COMMUNITY LIKE OUR COLLEAGUES DON'T SEE THE RESEARCH. SOMETIME THROUGH GROWTH OF PARTICULAR AREAS AND IMPLEMENTATION SCIENCE I THINK WE'RE TRYING TO SUPPORT A BODY OF RESEARCH THAT MORE DIRECTLY SPEAKS TO THE NEEDS OF POLICY MAKERS AND PRACTITIONERS AND OUR HOPES IS THAT SOME OF THESE OTHER SOURCES OF INVESTMENT IN THIS CRITICAL INFRASTRUCTURE CAN HAPPEN AS WE DO THAT GOING FORWARD. >>ANY OTHER COMMENTS OR QUESTIONS? >>I HAVE A QUICK QUESTION. >>THANK YOU, I HOPE YOU FEEL BETTER. I JUST GOT OVER THAT VIRUS. IT WAS PRETTY BAD. I GUESS FOR ME ONE OF THE THINGS THAT SEEMS LIKE A NATURAL OPPORTUNITY HERE IS PUBLIC-PRIVATE PARTNERSHIP AND WHAT THEY HAVE DONE TO LOOK FOR PERFORM INDUSTRY OR PHILANTHROPIC PARTNERS TO DOUBLE DOWN AND BUILD THE INFRASTRUCTURE IN LIMCs? >>GREAT POINT. WE STARTED SOME CONVERSATIONS. JULIE GERBERDING JOINED AS A DIRECTOR. WE STARTED EXPLORING SOME OF THE WAYS IN WHICH WE HAVE BEEN ABLE TO ENGINEER PUBLIC-PRIVATE PARTNERSHIPS FOR CANCER RESEARCH DOMESTICALLY AND HOW WE MIGHT ADAPT SOME MODELS. WE'RE STILL AT EARLY STAGES. WE'VE HAD ONE-OFF ARRANGEMENTS WITH A SPECIFIC COMPANY WILLING TO PROVIDE A SPECIFIC DRUG FOR A SPECIFIC TRIAL BUT NOT REALLY A PLATFORM SOLUTION AND WE'RE VERY MUCH INTERESTED IN DEVELOPING THAT. I DON'T THINK IT'S IN PLACE CURRENTLY. >>SOME OF THE FOUNDATIONS AS WELL MAY BE INTERESTED IN PATHOGEN-RELATED DISEASES AND WE KNOW SEQUELAE FROM THE PATHOGEN RELATED DISEASES. SOMETHING WE'RE TRYING TO SUPPORT. >>AND WE'RE TRYING TO ACTIVELY SUPPORT. >>GREAT POINT. ANYBODY ELSE BEFORE WE MOVE TO THE NEXT PRESENTATION? >>CAN I ASK ONE OTHER QUESTION? SO MY QUESTION IS RELATED TO THE COMMENT FROM YOU, DR. ALI-OSMAN AND IT'S ABOUT THE ISSUE OF INFRASTRUCTURE IN LOW AND MIDDLE INCOME COUNTRIES IN REGARDS TO COUNTRIES IN AFRICA. THERE'S SUCH BARRIERS IN OBTAINING THE MOST BASIC PATHOLOGY MATERIALS AND THE DIFFERENT FACILITIES ACROSS THE COUNTRIES COMPLAIN EVEN WHEN THEY DO HAVE THE FINANCES TO PAY FOR THESE MATERIALS, THEY HAVE DIFFICULTY GETTING THEM FOR A VARIETY OF REASONS AND MANY COMPANIES COMPLAIN THEY DON'T HAVE DISTRIBUTORS TO GET THE SUPPLIES TO THE DIFFERENT COUNTRIES. TOE WHAT EXTEND CAN NCI WORK WITH THE INDUSTRY TO OVERCOME THE BASIC SUPPLY CHAIN BARRIERS? >>WE'RE THINKING ABOUT WHAT IS AN APPROPRIATE ROLE FOR US AND ACCESS INITIATIVES AND DIFFERENT PARTNERS AND WE'RE CERTAINLY PARTICIPATING IN THOSE DISCUSSIONS. I THINK AN EVIDENCE GENERATION ROLE IS COMFORTABLE FOR US. HOW CAN WE SUPPORT RESEARCH THAT WOULD SHOW HOW THE TOOLS CAN BE OPTIMALLY APPLIED IN THE SETTINGS TAKING UP FURTHER AND SOLVING THE MORE LOGISTIC AND ACCESS ISSUES YOU DESCRIBED IS OUTSIDE WITH WHAT THE NCI TRADITIONALLY DOES BUT WE'RE TRYING TO PARTICIPATE AND THINK ABOUT PARTICULARLY IF THERE'S AN AREA WE CAN CONTRIBUTE WHERE OTHERS MAY NOT BE ABLE TO AND HAPPY TO TALK TO YOU OFFLINE ABOUT THAT AS WELL. >>THANK YOU. >>ANY OTHER? OKAY. I THINK WE'LL MOVE ON IT THE SECOND PRESENTATION. GLOBAL ONCOLOGY SURVEY AT DESIGNATED CANCER CENTERS. IT WILL BE PRESENTED BY HAILEY. >>I'LL START. I'M SHARE THE RESULTS OF OUR 2021 GLOBAL ONCOLOGY SURVEY. I'LL START WITH BACKGROUND ON THE SURVEY. SHARE SOME OF THE RESULTS AND TALK THROUGH SOME CONSIDERATIONS AND HOW IT'S UTILIZED AND THEN PASS IT OVER TO LEAD US FOR DISCUSSION. A BIT OF BACKGROUND AS I THINK MOST PEOPLE KNOW THE CENTER FOR GLOBAL HEALTH TRACKS OUR GLOBAL CANCER RESEARCH INTERNALLY AND PERIODICALLY WE CONDUCT NON-NIH FUNDED LED BY THE NCI CANCER CENTERS. FOR THE LATEST ITERATION WE COLLABORATED WITH THE CENTERS. FIVE THEMSELVES ASCO AND AACR AND QUESTIONS ABOUT HIGH LEVEL AND ASKED DIFFERENT QUESTIONS AT THE CENTERS TO THE SURVEY HAD THINGS THAT TIE BACK TO THE CONTENT OF OUR STRATEGIC PLAN FOR CGH. TRYING TO UNDERSTAND WHAT THE CANCER CENTERS ARE DOING WITHOUT OUR NIH FUNDING AND WHERE IT ALIGNS AND COMPLEMENTS WHAT WE'RE LOOK AT IN OUR STRATEGY PLAN. I WANT TO MAKE ONE MORE NOTE ON WHY WE'RE FOCUSSING ON THESE ACTIVITY. THE MAJORITY OF NCI AWARDS ARE AWARDED TO INSTITUTIONS IN THE UNITED STATES. THE CHART ON THE LEFT YOU CAN SEE 86% OF OUR FUNDING IN FISCAL YEAR 2021 WENT TO U.S. INSTITUTIONS CONDUCTING RESEARCH IN THE U.S. 13% WENT TO INSTITUTIONS WITH FOREIGN COLLABORATORS AND 1% FOR DIRECT INTERNATIONAL AWARDS AND SMALLER OUT OF THAT 1% WENT TO LIMC INSTITUTION. ALSO THE BREADTH OF THE NON-NIH FUNDED GLOBAL ONCOLOGY ACTIV ACTIVITIES IS BEYOND THE SCOPE FUNDED BY NCI. IT'S A MORE COMPREHENSIVE VIEW OF WHAT THE CENTER DOING WITH GLOBAL ONCOLOGY. A BRIEF HISTORY OF THE SURVEY. IT'S THE FOURTH TIME. THE FIRST TIME WAS IN 2012 AS WE STOOD UP THE CENTER FOR GLOBAL HEALTH. THERE WERE WE GOT 31 RESPONSES AND THEY REPORTED 175 GLOBAL ONCOLOGY PROJECTS. WE MADE IT MORE SYSTEMATIC AND GOT 54 RESPONSES FROM 64 CENTER AND THEY REPORTED 257 PROJECTS. IN 2018 WE USED GOOGLE FORM AND EXCEL AND GOT 613 PROJECTED REPORTED. A HUGE INCREASE AND ASKED FOR THE FIRST TIME WHETHER OR NOT CANCER CENTERS HAD A GLOBAL ONCOLOGY PROGRAM. IT WAS DEFINED AS GLOBAL ONCOLOGY OR GLOBAL HEALTH ACTIVITIES AND 33 CANCER CENTERS HAD A PROGRAM. FOR 2021 WE'VE DONE THE MOST SYSTEMATIC DATA COLLECTION YET USING AN ONLINE SURVEY TOOL AND WE HAD 67 RESPONSES, 517 PROJECTS REPORTED AND 28 PROGRAMS BUT WHAT'S IMPORTANT HERE THIS ISN'T A DECREASE IN THE NUMBER OF GLOBAL ONCOLOGY PROGRAMS BUT WE CHANGED THE DEFINITION BASED ON FEEDBACK FROM VARIOUS STAKEHOLDERS AND SO THIS IS 28 CANCER CENTERS WITH A DEDICATED DEPARTMENT OR OFFICE FOR GLOBAL ONCOLOGY. SO 61 OUT OF THE 67 RESPONDING CANCER CENTERS REPORTED SOME KIND OF INVOLVEMENT IN GLOBAL ONCOLOGY. 28 WITH A FORMAL PROGRAM AND 33 REPORTED ACTIVITIES OUTSIDE THE FORMAL PROGRAM. SIX HAD NO GLOBAL ONCOLOGY ACTIVITY TO REPORT. IN YELLOW THERE'S THE OFFICIAL DEFINITION OF GLOBAL ONCOLOGY PROGRAM WE USED AND ONE INTERESTING THING TO POINT OUT AT THE BOTTOM OF THE 33 CANCER CENTERS WITHOUT A FORMAL PROGRAM, 10 INDICATED THEY PLAN TO CREATE A PROGRAM IN THE NEXT THREE TO FIVE YEARS. THIS IS SOMETHING FOR US TO KEEP AN EYE ON. AND THIS LEVEL OF INVOLVEMENT LINES UP WELL WITH THE GRAPH WE SEE ON THE RIGHT. THIS IS HOW CANCER CENTERS S RELATE THE GLOBAL ONCOLOGY RELATED TO THE OTHER PRIORITIES OF THE OTHER CANCER CENTERS. FOR THEM IT'S MODERATE OR HIGH PRIORITY. HERE YOU SEE THE GRAPH AND YOU SEE THE GOVERNMENT AND CORPORATE. THE TAKEAWAY IS THERE'S A LOT OF DIVERSE FUNDING SOURCES. MORE INTERNATIONAL THAN WE WERE EXPECTING. AGAIN, THIS IS THE NUMBER OF CANCER CENTERS THAT REPORT THE FUNDING SOURCES. WE DON'T HAVE DATA ABOUT THE DOLLAR AMOUNTS OF FUNDING THEY'RE GETTING FROM EACH OF THEM. I TALKED GOOD HOW MANY GLOBAL CENTERS ARE INVOLVED WITH GLOBAL ONCOLOGY. CANCER CENTERS REPORTED 517 TOTAL PROJECTS AND SENT THEM TO THE P.I.s FOR DETAILS AND THE REST OF THE SLIDES WE'LL TALK ABOUT THE 447 PROJECTS FOR WHICH WE HAVE UPDATED DETAILS FOR ANALYSIS THEY WERE ALL ACTIVE IN 2021. WHAT IS A PROJECT? THIS IS THE DEFINITION IN YELLOW. AND IT'S IN PARTNERSHIP WITH A SETTING OUTSIDE THE UNITED STATES AND CAN INCLUDE UNFUNDED PROJECTS. WE TOOK THOSE AND YOU COMPARED THEM TO THE NIH-FUNDED S PROJECTS AT THE SAME TIME AND 288 WITH INTERNATIONAL COLLABORATORS IN THE SAME PERIOD. THESE NEXT FEW SLIDES OF RESULTS SHARE SOME OF THE NON-NIH ONES BY THEMSELVES AND SOME IN COMPARISON. THIS FIRST ONE IS A COMPARATIVE SLIDE. WE'RE LOOKING AT THE BREAKDOWN OF GRANTS AND PROJECTS BY CANCER SCIENTIFIC OUTLINE IN THE CSO CODE LOOSELY FOLLOWING THE CANCER CONTINUUM. THIS IT THE RED BAR IS THE NIH GRANTS ASSIGNED AND THE BLUE ARE THE NON-NIH FUNDED PROJECTS. WE CAN SEE THERE'S A LOT OF NIH GRANTS ON BIOLOGY AND ETIOLOGY AND THEN THE NON-NIH FUNDED PROJECTS ARE PICKING UP THE SLIDE IB CANCER CONTROL SURVIVORSHIP AND RESEARCH. WE NOTICE RESEARCH ON PREVENTION IS PRETTY LOW FROM BOTH FUNDING SOURCES. PROJECT AND GRANTS COULD BE CODED TO MULTIPLE CSO CODES. WE'RE GOING TO START LOOKING WITH GEOGRAPHIC DISTRIBUTION. THIS ONE IS SHOWING JUST THE NON-NIH FUNDED GLOBAL ONCOLOGY PROJECTS. ON THE PROJECTS THERE WERE A TOTAL OF 85 COUNTRIES WITH COLLABORATING INSTITUTIONS. THIS GRAPH IS SHOWING THE 20 COUNTRIES THAT COLLABORATED ON THE HIGHEST NUMBER OF PROJECTS. AND THE DARK BLUE BARS INDICATE LMICs. THE LIGHTER BLUE ARE HIGH-INCOME COUNTRIES AND THE GRAY NUMBER ON THE TOP OF THE BAR IS THE NUMBER OF PROJECTS WITH AT LEAST ONE COLLABORATING INSTITUTION IN THE COUNTRY. THE WHITE NUMBER IN THE BAR THOUGH IS THE NUMBER OF CANCER CENTERS THAT WERE LEADING THE PROJECTS. THERE'S SORT OF SOME UNEQUAL DISTRIBUTION. FOR TAN TANZANIA THEY WERE LED BY SOMETIMES SINGLE CANCER CENTERS WITH SEVERAL PROJECTS IN ONE COUNTRY. WE SEE A LOT OF LIMC INVOLVEMENT AND THAT'S EXCITING TO SEE. THE RED SECTIONS OF THE BAR ARE THE NIH-FUNDED GRANTS. AND SO REALLY OUR DISTRIBUTION OF LIMC TO HIC SHIFTED AND WE SEE THE VOLUME DRIVEN BY NIH-FUNDED GRANTS. MOVING ON TO ANOTHER SECTION WE ASKED ABOUT, TRAINING. HOW MANY CANCER CENTERS OFFER LOCAL DIDACTIC ONCOLOGY TRAINING AND 15 CENTERS WERE LISTED AND THEY'RE ON THE RIGHT. THERE WERE ANOTHER 18 CANCERS THAT OFFERED DIDACTIC GLOBAL ONCOLOGY TRAINING. OVER HALF DID OFFER SOME KIND OF LOCAL ONCOLOGY TRAINING. A BIG ISSUE WICK THE SURVEY IS IT'S DIFFICULT FOR CANCER CENTER TO TRACK THE INFORMATION AND WE HEARD THIS ANECDOTALLY AND WE ASKED THE CANCER CENTERS WITH GLOBAL ONCOLOGY ACTIVITY WITHOUT A PROGRAM HOW TO TRACK THEM AND 17 RESPONDED IT WAS DONE BY INDIVIDUALS AND 14 ARE NOT SYSTEMATICALLY TRACKED AT ALL. WHILE WE THINK IT'S STILL THE BEST DATA SOURCE AVAILABLE AND INTERESTING AND VALUABLE INFORMATION TO HAVE, IT'S IMPORTANT TO REMEMBER THIS IS VERY HARD FOR CANCER CENTER TO TRACK AND REPORT ON AND ESPECIALLY TRUE FOR CONSORTIUM CANCER CENTERS. DESPITE THE CANCER CENTERS AND OTHERS IN THE COMMUNITY ARE USING THE SURVEY QUITE A BIT. THIS SLIDE IS SHOWING HOW CANCER CENTERS USED THE RESULTS FROM THE PREVIOUS SURVEY CONDUCTED IN 2018. WE ASKED THEM HOW TO USE THE SURVEY AND THAT'S REFLECTED IN THE BARS BELOW. THE 25 CANCER CENTERS INCREASED THEIR KNOWLEDGE ABOUT OTHER GLOBAL ONCOLOGY ACTIVITIES OR COLLABORATIONS. 24 COMPARED THEIR LOCAL ONCOLOGY PROGRAMS TO THOSE OF OTHER CANCER CENTERS AND THOSE TEX AT THE TOP IS ANECDOTAL INFORMATION WE HEARD AS WE CONTINUE TO ENGAGE WITH CANCER CENTERS. AND ONE COOL EXAMPLE WAS A PRESENTATION ON FUNDING DATA IN GLOBAL CANCER RESEARCH AND ONE PRESENTER WAS HAVE THE UNIVERSITY OF WISCONSIN AND TALKED ABOUT A COUPLE YEARS AGO FIRST USED THE 2018 SURVEY RESULTS TO GROW THE GLOBAL ONCOLOGY PROGRAM AND THEN MOVED TO THE UNIVERSITY OF WISCONSIN AND INITIATED THE PROGRAM THERE AND WAS HELPINGO OOUS -- HELPI US CO-DESIGN THE SURVEY AND IMPLEMENTED A PROGRAM AND HELPED US IMPROVE THE SURVEY AND MADE SURE IT APPLIED TO VARIOUS TYPES OF CANCER CENTERS. WE THINK THAT THE RESULTS OF THE SURVEY WILL BE BENEFICIAL TO A LOT OF PEOPLE IN THE GLOBAL ONCOLOGY COMMUNITY. THE CANCER CENTERS THEMSELVES RESEARCH INSTITUTIONS AND HELPING TRAINEES AND OTHER FUNDERS AND NATIONAL REGIONAL AUTHORITIES WHO MAY WANT TO CONDUCT SIMILAR SURVEYS. WE'RE SUBMITTING A MANUSCRIPT EARLY NEXT YEAR AND TAKING THE INFORMATION TO VARIOUS CONFERENCE TO SHARE THIS AND DISSEMINATE RESULTS AND ANSWER QUESTIONS. WE'LL USE THE REST OF THE TIME FOR OPEN DISCUSSION. >>THANK YOU. I'M A FORMER CANCER DIRECTOR HERE AT INDIANA UNIVERSITY AND LEAD THE CENTERS OF GLOBAL HEALTH FOR ONCOLOGY AND HAVE BEEN INVOLVED IN BUILDING A WESTERN PROGRAM IN WESTERN KENYA THE LAST 17 YEARS. IT'S NEAR AND DEAR TO MY HEART AS A FORMER DIRECTOR. THE KEY TAKEAWAY IS THERE'S A BROAD INTEREST IN GLOBAL ONCOLOGY INCREASING AT ALL THE CANCER CENTERS. THE CANCER CENTERS HAVE MAINTAINED ONCOLOGY PROGRAMS AND SOME ARE OFFERING MORE FORMALIZED PROGRAMS THAN THEY HAVE IN 2018. IT REFLECTS THE ENTHUSIASM FROM THE YOUNGER STUDENTS AND FACULTY MEMBERS. THE PROBLEM IS THE TRACKING AND REPORTING OF THE DATA IS CHALLENGING. THERE WERE GRANTS WE HAD AT THE NCI THE DIRECTORS DIDN'T KNOW ABOUT. THERE'S AN OPPORTUNITY TO EXPAND THE FIELD OF GLOBAL ONCOLOGY AND TRAIN AT THE LIMCs WITH OTHER STRATEGY PARTNERSHIPS AND NEED A BENCHMARK FOR SUCCESS INCLUDING RESEARCH, EDUCATION AND COE. THESE ARE THE BENCHMARKS I THINK WE CAN PUT IN OUR CORE APPLICATIONS. IN THE REMAINING FEW MINUTES AND IT'S UP TO DR. ALI-OSMOND HOW FAR WE GO BUT WHAT THE BARRIERS TO INCREASE ENGAGEMENT IN GLOBAL ONCOLOGY? HOW DOES ENGAGING GLOBAL ONCOLOGY BENEFIT THE CANCER CENTERS AND WHAT IS THE ROLE IN AMPLIFYING OR LEVERAGING THE BENEFITS? AND WHAT CAN WE BE DOING TO INCREASE OR FACILITATE THE RESPONSE? I'LL PAUSE HERE AND I WANT TO SHOW MY DELIGHT IN HAVING DR. BERNOLI AS NEW LEADERSHIP AND MY SHOUT OUT TO SHELLY AND OUR HEARTS ARE BREAKING FOR YOU. >>WE HAVE ABOUT SIX MINUTES FOR QUESTIONS. ANY QUESTIONS FOR THE TWO SPEAKERS? >>FRANCIS. >>A QUICK OBSERVATION. I NOTICED ON THE FUNDING IT DIDN'T SEEM TOO MUCH FROM INDUSTRY. AM I RIGHT? >>IS THAT A LOST OPPORTUNITY? >>I THINK IT'S FAIRLY LOW BOTH FOR U.S. AND NATIONAL PRIVATE SECTOR. OUR WORK IN KENYA HAS BEEN STRONG BUT THROUGH FOUNDATION RATHER THAN THROUGH THE RESEARCH COMPONENT PARTS. ALSO UNDER SOCIAL JUSTICE COMPONENTS FROM THE VARIOUS FOUNDATIONS. A COMMENT OR QUESTION? >>I WANT TO THANK THE SPEAKERS FOR THEIR PRESENTATIONS. VERY NICE. AND PAT, ONE QUESTION YOUR SECOND DISCUSSION QUESTION WILL BE VITAL FOR THERE TO BE AROUND PARTICULARLY WHEN THERE'S SO MANY DEFICITS WITHIN THE UNITED STATES. NEED FOR CAPACITY BUILDING WITHIN THE UNITED STATES. OTHER TAXPAYERS, ETCETERA, THEY'LL SAY WHY IS IT THAT'S IMPORTANT. I SAW IT WITH COVID. HAVE YOU GUYS GIVEN DISCUSSION HOW DO YOU MAKE SURE THE PUBLIC HAS AWARENESS AROUND THE IMPORTANCE OF GLOBAL ONCOLOGY? >>WE'RE ALL CITIZENS OF THE WORLD AND THE PROBLEMS THAT AFFECT YOU US IN THIS COUNTRY, ACCESS AND GLOBAL TOXICITY ARE ISSUES OF THE WORLD. THERE'S PROBLEMS THAT CAN BE SOLVED USING AND USING THE ARTICLE IN THE CANCER LETTER ABOUT THE PRAGMATIC LUNG TRIAL. LET'S LOOK AT HOW MUCH IT COST TO CONDUCT A CLINICAL TRIAL IN THIS COUNTRY AND HOW CRAZY IT IS. THERE'S LESSONS WE CAN LEARN HOW TO DELIVER BETTER CARE AND IMPROVE ACCESS TO CARE AND IMPROVE EDUCATION AND OVERCOMING CULTURAL BLOCKAGES THAT WILL TEACH US HERE. YOU CAN SPEAK OR WHISPER BETTER TO THIS THAN I CAN. >>TO BE CLEAR I BELIEVE THERE'S A MORAL OBLIGATION TO ADDRESS THE IMMENSE SUFFERING FROM CANCER ALL THE WORLD. AND THERE'S A SCIENTIFIC OPPORTUNITY. WE NARROW LANDSCAPE DISCOVERY WHEN WE RESTRICT OURSELVES TO THE 5% TO 6% OF CANCER AND IGNORE THE 70% OF CANCER IN LOW AND MIDDLE INCOME COUNTRY S. AND THERE'S LESSONS WE CAN APPLY IN THE UNITED STATES. I THINK AND SOME OF WHAT IS IN INFRASTRUCTURE IS MORE OF THE EXTREME PROBLEMS AND HAVING TO SOLVE AN EXTREME VERSION OF THE PROBLEM UNLOCK THE DEGREE OF CREATIVITY THAT CAN BE HARD TO SUMMON WHEN YOU'RE ONLY WORKING DOMESTICALLY. WE'RE WORKING HARD TO BETTER CONNECT OUR GLOBAL HEALTH EFFORTS WITH OUR DOMESTIC EQUITY EFFORTS BECAUSE MAKING THAT LINKAGE IS IMPORTANT. >>THANKS FOR THE OPPORTUNITY TO BE HERE AND I ENJOYED THE PRESENTATION. I WAS CURIOUS WOULD THERE BE OPPORTUNITIES TO CREATE AN RFP TO BUILD ON AND ENCOURAGE APPLICATIONS? THERE WAS A MEETING A COUPLE YEARS BACK THAT WAS TRADITIONAL PRACTICES. AND AGAIN, BY HAVING AN RFP, THAT CAN STIMULATE APPLICATIONS. THAT AREA I THOUGHT IT MAY BE AN OPPORTUNITY AS WELL THE ROLE OF ENVIRONMENTAL FACTORS IN CARCINOGENESIS IN LOW AND MIDDLE INCOME COUNTRIES. THANK YOU VERY MUCH. >>WE HAVE ABOUT A MINUTE. >>NO, I'LL SKIP. YOUR ECHOING SO I'M WORRIED SO I'LL PASS ON THE QUESTION. >>WE HAVE ABOUT FIVE MINUTES LEFT. SATISH, YOU WANT TO TOUCH ON THE MOON SHOT AND THE CONCEPTS YOU'RE KICK AROUND AT NCI AND HEAR WHAT THE SUBCOMMITTEE THINKS? >>I'M SURE WE'LL HAVE MORE REMARKS TOMORROW BUT WE'VE BEEN ACTIVELY SUPPORTING SOME GLOBAL HEALTH DISCUSSION AND I THINK THE MRNZ AND PRIORITIES ARE STILL TO BE DETERMINED. I THINK WHAT IS CLEAR IS THERE'S' TREMENDOUS AMOUNT OF INTEREST RECALL INTERNATIONALLY IN PARTICIPATING OR COLLABORATING WITH THE NCI AND OTHER U.S. PARTNERS AS PART OF THE MOONSHOT. THAT WAS LIMIT ADDITIONAL RESOURCES. WE BELIEVE THERE'S A LOT OF OPPORTUNITY WITH NEW COLLABORATIONS AND PROGRAMMING BUT THERE'S ALSO AN IMPORTANT OPPORTUNITY FOR PRIOR POLITICAL VISIBILITY AROUND CANCER AND OTHER PARTS OF THE WORLD WE'RE FORTUNATE TO ENJOY BIPARTISAN SUPPORT. IN OTHER COUNTRIES THERE'S REMARKABLE PEOPLE DOING REMARKABLE WORK OFTEN AGAINST GREAT ODDS THAT ENJOY THE SAME SUPPORT FROM THEIR MINISTRIES AND POLITICAL LEADERSHIP. THERE'S BEEN INTEREST IN CANCER-SPECIFIC PROGRAMMING AGAIN AS AN OPPORTUNITY TO HIGHLIGHT HOW IMPORTANT IT IS AS A PUBLIC HEALTH PROBLEM WORLDWIDE. >>I HEAR I HAVE AN ECHO -- OH, I CAN HEAR MYSELF. I'M OUT OF THE COUNTRY. SATISH, ARE YOU TALKING ABOUT RESOUR RESOURCES? REAL MONEY COMING TO THE PROGRAM? >>WE CAN ALWAYS USE MORE RESOURCES. INTEREST AND VISIBILITY IS VALUABLE TO US. I THINK BOTH ARE NEEDED AND I WANT TO UNDERMINE WHAT DR. GRETCHEN WILL HAVE TO SAY ABOUT THE MOONSHOT AND HER REMARKS. >>THANK YOU, FRANCIS. THIS IS MY PERSONAL VIEW. THE NIH EFFORT TO DEAL WITH AND OVERCOME DISPARITIES IS VIRTUALLY ENTIRELY FOCUSSED ON DISPARITIES WITHIN THE UNITED STATES. THE NCI IS SOMEWHAT ATYPICAL IN HAVING SO MUCH EMPHASIS ON TRYING TO ADDRESS DISPARITIES OUTSIDE THE UNITED STATES. AND I THINK THAT EXPRESSIONS FROM NIH LEADERSHIP IN ADDRESSING HEALTH DISPARITIES OUTSIDE THE UNITED STATES AS WELL AS INSIDE THE UNITED STATES WOULD BE IMPORTANT AND USEFUL. >>I THINK THAT'S A FANTASTIC POINT. I'M SURE THERE'LL BE LOTS OF DISCUSSIONS TO SEE HOW THAT CHANGE OF CULTURE, SO TO SPEAK CAN HAPPEN. ANY OTHER COMMENTS? WE'RE ALMOST ON THE MINUTE. THANK YOU FOR A LIVELY EXCHANGE. I THINK -- HOW DO WE GO FROM HERE AND SEGUE TO THE NEXT SUBCOMMITTEE OR -- >>SO WE'LL TAKE A 5-MINUTE BREAK AND GET STARTED AT 2:20. >>ALL RIGHT. >>WITH THAT THE MEETING'S ADJOURNED. >>THIS IS A PUBLIC MEETING BEING VIDEOCAST AND RECORDED. MEMBERS OF THE PUBLIC WHO MAY WISH TO EXPRESS VIEWS REGARDING ANY ITEMS DISCUSSED DURING THE MEETING MAY DO SO BY WRITING TO THE NCAB EXECUTIVE SECRETARY WITHIN 10 DAYS. ANY WRITTEN STATEMENTS OR QUESTIONS WILL RECEIVE CAREFUL CONSIDERATION. THE FOLLOWING NCAB SUBCOMMITTEE MEMBERS ARE PARTICIPATING IN THE VIRTUAL MEETING. THE CHAIR AND DR. ALI-OSMAN AND DR. FRIESE, DR. WAKEFIELD. THERE'S A QUORUM. ARE THERE ANY QUESTIONS REGARDING PROCESS? DR. PASKE. >>GREAT TO SEE YOU ALL. I WANTED TO WELCOME DR DR. BERTOGNOLI AND EXCITED TO HER ROLE AS NCI DIRECTOR AND WELCOME HER TO HEAR OUR REPORT. DID YOU HAVE ANYTHING YOU'D LIKE TO SAY BEFORE WE START? I'M PUTTING YOU ON THE SPOT? >>NO, THANK YOU. >>I KNOW THIS IS A PASSION OF YOURS. THANK YOU SO MUCH. I WANT TO START BY GOING OVER THE AGENDA WHICH WAS SHOWN AS WE GATHERED. I'M GOING TO GO OVER THE REVIEW AND CHARGE OF THE AD HOC WORKING GROUP OF THIS AD HOC SUBCOMMITTEE. A AND WE'LL GO TO THE DESCRIPTION OF THE SOURCES OF DATA AND INFORMATION RECEIVES. WE'LL PRESENT THE REPORT AND THEN OPEN IT UP FOR DISCUSSION, MINDFUL OF OUR TIME AND THEN WE'LL GO THROUGH THE FINAL SLIDE ON THE NEXT STEP AND PEOPLE CAN THINK OF WHAT WE WOULD WANT TO DO NEXT IN THE SUBCOMMITTEE. THAT'S GOING TO BE OUR FINAL CHARGE FOR TODAY. SO WE WERE THE SUBCOMMITTEE ON POPULATION SCIENCE, EPIDEMIOLOGY AND DISPARITIES WAS CHARGED WITH CONVENING AN AD HOC WORKING GROUP TO ADVISE ON STRATEGY APPROACHES AND CANCER ON RACIAL AND ETHNIC MINORITIES AND UNDER SERVED POPULATIONS. AND WE IDENTIFIED THE AREA OF HIGH POTENTIAL OF REDUCING HEALTH DISPARITIES. THE WORKING GROUP WAS CHARGED WITH IDENTIFYING AT THE BARRIERS AND STRATEGY APPROACHES TO BETTER ADDRESS CANCER RESEARCH AND IMPLEMENTING THE NEW STRATEGY RESEARCH APPROACHES EFFECTIVELY. THIS WAS OUR FORMAL CHARGE TO THE WORKING GROUP. THE POPULATION GROUPS WE AGREED TO FOCUS ON ARE LISTED HERE AND INCLUDE NOT ONLY RACIAL AND ETHNIC GROUPS BUT ALSO RURAL RESIDENTS, OLDER ADULTS, LGBTQ AND AYA POPULATIONS. MEMBER THIS MUCH THIS WORKING GROUP INCLUDED THE CO-CHAIRS DR. MARTINEZ AND DR. DUBANI AND DR. PHIL KASSEL WAS OUR DESIGNATED OFFICIAL. I WANT TO THANK THE CO-CHAIRS AND DR. CASTLE FOR THE AMOUNT OF WORK THAT WENT INTO CONVENING AND COMPLETING THE REPORT. OUR FABULOUS GROUP OF MEMBERS WHO MET WITH US AND PROVIDED GREAT INSIGHTS, DR. HENDERSON AND DR. HALLVERT AND DR. OCHOA AND SEVERAL MEMBERS ARE ON THE CALL AND I ALSO WANT TO THANK THEM AND TELL THEM IT WAS A PLEASURE. THE SOURCES OF DATA AND INFORMATION. WE HAD OUR FIRST MONTHLY MEETING JULY OF 2021. AND IN ADDITION TO HAVING MONTHLY MEETINGS OF THE COMMITTEE WE HAD MONTHLY CO-CHAIR MEETINGS. THROUGHOUT THE TIME WE HEARD SPEAKERS FROM THE CENTER FOR RESEARCH STRATEGY, DCCPS AND CRHCD. THAT INFORMED US AS WE PROCEEDED. SO OUR REPORT DRAFT OF THE REPORT WAS SENT TO THE NCAB SUBCOMMITTEE MEMBERS. AT THE END TODAY BEFORE WE GO TO NEXT STEPS WE'LL NEED TO HAVE A VOTE TO ACCEPT THE REPORT. I'M GIVING A HEADS UP TO THOSE ON THE NCAB SUBCOMMITTEE MEMBERS WHO GOT THE DRAFT REPORT THIS MORNING FROM ME. IT'S NOT QUITE FINALIZED. IT WILL BE PRESENTED AND THERE'LL BE A FORMAL VOTE. I'LL TURN IT OVER TO GO THROUGH THE BACKGROUND AND METHODOLOGY WE USED. >>WHAT I'LL DO IS WALK THROUGH THE ANALYSIS FRAMEWORK FOR THE REPORT. AND THEN WE'LL TALK ABOUT RECOMMENDATIONS. WE DEFINED THE PROCESS AND WE DEFINED THE GROUPS AND HOW TO OPERATIONALIZE THE SEARCH. THE DEFINITION WE USED WAS PREVENTIBLE DIFFERENCES FOR DISEASE BURDEN THAT CAN CONTRIBUTE TO THE DISEASE RISK AND OUTCOMES AND DUE PRIMARILY TO STRUCTURAL AND SOCIAL INEQUITIES. I THINK THIS IS WAS IMPORTANT TO ADD. THE KEY WE FELT WAS IMPORTANT WAS THE DIFFERENCES SHOULD NOT OCCUR. EQUITABLE ACCESS TO CARE AND SOCIAL CONDITIONS. YOU'LL SEE THE FRAME WORKS WE USED TO GUIDE OUR THINKING AROUND THIS AND THE FACT THAT HEALTH INEQUITIES AND DISPARITIES THAT COME FROM THE THINGS AT MULTIPLE LEVELS AND SO THIS WAS AN APPROACH WE TOOK TO FIND THE FINDINGS YOU'LL BE HEARING FROM LATER. WE PAUSED AND THERE'S AN A NUMBER OF FRAMEWORKS REFERENCED. THESE EXAMPLES AND OTHERS AND THE ONE FROM NIMHD WAS ONE WE USED TO HELP US THINK THROUGH SOME OF THE WAYS THAT RECOMMENDATIONS COULD BE FRAMED. AS YOU CAN SEE, THIS RELATES CLOSELY TO THE SOCIOLOGICAL MODEL AND THE INDIVIDUAL AND INTERPERSONAL AND COMMUNITY AND SOCIAL LEVELS OF INFLUENCES. IT GIVES YOU A LENS TO HOW TO THINK ABOUT THE APPROACH TO ADDRESSING HEALTH. TO GUIDE OUR SEARCH WE NEED TO DIVIDE INTO POCKETS AND THIS IS THE FRAMEWORK WE USED TO HELP DESIGN THE SEARCH. CAN SEE ON THE LEFT SIDE ETIOLOGY, PREVENTION, DETECTION AND DIAGNOSIS. TO LOOK AT WHERE THE FUNDING WAS AND WHERE IS CURRENT INVESTMENT NOW WE USED THE APPROACH TO BUCKET THE GRANTS OF THOSE PROJECTS THAT WE IDENTIFIED THROUGH THE SEARCH. AND ACROSS AREAS NCI USES TO INFORM THE BODY OF WORK. WE WERE UNFORTUNATE TO BE SUPPORTED BY JOSH COLLINS AND CHRISTINE AND OTHERS FROM THE CENTER FOR RESEARCH STRATEGY. YOU CAN SEE THEY DID WORK AND THIS DOESN'T SPEAK TO THE VOLUME OF WORK INVOLVED IN DOING THE WORK AND WE'RE GRATEFUL TO THEM AND THE TIME THEY SPENT TO DO MORE SEARCHS AND ACCUMULATING THE DATA AND IDENTIFYING THE PROJECTS. THIS IS A BASIC OVERVIEW OF HOW THE STRATEGY WAS DESIGN AND IMPLEMENTED. YOU SEE THE BASE PROJECTS AND THE CONCEPTS TO APPLY TO POPULATIONS AND YOU SAW THE UME OF SCIENCE AND OUTLINE APPROACH AND THROUGH THE PROCESS FOCUSSED ON NIH SEARCH AND IDENTIFIED CANCER GRANTS. YOU ALSO FIND IN SUBSEQUENT SLIDES THE FUNDING THAT IS SPECIFICALLY FROM NCI. OUT OF THE NIH FUNDING WHAT PROPORTION WERE FUNDED BY NCI. THE GRANTS RELEVANT TO THE IDENTIFICATIONS OF FOCUS AND WENT THROUGH A PROCESS WHERE THE INITIAL SEARCH RESULTS WERE REVIEWED AND IDENTIFIED AREAS WHERE PERHAPS THE ALGORITHM WASN'T WORK QUITE RIGHT AND I WANT TO THANK DIANNE AND HER WORK AND THAT RESULTS IN THE FINALIST OF GRANTS YOU'LL SEE IN A FEW SLIDES FROM NOW. TO REITERATE AND TO REMIND FOLKS WE FOCUSSED ON AFRICAN AMERICAN AND ASIAN-AMERICAN AND HISPANIC AND NATIVE ALASKAN AND SPECIALTY MINORITIES AND AYA. ALSO FOR SOME GROUPS IT WAS NOT POSSIBLE TO -- WE COULD NOT FIND A WAY TO OPERATIONALIZE THE SEARCH. AS SUCH WE DID NOT GET ADEQUATE INFORMATION ON INVESTMENTS. AGAIN GOING BACK TO THE BASE PROJECT CONCEPT AND WE FOCUS ON THE PROJECTS AND THE MULTIPLE PROJECTS. ONE WERE IDENTIFIED OR WORKED ON DISPARITIES RELATED PROJECT OF THE POPULATION OF INTEREST AND WE DID NOT COUNT MULTIPLE PROJECTS AS SEPARATE PROJECTS. SO ONE RO1 WILL BE COUNTED AS P01 OR U54. WE COUNTED EACH OF THEM. WE NEEDED TO MAKE A DECISION TO INCLUDE SOME OF THE PROJECTS. IT INCLUDES INTERNATIONAL ASPECT WITH FOCUS ON DOMESTIC DISPARITIES RESEARCH AND SUPPLEMENTS TO BASE PROJECT OR CURRENTS GRANTS BUT DID NOT COUNT CANCER CENTER GRANTS BECAUSE THE INFRASTRUCTURE THINGS DIDN'T COUNT OTHERS. WE FELT INTERNATIONAL PROJECTS DIDN'T FALL WITHIN OUR CHARGE BUT WE NEEDED TO MAKE A DECISION ON HOW TO APPLY THAT AND THAT'S WHAT WE'VE DONE HERE. KEEP THAT IN MIND AS WELL. THE BASE PROJECTS ALL BUDGETS COUNTED AS ONE AND MULTIPLE PROJECTS WITHIN BASE PROJECT WERE COUNTED AT 1. WE USED THE RCDC. THERE'S LOVE AND HATE FOR RCDC BUT THAT'S WHAT WE HAVE AND WHAT WE USED. AUTOMATIC TEXT MINING WAS USED I MENTIONED THE SCIENTIFIC OUTLINE WHICH IS WHAT YOU SEE HERE AND YOU SEE THE STRUCTURE IN THE PAST PRESENTATION OR SLIDES BEFORE. I WANT TO THANK THE NCI STAFF FOR SUPPORT AND FOR STEADYING US THROUGH THE PROCESS. OVER TO YOU. >>THANK YOU, VERY MUCH. I'M GOING TO GO THROUGH THE RESULTS AND WE'RE GOING LOOK TO AT THE RESULTS FROM THE FIS YAL YEAR '21 PORTFOLIO AND LOOK AT BASE PROJECTS WITHIN POPULATIONS ACROSS THE CONTINUUM. EXPLAIN BOTH BASE PROJECTS AND THEN WE'LL GIVE YOU AN EXAMPLE I MADE A SLIDE WITH THE PANELS FOR ALL THE POPULATIONS. SO AGAIN, WE USED FISCAL YEAR '21 PORTFOLIO AND STARTED WITH FISCAL YEAR '21 NIH CANCER GRANTS USING THE CODES NICELY EXPLAINED TO YOU. THERE WERE ABOUT 9600 BASE PROJECTS OF WHICH 75% WERE NCI. WE THEN REMOVED THE GRANTS THAT DIDN'T MEET INCLUSION CRITERIA. SO YOU CAN SEE ON THE BOTTOM LEVEL WHAT WAS EXCLUDED AND THAT GAVE US IN THE NIH CANCER RESEARCH PORTFOLIO ABOUT 700 BASE PROJECTS, 71% OF THOSE, ABOUT 5400 WERE FUNDED BY THE NCI AND WHAT WE'RE GOING SHOW YOU ARE THE BASE PROJECTS BY THE POPULATIONS OF INTEREST. SO A DESCRIPTION. THE LEFT SIDE IS THE POPULATIONS OF INTEREST. THE NEXT IS FROM ALL OF NIH OF WHICH THERE WERE 7327. WHAT PERCENT OF THEM WERE CONDUCTED IN EACH OF THE POPULATION YOU CAN SEE THE NUMBERS THERE FOR EACH POPULATION AND THEN WHAT WE DID WAS THEN INFERENCE AND PUT THE PERCENT OF THE TOTAL OF CANCER RELEVANT NIH PROJECTS. SO WITH 4.23%. YOU CAN SEE THAT FOR EACH OF THE POPULATIONS. IF WE WERE LOOKING AT THE TWO BASE PROJECTS ADMINISTERED BY THE NCI WHICH IS 5412. THAT CAME FROM A PREVIOUS SLIDE. YOU CAN SEE WE DID THE SAME EXERCISE, 246 DIVIDED BY 5512 IS ABOUT 4.55%. AND THE LAST COLUMN IS THE PERCENT OF THESE GRANTS ADMINISTERED BY NCI AND THEY'RE ADD MINNESOTASTERED -- ADMINISTERED BY THE NCI. THE TOTAL POPULATION BY GROUP AND THEN TOTAL PERCENT OF TOTAL. HE EXPLAINED THE CATEGORIES WHICH ARE SIMILAR TO USE ACROSS THE CONTINUUM. YOU GO DOWN AND YOU'LL SEE BIOLOGY AND EARLY DETECTION, TREATMENT CONTROL AND SURVIVORSHIP AND OUTCOMES NOT CHARACTERIZED. AND THE SECOND COLUMN IS THE NIH CANCER COMPARATOR. OF ALL 7327 NIH CANCER GRANTS HOW ARE THEY BROKEN DOWN. OF ALL THE NIH CANCER GRANTS, 42.7% ARE CATEGORIZED AS BIOLOGY. IF WE MOVE ACROSS POPULATION GROUPS IN BLACK OR AFRICAN AMERICAN POPULATION, WE HAVE FOUND 310 GRANTS. OF THOSE 310 GRANTS, WHAT PERCENT ARE CATEGORIZED IN BIOLOGY? THAT'S 26.5%. WHAT PERCENT ARE CHARACTERIZED IN ETIOLOGY BUCKET? 37.4. PREVENTION, 18.7. ETCETERA. YOU CAN GO AND COMPARE THAT COMPARATOR COLUMN SHOULD BE THE CARE FOR FOR ALL THESE OTHER CATEGORIES. SO WE WERE TO PICK THIS SEXUAL AND GENDER MINORITIES GROUP WHICH WE FOUND 19 GRANTS, 10.5% WERE CHARACTERIZED AS BIOLOGY COMPARED TO THE CANCER COMPARATOR OF 42.57% YOU'LL NOTICE. SO THE GRAY BAR IS THE NIH CANCER COMPARATOR. AGAIN THE PERCENT WHAT WAS IN THE FIRST COLUMN I SHOWED YOU AND THE RED BAR THE EXAMPLE FOR THE BLACK OR AFRICAN AMERICAN PORTFOLIO. YOU CAN TELL WHERE THERE ARE FEWER GRANTS IN THE BLACK OR AFRICAN AMERICAN PORTFOLIO COMPARED TO THE NIH COMPARATOR GROUP AND THIS IS NOT BY NUMBER. THIS IS BY PERCENTAGE OF THE TOTAL FOUND IN THE POPULATION GROUP. YOU CAN SEE THERE ARE FEWER GRANTS IN BIOLOGY AND TREATMENT. AND THE ETIOLOGY PREVENTION AND CANCER CONTROL REALLY WE FOUND A LOT OF GRANTS IN THOSE AREAS WITHIN THE 310 WE FOUND FOR THE BLACK OR AFRICAN AMERICAN PORTFOLIO. I PUT ALL THE REST OF THE GROUPS ON ONE SLIDE. IF YOU QUICKLY LOOK AT BIOLOGY AND TREATMENT, CAN SEE A PATTERN THAT IS IN ALL THE GROUPS. THE TWO AREAS HAVE FEWER OF THE PERCENT OF GRANTS BEING CONDUCTED IN THOSE TWO AREAS. BIOLOGY AND TREATMENT. BUT I DO WANT TO REMIND YOU ABOUT THE ABSOLUTE NUMBERS. . THE NUMBER OF GRANTS WE FOUND FOR ALL THE POPULATIONS WERE EXTREMELY LOW. I'M GOING TO TURN IT BACK OVER TO FINISH OUT WITH THE SUMMARY OF THE FINDINGS AND THE RECOMMENDATIONS THE WORKING GROUP IS PUTTING FORTH. >>THANK YOU. >>YOU CAN SEE WHEN YOU LOOK AT FOR INSTANCE WHY THE PATTERN WAS SHOWING IN TERMS OF DISTRIBUTION OF FUNDING IT SEEMS TO MIRROR SOME OF THE CONCERNS AND INTERESTS OR INITIATIVES AROUND CLINICAL TRIAL TREATMENT TRIALS AND ETHNIC MINORITIES AND PEOPLE ENROLLED. I THINK IT'S A WAY TO SAY A LOT OF THESE THINGS THAT ARE INTERTWINED AND INTERCONNECTED AND THE APPROACH NEEDS TO REFLECT THE COMPLEX NATURE OF THE PROBLEM AND THE OPPORTUNITY TO USE APPROACHES THAT ARE MORE COMPREHENSIVE THAN MAYBE TRADITIONAL APPROACHES. THIS IS TO SUMMARIZE THE FINDINGS. WE FOCUSSED A LOT ON DISCOVER PROCESS OF HOW IT'S DISTRIBUTED AND THE EMPHASIS AND THE GAPS. AND WE LOOKED AT WHERE THE EMPHASIS IN RESEARCH IT'S NO SURPRISE MANY ADVOCATE NORD AREA LOOK AT THE DISTRIBUTION. AND THIS STILL SMALL NUMBERS RELATIVE TO OVER ALL PORTFOLIO AND IF YOU LOOK AT DISEASE AND HOW DO WE FIND A WAY TO TRY AND INCREASE THAT FOCUS AND EMPHASIS WHERE THERE'S GREAT UNDER REPRESENTATION. REASON THE RESEARCH WE IDENTIFIED MORE PROJECTS AND A FEW ON TREATMENTS RESEARCH. AND WHAT WE DISCOVERED THOUGH WE DIDN'T DO A DEEP DIVE, A LOT OF THE STUDIES COME FROM RELATIVELY FEW POPULATION GROUPS. THERE'S RESEARCH FROM A MULTI-ETHNIC COHORT STUDY. I THINK EVEN IF YOU SEE RESEARCH DISTRIBUTED TO GIVE US A GOOD SENSE OF THE CONTEXT IN WHICH ALL THIS IS OCCURRING. ALSO AN IMPORTANT PIECE YOU HEAR FROM US AND RECOMMENDATIONS IS THAT THE INFORMATION WAS LACKING. THERE'S AREAS WHERE WE HAD OPPORTUNITIES TO HAVE MORE ACCURATE DATA. THE PACIFIC ISLANDER GROUP NEEDS TO BE LOOKED AT AND THE CDC IS DOING SO. SOME POPULATIONS ARE UNDER STUDIED OR IT'S NOT EASY TO FIND THE INFORMATION WITHIN THE GROUPS. AYA AND OLDER ADULTS. THESE ARE AREAS IN WHICH WE CAN IDENTIFY THEM SYSTEMATICALLY AND HELP KNOW THE EFFORTS BEING MADE AND THE IMPACT. THAT LIMITS THE DEGREE TO WHICH WE CAN LOOK AT THE POPULATION IN TERMS OF THE CURRENT INVESTMENT AND RESEARCH IN THE GROUPS. INCLUSIVENESS OF RESEARCH. WE HAVE BROKEN THIS DOWN TO KEY AREAS. WE PRESENTED BOTH TO YOU TO REVIEW, EXAMINE AND ACT ON IN A WAY YOU SEE FIT. THE SPECIFIC RECOMMENDATIONS AND I THINK IT GOES WITHOUT SAYING BASED ON WHAT WE FOUND WE NEED TO EXPAND THE CURRENT INVESTMENTS INCLUDING INVESTIGATOR INITIATED AWARDS AND REMOVE BARRIERS AND INEQUITIES AND WE PUT DISPARITIES AND INEQUITIES IN THE FUNDED GRANT PORTFOLIO. THAT'S IMPORTANT TO CONSIDER. YOU HEARD OF GRANTS FUNDED BY NCI AND NIH IN GENERAL AND WHETHER THERE'S A WAY HOW CLINICAL TRIAL IS BEING MONITORED OR TRACKED AND AGGREGATED THE DATA CAN HELP THE NCI UNDERSTAND THE KNOWLEDGE BASE AND AREAS OF OPPORTUNITY WITHIN THE POPULATION. I SPOKE ABOUT MONITORING EVALUATIONS. IF YOU DON'T LOOK YOU WON'T SEE IT AND IF YOU LOOK YOU'LL SEE OPPORTUNITIES WHERE WE CAN MAKE PROGRESS OR IDENTIFY AREAS THAT NEED ATTENTION. ONE AREA WE RECOMMENDED TO THE NCAP AND NCI IS TO CONSIDER THE REPORT IN ADDRESSING INEQUITIES AND THE FUNDING IN THE AREA CAN HELP KEEP IT FOCUSSED ON THIS AND IDENTIFY NEW OPPORTUNITIES TO ADDRESS. SO THESE ARE A BROAD SENSE OF RECOMMENDATIONS AND I WANT TO MAKE SURE YOU CAN GET A SENSE OF THESE WE'RE AWARE NCI HAS TAKEN STEPS TO LOOK AT INEQUITIES AND A WORKING GROUP AND GUIDETION PRINCIPLES AND PRIORITIES USING THE RECOMMENDATIONS TO MOVE THESE TO ACTION. IT'S IMPORTANT. AND A FRAMEWORK FOR INCLUSIVE RESEARCH THAT WOULD BE IMPORTANT TO ADOPT. THIS GOES BACK TO ISSUES OF WHAT NEEDS TO BE DONE AND HOW TO GET IT DONE KNOWING IT WILL BE A MARATHON AND IT WILL TAKE MANY PIECES COMING TOGETHER. WE'LL HAVE TO THINK HOW TO DO THIS SYSTEMATICALLY ONE STEP AT A TIME AND FOCUS ON THE POPULATIONS OF INTEREST AND IDENTIFIED IN THIS POPULATION AND THIS GOES BACK TO WHAT I SPOKE TO ABOUT INTENTIONAL APPROACH. THE NEXT PIECE GOES WITHOUT QUESTION AND I THINK ALL THESE ARE INTERTWINED AND INTERRELATED AND WITH NCI EFFORTS AND TRAINING IS IMPORTANT. YOU'LL HEAR IN MOVING THIS AGENDA FORWARD WE NEED TO PAY ATTENTION INCLUSIVE DIVERSITY WITHIN THE AREA. THERE'S INITIATIVES AND TRAINING BUT IT'S IMPORTANT TO THINK OF THESE RECOMMENDATIONS IN THE CONTEXT OF WHO DOES THE SCIENCE AND FOR WHOM THE SCIENCE ARE CONDUCTED AND HOW TO MOVE ALL THESE IN A WAY THAT ADVANCES THE AGENDA AND IN MANY WAYS HAVE THE MOONS MOONS MOONSHOT INITIATIVE. >>THANK YOU VERY MUCH. IF I HAD TO HONE DOWN WORDS I WOULD SAY INTENTIONAL FUNDING, SUPPLEMENTS TO ADDRESS THE DEFICITS IN THE NUMBER OF GRANTS THAT INTENTIONALLY FOCUS ON THESE POPULATIONS. DISAGGREGATE DATA. WE'RE RECOMMENDING A CHECKLIST ON GRANTS TO MORE EASILY UNDERSTAND WHAT POPULATIONS WERE BEING STUDIED AND THE FOCUS. TWICE ON THE LAST PAGE WE FOCUSSED ON INCREASING FUNDING TO DIVERSE AND UNDER-REPRESENTED INVESTIGATORS. THOSE ARE A SUMMARY OF OUR RECOMMENDATIONS. THANK YOU VERY MUCH. I SEE JOHN HAS HIS HAND UP AND JOHN TO YOU FIRST. >>THANK YOU SO MUCH. THIS IS CRITICALLY IMPORTANT AS WE ADVANCE IN THIS AREA OF COURSE I HAVE 100 QUESTIONS BUT JUST ASK THIS ONE. IN TERMS OF A POOL OF GRANTS FOR CLINICAL, THAT STOOD OUT TO ME. WERE THOSE MAINLY UM1, UG1. WHAT GRANTS COMPROMISE THAT PARTICULAR CATEGORY. YOU DON'T REALLY THINK THE RO1 TO SOME DEGREE. OR THE BIOLOGY IS DISPARITIES I'M GUESSING THEY'RE THE R21 TYPES BUT FOR THE CLINICAL, THE QUESTION BECOMES DO WE HAVE THE RIGHT SET OF MECHANISMS TO EVEN ADDRESS THESE ISSUES? >>WE DID NOT LOOK AT CLINICAL TRIAL ACCRUAL. >>THE QUESTION IS WHAT TYPE OF GRANTS COMPROMISE THAT CATEGORY? >>MORE THE R01 TYPES. I CAN TELL YOU WHAT WE EXCLUDED. WE EXCLUDED SUPPLEMENTS AND P30s. WE EXCLUDED INTERNATIONAL PROJECTS AND INTERNATIONAL DOMESTIC TRAINING AND CAREER. >>WHEN I THINK OF CLINICAL RESEARCH AND CLINICAL TRIALS I THINK THE UG1s AND THE INFRASTRUCTURE TYPE IN PLACE AT THE LARGER ACADEMIC CENTER. WHEN WE SEE BIG DISPARITY IN CLINICAL RESEARCH IN THE GROUPS, DO WE EVEN HAVE THE RIGHT MECHANISMS IN PLACE TO ADDRESS THIS? THAT IS SOMETHING MAYBE MONICA, FOR YOU TO THINK ABOUT AND OTHERS AS WELL >>THE BIG THING AS YOU SAW WAS THERE WERE SO MANY BARRIERS RIGHT NOW IN THE WAY WE COLLECT THE DATA. IN TERMS OF HOW IT'S CODED AND DID THE DATA MINING. THAT NEEDS TO BE ADDRESSED. I BELIEVE LISA WAS NEXT. THANK YOU, JOHN. >>FIRST, I WANTED TO CONGRATULATE YOU ON THE PRESENTATION AND THE OVER ALL INCREDIBLE MAGNIFICENT WORK IN LEADING THE AD HOC SUBCOMMITTEE. I WAS A PLEASURE TO JOIN UNDER YOUR LEADERSHIP. I WANTED TO ADDRESS THE LOW AMOUNT OF RESEARCH LOOKING AT TUMOR BIOLOGY IN THESE SUB GROUPS AND THIS GOES BACK TO THE POINT DR. GAPAL MADE IN MAKING THE DISCUSSION ON GLOBAL CANCER RESEARCH. WE HAVE TO BEAR IN MIND CANCER AT THE CORE IS A GENETIC ISSUE AND WHEN WE LOOK AT POPULATIONS HOMOGENEOUS WE'LL MISS SO MUCH IMPORTANT GENETICS THAT COULD BE RELEVANT TO NOVEL TREATMENTS AND OUTCOMES. >>THANK YOU, LISA. EXCELLENT POINT. WE VALUED YOUR SERVICE ON THE SUBCOMMITTEE. DR. MARTINEZ IS ON AND WAS LISTENING THE WHOLE TIME AND UNFORTUNATELY AT THE AIRPORT ON HER WAY TO SAN ANTONIO. SHIRLEY THEN RAY THEN MONICA. >>YOU DID A WONDERFUL WOULD BE JUDGES A DIFFICULT TASK AND I WANT TO DO AN IMPOSSIBLE TASK. MAJORITY OF DISPARITY DUE TO ACCESS AND EVERY NIH INSTITUTE HAS A DOG IN THIS FIGHT. THERE ARE THINGS ACROSS EVERY INSTITUTE. IMPLEMENTATION SCIENCE DOESN'T DISTINGUISH BETWEEN HEART DISEASE AND CANCER. THERE HAS TO BE A WAY TO HARNESS A PAN-NIH ASPECT OF BOTH COLLECTING DATA AND UNDERSTANDING HOW TO DO THINGS TOGETHER. >>THANK YOU. WE LIMITED THE SEARCH TO CANCER BUT WE HAVE THE WHOLE NIH DATABASE. WE COULD DO THAT. THAT'S ABOVE MY PAY GRADE BUT SOMETHING MONICA WOULD NEED TO TAKE UP. I LOVE THAT. NOW THAT WE'VE DONE IT IT CAN BE A NICE TEMPLATE THAT WE CAN USE. THANKS VERY MUCH, SHELLY. I APPRECIATE THAT. RAY, I THINK YOU'RE NEXT. >>HELLO, EVERYONE. I'M DELIGHTED TO JOIN YOU TODAY. I WAS TRYING TO BE QUIET AS I LISTEN IN ON MY FIRST MEETING BUT I CANNOT HOLD MYSELF ANY ANYMORE. AS IMPERFECT AS THE EFFORT MAY HAVE BEEN IT'S HEARTENING AND GRATIFYING TO SEE THE WILLINGNESS TO MEASURE. A COUPLE MEANT I WANTED TO MAKE. THE FIRST IS IT'S NO SURPRISE HERE, HOPEFULLY THERE'S NO SURPRISE TO ANYBODY HERE, THIS IS A PROBLEM. AT THE HEART IS THE MISMATCH BETWEEN WHERE THE UNDER SERVED AND DISADVANTAGED GO TO SEEK AREA AND THE INFRASTRUCTURE AND PEOPLE, THE TEAMS THAT PROVIDE CARE FOR THEM. AND THIS EXTENDS FROM CLINICAL TO RESEARCH AS WE SEE. I THINK AS WE DESCRIBED THE NATURE OF THE PROBLEM WHICH IS VITAL, OBVIOUSLY, IT'S GOING TO BE REALLY IMPORTANT TO TRY AND COME UP WITH SOLUTIONS AND SOLUTIONS WILL HAVE TO BE INNOVATIVE. AT THE HEART OF THE INNOVATION HAS TO BE HOW DO YOU BRIDGE THE GOAL BETWEEN THE STRUCTURAL ENVIRONMENT WITHIN WHICH PEOPLE WHO PROVIDE CARE TO THESE PATIENTS THAT WE'RE WORRIED ABOUT, THE POPULATIONS WE'RE WORRIED ABOUT AND THE NATURE OF THE INCENTIVES AND THE ENVIRONMENT OF THE WORK IN RELATION TO THESE VITAL EFFORTS. THE SCIENTIFIC EFFORT WHERE PEOPLE DON'T RECOGNIZE THE DAILY PROFESSIONAL ACTIVITIES AS IN ANY WAY, SHAPE OR FORM CON DENED TO THE ISSUE OF HEALTH CARE DELIVERY IN SOME WAYS IS NOT THAT DIFFERENT FROM THE GLOBAL CANCER CARE DELIVERY. I WONDER. IF THIS IS SUCH A WICKED PROBLEM ARE WE TALKING TO ALL THE POTENTIAL PARTNERS WE HAVE? ONE ARE THE PROFESSIONAL GROUPS THAT HAVE MEMBERS THAT STRADDLE BETWEEN THE SCIENCE AND THE CLINICAL CARE DELIVERY. AT LEAST THE MEMBERSHIP HAVE SEGMENTS CLOSER TO THE POPULATIONS. DO WE EVEN HAVE AN A FRAMEWORK TO CONNECT WITH THESE PROFESSIONAL GROUPS TO TRY AND FIGURE OUT SOLUTIONS TO THIS HUGE WICKED PROBLEM? >>THANK YOU, RAY. I LOVE THE CHARACTERIZATION AS A WICKED PROBLEM. WE HAVE PARTNERS AND WE HAVE KAREN ON HERE. YOU HAVE THE PRESIDENT OF ASPO. WE HAVE GREAT OPPORTUNITIES THERE. >>A PART OF WHAT YOU SAID IS FUNDAMENTAL ISSUE THAT WAS WEAVED INTO THE RECOMMENDATIONS IS THAT WE ARE STUDYING FUNCTIONS AND WE LOOK AT PEOPLE WHO NEED IT MOST AND HOW DO WE REACH THEM OR INCLUDE THEM IN THE CARE? AND I KNOW NCI HAS MADE EFFORTS TO TRY AND ADDRESS THIS BY PARTNERING WITH HEALTH CENTERS AND OTHERS AREAS AND THOSE ARE OPPORTUNITIES WE HAVE. YOU'RE MORE INCLUSIVE AND HOW DO WE AND LOOKED AT THE WORK AND HOW DO WE GET PEOPLE AND CLINICAL TRIALS ARE SOME OF THE BEST MOST IMPORTANT INNOVATIONS OCCUR AT CLINICAL TRIALS AND. WHEN PEOPLE DON'T GET ACCESS TO THEM IT'S A SOURCE OF SYSTEMIC INEQUITIES. YOU HIT ON SOMETHING I HOPE WE CAN HOLD ON TO AS WE LOOK AT HOW THE PROCESS IS LOOKED AT AND HOW IT CAN BE INTO OTHER INITIATIVES AND PARTNERSHIPS TO MAKE THIS HAPPEN. I BELIEVE THAT'S AT THE HEART OF IT ALL. >>MONICA AND NEELY. GO AHEAD. >>A COUPLE THINGS. EVERY TIME WE HAVE THESE COVERINGS BY SUCH A THOUGHTFUL AND CAREFUL AND KNOWLEDGEABLE GROUP, I FEEL THE DISCUSSION IS RICHER AND MORE NUANCED. AND MORE PRODUCTIVE. I THANK YOU FOR THAT. I WANT TO PLAY BACK TO YOU AND WHAT I'M HEARING. NCI DOES RESEARCH. WE'RE A RESEARCH ORGANIZATION. THE ISSUES WE'RE TALKING ABOUT TODAY GO DEEP, DEEP, DEEP WITHIN OUR SOCIETY. THERE ARE TWO WAYS AND ASKING THE RIGHT QUESTION IS ALWAYS THE HARDEST PART IN ANYTHING WE DO IN SCIENCE. I'M PROPOSING THERE ARE TWO FEIGN FOCUSES FOR OUR QUESTIONS. THIS MAY BE SIMPLISTIC BUT I THINK IT HELPS WITH STRATEGY. THE ONE FOCUS IS INCLUSION IS CRITICAL. WE HAVE TO HAVE INFORMATION AND INCLUSION OF EVERYBODY. WE CANNOT HAVE ANY EXCLUDED GROUP. AND UNDER REPRESENTED DOESN'T MEAN IN RESEARCH TERMS YOU GOT TO -- YOU HAVE IN PROPORTION TO ANSWERING THE QUESTION. SO I'M GOING MAKE SOMETHING UP. IF YOU NEED 100 PEOPLE TO ANSWER THE QUESTION AND 80% OF YOUR PEOPLE ARE CAUCASIAN, YOU WON'T ANSWER YOUR QUESTION WITHOUT 100 IN EACH GROUP. INCLUSION DOES NOT NOT MEAN PROPORTIONAL REPRESENTATION. THAT'S NUMBER ONE. IF WE DON'T MAKE THIS CLEAR WE'LL LOSE OPPORTUNITIES. IT'S ALL ABOUT ANSWERING QUESTIONS NOT JUST CHECKING BOXES. NUMBER TWO, THE OTHER FOCUS BESIDES INCLUSIVENESS IS ELIMINATING BARRIERS. UNDERSTANDING WHAT THE BARRIERS ARE AND UNDERSTANDING HOW TO OVERCOME THEM. NOW, WE CAN'T NECESSARILY OVERCOME THEM. WE'RE THE RESEARCH PEOPLE NOT THE IMPLEMENTATION PEOPLE. SO TO THAT THIRD THING I WANT TO SAY MAKE A COMMITMENT TO ALL OF YOU IS THAT WHAT NCI NEEDS TO DO FRANKLY WITH OUR BULLY BULL PIT -- BULLY PULPIT IS TO ADVOCATE. I WANT TO HEAR. I NEED TO KNOW FROM YOU, DO YOU HAVE TWEAKS TO WHAT I JUST SAID. THIS IS THE WAY I PROPOSE TO TRY TO REPRESENT WHAT YOU'RE TELLING ME HERE TODAY. >>I THINK I'M SEEING NODS, YES, MONICA. WE DID NOT LOOK AT REPRESENTATION IN CLINICAL TRIAL ACCRUAL. WE'RE LOOKING AT THE GRANT PORTFOLIO. BUT IF YOU WANTED TO STUDY A PROBLEM YOU NEED INCLUSIVENESS. THAT'S BIGGER THAN JUST CLINICAL TRIAL REPRESENTATION. >>LET ME TELL YOU WHY I'M PUSHING YOU ON THIS, WHEN YOU DO DIAGRAMS AND SHOW BIOLOGY, WE DON'T HAVE ENOUGH BIOLOGY GRANTS AND YOU'RE TALKING GLOBAL GRANTS, I THINK THAT'S GREAT. IT'S IMPORTANT INFORMATION BUT I'M SAYING THAT ON TOP OF THAT IT'S MORE ABOUT THE QUESTIONS AND ANSWERING THE QUESTIONS THAN REPRESENTATION. I'M LOOKING FOR A BETTER -- A STRUCTURE THAT ASSURES IT MEETS THE NEEDS OF BEYOND THE CATEGORIES WE JUST HAVE TODAY. >>THAT FRAMEWORK SPEAKS TO ME. THE AND I THINK THE LAST PIECE OF ADVOCACY IS THE BULLY PULPIT BECAUSE THERE'S A BOUNDARY TO WHAT YOU CAN DO BUT YOU HAVE THE BULLY PULPIT WE CAN USE AND WE BASICALLY CREATED A FRAMEWORK AROUND EQUITY AND IMPLEMENTED WHAT IT COULD DO AND SAID THE BULLY PULPIT IS USED TO ENCOURAGE NOT INTIMIDATE, ENCOURAGE OTHER PEOPLE TO BE ENGAGED. I THINK THAT WILL BE A POWERFUL WEAPON FOR THE NCI TO DO. WITH THAT SAID, I LOVE THE IDEA OF INCLUSION. THAT'S ALL ABOUT INCLUSION INTO SCIENCE BUT ALSO WE EXPECT INCLUSION AND SCIENCE AND ALL OF A SUDDEN THERE'S A MOVEMENT TO HAVE MORE PEOPLE IN CARE BECAUSE THAT YOU CAN'T HAVE THE OTHER. I CAN MAKE A JOKE, LOVE AND MARRIAGE. YOU CAN'T HAVE ONE WITHOUT THE OTHER. AND THAT'S A POWERFUL WAY TO FRAME THIS WITH FUNDING. THERE NEEDS TO BE FUNDING AND WORKFORCE. >>YOU'RE NEXT. >>I'LL PICK ON WHAT MONICA WAS TALKING ABOUT. AS WE'RE TALKING ABOUT THE BARRIERS THAT WE CAN IDENTIFY FOR RESEARCH, I THINK THE KEY ROLE IS THEN ALSO THE RESEARCH ON HOW TO OVERCOME THE BARRIERS EFFECTIVELY WHICH GOES BACK TO MENTIONED ABOUT IMPLEMENTATION SCIENCE AND WHETHER IT MEANS ELECTRONIC HEALTH RECORDS SO THEY GET ASKED A QUESTION WHETHER IT'S ABOUT TELEHEALTH OR INNOVATIVE CARE DELIVERY IN DISTANT GROUPS ACOR TRANSPORTATION. I THINK WE CAN DO THAT TYPE OF RESEARCH. IT'S MAYBE DIFFERENT FROM DISCOVERY RESEARCH BUT IT WILL HELPY -- HELP US DOING RESEARCH. MY QUESTION TO THE GROUP IS YOU DID A TERRIFIC JOB. IT'S AMAZING AND TO SEE WHERE THE GRANTS ARE BUT YOU WERE LIMITED BY WHERE THE KEY WORDS WERE. EVERY GRANT ON TELEHEALTH COULD OVERCOME DISTANCE AS A DISPARITY OR COULD OVERCOME DISPARITIES IN GROUPS THAT DON'T HAVE MUCH TRANSPORTATION IN URBAN SETTINGS. BUT YOU WOULD NOT HAVE PICKED THAT UP NECESSARILY YET. IT SEEMS LIKE FOR DOING THE BETTER JOB WITH A MEASUREMENT WE MAY NEED TO ADD MORE CHECK BOXES OR ENSURE WE CAPTURE WHAT IS HAPPENING AND UNDERSTAND THE TYPE OF SCIENCE TO MOVE US FORWARD IN OVERCOMING THE BARRIERS. >>WE WOULD HAVE GOTTEN A TELEHEALTH GRANT IF IT FOCUSSED ON RURAL POPULATIONS AND IT WAS FOCUSSING ON GETTING THEM IN THROUGH SURVIVORSHIP CARE. >>IF IT'S TELEHEALTH WITHOUT THE WORD MENTIONED MAYBE EVERYBODY DOES THAT NOW. >>WITHOUT RURAL MENTIONED, WE WOULDN'T HAVE GOTTEN IT. IT WAS THE POPULATION GROUPS WE HAD A LOT OF PROBLEMS WITH. THAT WAS THE BIGGEST PROBLEM. KAREN, YOU'VE BEEN WAITING SO PATIENTLY. >>NO WORRIES. IT'S A PHENOMENAL DISCUSSION. I AGREE WITH WHAT WAS SAID. I LOVE THE FRAMEWORK AND IT FOCUSES ON WHAT NCI AND WHAT NIH -- WHAT THAT SCOPE OF INFLUENCE IS, WHICH IS RESEARCH. I WANT TO MAKE A QUICK COMMENT AND THIS MAY BE PROVOCATIVE BUT I THINK THERE'S A GREAT UNDERSTANDING OF WHAT THE BARRIERS ARE THAT ARE ACCESS TO CARE. I TEND TOWARDS THERE'S RICH FOUND FOR US TO DO RESEARCH AND FUND RESEARCH THAT ALLOWS US TO OVERCOME THE BARRIERS AND IMPLEMENTATION SCIENCE STUDIES AND HOW TO CREATE MORE ACCESS TO CARE AND UNDERSTANDING WHAT MANY OF THESE BARRIERS ARE. AT LEAST THAT'S MY POINT OF VIEW. I WOULD HOPE PART OF THE NEXT STEP FORWARD WOULD GIVE SOME TONIGHT FOR US TO TRY TO PRIORITIZE THE GRANTS AND HOW DO WE OVERCOME SOME OF THE CHALLENGES WITH EVEN DIGITAL LITERACY IN THE ERA OF TELEHEALTH. I PERSONALLY SEE THAT'S WHERE NCI AND NIH CAN PLAY A MAJOR ROLE. WHEN IT COMES DOWN TO ADVOCACY AND I THINK SHELLY SAID ACCESS COMES THROUGH ADVOCACY AN HE'S 100% CORRECT. THAT STARTS TO GET -- CORRECT ME IF I'M WRONG, BEYOND THE SCOPE OF WHAT NIH AND NCI CAN DO. SOME CANCER CENTERS CAN DO IT BUT MOST ARE 501C3s AND HAVE A LITTLE BIT OF A HANDCUFF BASED ON WHAT IT IS THEIR ADMINISTRATION WILL ALLOW THEM TO DO. THIS IS WHERE PROFESSIONAL ORGANIZATIONS COME IN LIKE ACI WHERE THE CANCER CENTERS STAND TOGETHER AND OTHER PLACES BUT NOT WHERE WE CAN AND DO ADVOCATE IN WASHINGTON, D.C. AT THIS MOMENT THOUGH WE'RE NOT MEETING IN PERSON. I'M HERE FOR ADVOCACY STRATEGIES. WE HAVE THE POTENTIAL TO INFLUENCE THE ADVOCACY. NO ADVOCACY PLAY FEDERAL, STANDARD OR LOCAL IS SUCCESSFUL WITHOUT DATA. AND MUCH OF THAT DATA COMES FROM GRANTS THAT ARE FUNDED BY THE NCI. SO A THOUGHT I HAD LISTENING TO ALL THIS IS HAVE WE SAT DOWN AND FORMALIZED THAT AND MODEL LEGISLATION INTENDED TO CREATE A CHANGE OR POLICY THAT ENHANCES ACCESS OR WOULD IMPROVE THE LIFE OF A CANCER PATIENT OR THEIR FAMILY. HOW MANY OF THOSE USE NCI FUNDED RESEARCH AS THE BASIS FOR THE ADVOCACY PLAY? I KNOW WE DO. SOMETHING WE CAN THINK ABOUT IN THE FUTURE AS WE THINK ABOUT THE HANDOFF FROM RESEARCH TO ADVOCACY. NOT THAT NCI COULD SHAPE ITS RESEARCH PORTFOLIO BASED ON WHAT THEY CONSIDER A GOOD ADVOCACY PLAY BUT I THINK THE IMPACT OF THAT RESEARCH IN CREATING LEGISLATION OR REGULATIONS THAT HELP IMPROVE OR REDUCE THE CANCER BURDEN IS SOMETHING NCI SHOULD TAKE CREDIT FOR. THAT'S MY TWO CENTS. >>THANKS, KAREN. WE HAVE FOUR MINUTES LEFT. I'LL TAKE A CHAIR'S PREROGATIVE HERE. I WANT TO SAY ONE BIT OF EDITORIALIZ EDITORIALIZ EDITORIALIZATION BEFORE I GET TO MY LAST SLIDE. THE DATA SAYS TO ME WE HAVE TO GET MORE PEOPLE TO DO RESEARCH IN THESE POPULATIONS. PEOPLE ARE NOT DOING RESEARCH IN THESE POPULATIONS. THAT'S THE BOTTOM LINE. HOW DO WE DO THAT? THERE'S POPULATIONS HARD TO GET ACCESS TO MRAB NOT AS EASY TO WORK WITH AS THE -- MAYBE NOT AS EASY TO WORK WITH AS THE PEOPLE THAT COME IN YOUR CENTER BUT THE PEOPLE WE HAVE TO BE WORKING WITH AS A CANCER COMMUNITY AND THAT'S THE BOTTOM LINE AND MAIN MESSAGE. >>THANK YOU. THIS WAS FANTASTIC AND GREAT DISCUSSION. I WANT TO BE VERY CAUTIOUS ABOUT THE WORDS WE USE IN TERMS OF THE TYPES OF POPULATIONS. POPULATIONS AREN'T DIFFICULT TO REACH. IT'S THE FACT WE HAVEN'T ENGAGED POPULATIONS AND THE CENTERS WE ELEVATE THE ROLE OF COMMUNITY ENGAGEMENT. IT NEEDS TO BE POPULATION BASED NOT THE PEOPLE WALKING THROUGH THE DOORS. THAT'S WHERE THE CHANGE WILL COME. I'M EXCITED THE WAY TO HELP DRIVE THE CONVERSATIONS. GREAT WORK TO THOSE WHO ARE BOOTS ON THE GROUND. I'M AN ADD-ON AT THIS POINT BUT EXCITED FOR THIS WORK. >>THANKS, KAREN. EXACTLY I'LL MOVE TO THE LAST SLIDE. ON THE 7th WE'LL DO A PRESENTATION. A LITTLE SHORTER THAN THE ONE TODAY. BEFORE I GO THERE, WE NEED TO HAVE A VOTE AMONGST THE MEMBERS OF THE SUBCOMMITTEE WHO ARE ON THE CALL WHICH IS FRANCIS, CHRIS, MARGARET, SUSAN, TO ACCEPT THE REPORT. >>I MOVE TO ACCEPT THE REPORT. >>SECOND? >>SECOND. >>ANY DISAGREE? >> >>I HAVEN'T READ THE ENTIRE REPORT BUT FROM WHAT I HEARD TODAY I THINK YOU'VE DONE A GREAT JOB AND IN FULL AGREEMENT WITH YOUR RECOMMENDATIONS. >>THANK YOU. I DID SEND IT TO YOU I'M SORRY IT WAS TODAY. I NEEDS TO BE FORMATTED AND PHIL'S GROUP STEPPED UP TO DO THE FORMATTING. JOY, CAN I MOVE ON NOW? >>THERE'S A LIST HERE. SO WE'RE GOING PRESENT AGAIN. WE'LL PRESENT ON WEDNESDAY. WE'LL HAVE A MOTION TO NCAB FOR ACCEPTANCE AND NCI WILL DISTRIBUTE THE REPORT AS THEY SEE FIT. IN THE LAST MINUTE, NOW OUR SUBCOMMITTEE CAN MOVE ON TO OTHER CHARGES. WE DON'T HAVE A LOT OF TIME TODAY BUT I WOULD RECOMMEND WE HAVE ON OUR NEXT MEETING WE OPEN IT UP TO FIGURE OUT WHAT WE WANT TO DO NEXT. IN THE PAST I THINK WE TALKED ABOUT LOOKING AT THE PROBLEM OF CLINICAL TRIAL ACCRUAL. ACCRUAL OVER ALL AND IN THE POPULATION GROUPS WE DISCUSSED TODAY. WE CAN DO THAT AT OUR NEXT CALL IF THAT'S ALL RIGHT WITH EVERYBODY AND I WILL THANK YOU ALL. I WANT TO THANK AGAIN MY CO-CHAIRS, PHIL AND YOUR GROUP AND ALL THE FOLKS THAT PROVIDED THE DATA AND THE WONDERFUL MEMBERS OF THE WORKING GROUP. IT WAS A PLEASURE TO SERVE WITH YOU ALL. THANK YOU VERY MUCH AND THE MEETING IS ADJOURNED. THANK YOU. [PUBLIC MEETING STATEMENT] THE FOLLOWING NCAB MEMBERS ARE PARTICIPATING IN THE VIRTUAL MEETING. THE CHAIR DR. ALI-OSMAN AND DR. PASKET AND DR. WAKEFIELD. THERE'S A QUORUM. ARE THERE QUESTIONS REGARDING PROCESS? YOU MAY NOW BEGIN THE MEETING. >>GOOD AFTERNOON, EVERYBODY. WE'RE BRING UP THE END OF OUR FIRST DAY OF THE NCAB MEETING. I'D LIKE TO WELCOME THE OTHER MEMBERS OF THE SUBCOMMITTEE AND OTHER MEMBERS AND BSA MEMBERS AND THE NCI LEADERSHIP AND INVESTIGATORS AND MEMBERS OF THE PUBLIC. I WANT TO GIVE A SPECIAL WELCOME TO DR. BERTAGNOLLI. I'D LOVE TO GIVE YOU AN OPPORTUNITY TO ADDRESS THE SUBCOMMITTEE FOR A MOMENT IF YOU'D LIKE. >>THANK YOU VERY MUCH. I'M DELIGHTED TO BE HERE AS YOU PROBABLY ALL KNOW. MY MOST RECENT POST WAS WITH A CLINICAL TRIALS GROUP AND THE TOPIC IS OF INTEREST TO ME AND GLAD TO BE HERE AND LOOK FORWARD TO THE DISCUSSION. THANK YOU. >>THANK YOU SO MUCH. THE SUBCOMMITTEE ON CLINICAL INVESTIGATIONS HAS A UNIQUE PURPOSE TO ADVISE THE NCAB ON THE ENTIRE RANGE OF CLINICAL INVESTIGATIONS. INCLUDING ISSUES AND TRIALS FOCUSSED ON DETECTION AND PREVENTION AND DIAGNOSTICS AND COURSE THE TREATMENT AND MANAGEMENT OF CANCERS. WE WORK IN CONCERT WITH THE EXPERIMENTAL SUBCOMMITTEE AN AD HOC SUBCOMMITTEE. WE'RE RESPONSIBLE FOR A BROAD SET OF CONCERNS TO GET TO A PLACE TO INCREASE CURES AND IMPROVE THE MANAGEMENT OF OUR PATIENTS AND PATIENTS AT RISK FOR CANCER WHO AREN'T YET AFFLICTED. SO A MAJOR RESPONSIBILITY OF OUR SUBCOMMITTEE IS TO ADVISE THE NCAB AND THE NCI ON THE PROGRAM THE LARGEST NATIONALLY FUNDED CLINICAL TRIALS PROGRAM IN THE COUNTRY. THE NCTN CLINICAL TRIALS NETWORK HAS ALL SIZES ACROSS THE COUNTRY FROM COMMUNITY PROGRAMS AND COMMUNITY SITES ALL THE WAY THROUGH LARGE NCI DESIGNATED CANCER CENTERS. THIS YEAR WE'RE LOOKING FORWARD TO A NEW RFA TO RECOMPETE THE PROGRAM. SO IN PREPARATION FOR THIS, THE NCI AND THE LEADERSHIP TEAM HAS CREATED A DETAILED SURVEY TO ASSESS THE HEALTH AND CONDUCT OF THE PROGRAM OVER THE LAST FEW YEARS AND THIS IS GOING TO PROVIDE CRITICAL INFORMATION TO HELP CRAFT THIS PLAN MOVING FORWARD. I'D LIKE TO INTRODUCE OUR SPEAKER TO GO THROUGH THE RESULTS OF THE STUDY. OUR GOAL WOULD BE TO SPEND THE NEXT 30 OR 40 MINUTES REALLY GOING THROUGH THE SURVEY IN DETAIL AND SPEND THE LAST PORTION OF THE MEETING GET FEEDBACK FROM SUBCOMMITTEE MEMBERS AND OTHER MEMBERS HOW TO INCORPORATE THE RESULTS AND ADVISE MOVING FORWARD AND INCORPORATING IT INTO A NEW RFA. >>THANK YOU AND THANK YOU TO EVERYBODY FROM THE SUBCOMMITTEE. I'M HAPPY TO BE HERE TO BE ABLE TO SPEAK ON THE SURVEY ON THE FIRST THREE AND A HALF YEARS OF OUR PROJECT FROM 2019 THROUGH FEBRUARY OF 2025. THE NCI CLINICAL TRIALS NETWORK WAS ESTABLISHED IN 2014. IT WAS ESTABLISHED FROM THE COOPERATIVE GROUP PROGRAM IN EXISTENCE 50 YEARS AT THAT TIME. AND IT ESTABLISH AND SUPPORT A TRUE NETWORK. WE OPERATED ALL THE COOPERATIVE GROUPS IN THE FORMER SYSTEMS SOMEWHAT SEPARATELY. WE HAD OVER PROBABLY THE 10 YEARS PRIOR TO THE ESTABLISHMENT OF THE NCTN DONE MORE AND MORE IN TERMS OF TRYING TO CENTRALIZE ADMINISTRATIVE AND REGULATORY PROCEDURES IN ORDER TO FACILITATE CLINICAL TRIALS IN CANCER TREATMENT ACROSS THE ENTIRE PROGRAM. WE WANTED TO SUPPORT AN INFRASTRUCTURE DESIGN TO HARMONIZE PROCESSES AND PROMOTE COLLABORATIONS AMONG THE GROUPS AND TO HAVE IT OPERATE AS A NETWORK. TO THE FOCUS WAS TO CONTINUE ON THE OBJECTIVES THE PROGRAM HAD AND FOCUS ON QUESTIONS NOT WELL SUPPORTED IN A COMMERCIAL ENVIRONMENT. MAINTAIN A COMMITMENT TO THE SPECIAL POPULATIONS THIS IS A NATIONAL NETWORK WHICH HAS AN EMPHASIS ON PHASE 3 TRIALS AS WELL AS LARGE PHASE II TRIALS AND SOME LARGE DEVELOPMENT TRIALS AND WANTED TO ON THE ADVICE ON THE INSTITUTE OF MEDICINE TO PRIORITIZE TRIALS AND INCORPORATE INNOVATIVE SCIENCE AND DESIGN IN THE CLINICAL TRIALS AS WELL AS TO PROVIDE A FUNCTIONAL PLATFORM ACROSS THE NETWORK WHERE HOPEFULLY WE COULD PERFORM LARGE-SCALE TESTING OF WHAT WAS BECOMING INCREASINGLY SMALLER SUBSETS OF MOLECULARLY DEFINED CANCERS EVEN IN VERY COMMON CANCERS AND TRULY TO INCORPORATE PRECISION MEDICINE INTO OUR PORTFOLIO ALONG WITH TRIALS IN RARE TUMORS. SO THE ORGANIZATION THAT MANY OF YOU MAY BE FAMILIAR WITH WAS WE HAD 10 COOPERATIVE GROUPS AT THE TIME PRIOR TO 2014 AND THEY WERE CONSOLIDATED INTO FOUR U.S. ADULT GROUPS AND ONE PEDIATRIC GROUP WHICH IS THE CHILDREN'S ONCOLOGY GROUP AND HAD A CANADIAN COLLABORATING NETWORK GROUP AS WELL. IN ADDITION, WE HAVE ALWAYS OPERATED IN CONCERT WITH THE DIVISION OF CANCER PREVENTION WHO OVERSEES THE NCI COMMUNITY ONCOLOGY RESEARCH PROGRAM. SO ALL THEIR SITES COULD PARTICIPATE IN OUR NETWORK AS WELL FOR CANCER TREATMENT TRIALS. A BIG PORTION OF THIS ESTABLISHMENT IN 2014 WAS TO CENTRALIZE AS MANY FUNCTIONS AS WE COULD THAT COULD BENEFIT ALL THE NETWORK GROUPS AND NDCP AS WELL INCLUDING A CENTRAL IRB WITH FOUR BOARDS, THE CANCER TRIAL SUPPORT UNIT WITH ADMINISTRATIVE AND REGULATORY FUNCTIONS AND RT AND IMAGING CORE CENTER THAT HELPED WITH ASSURANCE ON IMAGING AND RADIO THERAPY WHEN INCORPORATED IN TRIALS AND LAST BUT NOT LEAST TO HAVE A COMMON DATA MANAGEMENT SYSTEM WITH CENTRAL HOSTING ACROSS ALL THE DIFFERENT NCTN GROUPS AND THEY HAVE THEIR OWN PARTICIPATING SITE AND I LINK TO IT'S OWN BIO REPOSITORY OR TUMOR BANKS. SO THIS IS JUST TO GIVE YOU AN OVERVIEW OF THE WEEKLY INTERVENTION ACCRUAL. THIS DOES NOT INCLUDE SCREENING WHICH FOR US IN THE NCTN MEANS SOMETIMES PATIENTS ARE SCREENED AS A FIRST STEP WHEN THEY'RE ALREADY CONSENTED AND ON THE CLINICAL TRIAL TO MAKE SURE THEY'RE APPROPRIATE FOR A PARTICULAR CLINICAL TRIAL THIS IS OUR ACCRUAL FOR THE YEARS 2019 THROUGH THE FIRST HALF OF 2022. WE HAVE SORT OF A SET PATTERN AS YOU CAN SEE HERE FOR ACCRUAL IN ANY ONE YEAR. YOU SEE THE 52 WEEKS OF THE YEAR FROM JANUARY TO DECEMBER. AND THE UPS AND DOWNS MIRROR MOST OF THE TIME FEDERAL HOLIDAYS. YOU CAN SEE FOR 2020 IN THE DOTTED LINE THAT'S IN GRAY, YOU CAN SEE IN THE MIDDLE OR BEGINNING OF MARCH 2020, A LARGE DIP IN OUR ACCRUAL WITH THE ONSET OF THE PANDEMIC. WE WERE ABLE TO RECOVER WITH HELP OF ALL THE NCTN GROUPS AND STAFF AS WELL AS THE PARTICIPATING SITES. YOU CAN SEE THE DOTTED GRAY LINE CAME BACK UP AND FOLLOWED THE NORMAL PATTERN WHERE WE ONLY SEE DEPTHS AROUND THE END OF DECEMBER, DECEMBER HOLIDAYS AND THE EARLY NEW YEAR. WHAT WE WANTED TO DO IN ASSESSMENT FOR THE PROGRAM OF THE RE-COMPETITION IS SURVEY THE KEY LEADERS THAT PARTICIPATE IN THE TRIALS DURING THE CURRENT PROJECT PERIOD. WE'RE GOING TO PRESENT THE RESPONSE TO THE MAIN QUESTIONS ON THE NCTN PERFORMANCE SURVEY FOR THE PERIOD THEY WERE COMMENTING ON. THE SURVEY WAS MEANT TO BE CONDUCTED SO SOMEONE COULD RESPONSE TO IN 10 OR 15 MINUTES AND ADD COMMENTS AS WELL. WE BASED THIS ON THE PREVIOUS SURVEY AND HERE WE WERE FOCUSSING NOT ON EVERYBODY IN THE NETWORK BECAUSE WE HAVE PROBABLY OVER 12,000 TO 14,000 INDIVIDUAL INVESTIGATORS AND CRA STAFF BUT THE GROUP PARTICIPANTS AS IDENTIFIED BY THE GROUPS AND LEADING ACADEMIC SITES AND SPECIAL GRANT PROGRAMS AND THE NCOR P.I.s. THE SURVEY WAS OPEN FROM JULY 25 TO AUGUST 26 OF THIS SUMMER. THERE WERE APPROXIMATELY 335 RESPONDENTS. OF THOSE WHO RESPONDED, OVER 270 OF THEM RESPONDED TO OUR FIRST OVER ALL QUESTION WHICH WAS SATISFACTION OF THE NETWORK AND THEN THERE'S A DROP OFF WHERE YOU SEE PEOPLE GO THROUGH THE SURVEY BUT MOST PEOPLE DID COMPLETE IT. OUT OF THE RESPONDENTS WHAT ANSWERED ON SOME COMMENT ON THE ASPECT OF THE PROGRAM WHAT WE CALL MEANINGFUL COMMENT. THERE WERE ALMOST 800 OF THOSE AND BY MEANINGFUL WE MEAN NOTHING TO ADD OR NOT APPLICABLE. THEY PROVIDED AT LEAST ONE COMMENT IF NOT MORE ON ONE QUESTION. THAT WAS 80% OF THE 272 WHO COMMENTED ON OVER ALL SATISFACTION WHO PROVIDED A MEANINGFUL COMMENT. ON THE LEFT SIDE YOU SEE THE DISTRIBUTION BY GROUP. IT DOESN'T ADD UP TO 100%. IT ADDS UP TO MUCH MORE THAN THAT AND THAT IS BECAUSE PEOPLE WERE ALLOWED TO -- ARE OFTEN MEMBERS OF MORE THAN ONE GROUP AND SO THEY ACTUALLY RESPONDED BY DESIGNATING THEIR AFFILIATION IN THE GROUPS THEY BELONG TO. AND THE PEDIATRIC GROUP AND CANADIAN GROUP ARE MORE SPECIALIZED AND YOU SEE THE PERCENT OF RESPOND S OF THE 335 FROM THOSE GROUPS. YOU SEE THE BREAK DOWN BY THE ROLE AND THEY CAN NOTE YOU SEE THE GROUP OPERATIONS AND STATISTICS AND OTHER LEADERSHIP AND KEY PERSONNEL AND COMMITTEE CHAIRS AND STUDY P.I.s AND GROUP MEMBERS WHO MAKE UP A SIGNIFICANT PORTION. YOU STE THE BREAKDOWN OF WHAT RESPONDENTS FELT WERE THE PRIMARY AREA OF EXPERTISE AND RANGES THROUGH THE SPECIALIZED SPECIALTIES WITH MEDICAL ONCOLOGY PROBABLY BE THE MOST PREVALENT BECAUSE MOST OF OUR TRIALS FALL INTO THAT CATEGORY AND HAVE SIGNIFICANT REPRESENTATION FROM PEDIATRIC ONCOLOGY AND STATISTICS DATA MANAGEMENT AND RADIATION ONCOLOGY AND NURSING ETCETERA. THIS IS ALSO THE BREAKDOWN OF THE RESPONDENTS BY PRIMARY AREA OF DISEASE. IT GOES ACROSS ALL THE DISEASE. THERE'S A CATEGORY CALLED NON-APPLICABLE PEOPLE COMING IN WITH NOT A SPECIFIC DISEASE AREA THEY FELT WAS PRIMARY LIKE DATA MANAGEMENT OR ADMINISTRATIVE. OUR MAIN FIRST QUESTION WAS THE OVER ALL SATISFACTION OF THE NCTN BY THE PEOPLE WHO RESPONDED. THIS IS THE RESULT IN 2016. THAT WAS ABOUT TWO AND A HALF YEARS IN THE BEGINNING OF THE NCTN. AND SIGNIFICANT ROOM FOR IMPROVEMENT, IF THERE STILL IS, AT THAT TIME. THEN YOU CAN SEE THE IMPROVEMENT THAT WE SAW IN THE RESPONDENTS IN 2022. SO ACTUALLY THE SATISFIED RANGE WHICH IS THIS IS A 10-POINT SCALE OF 1-10 WITH 10 VERY SATISFIED AND 1 UNSATISFIED AND SATISFIED IS GRADE 6-10. IN 2016 IT WAS ABOUT 65%. AND IT IMPROVED ALMOST 89% IN 2022. WHEN WE LOOKED AT VERY SATISFIED RANGE WHICH IN 2016 WAS THE AREAS BETWEEN IF YOU GRADED SOMETHING AT BETWEEN 8-10, IT WAS 24% IN 2016 AND IN 2022, IT WAS OVER 50%. SO THERE WAS A SIGNIFICANT IMPROVEMENT IN THE RESPONDENTS OUTLOOK AND COMMENTS AND ON THE PERFORMANCE OF THE NCNN. I THINK THAT REFLECT THE HARD WORK OF EVERYONE IN THE SYSTEM AND AT THE NCTN GROUP WORKING TOGETHER TO MAKE THIS A TRUE NETWORK. WE ASKED HOW SATISFIED WERE YOU WITH CERTAIN ASPECTS OF THE NCTN IN TERMS OF ACHIEVING ITS GOALS. THIS IS A SCALE WHERE RESPONDENTS FELT THE PARTICULAR GOAL MET EXPECTATIONS OR EXCEEDED THOSE. THOSE WERE THREE REAL AREAS WHERE THERE WAS SIGNIFICANT PERCENTAGE OF THE RESPONDENTS FELT MORE IMPROVEMENT WAS NEEDED OR WAS UNSATISFACTORY. THAT'S THE PURPLE. IN REGARD TO ENROLLMENT AND RETENTION OF DIVERSE POPULATIONS. COMPLETION OF TRIALS AS WELL AS ACTIVATION OF THE TRIALS AS WELL. IN TERMS OF COLLABORATION ACROSS THE GROUPS AND ACROSS MEDICAL SPECIALTIES AND PUTTING INNOVATIVE SCIENCE AS WELL AS DEVELOPMENT FOR YOUNG INVESTIGATORS, THE NUMBER AND PERCENTAGE THAT MET EXPECTATIONS OR EXCEEDED IT WAS SIGNIFICANT. SO PUT SOME OF THE DISSATISFACTION FOR DIVERSE POPULATIONS ENTERED INTO THE TRIAL AND CONTRACT WE HAD A LONG HISTORY OF TRYING TO INCREASE OUR OUTREACH TO DIVERSE POPULATIONS. DR. McCASKILL-STEVENS PRESENTED FOR TRIALS ACROSS ALL PHASES TO THE BSA AND NCAB JUNE OF 2020. OVER THAT 20-YEAR PERIOD YOU CAN SEE HERE IF YOU JUST LOOK AT THE MINORITY THE PERCENTAGE OF MINORITY ACCRUAL IT'S GONE FROM 14% TO 25%. NOW, THE MINORITY ACCRUAL IS DEFINED HERE INCLUDES ETHNICITY. HISPANIC OR LATINO PATIENTS AND THOSE ARE SPLIT OUT IN RED BELOW WHERE IT'S GONE FROM 4% TO 10%. IT'S DEFINITELY NOT WHERE WE ALL WANT TO BE AND WHERE IT SHOULD BE IF WE WERE TRYING TO GET A DIVERSE POPULATION THAT REPRESENTS THE UNITED STATES AS POSSIBLE BUT IT HAS BEEN A SLOW AND STEADY IMPROVEMENT BUT AS DEMONSTRATED IN THE SURVEY RESPONSES, WE STILL HAVE A SIGNIFICANT WAY TO GO. IN TERMS OF THE COMMENTS OR THEMES FROM THE QUALITATIVE COMMENTS PROVIDED AND TRYING TO SAY HOW SHOULD WE INCREASE ENROLLMENT TO CLINICAL TRIALS, THERE'S A LOT OF COMMENTS WE NEEDED TO PROVIDE MORE PROGRAM DEVELOPMENT AT SITES WHERE THE MOST VULNERABLE PATIENTS ARE GETTING CARE AND FOCUSSED ON HOW TO REDUCE THE WORK LOAD TO CONDUCT STUDIES SO IT WOULDN'T BE SO DIFFICULT TO CONDUCT STUDIES FOR ALL TYPES OF PATIENTS AND FOCUSSED ON RECOMMENDING WE STANDARDIZE PROCESSES, REDUCE THE AMOUNT OF DATA COLLECTION AND HAVE WIDER PARAMETERS ON ELIGIBILITY AND OUR PATIENT VISITS, MORE EMPHASIS ON REMOTE AND VIRTUAL COLLECTION OF DATA AND TELEHEALTH. IN TERMS OF SUGGESTIONS TO IMPROVE THE EXPERIENCE OF THE ENROLLING SITES, WE HEARD OVER AND OVER AGAIN IN THE COMMENTS THAT THERE WERE A LOT OF REGULATORY MANDATES AND DUPLICATIVE DATA ENTRY AND AS SOMEONE SUGGESTED IN THE COMMENTS IT SEEMED LIKE PEOPLE WERE SPENDING MORE TIME COMPLYING THAN ENROLLING IN TERMS OF THE CLINICAL TRIAL EXPERIENCE. THEY ALSO ASKED GREATER CONSISTENCY OF MORE CENTRALIZED RESOURCES. THINGS THAT COULD BE USED ACROSS PROTOCOLS AND STUDIES INCLUDING CHECKLISTS AND CALENDARS AND MAYBE FREQUENTLY ASKED QUESTIONS ON PROTOCOLS, GREATER COMPENSATION FOR STAFF TIME AND ENERGY AND COMMON GUIDELINES. THOUGH WE HAVE GENERAL GUIDELINES ALL THE NCTN GROUPS ADHERE TO IT SEEMS LIKE MORE AND MORE SITES WERE SAYING IT WOULD BE EASIER TO ALL DO THINGS MORE CONSISTENTLY AND NOT HAVE AS MUCH AS DIFFERENCES EVEN IF THEY'RE MINOR BETWEEN GROUPS. AND TO PUT IN CONTEXT THE ISSUE OF STUDY ACTIVATION. I'VE LISTED OUR OVER ALL WHAT WE CALL TIME LINE FOR DEVELOPMENT OF A STUDY. AND THE TIME LINE REALLY STARTS ATE THE FIRST TIME THERE'S A REVIEW OF THE PROPOSAL AT CTEP OR DISEASE SPECIFIC STEERING COMMITTEE TO WHEN THE TRIAL IS ACTIVATED. SO SOMEONE COULD PUT THE PATIENT ON TRIAL. IT'S BROKEN DOWN BY PHASE AND THEN BY THE SIZE OF THE LATE-PHASE CLINICAL TRIALS AND THE ABSOLUTE DEADLINE RANGES FROM 400 FOR SMALL PHASE 1 TRIAL AND SMALL PHASE 2 TO PHASE 3 TRIAL, 540 DAYS. THOUGH CONCEPT APPROVAL REVIEW AND PROTOCOL OFFERING ITSELF DON'T TAKE UP THE MAJORITY OF THE TIME AND THE TIME LINE, THE MAJORITIES IN PROTOCOL APPROVAL AND ACTIVATION. THAT'S A BACK AND FORTH ON DIFFERENT ASPECTS OF THE PROTOCOL AND FOR MANY STUDIES INCLUDES CONTRACTING WITH PHARMACEUTICAL COMPANIES AND OTHER THINGS THAT HAVE TO BE DONE, SOMETIMES DIAGNOSTIC COMPANIES AS WELL AND WE FIND THAT'S THE AREA WHERE WE HAVE THE MOST I WOULD SAY DELAYS IN THE TIME LINE. THESE ARE THE ABSOLUTE TIME LINES. THE TARGETS EVERYONE TRIES TO DO THEM MORE QUICKLY AND THESE ARE OUR ABSOLUTE TIME LINES THAT HAVE BEEN IN PLACE SINCE ABOUT I THINK PROBABLY 2015 OR 2016. WE STARTED WITH LONGER TIME LINES TO START WITH AND WE DID MAKE SOME IMPROVEMENT ON THAT. EVEN WITH THE TIME LINES, THE EMPHASIS IS SUCH THAT WE KNOW THIS IS NOT AS QUICK -- WE'RE NOT AS QUICK TO ACTIVATE STUDIES AND TO COMPLETE THEM AS WE ALL WANT THAT TO BE. SO IN TERMS OF STREAMLINING INCREASING COLLABORATION. THERE WERE QUITE A FEW COMMENTS ABOUT MAYBE FORMALIZING INTERGROUP DISEASE PHASE WORKING GROUP TO FIGURE OUT HOW TO RECOGNIZE PARTICIPATION OR PARTICIPANTS FROM MULTIPLE NCTN GROUPS AT THE LEVEL OF P.I. AND MAKE IT A TRUE COLLABORATION. MORE MEETINGS TOGETHER AND CONTINUE CULTURAL CHANGES TO ENHANCE COLLABORATION AS WELL AS STREAMLINING PROCESS AND ENCOURAGE INNOVATION. AND LASTLY BUT NOT LEAST, THEY FELT THE MORE WE COULD COMMUNICATE AND SHARE BEST PRACTICES AND ALSO HAVE SOME KIND OF FORUM BY WHICH GROUPS CAN SHOWCASE THEIR WORK AND FOSTER UNDERSTANDING BETWEEN EACH OTHER ABOUT WHAT THEY'RE DOING AND WHAT'S COMING DOWN THE PIPELINE, THE BETTER IT WOULD BE AND THAT WOULD ONLY ENHANCE THE NETWORK. THERE WERE ALSO SUGGESTION TO IMPROVE INVESTIGATOR EXPERIENCES ESPECIALLY FOR JUNIOR INVESTIGATORS. YOU CAN SEE THIS LISTED HERE. A LOT OF THEM WAS MAKING SURE THAT ALL THE CLINICAL RESEARCH WE DO THAT WE TRY TO DIVIDE IT UP AS MUCH AS POSSIBLE TO RECOGNIZE JUNIOR INVESTIGATORS AND THAT WE SHOULD PROVIDE MORE GUIDANCE AND MENTORSHIP. SO THE NEXT QUESTION WAS ABOUT THE CENTRALIZED SERVICES AND THE ADMINISTRATIVE ASPECTS OF THE NCTN. THIS IS A FOUR-POINT SCALE SIMILAR TO THE PREVIOUS QUESTION AND YOU CAN SEE FOR TWO OF OUR CENTRALIZED SERVICES THE BIGGEST WHICH ARE THE NCI CENTRAL IRB AND IS THE CANCER TRIAL SUPPORT UNIT THE TWO BARS ON THE BOTTOM OF THE GRAPH. THERE WAS OVERWHELMINGLY PERCENTAGE OF THE RESPONDENTS THAT ON THOSE CENTRALIZED SERVICES WE MET EXPECTATIONS OR EXCEEDED THEM. HERE YOU CAN SEE THAT THERE WAS SIGNIFICANT DISSATISFACTION ABOUT THE APPROVAL AND BIO SPECIMEN INSPECTION AND OTHER CORRELATIVE STUDIES OR SPECIMEN STUDIES IN THE CLINICAL TRIALS. THAT'S THE NUMBER ONE MAIN CRITICISM OF THE NETWORK. SO WHEN WE LOOK AT WHAT WE REALLY PROVIDE IN TERMS OF STUDY SUPPORT TO THE SITE, THIS IS AT THE SITE LEVEL. FOR MANY MANY YEARS PRIOR TO 2014 WE HAD A BASE RATE BETWEEN 1995 AND 2014 WHERE WE PROVIDED $2,000 TO THE SITE FOR EVERY PATIENT ENROLLED PLUS SOME FOLLOW-UP PAYMENTS. THAT WAS SET MATTER WHAT PHASE IT WAS OR WHETHER IT WAS AN IND OR IND EXEMPT TRIAL AND WHEN WE INSTITUTED THE NCTN IN 2014 WE TRIED TO DIVIDE THAT UP A LITTLE BIT IN TERMS OF HAVING WHAT WE DESIGNATED AS HIGH-PERFORMING SITES AND THOSE WOULD BE LEAD ACADEMIC PARTICIPATING SITES OR SITES WITH DIRECT GRANTS FOR THEIR PARTICIPATION. THEY COMPETE FOR THE GRANTS BUT OF THE LEADERSHIP THE SCIENTIFIC LEADERSHIP THEY PROVIDE TO THE GROUPS AS WELL AS THEIR ACCRUAL. AND THEN IN 2019 WE WERE FORTUNATE ENOUGH TO GET A BIT MORE FUNDING SO WE COULD ACTUALLY ALSO MAKE A DISTINCTION BETWEEN IND AND NON-IND SITE STUDIES BECAUSE THE IND SITES OR STUDIES ARE THE ONES THAT HAVE QUITE A BIT OF REPORTING AND REGULATION ASSOCIATED WITH THEM. SO BECAUSE OF THAT, WE HAVE A BREAKDOWN IN THE AMOUNT OF FUNDING THAT GETS SENT TO EACH OF THE INDIVIDUAL SITES PER ENROLLED PATIENT OR PER CASE REIMBURSEMENT. EVEN WITH ALL THIS, IN ADDITION WE DO MEDICARE COVERAGE ANALYSIS AND ALL THE TRIALS MOUNTED IN THE NCTN TO MAKE SURE AS MUCH AS POSSIBLE WE'RE FOLLOWING THE STANDARD OF CARE TO THINGS ARE BILLABLE TO INSURANCE FOR WHAT WE DO AND TO MAKE SURE WE'RE CONDUCTING CLINICAL TRIALS IN REAL-WORLD SETTING. HOWEVER, EVEN WITH THAT, WE STILL OBVIOUSLY DON'T PROVIDE SIGNIFICANT FUNDING WHEN YOU COMPARE IT TO INDUSTRY. NOW, INDUSTRY FUNDS THEIR CLINICAL TRIALS AT SITES DIFFERENTLY. A LOT OF THEIR MONEY DOES GO TO SITE INITIATION AND SITE SELECTION WHICH WE DON'T HAVE SINCE WE HAVE A STANDING MEMBERSHIP ACROSS THE NCTN AND VARIOUS GROUPS. WITH THAT THEY FUND PER MILESTONE AND FOR CERTAIN STUDIES OUR PHARMACEUTICAL PARTNERS PROVIDE ADDITIONAL FUNDING THAT CAN SOMETIMES ALMOST DOUBLE WHAT IS BEING PROVIDED BY THE GOVERNMENT AS THE BASE RATE AND A LOT OF THAT IS FOR TRIALS THAT ARE PARTICULARLY HAVE AN ASPECT THAT ARE EITHER IN RARE POPULATION AND/OR MAY BE DESIGN FOR POTENTIAL REGISTRATION OR MARKETING INDICATION BY THE FDA. SO IT'S HARD TO TO COMPARE THE SITE PAYMENTS BETWEEN AN INDUSTRY SPONSORED STUDY AND OUR OWN EXCEPT WE DO KNOW THAT GOING BACK TO THE IOM REPORT IN 2010 IT WAS ESTIMATED THAT INDUSTRY SUPPORTED-SITES WAS BETWEEN 2.5 TO 7.5 DISCREPANCY IN THE PAYMENT AMOUNTS. A LOT OF THAT IS BECAUSE WE'RE DOING SEPARATE TRIALS BUT WE KNOW COMPARED TO INDUSTRY SITES AND THE PAYMENTS THEY RECEIVE FOR TRIALS THAT WERE SIGNIFICANTLY BELOW THAT IN TERMS OF OUR FUNDING. ON THE NEXT SLIDE YOU CAN SEE THIS WAS THE MOST COMMON COMMENT THE FUNDING WAS NOT SUFFICIENT PARTICULARLY MANY PEOPLE TOLD US THEIR SITES WERE INCREASINGLY FOR STUDIES OVER NCTN EVEN IF THE TRIAL WAS VERY INTERESTING SCIENTIFICALLY FOR PRACTICAL REASON WE DON'T PROVIDE ENOUGH FUNDING AND THERE'S MORE COMPLEX, NUANCED STUDIES EVEN WITH CENTRALIZED SUPPORT AND FOR EVERYBODY WHO PARTICIPATE IN THE U.S. IN THE NETWORK IT'S FREE AND OTHER REGULATORY ASPECTS THE SITES ARE NOW LESS WILLING TO CONSIDER OR PARTICIPATE IN THE NCTN STUDIES BECAUSE OF THE GROWING FINANCIAL DEF SIS. -- DEFICIT. SO WE NEXT ASKED A QUESTION ON THE OVER ALL SATISFACTION OF THE MENU OF TRIALS. YOU SEE THAT BROKEN DOWN HERE. IT WAS PRETTY CONSISTENT ACROSS THE THREE AREAS THAT WE DESIGNATED. ONE IS JUST THE PORTFOLIO IN GENERAL AND THE NUMBER OF TRIALS FOR ADOLESCENTS AND YOUNG ADULTS OR AOYA TRIALS AND THE NUMBER OF TRIALS AVAILABLE. THOUGH THERE WAS QUITE A BIT OF SATISFACTION IN TERMS OF MEETING EXPECTATIONS OR EXCEEDING THEM, THERE WAS STILL WAS A SIGNIFICANT NUMBER OF RESPONDENTS WHO FELT THAT THERE WAS SOME IMPROVEMENT THAT WAS NEEDED. SO WHEN WE LOOKED AT THE QUALITATIVE COMMENTS THAT CAME BACK IN THIS AREA, THERE SEEMED TO BE A SPLIT BETWEEN SITES THAT WERE LOOKING FOR RELATIVELY SIMPLE OR STRAIGHTFORWARD QUESTIONS ABOUT VARIOUS REGIMENTS THEY THOUGHT WOULD BE VERY INTERESTING AND APPROPRIATE AND REALLY COULD AFFECT STANDARD OF CARE THAT NO ONE WOULD ADDRESS INCLUDING INDUSTRY AS WELL AS ANOTHER GROUP WHO CONCENTRATED ON MORE COMPLEX SIGNAL SEEKING TRIALS. IT WAS OBVIOUS FOR SOME SITES PARTICULARLY SITES THAT MAY NOT HAVE AS ROBUST A CLINICAL RESEARCH STAFFING PROGRAM AT THEIR INSTITUTION THAT IT'S VERY DIFFICULT FOR THEM TO DO SOME OF THE COMPLEX TYPES OF TRIALS AND SIGNAL-SEEKING TRIALS THAT ARE DONE AND DO THEM IN RARE POPULATIONS AGAIN BECAUSE OF FUNDING AND ALSO BECAUSE THEY MAY NOT SEE THOSE TYPES OF PATIENTS VERY FREQUENTLY. ON THE OTHER SIDE THERE WERE PEOPLE WHO WANTED TO SEE MORE SIGNAL SEEKING TRIALS RATHER THAN FOCUS ON PRACTICE-CHANGING PHASE 3 TRIALS AND FELT IT WOULD BE GOOD USE OF THE NCTN. THOUGH THERE'S PEOPLE ON BOTH SIDES OF THIS AND IT DEPENDS ON THE PARTICULAR SITE AND WHAT FITS THEIR PROGRAM, AND WE DO OFFER THE FULL SPECTRUM OF SIGNAL SEEKING TO DEFINITIVE PHASE 3 TRIALS THE BEST QUOTE WE NEEDED TO ASSURE A BALANCE BETWEEN LARGE SIMPLE TRIALS AND MORE COMPLEX TRIALS THAT NEED IN BE DONE WITH PRECISION MEDICINE. OUR NEXT QUESTION WAS TO ASK ABOUT THE VARIOUS THINGS WE PUT IN PLACE WHEN COVID-19 HIT AND THE PANDEMIC BEGAN TO AFFECT CLINICAL TRIALS IN MARCH OF 2020. WE DID A SERIES OF THINGS YOU SEE LISTED ON THE LEFT. WORKING WITH LOCAL HEALTH CARE PROVIDERS, ORAL DRUGS, REMOTE CONSENT AND AUDITING AND ALL ALLOWING PRACTITIONERS TO SIGN OFF ON DRUGS IF THEY'RE INSTITUTION HAD A PROGRAM TO DO THAT. WE ASKED ABOUT THE SATISFACTION OF THE PROCESSES WE PUT IN PLACE RATHER QUICKLY AFTER THE ONSET OF THE PANDEMIC. THERE WAS OVERWHELMING SUPPORT FOR THESE. THAT'S THE GREEN AND SALMON AND IT'S OVER 80% IN EVERY CATEGORY. WE ALSO TRIED TO BROADEN ELIGIBILITY CRITERIA AND THE EFFORT PUT TOGETHER TO TRY TO SAY WHAT CAN WE DO TO BROADEN ELIGIBILITY AND DIFFERENT ASPECTS OF THE PROGRAM WITH ASCO AND FDA AND FRIENDS OF CANCER RESEARCH AND NCI PUT TOGETHER TO BROADEN AND IMPROVE ELIGIBILITY. AND WHAT I'M CIRCLE ARE THREE AREAS THAT SEEM WELL ACCEPTED WHICH WERE TO DECREASE THE BURDEN OF EXCLUDING PATIENTS BECAUSE OF PRIOR CONCURRENT MALIGNANCIES AS WELL AS PRIOR THERAPIES AND TO FOCUS ON USING THE STANDARD COLLABORATORY REFERENCES AND TEST INTERVALS AT THE SITE FOR ELIGIBILITY. BUT PRETTY MUCH EVERY ASPECT HERE WAS HAD A LOT OF SUPPORT FROM THE VARIOUS RESPONDENTS IN TERMS OF ACCEPTABILITY AND BROADENING ELIGIBILITY. SOME THAT ARE MORE PROBLEMAT IC, PERTAINS TO HOW WE WERE IMPLEMENTING THEM AND THE LANGUAGE AND WE HAVE A PROGRAM FOR EVERY PROTOCOL THAT WE VIEWED AND LOOK AT THE ELIGIBILITY AGAINST THESE COMPONENTS AS WELL AS OTHERS SHA HAVE COME OUT SINCE THEN AND TRIED TO MAKE THEM AS BROAD AS POSSIBLE ON A REGULAR BASIS TO MAKE SURE WE'RE DOING THIS ON EVERY TRIAL AS WE MOVE ALONG. AGAIN THE FEEDBACK WAS MAINLY SUPPORTIVE OF ALL THE PROCESSES WE PUT IN PLACE DURING THE COVID-19 PANDEMIC AND FOR BROADENING ELIGIBILITY. THOUGH I FOCUSSED ON A LOT OF AREAS OF DISCONTENT IN THE FIRST PART OF THE PERFORMANCE, THERE WERE QUITE A FEW POSITIVE EXPERIENCES AND IT'S ALSO REFLECTED IN THE SATISFACTION OF THE NETWORK THAT HAS IMPROVED OVER THE LAST SIX YEARS AND IN PARTICULARLY WE SEE MORE AND MORE THAT PEOPLE ARE TRYING TO COLLABORATE MORE THAN BEFORE AND NOW THAT WE HAVE THE TOOLS AND INFRASTRUCTURE IN PLACE MORE AND MORE ARE COLLABORATING ACROSS THE ENTIRE SPECTRUM OF STUDIES WE DO AND VARIOUS GROUPS. IN SUMMARY, IF WE WERE TO FOCUS ON ALL THE COMMENTS MADE AND WHAT WE GOT FROM THE QUANTITATIVE QUESTIONS WE ASKED DURING THE SURVEY, THE NUMBER ONE CONCERN WAS WITH THE FUNDING FOR ALL THE ELEMENTS OF THE STUDY AND THAT THEY FELT WE NEEDED TO ACHIEVE BEST BALANCE BETWEEN FUNDING AND REQUIREMENTS. THERE WAS QUESTS FOR CONSISTENCY AND THE SAME EXPECTATIONS FOR CLINICAL TRIALS ACROSS THE GROUPS. THEY WANTED TO FOSTER COLLABORATION AND RECOGNITION AS WELL AS DOING BETTER ACTIVATION AND CONDUCT OF TRIALS AND ALMOST UNIVERSAL THEY WANTED US TO CONTINUE ALL THE CHANGE IMPLEMENTED DURING THE PANDEMIC AND WE HAVE MOVED TO DO THAT AND ALSO TO HOPEFULLY HELP IDENTIFY MORE FLEXIBILITY AND DECENTRALIZED AND INCORPORATED. AND THERE'S BEEN CLINICAL TRIALS IN TRANSLATIONAL RESEARCH COMMITTEE WE HAVE A BIG EFFORT TRYING TO LOOK AT A STRATEGIC VISION FOR CLINICAL TRIALS 2030 AND BEYOND AND DEVELOP MORE FLEXIBLE, SIMPLER, LESS EXPENSIVE HIGH IMPACT CLINICAL TRIALS AND THEY IDENTIFIED FOUR AREAS WE'RE TRYING TO WORK ON MOVING FORWARD REFLECT THE DIVERSITY OF PATIENTS WHO GET CANCER ACROSS THE UNITED STATES AND WORKING WITH INTERNATIONAL COLLABORATORS AND STREAMLINE PROCESSES AND DECREASE BURDENS FOR THE SITE AS MUCH AS WE CAN. TODAY WE WANTED TO TAKE A FEW MINUTES TO GET YOUR IMPRESSIONS AND TO MAYBE HAVE SOME FEEDBACK OF WHEN YOU LOOKED AT THE INFORMATION AND LEARNED MORE ABOUT IT WHAT CAN WE DO TO CONTINUE IMPROVE SATISFACTION AND BEST MANAGE THE CRITICAL FUNDING CONCERNS THAT HAVE BEEN RAISED. A LOT OF THE QUALITATIVE FEEDBACK THAT WAS POSITIVE WE RECEIVED IN THE SURVEY DOES REFLECT THE PROGRESS OF THE NCTN. WE DO SEE SITES ENROLLING TO TRIALS FOR MULTIPLE GROUPS AND THEY HAVE A LOT OF SUGGESTIONS NOW HOW TO IMPROVE THAT EXPERIENCE. WE HAVE SEEN CHANGES WHERE PEOPLE ARE REQUESTING MORE INFORMATION, GUIDANCE AND OPPORTUNITIES TO SUCCEED THE PROGRAM RATHER THAN CHANGE SOMETHING SPECIFICALLY AND MORE AND MORE ARE SUGGESTING THERE NEEDS TO BE GREATER COMMUNICATION AND OPPORTUNITIES FOR MEETINGS AND FOR THE JUNIOR INVESTIGATORS ACROSS TRIALS ETCETERA. I'LL TURN IT BACK FOR FURTHER DISCUSSION AND HAPPY TO ANSWER ANY QUESTIONS YOU MAY HAVE. >>THANK YOU TO YOU AND YOUR TEAM FOR THIS EFFORT IN HELPING US UNDERSTAND SOME OF THE CHALLENGES I THINK MANY OF US HAVE FELT THAT ARE THERE BUT NOW HAVE DISCREET DATA AND HOW MANY ADVANCES HAVE BEEN MADE AND I THINK THE SURVEY BRINGS THAT IN STARK RELIEF. I'D LIKE TO OPEN THE FLOOR FOR ANY MEMBERS WHO HAVE QUESTIONS. >>THANK YOU. A LOT OF DATA. I WANT TO PLEAD WITH YOU ALL TO MAKE IT ABSOLUTELY CLEAR WHEN WE TALK ABOUT STREAMLINING DATA COLLECTION, WE DO NOT MEAN WE WILL NOT COLLECT RACE, ETHNICITY, LANGUAGE SPOKEN, IMMIGRATION STATUS WHERE PEOPLE LIVE AND THE SOCIAL DETERMINATES OF HEALTH. THOSE ARE VITAL TO OUTCOMES. AS WE SPOKE ABOUT IN THE LAST SUBCOMMITTEE MEETING, DISAGGREGATION OF RACE AND ETHNICITY. UNLESS YOU SPECIFICALLY SPATE THOSE STILL HAVE TO BE COLLECTED THEY HAVE TO BE OFF THE TABLE WHEN YOU TALK ABOUT STREAMLINING. I'VE BEEN DOING THIS FOR A LONG TIME AND I HAVE A LOT OF EVIDENCE ABOUT WHAT I SAY AND WE NEED TO MAKE IT MANDATORY THAT ALL HOSPITALS USE SELF-REPORTED RACE AND ETHNICITY AND STOP CODING PEOPLE FOR RACE AND ETHNICITY. THAT'S STILL HAPPENING TODAY IN 2022. WE HAVE TO STOP THAT. THANK YOU. >>WE HAVE THE TABLE THAT SHOWED INCREASE IN ENROLLMENT ACROSS MINORITY GROUPS. I WAS CURIOUS ABOUT RURAL AMERICANS AND HAS NONE OF THAT BEEN COLLECTED TO WHAT ELECTRA WAS SAYING. FROM THE LAST SUBCOMMITTEE I THINK THAT COULD BE A REAL OPPORTUNITY IN THE NEW RFA AND IN DATA GOING FORWARD BECAUSE IT WASN'T ADDRESSED. >>I WILL SAY WHAT I SHOWED WERE THE MANDATORY CATEGORIES THAT ARE MANDATED BY CONGRESS AND BY THE NIH. WE HAVE ALWAYS COLLECTED AND CONTINUED TO COLLECT THAT. WE DO COLLECT LOCATION AND WE HAVE THAT INFORMATION AND WE DON'T REPORT THAT OFFICIALLY TO NIH BECAUSE THAT'S NOT PART OF THAT PARTICULAR MANDATE THOUGH THEY'RE LOOK AT THAT. SAME THING WITH AGE. WE DO HAVE THAT BREAKDOWN AND USUALLY WHEN WE START THE PROCESS WE TRY TO CREATE A QUOTE, UNQUOTE, HEAT MAP TO GIVE THE BREAKDOWN OF WHERE PATIENTS ARE COMING FROM AND WHAT THEIR CANCER INCIDENCE IS AND FROM LOCATION. WE DON'T PRESENT TO NIH BECAUSE IT'S NOT PART OF THE STANDARD CONGRESSIONALLY MANDATED PROGRAM AND WE DO REPORT ON IT AND WE'RE TALKING ABOUT PLANS HOW TO MAKE IT MORE AVAILABLE ON A PROGRAMMATIC BASIS. THE NIH WILL INCLUDE AGE AS PART OF THE OFFICIAL MANDATE. THE OTHER CATEGORIES ARE THINGS WE HAVE TO LOOK AT. SOME LOOK AT INSURANCE INFORMATION. THAT'S WHERE THERE'S MORE SENSITIVITY IN TERMS OF TRYING TO FIGURE OUT THE BEST WAY TO DO THAT BUT WE'RE TALKING WITH DCP AND OTHER GROUPS ACROSS THE BOARD WE WANT TO GET AS MUCH AS INFORMATION AS IS APPROPRIATE TO CATEGORIZE THE PATIENT POPULATIONS THAT ARE PARTICIPATING IN THE TRIALS. WE CAN IMPROVE THAT OVER TIME. >> I APPRECIATE THE EARLIER COMMENTS. I HAD A COUPLE QUESTIONS. I TOTALLY AGREE WITH THE COMMENT WHAT YOU FOUND REGARDING THE COST. BEING ON THE RECEIVE END OF THE APPLICATIONS. THE COSTS ARE WAY UNDER ESTIMATED. THAT COULD BE A STUDY ITSELF. ESPECIALLY TO THE COMMUNITY SITES. WHAT'S IT TAKE YOU TO DO A STUDY? IT TAKES A LOT. THAT'S ONE. THE OTHER PART IS IN TRYING TO DOUGH THE STUDIES IN THE COMMUNITY, THE PARTNERSHIP WITH PRIMARY CARE DOCS IS A FABULOUS OPPORTUNITY. >>THANK YOU. >>THANK YOU. THAT WAS AN INTERESTING PRESENTATION. CONGRATULATIONS ON ARE REDUCING THE TIME TO ENROLLMENT. I DON'T KNOW IF YOU RECALL 2009. WE WERE AT 640 DAYS. THAT'S A SIGNIFICANT IMPROVEMENT. I DO WANT TO COME BACK TO COSTS. THIS HAS ALWAYS BEEN WITH US. THE TRUTH IS IT COSTS MORE TO DO WITH THE TRIALS THAN WE'RE WILLING TO GIVE THE INVESTIGATORS. WHETHER IT'S COLLECTING A SAMPLE. ANYBODY HERE WILL TELL YOU COLLECTING A SAMPLE TODAY IS VERY EXPENSIVE AND THERE'S NO ONE THAT REIMBURSES FOR COLLECT A SAMPLE. WE WOULD SOLVE SO MANY PROBLEMS BUT NO ONE ADVOCATES FOR THAT. I WAS WONDERING IT SEEMS TO ME WE CAN START THINKING ABOUT NCI DOING MORE OF THE TRIALS AND REIMBURSING AT HIGHER RATES AND WE NEED WE'LL HAVE REAL NEEDS FOR AGENTS AND I THINK WE SHOULD THINK ABOUT THIS DIFFERENTLY GOING FORWARD AND I TAKING ON MORE TRIALS UNDER NCI'S LEADERSHIP. >>WE DID TARGET A LOWER NUMBER OF PATIENTS VIS A VIS WHAT WE HAVE PREVIOUSLY DONE. THERE ARE A LOT OF IDEAS AND PROGRAMS AND YOU'RE RIGHT IT BECOMES A BALANCE BETWEEN PRIORITIZING WHAT YOU CAN DO AT A REASONABLE REIMBURSEMENT COST TO GET THE TRIALS DONE WE MANAGED TO RUN ADULT MATCH AND PEDIATRIC MATCH WHICH HAD ADDITIONAL COMPENSATION. IT WASN'T A LOT BUT WE HAVE SOME NEW PRECISION MEDICINE TRIALS AND ONE IS COMBINATION MATCH AND MILO MATCH AND IN IMMUNOTHERAPY THE HIGH-PRECISION MEDICINE HIGH COMPLEX TRIALS AND THAT'S TAKING ADDITIONAL RESOURCES TO DO AT THE NCI LEVEL AND TO PROVIDE THE ASSAY INFORMATION TO ASSIGN PATIENT TO TRIALS. THERE'S A BUSINESS WE HAVE TO ACHIEVE AND THE QUESTION IS HOW BEST TO DO THAT. >>MEG, THIS WAS GREAT. THANK YOU. COMING FROM INDUSTRY THOUGH THINKING BACK TO WHAT ELECTRA WAS SIG, I THINK I WONDER IF WE SHOULD RETHINK SOME OF THESE THINGS. MY BIAS IS COMING FROM INDUSTRY, FRIENDS AND ANECDOTES I'M SURE I DON'T HAVE THE SURVEY TO SHOW WHERE THEY DON'T WANT TO COLLABORATE OR SHARE WITH NCI. AND A LOT OF THIS IS OLD FASHIONED BIASES ABOUT RETAINING PATIENTS. I NOTICED ON YOUR SLIDE, 28. ONE OF YOUR RESPONDENTS BROUGHT UP RETAINING PATIENTS. IN OTHER WORDS, QUALITY OF THE DATA. MISSING DATA. ADHERENCE TO ORAL MEDICINES. BIG PROBLEM WITH STUDIES UP TO 50% OF PATIENTS GETTING AN ORE PILL AND WHO WANTS TO DEAL WITH 50% OF PEOPLE NOT TAKE THE PILL? COLLECTING DATA ON THE COMPETERS AND IN TERMS OF MINORITY GROUP COMPLETERS AND UNDERSTANDING THE SUCCESSES BECAUSE I THINK THERE ARE SUCCESSES. THERE'S ALSO SUCCESSES HISTORICALLY WITH YOU DEAL WITH COMPLEX NEW MEDICINES AND THE LUNG CANCER STUDY. DIDN'T THEY ACCRUE FASTER THAN INDUSTRY FOR COMPARABLE LARGE TRIALS? IT WAS THE DRUG, NOT THE MONEY. I DON'T THINK MORE MONEY WAS GIVEN BY ROCHE OR GENENTECH. I THINK THE NCI BROUGHT IN A VERY INTERESTING, EXCITING NEXT GENERATION TREATMENT TO ADD TO STANDARD THERAPY FOR LUNG CANCER. THOSE ARE THOUGHTS. ABOUT THE TOPIC OF PRECISION MEDICINE, I THINK ONE OF THE HEADWINDS WE HAVE TO RECOGNIZE IS WHAT I'VE SEEN HAPPEN IS THE BURDEN OF TURNAROUND TIME. STO GET NEXT GENERATION SEQUENCING YOU'RE TALKING TWO WEEKS MINIMUM. IF SOMEONE IS FAMILY AND HAVE PROBLEMS AND WANT TO GET TREATED, THEY WON'T WANT TO WAIT TWO WEEKS. DR. JOHNNY WAS TEACHING PEOPLE START THEM ON CHEMO NOW AND WHEN YOU GET THE NEXT GENERATION RESULT BACK ADD IT ON TO THE STA STARTED CHEMOTHERAPY. ARE PROTOCOLS ALLOWING THAT KIND OF THING? NO. YOU USUALLY HAVE CONSISTENCY AND THE JOHNNY ADVOCACY IS AN OFF-PROTOCOL ADVOCACY IF YOU THINK ABOUT IT. ONE QUICK THOUGHT, DIAGNOSTIC COMPANIES ARE TRYING TO ADDRESS THIS. YOU'RE PROBABLY AWARE OF THE EXACTNESS CONSORTIUM FROM MONTREAL WITH 17 DIFFERENT CENTERS LOOKING AT TURNAROUND TIME THE TIME MINIMUM. IF WE CAN FIND AND LEARN FROM THAT OR REPLICATE IT IT WOULD BE A REAL GAME CHANGER FOR ADVANCING THE HIGHLY COMPLEX NEW TRIALS. THAT'S ENOUGH. THANK YOU. >>I THINK WE HAVE DR. NEWMAN AS WELL. >>THANK YOU FOR THE AWESOME DATA. I WANTED TO ADD A COMMENT REGARDING THE ACCRUAL OF DIVERSE POPULATIONS ON TO CLINICAL TRIALS AND HERE WHERE THERE'S APPLAUSE TO BE GIVEN ON IMPROVING THE DIVERSITY OF OUR ACCRUAL OF CLINICAL TRIALS AND IT WAS WONDERFUL TO SEE THE RESPONDENTS MAKE THE SURVEY EXPRESSED A STRONG INTEREST IN CONTINUED IMPROVEMENT WITH REGARD TO DIVERSE ACCRUAL RATES. HOWEVER IT'S STILL IMPORTANT TO EMPHASIZE THE FACT WE HAVE ONGOING PROBLEMS AT THE PROVIDER LEVEL IN TERMS OF INADEQUATE PROVIDER OFFERING CLINICAL TRIALS TO MINORITY AND UNDER SERVED PATIENTS AND SPENDING INADEQUATE AMOUNT OF DISCUSSING CLINICAL TRIALS WITH PATIENTS WITH MINORITY BACKGROUNDS. IT'S BEEN WELL DOCUMENTED. ONE OF THE BIGGEST REASONS FOR NON-PARTICIPATION IS THE FAILURE TO HAVE BEEN OFFERED A CLINICAL TRIAL. AND IN CANCER CENTERS DEMONSTRATING SURVEY ANALYSIS THE PROVIDERS IN MANY OF THE CANCER CENTERS DON'T FEEL THAT IT'S WORTH THEIR TIME TO INVEST IN TRYING TO EXPLAIN CLINICAL TRIALS TO MINORITY OF PATIENT FOR A VARIETY OF REASONS, CONCERNS REGARDING INSURANCE AND ABILITY OF THE PATIENTS BEING ABLE TO COMPLY AND PAY. YOU CAN COME UP WITH A BILLION EXPLANATIONS BUT PROVIDERS ARE NOT UNFORTUNATELY OFFERING CLINICAL TRIALS ACROSS THE BOARD PROPORTIONATELY. >>THANK YOU. >>IT'S BEEN A GREAT DISCUSSION. ARE THERE ANY OTHER COMMENTS OR QUESTIONS? I HAVE A QUESTION. YOU'VE HAD MORE TIME WITH THE SURVEY RESULTS THAN THE REST US AND LOOKED OVER A LOT OF THE COMMENTS SITES ARE MAKING. WHICH ARE THINGS WE CAN DO NOW AND THE NEW COMPETE THAT'S GOING TO GO FORWARD AND MAY BE REVENUE NEUTRAL? I THINK THE LARGEST THING WE'VE BEEN HEARING IS WE NEED MORE FUNDING FOR THE TRIALS AND HOPEFULLY WE CAN ADVOCATE FOR THAT. HOW CAN WE PRIORITIZE WHAT IS DOABLE AND FEASIBLE TO MAKE THINGS BETTER? >>THE WHOLE EFFORT WE'RE TRYING TO DEVELOP UNDER CTAC WITH THE STRATEGY VISION TO DECREASE THE AMOUNT OF DATA COLLECTION AND TO REALLY ONLY CORRECT WHAT WE REALLY NEED. WE HAVE EXPERIENCE IN CONDUCTING CLINICAL TRIALS WITHIN COMMUNITY AND ACADEMIC CENTERS OVER THE LAST 60 PLUS YEARS AND MORE RECENT COMMUNICATIONS AND PROBABLY BETTER DATA ON THE BURDENSOME BARRIERS THAN THE PAST. IT'S REVENUE NEUTRAL IN THE SENSE IT WOULD BE A PLUS. IF WE HAD STREAMLINE TRIALS IN TERMS OF THE COLLECTION AND WEREN'T TRYING TO PUT SO MANY NICE TO HAVE THAT IF PRIORITIZED WHEN IT'S IMPORTANT TO HAVE ANCILLARIES AND THOSE ARE THE ONES WE SHOULD FUND IN TERMS OF COMPLEX TRIALS AND WITH SO MANY TRIALS WE ONLY NEED TO COLLECT WHAT'S REALLY IMPORTANT. AND IF WE PRIORITIZE THAT, I THINK THAT WILL HELP NOT JUST AT THE SITES FOR THE GENERAL POPULATION BUT IN TERMS OF OUTREACHING TO MORE DIVERSE POPULATIONS. AND IF WE CONTINUE THE THINGS WE DID DURING THE PANDEMIC LIKE MORE OF A RELIANCE ON LOCAL PHYSICIANS FOR CERTAIN THINGS THEY CAN DO, MORE TELEHEALTH AND REALLY STREAMLINE THOSE THINGS, THOSE ARE SOME WHAT REVENUE NEUTRAL IF NOT DECREASING COSTS WE CAN PRIORITIZE. THOSE ARE SOME THINGS. WE CAN REALLY STICK TO IT. THE HARD THING IS WE CAN TALK ABOUT PRIORITIZATION AND THAT'S WELL AND GOOD UNTIL YOU ASK PEOPLE WHICH OF THE FIVE THINGS DO YOU WANT AND EVERYBODY HAS AN ARGUMENT FOR EACH OF THE FIVE. I THINK THERE IS MUCH MORE OF A REAL GROWING CENSUS WE NEED TO DO THAT AND THINGS IN THE PAST WASN'T HELPING IN TERMS OF ADDITIONAL DATA COLLECTION. THAT'S CERTAINLY ONE AREA WE CAN WORK ON THAT WOULD BE MORE REVENUE NEUTRAL AND HELP THE PROGRAM AND THE SITES AND OUTREACH. THE OTHER IS SHARING MORE INFORMATION AND COLLABORATING MORE. MAKING SURE WE DO THAT PERVA PERVASIVELY ACROSS THE PROGRAM. >>THOSE ARE REALISTIC WAYS TO MAKE THE SYSTEM BETTER. THE NCTN STUDIES RUN THROUGH THE PROGRAM I RUN AT HOPKINS AND WE HAD TO HIRE ONE FULL TIME STAFF MEMBER JUST TO DO THREE TO TEN-YEAR FOLLOW-UP ON STUDIES WELL AFTER THE INITIAL THERAPEUTIC WAS DONE. THAT'S A RESOURCE THAT COULD BE USED TO ACTIVATE MORE STUDIES. I THINK DIFFERENT SITES MAY HAVE MORE DETAILED INFORMATION REGARDING WHAT KIND OF DATA IS BEING COLLECTED THAT IS LESS NECESSARY. I THINK THAT COULD DECREASE THE BURDEN AS WELL. I THINK THE BIGGEST THING WE CAN ADVOCATE FOR IS TO FUND THE TRIALS A LITTLE BIT BETTER BUT IF WE DON'T HAVE THAT OPTION, I THINK THERE'S A LOT OF THINGS WE CAN DO TO THAT CAN HELP MORE THAN JUST ON THE MARGIN. >>IF I CAN ASK A QUICK FOLLOW-UP. I'M SURE THIS HAS BEEN DONE AT SOME POINT BUT HAVING DONE THE BUDGET, THINKING BACK I DON'T RECALL, HAVE WE DONE A BUDGET THAT SAYS IF WE REIMBURSE AT A CERTAIN LEVEL IT WOULD BE CLOSER TO WHAT THE INVESTIGATORS NEED? ASSUMING SOME BREAKING NEWS OF THE PORTFOLIO TYPES OF TRIALS. DO WE KNOW WHAT KIND OF BUDGET WE'LL BE TALKING ABOUT? >>I DON'T KNOW IF WE KNOW FOR SURE. A LITTLE BIT IS THE WAY INDUSTRY FUNDS AND PROBABLY WILL NOT BE AS STREAMLINED IN TERMS OF DATA COLLECTION. WE KNOW IT'S AT LEAST TWO TO THREE TIMES WHAT WE CURRENTLY FUND. BESIDES THAT, BUT WE HAVE LOOKED AT SOME TOOLS TO SEE IF WE CAN RUN SOME OF OUR TRIALS THROUGH THE TOOLS AND SEE WHAT THE DIFFERENTIAL IS WE ESTIMATE IT'S AT LEAST TWO TO THREE TIMES IF NOT MORE. >>WE CAN FUND A FUNDING MOLT MODEL. >>OKAY. >>WE CAN BE PROACTIVE. WE HAVEN'T HAD A DECREASE IN ACCRUALS EXCEPT FOR THE COVID YEAR. THAT'S COMING WITH WHAT COSTS ARE. WE DON'T HAVE TO BE REACTIVE WHEN WE SEE ACCRUALS DIP FURTHER. INSTEAD WE CAN TRY TO MAINTAIN OR INCREASE ACCRUALS IF WE CAN MAKE THOSE CALCULATIONS NOW. >>AND I WANT TO THANK EVERYONE ON BEHALF OF ALL THE SUBCOMMITTEE CHAIRS SINCE THIS IS THE LAST OF TODAY AND LOOK FORWARD TO SEEING EVERYONE BACK TOMORROW. THANK YOU VERY MUCH. >>THANK YOU. >>THE NCAB SUBCOMMITTEES HAVE CONCLUDED AND THE SESSIONS WILL BEGIN TOMORROW DECEMBER 6 AT 1:00 P.M. ON A SEPARATE VIDEOCAST SESSION. THIS VIDEOCAST SESSION WILL NOW END.