WELCOME TO THE 84TH MEETING OF THE NCRA, GOOD TO SEE EVERYBODY'S FACES AS I SAYER TIME WE START THIS MEETING I APPRECIATE TO YOU ALL JOINING US TODAY, OUT OF YOUR BUSY SCHEDULES. I KNOW ADVOCATES WEAR MANY HATS AND THIS IS JUST ONE OF THEM SO I APPRECIATE YOU DEDICATING YOUR TIME TO US TODAY AND THE TIME THAT YOU PROBABLY SENT GLANCING AT THE MATERIALS WE SENT TO YOU IN THE DAYS BEFORE THIS MEETING. I LOOK FORWARD TO SPENDING A COUPLE OF HOURS WITH YOU TODAY. AS USUAL WE WILL HAVE DR. SHARPLESS JOINING FOR A DIRECTOR'S UPDATE, ALSO A LEDGE UPDATE AS IS THE USUAL HERE TO TALK ABOUT WHAT IS HAPPENING IN THAT PORTION OF OUR LIFE. ALSO TODAY WE HAVE DR. BOB CROYLE JOINING US WHO WILL TALK A LITTLE BIT ABOUT HIS WORK AND A BIG PA PART OF NCI PORTFOLIO AND AS MANY OF YOU SAW WE HAVE DR. DANIELLE CARNIVAL JOINING US TODAY FROM THE WHITE HOUSE OSTP TO TALK ABOUT SOME OF THE WORK THAT THAT OFFICE IS DOING IN CANCER SO THAT SHOULD BE INFORMATION SESSION AS WELL AS I THINK PROBABLY AN INTERACTIVE SESSION AFTER SHE PRESENTS. THEN TO CLOSE THE MEETING TODAY, ANJEE AND I HAVE A LITTLE HOUSEKEEPING TO DO WITH YOU GUYS IN TERMS OF MEETING MINUTES AND MEETING DATES FOR THE COMING YEAR ALSO MAYBE TO CONTINUE ON SOME EQUITY DISCUSSIONS. SO AGAIN, THANK YOU ALL FOR JOINING US, THANK YOU TO THE OAR STAFF FOR HELPING GET US HERE AND I WILL TURN IT OVER TO ANJEE TO GET UNDERWAY. >> WE HAVE A PACKED AGENDA TODAY SO I'M GOING TO GET START WITH OUR OPENING STATEMENT. AND I WELCOME EVERYBODY TO TODAY'S MEETING. AS COMMITTEE MEMBERS YOU MUST ABSENT YOURSELF DURING SPECIFIC DISCUSSIONS WHENEVER YOUR PARTICIPATION AND DELIBERATIONS ON A PARTICULAR PRODUCT PROGRAM OR SPECIFIC MATTER WOULD CONSTITUTE A CONFLICT OF INTEREST OREEIATE THE APPEARANCE OF ONE. IT IS INCUMBENT UPON YOU TO ADVISE EXECUTIVE SECRETARY TO ABSTAIN FROM ANY PARTICIPATION OR MATTER IN LIGHT OF COP GOVERNING POLICIES BASED ON FINANCIAL HOLDING OF SPECIAL GOVERNMENT EMPLOYEES INCLUDING ALL MEMBERS OF THIS COMMITTEE. WE MUST DEPEND UPON YOU TO VOLUNTARILY ABSENT YOURSELF DUG ANY ALL DISCUSSIONS AND MATTERS THAT WOULD COULD CONCEIVABLY IMFACT STATUS OF THOSE HOLDINGS. WE TRUST YOUR JUDGMENT IN THESE INSTANCES. BY LAW A QUORUM IS REQUIRED FOR EACH INCIDENCE WHICH A VOTE OCCURS IN OPEN SESSION DURING THIS MEETING. APPOINTED MEMBERS MUST BE PRESENT TO VOICE THEIR VOTES. NEW MEMBERS WHO ARE NOT CURRENT MEMBERS NCR ADVISORY BOARD DON'T VOTE UNTIL THEY HAVE BEEN CLEARED BY NCI ETHICS OFFICE AND OFFICE OF HUMAN RESOURCES. OUR PUBLIC COMMENT STATEMENT MEMBERS OF THE PUBLIC CAN BE WISHED TO EXPRESS VIEWS REGARDING ITEM DISCUSS DURING THIS MEETING THEY DO SO BY WRITING AMY WILLIAMS EXECUTIVE SECRETARY WITHIN TEN DAYS OF MEETING, ANY WRITTEN STATEMENTS BY MEMBERS OF THE PUBLIC WILL RECEIVE CAREFUL CONSIDERATION. WELCOME TO TODAY'S MEETING. I KNOW WE HAVE A LOT OF UPDATES SO I'M LOOKING FORWARD TO HEARING WHAT OUR AGENDA WILL BE COVERING. I APPRECIATE WHAT AMY AND PATRICK HAVE DONE PUTTING THIS MEETING TOGETHER. AMY, I WILL TRANSITION TO THE DIRECTOR'S UPDATE. IS THAT CORRECT? >> YOU ARE TRANSITIONING TO DR. CROYLE. DCCPS DIRECTOR UP STATE. >> EXCELLENT. SO FIRST OFF WE ARE GOING TO WELCOME DR. BOB CROYLE DIRECTOR OF NCI DIVISION OF CANCER CONTROL POPULATION SCIENCES FOR UPDATE LOOKING FORWARD TO THIS PRESENTATION DR. CROYLE. >> THANKS, ANJEE. THANK YOU FOR HAVING ME HERE TODAY. I THINK YOU GUYS ARE GOING TO RUN THE SLIDES? >> YOU GOT IT. >> OKAY. GREAT. I P PUT IN THE CHAT THE LINK TO OUR WEBSITE, I REALLY ENCOURAGE YOU TO CHECK THAT OUT. THE DIVISIONS OF WEBSITE BECAUSE I'M GOING TO HIT A FEW HIGHLIGHTS AND THERE'S SO MUCH MORE. THE OTHER THING THAT I WANTED TO MENTION TO YOU TODAY AS WELL IS THAT WE JUST RELEASED OUR DIVISION ANNUAL REPORT AND I WILL MAKE REFERENCE TO THAT LATER AND I WILL PUT A LINK OF THAT IN THERE ALSO. BECAUSE THE -- THIS YEAR IS MY LAST YEAR AS DIVISION RESIDENT, I WILL BE RETIRING FROM THE NIH AT THE END OF THE CALENDAR YEAR. AND FORTUNATELY WE KIND OF PLANNED AHEAD AND THE RECRUITMENT FOR MY REPLACEMENT HAS BEEN COMPLETE. AND THAT INDIVIDUAL KATRINA GODDARD WILL BE STARTING OCTOBER 11 SO PRETTY SOON. THERE WILL BE SOME OVERLAP, I'LL BE AROUND TO HELP GET HER STARTED AS THE NEW DIRECTOR OF CANCER CONTROL AT NCI. SHE IS JOINING US FROM KEISER PERMANENTE IN PORTLAND WHERE SHE WORKS UP THERE NORTHWEST RESEARCH CENTER. AND SO AS A RESULT OF THAT, WE DID A LITTLE BIT MORE EXTENSIVE ANNUAL REPORT THIS YEAR THAN TYPICAL. WHICH ALSO INCLUDES SOME RETROSPECTIVE AS WELL. SO NEXT SLIDE. SO I'M GOING TO GIVE YOU A VERY HIGH-LEVEL OVERVIEW OF WHAT OUR DIVISION, DIVISION OF CANCER CONTROL POPULATION SCIENCES DOES. AND IT IS A BIT OF AN UNUSUAL DIVISION AT NCI. NIH FRANKLY BECAUSE OF THE BREADTH OF THE MISSION IT COVERS AND ALSO THAT IT REALLY IS THE BRIDGE BETWEEN NCI AND A LOT OF THE OTHER HHS AGENCIES AND PUBLIC HEALTH ACTIVITIES IN THE DEPARTMENT AND IN THE FEDERAL GOVERNMENT. WE ARE LEAD CONNECTOR TO THE CDC, AND WE GET INVOLVED IN A LOT OF PUBLIC HEALTH ISSUES AND PREVENTION RELATED TO CANCER SCREENING, TOBACCO CONTROL, I'LL TOUCH ON A NUMBER OF THOSE. BUT AS A RESULT OF THAT, WE HAVE A REALLY DIVERSE PORTFOLIO AND ONE THAT ALSO REALLY HAS BUILT A NUMBER OF AREAS OF RESEARCH THAT ARE RELATIVELY UNIQUE AT THE ENTIRE NIH. SO I WILL TOUCH ON SOME OF OUR COUPLE OF MAJOR INITIATIVES. I'M GOING TO DO A LITTLE BIT OF RETROSPECTIVE, TALK HEALTH DISPARITIES BECAUSE OUR DIVISION HAS THE LARGEST HEALTH DISPARITIES RESEARCH PORTFOLIO AT THE ENTIRE NIH. IN FACT OUR HEALTH DISPARITIES RESEARCH PORTFOLIO JUST IN THIS ONE DIVISION AT NCI IS LARGER THAN THE RESEARCH PORTFOLIO AT THE ENTIRE NATIONAL INSTITUTES OF MINORITY HEALTH AND HEALTH DISFAIRS. -- DISPARITIES SO WE PLAY A BIG ROLE IN HEALTH DISPARITIES RESEARCH. CANCER SURVEILLANCE, I'M GOING TO TOUCH ON BECAUSE WE REALLY HAVE GROWN THAT AREA THE LAST COUPLE OF YEARS. I WILL COME BACK TO THIS. WE EXPANDED NCI SURVEILLANCE PROGRAM AND OUR SERE PROGRAM. AND THAT HAS BIG IMPLICATIONS FOR MANY OF YOU AND YOUR ORGANIZATIONS BECAUSE OF LARGER SAMPLE SIZE MORE DATA ABOUT RARE DISEASES FOR EXAMPLE. AND ALSO MORE DATA ABOUT SUB POPULATIONS WITHIN THE US. I ALSO WANT TO TALK ABOUT SURVIVORSHIP PARTICULARLY FOR THIS GROUP SINCE A LOT OF YOU AS PATIENT ADVOCATES AND GET INVOLVED IN SURVIVORSHIP ISSUES WE HAVE A NEW DIRECTOR OF OUR OFFICE OF CANCER SURVIVORSHIP, SO I'M GOING TO TALK ABOUT THAT AND NEW DIRECTIONS WE ARE LOOKING FORWARD TO IN SURVIVORSHIP RESEARCH. PARTICULARLY GOING TO EMPHASIZE THOSE WHO ARE LIVING WITH METASTATIC CANCER. THIS IS AN AREA THAT I DON'T HAVE A LOT OF DATA ABOUT PARTICULARLY IN TERMS OF SURVIVORSHIP BUT AS TREATMENT IMPROVES AND PEOPLE LIVE LONGER EVEN WITH ADVANCE STAGE CANCER, THIS IS A REAL NEW IMPORTANT PRIORITY FOR US. SOME OF THE FUTURE CHALLENGES, I'M GOING TO TOUCH UPON AREAS THAT MAYBE YOU WEREN'T EXPECTING TO TALK ABOUT. AND ONE I'M GOING TO REALLY HONE IN ON WHICH I THINK NCI IS NOW MOBILIZING TO ADDRESS BUT IS OVERDUE IS CANNABIS. GROWING USE OF CANNABIS AND MANY DIFFERENT FORMS, USE OF CANNABIS AMONG CANCER PATIENTS, BUT ALSO IN THE GENERAL POPULATION. WITH DECRIMINALIZATION IN MANY STATES. ONE OF MY RECOMMENDATIONS TO MY COLLEAGUE Z AS I DEPART NCI IS I STRONGLY FEEL THAT THE INSTITUTE NEEDS TO STEP UP AND GENERATES MORE EVIDENCE IN THIS AREA PARTICULARLY AS RELATES TO CANCER PREVENTION. AND I WILL TELL YOU EXAMPLES HOW WE ARE STARTING TO RAMP UP IN THIS AREA AND ALSO WAYS TO THINGS WE ARE DOING MORE SPECIFICALLY. WE HAVE SPECIFIC COMMUNICATION CHANNELS OUT OF THE DIVISION IN PARTICULAR AREAS OF RESEARCH THAT YOU MIGHT BE INTERESTED FROM SUBSCRIBING TO SOME TWITTER FEEDS OR LIST SERVES. NEXT SLIDE. SO PEOPLE IN GOVERNMENT LIKE ORG CHARTS BUT THERE IS A REASON FOR THIS. THAT IS IT REFLECTS WHAT AREAS WE COVER, WHAT THE PROGRAMMATIC MISSION AREAS ARE OF THE DIVISION. AND ALSO HELPS ME HIGHLIGHT FOR YOU HOW WE HAVE SOME UNIQUE AREAS WHERE WE ARE STRONG IN, UNIQUELY AMONG ALL THE INSTITUTES AT NIH. AS I MENTION, I HAVE BEEN DIVISION DIRECTOR SINCE 2003, THAT IS A RELATIVELY LONG TENURE AS DIVISION DIRECTOR AT ANY INSTITUTE. I JOINED NCI IN 1998. SO I ORIGINALLY CAME WHEN RICK CLAUSER WAS DIRECTOR AND THE ORIGINAL FOUNDERS OF THE OUR DIVISION, I WILL TELL YOU ABOUT HISTORY BECAUSE IT PROVIDES CONTEXT IN TERMS OF EVERYTHING FROM THE NATIONAL CANCER ACT AND NCI ROLE AND MISSION WITHIN THE FEDERAL GOVERNMENT. BUT I JOINED NCI WHEN NCI CREATE THIRD DEGREE TUITION. SO THIS DIVISION WAS MILY CREATED IN IN 1997. THE LEADERS AND FOUNDERS, BARBARA (INAUDIBLE) A LOT OF CREDIT FOR CREATING THE VISION BUT AS I SEGUE OUT OF THE NIH I WANT TO MENTION A COUPLE OF KEY PLAYERS IN THE LEADERS OF THE DIVISION, NAMES THAT ARE IMPORTANT TO KNOW. SO I MENTIONED EMILY WHO JOINED US AS OUR NEW DIRECTOR OF THE OFFICE OF CANCER SURVIVORSHIP AND SO SHE WAS LEADING LONG TERM SURVIVORSHIP PROGRAMS AT MEMORIAL SLOAN-KETTERING PARTICULARLY CHILDHOOD CANCER SURVIVORS, A PHYSICIAN INTERNIST AND SO THIS PAST YEAR HER FIRST YEAR AT NCI HAS BEEN Z ALL DURING COVID SO SHE JOINED DURING COVID BUT SHE IS IN THE PROCESS OF DEVELOPING A LOT OF NEW ACTIVITIES SO THATS IS WHY I WANT TO HIGH LIE A FEW OF THOSE BUT IMPORTANT PERSON TO KNOW AND ENCOURAGE YOU TO GET IN CONTACT WITH HER, SHE IS DOING OUTREACH AND GETTING EPIPUT AND IDEAS AND PRIORITIES. HERE IS ONE AREA WE ARE UNIQUE. RECENTLY NHLBI DEVELOPED A SIMILAR OFFICE BUT WE WERE THE FIRST AT NIH, THAT IS I HAVE A DEPUTY DIRECTOR FOR IMPLEMENTATION SCIENCE, THAT'S DAVID CHAMBERS WHO IS ONE OF THE NATIONAL AND INTERNATIONAL LEADERS IN IMPLEMENTATION SCIENCE. THIS IS AN AREA THAT WE HAVE GROWN IN THE LAST FEW YEARS. IF YOU EVER WONDERED WHETHER OR NOT IMPLEMENTATION SCIENCE IS AN AREA THAT NIH SHOULD STRONGLY SUPPORT WHICH IS SOMETHING WE HAVE BEEN ADVOCATING FOR A LONG TIME, JUST LOOK AT THE COVID EPIDEMIC, DEVELOPMENT OF NEW VACCINE AND SAY FREE, DECLARE VICTORY. COVID VACCINE IS GREAT. WELL OF COURSE THE DEVIL IS IN THE DETAILS NOT JUST OF THE DISCOVERY BUT AT IMPLEMENTATION, THE MUST BE PUBLIC HEALTH IMPLEMENTATION OF THE NEW DISCOVERY. SO A STRONG LESSON LEARNED AND THE ENTIRE BIOMEDICAL RESEARCH COMMUNITY OF THE IMPORTANCE OF CONDUCTING RESEARCH ON IMPLEMENTATION AND WE HAVE SEEN THAT LESSON IN TERMS OF COVID VACCINATION. ALSO (INAUDIBLE) HEALTH DISPARITIES RESEARCH IN THE DIVISION WHICH IS BIG PART OF WHAT WE DO. THE FOUR PROGRAMMATIC MISSION AREAS WE COVER FOR NCI EPIDEMIOLOGY, SURVEILLANCE, BEHAVIORAL RESEARCH AND HEALTHCARE DELIVERY RESEARCH. MANY INSTITUTES HAVE EPIDEMIOLOGY RESEARCH PROGRAM, OTHER INSTITUTES DO NOT HAVE A UNIQUE ROLE LIKE NCI HAS IN NATIONAL DISEASE SURVEILLANCE. PUBLIC HEALTH SURVEILLANCE IS SOMETHING CDC DOES BUT NCI IS UNIQUE WITH THE SEER PROGRAM AND HAVING A MANDATE TO RUN REGISTRIES SO WE HAVE A UNIQUE PROGRAM BREADTH DEPETH AND CANCER SURVEILLANCE, MONITORING CANCER STATISTICS BUT ALSO LINKING THESE DATA WITH A LOT OF OTHER DATA SETS. WHEN I JOINED NCI IT WAS TO COME TO NCI TO BE THE FIRST NCI ASSOCIATE DIRECTOR FOR BEHAVIORAL RESEARCH. L THAT WAS BACK IN 1998. WHEN THAT AREA WAS BEING EXPANDED AND SO MY FORMER POSITION AS ASSOCIATE DIRECTOR FOR BEHAVIORAL RESEARCH IS NOW HELD BY A TERRIFIC SCIENTIST BILL KLINE WHO RUNS BEHAVIORAL RESEARCH PROGRAM. A COUPLE OF YEARS AGO I REORGANIZED AND CREATED NCI FIRST AND THE FIRST PROGRAM OF ITS KINDS AT THE NIH ON HEALTHCARE DELIVERY RESEARCH, HEALTH SERVICES AND OUTCOMES RESEARCH ESSENTIALLY. TRADITIONALLY THIS IS A MISSION AREA FOR THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY, AHRQ. BUT THEY GET VERY -- DON'T HAVE SMALL BUDGET AND VERY EVICTED MISSION AND AHRQ COVERS ALL DISEASE. SO TO MAKE SURE CANCER CARE DELIVERY RESEARCH IS BEING ADEQUATELY SUPPORTED, WE CREATED AN ENTIRE NEW PROGRAM WITH MULTIPLE BRANCHES. THAT'S WHAT WHY PAUL JACOBSON WE RECRUITED FROM LAFAYETTE CANCER INSTITUTE IN FLORIDA, HE WAS ASSOCIATE RECTOR FOR PREVENTION AND CONTROL AT MOFFETT CANCER CENTER AND BEFORE THAT SLOAN-KETTERING SO REALLY WELL KNOWN RECOGNIZED SCIENTIST WHO NOW RUNS THE HEALTHCARE DELIVERY RESEARCH PROGRAM. WHICH ALLOWS US TO RAPIDLY TRANSLATE DISCOVERYINGS TO CLINICAL PRACTICE. THIS IS JUST OUR BUDGET HISTORIES FOR THE DIVISION. SO NO TIME ON THAT BUT JUST IF YOU ARE CURIOUS FOR FUTURE REFERENCE. THIS IS A LITTLE BIT OF HISTORY I WAS MENTIONING FOR THOSE WHO AREN'T FAMILIAR WITH THIS, THAT THIS DIVISION WAS CREATED AS A RESULT OF BOARD INPUT. IN FACT IT WAS CRITICISM FROM BOARD MEMBERS NCAB, BSA, OTHER BOARDS OF NCI THAT LED NCI TO CREATE NEW DIVISION. NCI HAD BEEN CRITICIZED FOR AN INSUFFICIENT COMMITMENT TO BEHAVIORAL RESEARCH, TO CANCER CONTROL ACTIVITIES, AND SO OUR DIVISION WAS CREATED BACK THEN WHEN RICK CLAUSER WAS DIRECTOR. NEXT SLIDE. MAJOR MILESTONES IN THE HISTORY OF THE DIVISION SINCE LAUNCH, EXPANSION OF SEER WHICH HAS HAPPENED A COUPLE OF TIMES, MAJOR INVOLVEMENT IN THE CANCER MOON SHOT. CREATION OF OFFICE OF CANCER SURVIVORSHIP WHICH WAS DONE THROUGH A EXECUTIVE ORDER FROM PRESIDENT CLINTON BACK IN 1996. SO WHEN OUR DIVISION WAS CREATED, THE OFFICE OF CANCER SURVIVORSHIP WAS PLACED WITHIN OUR DIVISION. SO ONE OF THE MAJOR AREAS OUR DIVISION STRATEGIES WE HAVE USED TO ACCELERATE PROGRESS IN NEWER AREAS OF RESEARCH OR TO REENERGIZE AREAS OF RESEARCH IS BY MAJOR FINANCIAL COMMITMENTS TO CENTERS OF EXCELLENCE. TO COMPLIMENT THE CANCER CENTERS PROGRAM SO KEY TO NCI MISSION, SO I REALLY STRONGLY BELIEVE HAVING WORKED AT TWO CANCER CENTERS BEFORE I JOINED NCI, FRED HUTCHINSON AND HUNTSMAN CANCER INSTITUTE I WILL COME BACK LATER BECAUSE OUR DIVISION HAS A STRONG UNIQUE COLLABORATION WITH THE CANCER CENTERS PROGRAM THROUGH FUNDING A LOT OF SUPPLEMENTS TO CANCER CENTERS. BUT THE CENTERS MODEL AS SOMETHING WE ALL EXTENDED INTO A SPECIFIC AREAS OF SCIENCE, TO COMPLIMENT THE CANCER CENTER. THIS SHOWS FUNDING PERIODS FOR SERIES OF EXCELLENCE INITIATIVES SO GENERALLY P 50 OR U-54 GRANTS VERY AMBITIOUS, ALL THESE TOOK PLANNING AND INTERNAL ADVOCACY TO PERSUADE LEADERSHIP TO SUPPORT THESE AND BOARD OF SCIENTIFIC ADVISORS TO APPROVE THEM. BUT THEY REFLECT SOME OF THE MAJOR SCIENTIFIC PRIORITIES THE DIVISION OF THE LAST SEVERAL YEARS, IT GOES WITHOUT SAYING BUT I ALWAYS NEED TO REPEAT, ANYTHING LIKE THIS, TOBACCO USE IS STILL THE LEADING CAUSE OF CANCER DEATH IN THE U.S.. SO TOBACCO USE HAS COME DOWN A LOT. WHICH IS GREAT. BUT STILL ACCOUNTS FOR A LARGE NUMBER OF DEATHS MANY THE U.S. NOT JUST DUE TO CANCER. SO THAT WAS ONE AREA WE EMPHASIZE IN LAB COLLABORATION WITH OTHERS AND NOTE OUR DIVISION MORE THAN MOST OF DIVISION AT NCI, MOST HEAVILY EMBEDDED WITH INTERAGENCY COLLABORATION. BECAUSE OF THE COMMON RISK FACTORS SO TOBACCO USE IS A GREAT EXAMPLE THERE IS A COORDINATED EFFORT ACROSS HHS TOBACCO CONTROL WHERE ONE PLAYER, NATIONAL INSTITUTE ON DRUG ABUSE, NIDA AND FDA. SO MORE SO THAN MOST PARTS OF NCI A LOT OF OUR WORK IS INTERAGENCY COLLABORATIVE WORK. THE BREAST CANCER ENVIRONMENT RESOURCE CENTERS IS ANOTHER EXAMPLE, COLLABORATION WITH NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES, WE WORK CLOSELY WITH THEM ON ENVIRONMENTAL TOXIC EXPOSURE. SOMETHING REALLY UNUSUAL UNDER -- LEADERSHIP WE LAUNCH CENTERS OF EXCELLENCE AND ENHANCE COMMUNICATION RESEARCH, WE ARE THE ONLY DIVISION AT THE ENTIRE NIH THAT HAS A BRANCH ENTIRELY FOCUSED ON HEALTH COMMUNICATION RESEARCH. AGAIN, DURING THE COVID ERA, IT IS INCREDIBLY OBVIOUS THAT HEALTH COMMUNICATION IS REALLY KEY TO PUBLIC HEALTH. BUT SURPRISINGLY I THINK WE THE NIH COULD AND SHOULD INVEST MORE IN RESEARCH TO INFORM WHAT ARE THE EFFECTIVE STRATEGIES YOU HAVE SEEN PEOPLE BY THIS, HOW CAN WE GET PEOPLE RELUCTANT TO GET VACCINATED GET VACCINATED? WHAT IS THE MOST EFFECTIVE COMMUNICATION STRATEGY? SO HIGHLIGHTING THE IMPORTANCE OF THIS FIELD. HEALTH DISPARITY US MENTIONED, SOMETHING WE WORKED ON WITH OTHER ENTITIES AND AGENCIES. ENERGY BALANCE, OBESITY, OBESITY IS THE SECOND MOST IMPORTANT POPULATION RISK FACTOR CANCER AFTER TOBACCO USE AND THEN MOST RECENTLY IMPLEMENTATION SCIENCE RESEARCH CENTERS PART OF THE CANCER MOON SHOT. NEXT SLIDE. SO THIS IS OUR NEWEST CENTERS INITIATVE. SO WHEN WE FUND RESEARCH THAT REFLECTS HIGH SCIENTIFIC PRIORITY AND AGAIN, IN PART DUE TO COVID. AND THE SHIFT TO TELEHEALTH AND RELIANCE ON TELEHEALTH. WHAT WE RECOGNIZE IS THE RESEARCH BASE, EVIDENCE BASE IN MANY CANCER FOR HOW TO DO TELEHEALTH THE RIGHT WAY IS PRETTY THIN. WILL THERE'S MORE RESEARCH TELEHEALTH AND MENTAL HEALTHCARE AND SOME OTHER AREAS WITH SOME OTHER DISEASE DOMAINS SO WE FELT WE NEEDED TO START RAPIDLY RAMPING UP RESEARCH ON CANCER RELATED TELEHEALTH SO WE PUT UP AN RFA, RECEIVED APPLICATIONS ALREADY. SO APPLICATIONS ARE UNDER REVIEW. IN THE NEXT SEVERAL MONTHS COMING FISCAL YEAR WE ARE FUNDING NEW RESEARCH CENTERS AND TELEHEALTH AND CANCER. I'M EXCITED ABOUT THIS, ONE OF THE LAST GREAT INITIATIVES LAUNCHED DURING MY TENURE. NEXT SLIDE. ANOTHER HUGE AREA, AND ALWAYS QUESTIONS FROM PATIENTS ABOUT NUTRITION AND KAREN, WHAT SHOULD I BE EATING WHAT SHOULD THE DIET BE, A TREMENDOUS AMOUNT OF JUNK INFORMATION ON THE INTERNET THAT JUST MASSIVELY CONFUSES PEOPLE ABOUT NUTRITION. SEPARATING THE EVIDENCE FROM THE JUNK REALLY HARD REALLY DIFFICULT, PEOPLE GET ADVICE, PATIENTS GET ADVICE FROM FRIENDS AND RELATIVES AND SOME GOOD IDEAS SOME GOOKY IDEAS SO THE WHOLE NIH LAUNCHED A NEW NUTRITION RESEARCH PLAN. NCI IS BIG PART OF THIS, A LOT OF STAFF PARTICIPATED IN THIS AND SO THE NEXT COUPLE OF YEARS WHAT IS GOING TO HAPPEN IS WE IN OTHER PARTS OF NIH WILL START DEVELOPING INITIATIVES, RESEARCH INITIATIVES, TO FOLLOW THROUGH ON THE RECOMMENDATIONS OF THIS STRATEGIC PLAN. SO STAY TUNED FOR THAT. ONE AREA YES ARE LOOKING AT CLOSELY AT NCI NOTHING LAUNCHED YET BUT AREA WE ARE CONSIDERING, IS IMPROVING MEASUREMENT OF WHAT PEOPLE EAT AND THIRD DEGREE IS AREA NCI PROVIDES LEADERSHIP OF LEADERS, 24 HOUR DIETARY ASSESSMENT TOOLS THAT STATE OF THE ART AND SO ASSESSMENT IS A REAL STRENGTH IN THIS AREA. AND SO WE WILL BE FOLLOWING UP FUTURE INITIATIVES. NEXT SLIDE. ONE OF THE OTHER AREAS, WE PUT FUNDING ALL THESE RESEARCH CENTERS, AND BECAUSE CANCER IS BECOMING MORE OF A TEAM SCIENCE AND TEAM SPORT, WE HAVE ACTUALLY THE LAST FEW YEARS LED DEVELOPMENT OF THE A NEW FIELD WHICH WE CALL THE SCIENCE OF TEAM SCIENCE. RECENTLY PUBLISHED A BOOK THAT COMPILES ALL THE RESEARCH ABOUT WHAT MAKES TEAM SCIENCE MORE OR LESS EFFICIENT MORE PRODUCTIVE MORE EFFECTIVE MORE COLLABORATIVE. SO WE HAVE BEEN WORKING WITH THE NATIONAL ACADEMIES ON THIS, THERE IS A NEW ANNUAL CONFERENCE ON TEAM SCIENCE. SO JUST SHAMELESS PLUG FOR THIS. IF YOU ARE INTERESTED IN TEAM SCIENCE AS A TOPIC. NEXT SLIDE. I WANT TO MENTION THIS A LITTLE BIT, ALSO MY APOLOGIES TO JENNIFER, MAY REPEAT THIS A LITTLE BIT AT THE AACI MEETIN. BUT ONE OF THE STRATEGIC DECISIONS I MADE AS DIVISION DIRECT DOOR THE LAST FEW YEARS WHICH WAS A LITTLE CONTROVERSIAL TO SAY, IS TO MAKE SOME MAJOR NEW INVESTMENTS IN THE CANCER CENTERS AND THEIR CANCER PREVENTION AND CONTROL POPULATION SCIENCE PROGRAMS. SO A LITTLE CONTROVERSIAL BECAUSE PEOPLE SAY NCI DOESN'T HAVE CANCER CENTERS ALREADY HAVE LOT OF MONEY, THEY HAVE RESOURCES AND PHILANTHROPY, AFFILIATED WITH ACADEMIC INSTITUTIONS BUT WHAT I OBSERVED OVER THE YEARS IS THAT THE MONEY THAT WE HAVE SPENT YOUR TAX DOLLARS AT WORK OFTENTIMES CAN BE SPENT WITH A LOT OF ADDITIONAL SYNERGY SUPPORT EXISTING INFRASTRUCTURE WITHIN THE CANCER CENTERS. SO I DON'T THINK IT IS A BAD THING AT ALL. THAT MOST OF NCI RESEARCH GRANT MONEY GETS SPENT THROUGH THE CANCER CENTERS BECAUSE WHAT I HAVE SEEN OVER AND OVER IS THAT OFTENTIMES WITH RELATIVELY SMALL AMOUNT OF MONEY, THEY CAN LEVERAGE THAT TO DO BIG THINGS. THAT IS NOT TO SAY WE DON'T FUND GRANTS AND ALL ACADEMIC INSTITUTIONS LARGE AND SMALL, MANY DIFFERENT ORGANIZATIONS. BUT IN ORDER TO RAMP UP SOME NEW AREAS OF RESEARCH LAST COUPLE OF YEARS, THE STRATEGY I HAVE USED IS CANCER CENTERS SUPPLEMENT INITIATIVES. AND AS A WAY TO PLANT SEEDS AND RAPIDLY RAMP UP NEW AREAS OF RESEARCH. NEXT SLIDE. SO IF YOU GO TO OUR WEBSITE ALL THIS IS ON OUR WEBSITE WITH GREAT MORE DETAIL SO AGAIN, CHECK THAT OUT, WE LIST ALL CENTERS SUPPLEMENTS WHO GOT WHAT, WHAT TOPIC, ALL GREAT DETAIL. ON THE WEBSIT. BUT JUST AS BY WAY OF SUMMARY, SINCE I LAUNCHED THE EFFORT IN 2014 WE HAVE AWARDED FROM USING DIVISION FUNDS MOSTLY, SOME NCI CENTRAL FUNDS BUT OFTENTIMES OUR OWN DISCRETIONARY FUNDS THE SAME FUNDS THAT PAY FOR MY STAFF SALARIES THE SAME FUNDS THAT PAY FOR COMPUTERS, SO H IS A DISCRETIONARY EFFORT ON TOP OF WHAT NCI CENTRAL HAS DONE. WE HAVE AWARDED 261 ADMINISTRATIVE SUPPLEMENTS, 18 CANCER CENTER SUPPLEMENT INITIATIVES, HERE ARE MOST OF THE TOPICS INITIALLY THIS WAS A WAY TO RAMP UP HPV VACCINATION. A LOT OF YOU HAVE SEEN THE STATEMENT THE CANCER CENTERS MADE, WHAT HPV THAT WAS GROWN OUT OF COALITION FUNDED CONSORTIUM. GETTING THE CANCER CENTERS INVOLVED IN COMMUNITIES ON HPV VACCINATION. THIS IS SOMETHING THE CDC ASKED US TO DO. THEY SAID WE NEED YOUR CANCER CENTERS, MORE ENGAGED WITH OUR IMMUNIZATION PROGRAMS. THEY PLAY A LEADERSHIP ROLE, HOW DO WE DO THAT? WE SAID OKAY, WE WILL PROVIDE A LITTLE INCENTIVE, A LITTLE BRIBERY. WE WILL PROVIDE SUPPLEMENTS TO CANCER CENTERS WILLING TO ENGAGE IN PROGRAMS FOR HPV VACCINATION. CASHMAN AREAS WE WORK WITH HENRY -- OF THE CANCER CENTERS PROGRAM TO STRENGTHEN AND ADD NEW REQUIREMENTS TO THE CANCER CENTER SUPPORT BRAND. THE FIRST BEING THAT CANCER CENTER HAS TO DEFINE GEOGRAPHIC CATCHMENT AREA AND DESCRIBE CHARACTERIZE THE POPULATION THAT IT SERVES. LET'S BE CLEAR, LET'S BE ACCOUNTABLE FOR WHO WE ARE SERVING IN THE NATIONAL CANCER PROGRAM. LET'S MAKE SURE THE CANCER CENTERS UNDERSTAND AND VERY POO PHO SOPHISTICATED REVIEW NOT JUST PATIENTS THEY TREAT BUT THE COMMUNITIES THEY SERVE. WE ALSO WORKED WITH HENRY -- REQUIRE NOW A NEW REQUIREMENT FOR COMMUNITY OUTREACH ENGAGEMENT PROGRAMS AND ALL NCI DESIGNATED CANCER CENTERS. WHEN BEROLE THAT OUT IT WAS A LITTLE MIX PERCEPTION BUT I THINK JENNIFER CAN COMMENT ON THIS, I THINK MOST CANCER CENTER DIRECTORS FEEL THAT THE COE REQUIREMENT IN THE CANCER CENTERS HAS BEEN PERHAPS TRANSFORMATIVE AND REDEFINE THE RELATIONSHIP BETWEEN OUR CANCER CENTERS AND THEIR COMMUNITIES. AND ALSO PROVIDING NEW LEADERSHIP OPPORTUNITIES FOR MINORITY INVESTIGATORS AND COMMUNITY MEMBERS IN CANCER CENTER LEADERSHIP. WE PROVIDED THIS LAST YEAR FIRST EVER SUPPLEMENTS TO CANCER CENTERS TO COLLECT DATA ON CANNABIS USE AMONG CANCER CENTER PATIENTS. WE KNOW VERY LITTLE, IT IS A LITTLE FRIGHTENING ABOUT THE EXTENT THAT NATURE, THE USE OF CANNABIS AMONG CANCER PATIENTS WE KNOW IT IS HAPPENING. YOU HEAR ABOUT IT, WE HEAR IT ABOUT IT YOU GET ASKED ABOUT IT, THERE IS DATA OUT THERE COLLECTED FROM A COUPLE OF CENTERS, NOT A LOT. SO WE FUNDED OVER A DOZEN CANCER CENTERS TO COLLECT DATA, THAT DATA COMING IN THIS FALL, THIS IS GOING TO ATTRACT ATTENTION GENERATE QUESTIONS MANY THE PRESS AND IN YOUR MEMBERS. ABOUT THIS. SO IT IS JUST DESCRIPTIVE, TRYING TO GET A SENSE OF WHAT IS THE USE, WHAT PRODUCTS, EDIBLES, FATE, ET CETERA AND GIVE US A ROUGH BASELINE, GET TO KNOW WHAT IS HAPPENING SO WE CAN THEN DEVELOP MORE SPECIFIC TARGETED RESEARCH ON WHAT IS THE IMPACT, WHAT IS THE HEALTH IMPACT AND WHAT IS THE IMPACT ON SYMPTOM MANAGEMENT, THE IMPACT ON COPING WITH CANCER. AND OTHER TOPICS HERE LISTED THAT I WON'T GO THROUGH IN DETAIL FOR SAKE OF TIME SO LET'S GO TO THE NEXT SLIDE. SO WHAT IS NEXT IN TERMS OF THINKING ABOUT SUPPLEMENTS. I WILL BE GONE IN JANUARY SO THIS IS REALLY UP TO MY SUCCESSOR. HERE IS WHAT I'M RECOMMENDING THAT WE PAY A LOT OF CANNABIS USE PARTICULARLY CANCER PATIENTS. FDA HAS THE LEGAL AUTHORITY TO REDUCE NICOTINE IN CIGARETTES AS A STRATEGY FOR TOBACCO CONTROL. THEY HAVEN'T EXERCISED THAT AUTHORITY YET BUT THERE ARE A LOT OF DISCUSSIONS ABOUT THIS, WE ARE RAPIDLY TRYING TO PROVIDE MORE RESEARCH ON THIS. WHAT IS A LOW NICOTINE CIGARETTE LOOK LIKE DOESN'T IN FACT REDUCE THE ADDICTION POTENTIAL. WE THINK IT DOES. THIS MAY BE THE NEXT MAJOR PUBLIC HEALTH STRATEGY TO REDUCE THE HARM OF TOBACCO AND THAT IS REALLY REDUCING BY LAW BY REGULATION, NICOTINE LEVELS IN CIGARETTES REDUCING ADDICTIVE POTENTIAL, PARTICULARLY ADOLESCENTS. WE ARE HAVING NEW DISCUSSION WITH HRSA, HEALTH RESOURCE SERVICE ADMINISTRATION, HRSA IS FEDERAL AGENCY THAT FUNDS HEALTH CLINICS ACROSS THE COUNTRY. BIG PART OF THE AFFORDABLE CARE ACT, HEALTHCARE STRATEGY IN THE UNITED STATES OF THE UNDERSERVED, WE ARE HAVING A NONE OF DISCUSSIONS WITH THEM ABOUT WAYS WE CAN COLLABORATE WITH THOSE CLINICS AND BUILD A BRIDGE, A STRONGER BRIDGE BETWEEN THE HRSA CLINICS AND CANCER CENTERS. THERE'S OTHER DISCUSSIONS AND MEETINGS ABOUT THIS OVER THE LAST FEW YEARS, BUT THERE'S SOME POTENTIAL TO SCALE THIS UP WITH POTENTIALLY NEW FUNDS AT HRSA THAT MIGHT BE APPROPRIATED FOR THIS PURPOSE. SO THIS IS AN EXCITING NEW AREA. THAT I THINK. IT IS ONE THING TO SCREEN PEOPLE INITIALLY, IT IS ANOTHER THING TO GET GOOD HIGH QUALITY FOLLOW-UP THROUGH POSITIVE SCREENING. WE NEED TO BUILD STRONGER BRIDGES BETWEEN OUR CANCER EXPERTS AND THOSE INVOLVED WITH THE UNDERSERVED IN TERMS OF CANCER SCREENING. SO HEALTH DISPARITIES THIS IS MAYBE THE AREA IN MY DIVISION THAT AS I STEP DOWN I'M MOST PROUD OF WHAT HAS HAPPENED. THERE'S BEEN A LOT OF DISCUSSION ABOUT HEALTH DISPARITIES AT NIH AND HHS OVER THE YEARS. BUT TO ME IT IS ALL ABOUT FOLLOW THE MONEY, FOLLOW THE NUMBERS. WHERE IS THE MONEY GOING. SO WE HAVE BEEN TALKING ABOUT THIS ARE WE INVESTING PUTTING MONEY INTO THIS HUGE, HUGE PROBLEM. IT IS A BIG PROBLEM WITH CANCER AS YOU KNOW, CONTINUES TO BE, ESPECIALLY THE BLACK WHITE DISPARITY BUT SUBPOPULATIONS, THEY'LL COME BACK TO AMERICAN INDIAN, ALASKA NATIVES BECAUSE IT IS A PRIORITY FOR ME AND FOR OUR DIVISION GOING FORWARD. NEXT SLIDE. THE PROOF IS IN THE PUDDING. AND HOLDING MY GROUP, MY DIVISION ACCOUNTABLE, I'M PROUD THE TO SAY THE LAST FOUR YEARS WE HAVE DOUBLED RESEARCH FUNDING ON HEALTH DISPARITIES. NOW ABOUT 70% OF ALL THE GRANTS FUNDED BY OUR DIVISION INCLUDE A SPECIFIC AIM, A HEALTH DISPARITIES RESEARCH QUESTION. WE HAVE GREATLY DIVERSIFIED THE ENROLLMENT AND PARTICIPATION IN THESE STUDIES. SO AGAIN, THIS IS A BIG TEAM EFFORT, A LOT OF PEOPLE INVOLVED IN THIS. I CAN'T TAKE CREDIT FOR IT. BUT I THINK IT IS ONE THING TO TALK ABOUT THESE ISSUES BUT SHOW US WHAT YOU HAVE DONE. SHOW US WHAT YOU ARE DOING. WE ARE GOING TO HAVE A LOT OF NEW EVIDENCE THE NEXT FEW YEARS GENERATED BY RESEARCH TO ADDRESS HEALTH DISPARITIES QUESTIONS AND THEN BETTER EQUIPPED IN TERMS OF EVIDENCE TO TAKE ON THIS REALLY RECALCITRANT PROBLEM IN CANCER CONTROL. NEXT SLIDE. AND A BROADER DEFINITION OF HEALTH DISPARITIES IS PART OF OUR PART IN OUR DIVISION. NOT JUST RACE ETHNICITY BUT GEOGRAPHY. A LOT OF THE DISPARITIES IN THE UNITED STATES ARE GEOGRAPHIC. HUGE DIFFERENCES BETWEEN COUNTIES AND CANCER INCIDENCE AND MORTALITY RATES. THIS IS JUST ONE THAT WE HAVE HIGHLIGHTED OVER THE LAST FEW YEARS, WE TRIED TO DRAW THE CANCER ATTENTION TO RURAL URBAN DISPARITIES, IT USED TO BE URBAN CANCER RATES AND MORTALITY WAS HIGHER SEVERAL -- MANY YEARS AGO. THAT HAS COMPLETELY REVERSED. NOT ONLY MORTALITY DIFFERENCES THAT IS HIGHER IN RURAL COUNTIES THAN URBAN COUNTIES BUT THOSE RURAL URBAN COUNTIES IN DISPARITIES IN THE U.S. ARE NOT GETTING BETTER, IT'S GETSING WORSE. ONE OF THE DISPARITIES OF CANCER GETTING WORSE THE LAST FEW YEARS. NOT BETTER. AS POVERTY MOVES INTO RURAL AREAS, PARTICULARLY IN THE SOUTH EASTERN U.S. WHERE THIS IS REALLY KEY. YOU CAN SEE THE DARK GREEN THERE, THOSE ARE RURAL COUNTIES THAT HAVE HIGHER CANCER INCIDENCE RATES. SO WHAT THIS SUGGESTS IS THAT WE AT NCI NEED TO MORE FREQUENTLY THAN WE HAVE IN THE PAST, WE HAVEN'T DONE THIS IN THE PAST IS NOT ONLY CAR BEEN OUR RESEARCH TOWARD PEOPLE AND ETHNIC GROUPS AND GREAT NEEDS BUT GEOGRAPHICALLY TARGET OUR CANCER CONTROL EFFORTS MORE TOWARDS THE GEOGRAPHIC AREAS. OF GREATEST NEED AS WELL. NEXT SLIDE. SO FUTURE OPPORTUNITIES AND DISPARITIES, HERE ARE SOME AREAS THAT I THINK REALLY WE NEED MORE WORK IN, WHERE OUR RESEARCH PORTFOLIO AT NCI IS INADEQUATE, GROSSLY INADEQUATE. POPULATIONS SO KUDOS, MY GROUP IS REALLY LEADING THE EFFORTS OUTREACH AND WORK WE FUNDED SEVERAL SPECIAL PROJECTS RECENTLY FOR EXAMPLE ARIZONA, NEW MEXICO, OKLAHOMA, CASH FLOW RECTAL COLORECTAL CANCER SCREENING SO WE ALLOCATED MONEY TO CANCER MOON SHOT FUNDS TO GO THERE THREE CANCER CENTERS, OKLAHOMA ARIZONA, NEW MEXICO, FOCUSED ENTIRELY AROUND STRENGTHENING COLON CANCER SCREENING AND AIM POPULATIONS. SEXUAL AND GENDER MINORITIES WE KNOW SOME RISK FACTORS SOME CANCER ARE MORE PREVALENT. AND WE HAVE VERY LITTLE RESERGE FUNDED CURRENTLY AT -- RESEARCH AT NCI FOCUSING ON SEXUAL GENDER MINORITIES EVEN THOUGH IT IS A DISPARITY POPULATION FOR SOME TYPES OF CANCER. BEHAVIORAL RISK FACTORS. TOBACCO USE FOR EXAMPLE MUCH HIGHER IN THE BISEXUAL POPULATION JUST ONE EXAMPLE. ONE AREA WE ARE RAMPING UP THE LAST COUPLE OF YEARS TALKING ABOUT INTERNALLY AT NCI IS PERSISTENT POVERTY. THERE IS GEOGRAPHIC REGIONS THAT ARE OFFICIALLY CLASSIFIED AS HIGH PERSISTENT POVERTY. THAT MEANS HIGH POVERTY RATES FOR THREE EXECUTIVE CENSUSES. WE CAN MAP THOSE, WE CAN TARGET THOSE, BUT WHAT IS NEW AND DIFFERENT IS THAT WE HAVE BEEN PUBLISHING PAPERS, WE HAVE ANOTHER ONE THAT IS UNDER REVIEW RIGHT NOW SHOWING THAT PERSISTENT POVERTY REGIONS IN THE U.S. ARE WHERE CANCER MORTALITY IS HIGHEST. POVERTY AND CANCER HAROLD FREEMAN HAS BEEN SAYING FOR A LONG, LONG TIME. HE SAID YEAH WE HAVE RACIAL DISPARITIES ABSOLUTELY, PAY ATTENTION TO POVERTY. SAM BROADER SAID MANY YEARS AGO WHEN HE WAS NCI DIRECTOR, POVERTY IS A CARCINOGEN. IT IS SO OBVIOUS THAT WE DON'T PAY ENOUGH ATTENTION TO IT. THAT HAPPENS OFTEN PUBLIC HEALTH. SOMETIMES THE BIGGEST MOST OBVIOUS PROBLEMS GET FORGOTTEN. WE FORGET THAT TOBACCO USE STILL IS DRIVING A LOT OF CANCER IN THE US. SEEMS LIKE AN OLD TOPIC. POVERTY ABSOLUTELY. IF WE CAN REDUCE WEALTH INEQUITY WE CAN REDUCE CANCER INEQUITY. AND THEN ARPAH YOU WILL HEAR MORE FROM OSTP ABOUT ARPA H BUT A LOT OF NEW POSSIBILITIES THERE TO BE DEFINED. NEXT SLIDE. CANCER SURVEILLANCE I WILL GO THROUGH THESE QUICKLY BUT I WANT TO MAKE SURE ALL OF BRO AND YOUR ORGANIZATIONS AND CONSTITUENCIES ARE AWARE THAT RECENTLY WE SUBSTANTIALLY EXPANDED THE TIER PROGRAM. THIS WAS A GOAL OF MINE AND BARELY REACHED BEFORE MY RETIREMENT AND THAT IS 50 BY 50. COVER 50% OF THE U.S. POPULATION, AND THE NCI CANCER REGISTRIES THE SEER PROGRAM BY THE 50TH ANNIVERSARY, THE NATIONAL CANCER ACT. IT WAS THE NATIONAL CANCER ACT THAT FORMALLY LAUNCHED THE SEER CANCER SURVEILLANCE PROGRAM. WE HAVE AN OUTSTANDING CANCER SURVEILLANCE PROGRAM, IT IS THE ENVY OF MANY COUNTRIES IN THE WORLD. AND LYNN MURPHY THE LEADING THIS THE LAST FEW YEARS, STOLE HER FROM MASSIVE CANCER CENTER PCU HAS BEEN DOING -- DOING A ENHANCING AND STRENGTHENING OUR CANCER REGISTRIES IN COLLABORATION BE CDC, NEXT SLIDE. I WON'T GO THROUGH THESE BUT THESE ARE SOME OF THE THINGS WE HAVE DONE AS PART OF THE SEER EXPANSION,NESS HANSING DATA COLLECTION VARIABLE TO COLLECT -- ENHANCING COLLECTING BIOMARKER DATA, MORE TREATMENT DATA, SO NOT JUST MORE PEOPLE IN SEER, IT IS MORE DATA ABOUT THOSE CANCER PATIENTS WHO ARE IN THE CANCER REGISTRIES. AND LINKING THESE DATA WITH MANY OTHER DATA SETS. NEXT SLIDE. HERE IS THE IMPACT ON DISPARITY, UNDERSERVED POPULATIONS. THIS IS THE INCREASE IN THE NUMBERS OF THESE POPULATIONS SUB GROUPS THAT HAS OCCURRED AS A RESULT OF THIS EXPANSION. AND THE BIGGEST NUMBER IN THE BOTTOM RIGHT THERE IS HISPANIC LATINO POPULATIONS. WE HAD A LOT OF SPA IN THIS CASE LATINOS ENROLLED IN REGISTRIES IN CALIFORNIA NEW MEXICO, BUT THE STATE OF TEXAS AND STATE OF ILLINOIS FOR EXAMPLE ARE TWO OF THE STATES THAT NOW JOINED INTO THE NCI SEER PROGRAM AND GREATLY INCREASES THE HISPANIC REPRESENTATION IN SEER TEND THE DIVERSITY OF HISPANIC SUBPOPULATIONS. NOT JUST MEXICAN AMERICAN BUT GUATEMALA, PUERTO RICAN, ET CETERA. NEXT SLIDE. THIS IS THE CURRENT MAP OF THE SEER PROGRAM, WE COVERED THESE FOR SEER AND CDC COVERS THE OTHER STATES THROUGH THEIR PROGRAM. SO CDC IS AN IMPORTANT PARTNER. THEIR REGISTRIES DON'T HAVE THE SAME RESEARCH FUNDING OUR REGISTRIES HAVE. SO THESE ARE COMPLIMENTS TO ETCH OOH OTHER CDC AND NCI COMPONENTS ARE CRITICAL FOR THE NATIONAL DATA. OURS ARE A LITTLE BIT DIFFERENT BECAUSE THEY HAVE ALSO HAD THIS MAJOR RESEARCH MISSION AS WELL. NEXT SLIDE. I WILL PUT THIS I KNOW I'M ABOUT OUT OF TIME AND WANT TO TAKE QUESTIONS. AND SO LET ME HIGHLIGHT WHERE WE ARE GOING, THIS IS A TEASER, MAYBE AMY FUTURE YOU MIGHT HAVE EMILY COME YOU CAN TO THIS GROUP BECAUSE SHE HAS A LOT OF IDEAS ON SURVIVORSHIP RESEARCH. NCRA REALLY IMPORTANT SOURCE OF INPUT TO HER AS SHE REENVISIONS SURVIVORSHIP RESEARCH PROGRAM. SO SOME OBVIOUS THINGS IS THAT GOALS OF OFFICE CANCER SURVIVORSHIP, SOME FAMILIAR ALREADY, SO I'M GOING TO GO TO NEXT SLIDE. YOU KNOW THE HISTORY THERE ON THE RIGHT. SO ADVOCATES CREATED THE OFFICE OF CANCER SURVIVORSHIP AT NCI. IT DOCKET DAY NOT EXIST AS A RESULT OF ADVOCACY. IT WAS CREATED AND SHOWS YOU POWER YOU ALL CAN HAVE ON NCI MISSION PRIORITIES ORGANIZE. AS -- ORGANIZATION. AS NUMBERS ARE GROWING. ONE OF THE JOBS IN OUR DIVISION IS KEEP TRACK OF THESE NUMBERS. WE COMPUTE THESE STATISTICS. THE TOTAL NUMBER OF CANCER SURVIVORS IN THE US. BUT LOWER NUMBER IT IS DARK AND DASH LINE SHOW WE HAVE A GROWING NUMBER OF METASTATIC CANCER SURVIVORS, THAT'S WHAT IS REALLY NEW AND DIFFERENT. NEXT SLIDE. SO WE WANT TO SUPPORT RESEARCH IN THAT AREA. WE HAVE ALSO UPDATED THE CANCER SURVIVOR TRADITIONALLY SAY CANCER SURVIVOR YOU FINISHED CANCER TREATMENT. NOW YOU ARE POST TREATMENT YOU ARE SURVIVOR. WE EXPANDED THAT, NO, BECAUSE WE WANT TO INCLUDE ADDRESS SURVIVOR WHOSE ARE LIVING WITH CANCER. THEY ARE STILL UNDER TREATMENT. AND WE NEED MORE EVIDENCE ABOUT HAIR ISSUES OR CONCERNS THAT I SHALL NEEDS AND HOW TO ADDRESS THEM. NEXT SLIDE. SO THIS IS MORE THE SAME THAT IS EXPANDED DEFINITION AND -- NEXT SLIDE. HERE ARE SOME OF THE PRIORITIES THAT EMILY IS WORKING ON, THESE ARE THINGS TO TAKE A LOOK AT AND CONSIDER FUTURE DISCUSSION. NEXT SLIDE. FUTURE, I WILL GO THROUGH THESE QUICKLY. WHAT ONE OF THE THINGS SOME OF YOU ARE INVOLVED LUNG CANCER SCREENING. AND WE KNOW WE NEED TO RAMP UP EFFORTS AMONG CANCER SCREENING AND SOMETHING WE WANT TO DO WITH ACSN CDC. SO I'M TALKING TO THE CDC CANCER CONTROL DIRECTOR A COUPLE OF DAYS AGO ABOUT THIS. KAREN KNUDSON AT ACS SO THIS IS ONE OF OUR AGENDA ITEMS FOR DISCUSSION FOR 2022. WE ARE AWAITING ADDITIONAL EVIDENCE, WE FUNDED A NUMBER OF STUDIES ON HOW TO IMPLEMENT CESSATION PROGRAMS WITHIN LUNG CANCER SCREENING PROGRAMS RADIOLOGISTS ARE NOT USED TO HELP PEOPLE QUICK SMOKING BUT A PROVISION FOR REIMBURSEMENT SO WE FUNDED A NUMBER OF TRIALS TESTING DIFFERENT STRATEGIES HOW BEST TO INCORPORATE SMOKING CESSATION IN A LUNG CANCER PROGRAM. RESULTS OF THOSE TRIALS ARE GOING TO BE COMING OUT THIS FALL. THAT WILL INFORM STRATEGY NEXT YEAR. NEXT SLIDE. HERE IS AGAIN, THIS IS SO OBVIOUS, BUT WE NEED TO TALK ABOUT IT MORE. THE RAPID GROWTH OF LATINO POPULATION IN THE U.S. AND I DON'T THINK THAT'S FULLY APPRECIATED, THAT'S WHY PUT THESE NUMBERS HERE. SO WE NEED MORE EPIDEMIOLOGICAL EVIDENCE ABOUT CANCER IN THE -- THIS POPULATION. WE RECOGNIZE THAT, WE HAD A BIG MEETING ON THAT, A WEEK OR TWO AGO. IT IS NOT JUST THE USUAL SOUTHWEST STATES, OTHER STATES ARE SEEING RAPID GROWTH OF LAT MOW POPULATIONS AND PARTICULAR CANCERS AND PREVALENCE AND RISK FACTORS AND NEEDS TO ADAPT INTERVENTIONS FOR THOSE GROUPS. SO I WILL WRAP UP ON THIS, THIS IS FOR THE FUTURE. WHY AM I HARPING ON CANNABIS? LOOK AT THE TRENDS HERE. THIS IS 12TH GRADER USE OF CIGARETTES LOOK AT THAT GOING DOWN. FABULOUS SUCCESS, WE ARE DOING GREAT ON SMOKING PREVENTION BUT LOOK HOW MUCH HIGHER MARIJUANA USE IS THAN TOBACCO USE AMONG HIGH SCHOOL SENIORS. WE HARDLY HAVE A CLUE ABOUT THE HEALTH IMPACT OF WHAT HAS BEEN A HUGE GROWING UPTICK OF MARIJUANA USE. CANCER IS JUST ONE PART BUT WE NEED TO BE A PART OF IT. NEXT. THIS JUST SHOWS ALSO JUST THE VAPING COMPONENT. THE LAST COUPLE OF YEARS. INCREASE OF VAPE -- NICOTINE, INCREASE IN VAPE MARIJUANA, HIGH SCHOOL SENIORS. ALSO PROLIFERATION OF LIBERALIZATION OF CANNABIS REGULATION. SO USE IS GOING TO KEEP GOING UP FOLKS. WE NEED TO DEAL WITH THIS. WE NEED TO UNDERSTAND. SO THESERY AREAS TO CONSIDER RAMPING UP CANNABIS RESEARCH. NEXT SLIDE. GO TO NEXT SLIDE THESE ARE MAJOR NEW RESEARCH INITIATIVES OUR DIVISION HAS FUNDED THIS PAST YEAR TO GIVE A SENSE OF WHAT RECENT PRIORITIES HAVE BEEN. D IF YOU WANT MORE THESE ARE A LOT OF SPECIFIC NEWS FEEDS FROM OUR DIVISION. IF YOU ARE PARTICULARLY INTERESTED IN THE AREA LIKE HEALTHCARE DELIVERY RESEARCH YOU CAN GET NEWS AND UPDATES IN THAT AREA OF RESEARCH. SIMILAR WITH TWITTER FEEDS. FOR MY LAST SLIDE, HERE IS MY SUCCESSOR AND YOUR NEW DIRECTOR OF POPULATION SCIENCE, IF THE PAPERWORK IS DONE AS OF OCTOBER 11 KATRINA GODDARD, SHE WAS HERE LAST WEEK MEETING THE FOLKS. SHE'S TERRIFIC. A GENETIC EPIDEMIOLOGIST, HER Ph.D. TRAINING IN STATISTICS, WHICH IS A GREAT BACKGROUND FOR CANCER CONTROL POPULATION SCIENCE. AND THEN WE HAVE A HARD COPY AND ONLINE COPY OF LAST ANNUAL REPORT UNDER MY TENURE. AND IT IS ONLINE, I WILL POST A LINK TO THAT REPORT IF YOU WANT TO LOOK AT IT ONLINE. LET US KNOW, LET AMINO IF YOU WANT TO HARD COPY, BE GLAD TO MAIL ONE TO YOU, PROVIDE ONE TO NCRA MEMBERS. WE CAN DO THAT. AND LOT MORE INFORMATION ON THE PAST PRESENT AND FUTURE. HAPPY TO ANSWER QUESTIONS AND ALSO LET ME THANK ALL OF YOU NCRA FOR YOUR SERVICE. NOT JUST ON NCRA BUT FOR ALL OF YOU YOUR YEARS AND YEARS OF DEDICATION EF ADVOCACY WITH ORGANIZATION AND CONSTITUENCIES PARTICULARLY CANCERS AND ISSUES. WE RELY ON YOU, WE COUNT ON YOU, AND PARTICULARLY I'M GOING TO MAKE A REAL STRONG PITCH FOR OUR OFFICE OF CANCER SURVIVORSHIP AS -- IS DESIGNED TO BE YOUR FRIEND AND YOUR ADVOCATE WITHIN THE NCI. HOPEFULLY YOU CAN ALL CONNECT IN THE FUTURE. THANKS. >> THANKS SO MUCH, DR. CROYLE. I WILL TURN IT OVER TO ANJEE TO SEE IF WE HAVE QUESTIONS. WE HAVE ONE IN THE CHAT MAYBE TWO. THAT WAS TERRIFIC. SO MUCH IS HAPPENING IN DCCPS AND SO MANY ISSUES THAT YOU GUYS ARE WORKING ON TOUCH ON THE ISSUES THAT A LOT OF OUR BOARD MEMBERS AND OTHER ADVOCATES ARE WORKING ON IN THE COMMUNITY. SO SOMETIMES INFORMATION SHARING ACROSS ALL OF CANCER IS DIFFICULT AND YOU DID A GREAT JOB OF HIGHLIGHTING SO MUCH GOING ON HERE WITHIN THAT PORTION OF NCI PORTFOLIO. ANJEE DO YOU WANT TO -- I SAW KRISTEN'S QUESTION ABOUT -- THIS IS ONE I HEARD DR. PEMBERTHY. HER QUESTION RELATED TO SEER. DR. CROYLE, IF YOU HAVE A GENERAL STATEMENT OR LAY AUDIENCE SUGGESTION, I THINK THERE'S PROBABLY A COMPLICATED ANSWER BUT IS THERE SOMETHING THE ADVOCACY COMMUNITY CAN DO TO GET OTHER STATES TO PARTICIPATE IN SEER? HOW DOES THAT PARTICIPATION COME TO BE? >> SO THAT -- THE KEY CONNECT THERE FOR YOU WOULD BE YOUR STATE HEALTH DEPARTMENT. THIS LATEST EXPANSION OF SEER, PROBABLY THE LAST EXPANSION FOR THE NEXT FEW YEARS. BECAUSE IT COSTS MORE MONEY. IN THE LATEST -- WE RECENTLY HAD A COMPETITION BEFORE SEER CONTRACTS, THIS IS A CONTRACT COMPETITION, WE PUT OUT RFP. LEGALLY IN STATES IS STATE HEALTH CAN WANT WITH LEGAL AUTHORITY. IMPLEMENTS MANDATE. WE ARE FORTUNATE IN CANCER. EVERY STATE IN THE UNION, THIS IS NOT THE CASE FOR MOST, MOST, MOST DISEASES. EVERY STATE IN THE UNION AND PART AS A RESULT OF ADVOCACY CANCER IS REQUIRED, IT IS REPORTABLE DISEASE. HAS TO BE REPORTED, HAS TO BE STATISTICS HAVE TO BE COMPILED, PHYSICIANS REPORT THEIR CANCER CASES, HOSPITAL Z HAVE TO REPORT. OTHER NIH INSTITUTES WOULD LOVE TO HAVE THAT LEGAL AUTHORITY BUT DECISION ABOUT WHETHER OR NOT TO APPLY FOR SEER, SEVERAL STATES, WE HAD THE MOST RECENT PETITION DID NOT EVEN APPLY. MANY OF OUR RESEARCHERS, MANY ACADEMIC IN THOSE STATES WERE PROFOUNDLY DISAPPOINTED. IT TAKES TWO TO TANGO ON THIS, IT IS TYPICALLY A PARTNERSHIP BETWEEN ACADEMIC INSTITUTIONS AND STATE HEALTH DEPARTMENT. SOME STATE HEALTH DEPARTMENTS SAID WE ARE FINE, WE ARE GOOD. WE GOT MONEY FROM CDC AND WE LIKE BEING IN CHARGE OF SURVEILLANCE. IS MAYBE DON'T FEEL ENTHUSIASTIC ABOUT PARTNERING SHARING CO-LEADING WITH A CANCER CENTER OR AN ACADEMIC INSTITUTION. SOME OF THE CDC REGISTRIES ARE RIGHT IN THE SENSE THAT IT HAS BEEN THE CASE. IN FACT, IN SOME STATES, AFTER SOMEBODY BECAME SE,R REGISTRY, THE REGISTRY ITSELF, CORPORATIONS WERE MOVED, FROM THE STATE HEALTH DEPARTMENT TO CANCER CENTER. BECAUSE CANCER CENTER HAS MORE RESOURCES, MORE PEOPLE, MORE STAFF. GRANT MONEY. BUT IF YOU HAVE BEEN WORKING IN A STATE HEALTH DEPARTMENT RUNNING CANCER REGISTRY AND DOING FINE, THAT IS NOT MAYBE -- YOU DON'T NECESSARILY THINK THAT IS A GOOD IDEA. I KNOW SOME CANCER CENTERS WORK WITH STATE HEALTH DEPARTMENTS THAT SAID LET'S SUBMIT AN APPLICATION VIA SEER REGISTRY AND FOLKS AT STATE HEALTH DEPARTMENT SAID THANKS BUT NO THANKS. SO THERE'S POLITICS INVOLVED, THE OTHER CHALLENGE TOO IS IF YOU HAVE MULTIPLE CANCER CENTERS IN YOUR STATE, WHO IS GOING TO BE THE LEAD, ET CETERA. SO SOME OF THE NEW SEER REGISTRY, THE SEER REGISTRIES THE LEAD ENTITY IS STILL STAYING STATE HEALTH DEPARTMENT BUT CANCER CENTERS AND RESEARCHERS ARE MORE ABLE TO PARTICIPATE. IT OPENS UP POSSIBILITIES, IT OPENS UP ROUTES FOR NEW FUNDING FOR THE CANCER RESEARCHERS SO I CAN TELL YOU THAT CANCER INVESTIGATORS IN TEXAS, ILLINOIS, IDAHO IS A NEW CANCER REGISTRY. IDAHO, WHAT? THE STATE HEALTH DEPARTMENT IN IDAHO AND LEADERSHIP IN CANCER REGISTRY EARLY ON LIKE HEY, I WANT TO GET ON BOARD, I WANT TO DO THIS. LITTLE IDAHO IS A SEER REGISTRY SO YOU DON'T HAVE TO BE A BIG WELL THE WELL FUNDED ENTITY. -- WEALTHY FUNDED ENTITY. THAT'S THE LONG AN SHORTS OF IT. >> DR. CROYLE, YOU HAVE DONE A TREMENS DOUSE JOB UNDER YOUR LEADER SHIP CLEARLY A HUGE IMPACT. SO THANK YOU. AND FOR YOUR SERVICE AND WHAT YOU HAVE DONE FOR THE CANCER COMMUNITY. I HAVE ONE QUESTION, I KNOW THIS IS YOUR SORT OF LAST OPPORTUNITY TO GIVE US ADVICE BUT FOR YOUR SUCCESSOR AS A COUNCIL OF ADVOCATES AND SURVIVORS HOW CAN WE BE OF SUPPORT TO HER AS SHE COMES IN AND HAVING SEEN THEM AND BEEN IN THE ROLE, WHAT TYPE OF INPUT ADVICE OUTREACH CAN WE DO FOR YOUR DIVISION? >> SO I THINK NCRA CAN MORE THAN ANY OTHER BOARD WE HAVE CAN BE UNIQUELY SUPER HELPFUL TO THE NEW DIRECTOR. THE REASON IS KATRINA IS NOT COMING FROM THE CANCER WORLD. SHE IS NOT COMING FROM A CANCER CENTER, SHE WAS NOT PRIMARILY FUNDED BY NCI FOR ALL RESEARCH. SHE HAS DONE CANCER RELATED RESEARCH FOR SURE BUT A LOT OF DIFFERENT DOMAINS. AND SO THEN YOU ALL ARE IN INCREDIBLY GOOD POSITION TO INFORM AND EDUCATE AND ORIENT HER ABOUT ISSUES IN THE CANCER COMMUNITY. AND IN THE CANCER PATIENT COMMUNITY AND THE CANCER ADVOCACY COMMUNITY. SO I THINK ONE THING IF YOU DON'T MIND, I'M GOING TO DO IS NEXT TIME I TALK TO HER IS SUGGEST THAT FOLLOW-UP WITH AMY. AND YOU ANJEE AND TALK ABOUT WHAT WOULD BE A WAY FOR HER TO JUST LEARN. JUST LEARN FROM Y'ALL. ISSUES PERSPECTIVES, ET CETERA. BECAUSE AS YOU ALL KNOW, CANCER HAS POLITICS. CANCER HAS MANY DIFFERENT ORGANIZATIONS. CANCER IS SO COMPLEX OF A COMMUNITY, AND SO THERE'S A LOT TO LEARN. SHE IS COMING FROM THIS ISSUE WITH SOME UNIQUE EXPERTISE TOO. WHICH WE HAVEN'T HAD ON NCI LEADERSHIP EVER. THAT IS SHE IS AN EXECUTIVE ROLE IN A HUGE HEALTHCARE SYSTEM. KEISER PERMANENTE. SO SHE KNOWS HEALTHCARE DELIVERY AND LARGE CARE ORGANIZATIONS AND THOUSAND LEVERAGE THOSE FOR SCIENCE AND RESEARCH BETTER THAN ANYBODY WHO HAS BEEN ON OUR NCI LEADERSHIP. SHE'S BEEN DOING IT WITHIN A HEALTHCARE SYSTEM. EMBEDDED WITHIN A LARGE HEALTHCARE SYSTEM. SO YEAH, I THINK MAYBE THINKING ABOUT WAYS TO ENGAGE WITH HER AND FORMALLY AND INFORMALLY IT WOULDN'T -- I DON'T THINK IT MAKES SENSE TO HAVE HER COME TO NCRA ON BLINK ONE DAY AND NEXT KATRINA WHAT IS YOUR VISION, SHE KNOWS FOR THE FIRST HALF OF THE YEAR, YEAR SHE'S GOING TO BE IN A LEARNING MODE. SHE HAS IDEAS, SHE'S GOT PRIORITIES FOR SURE. BUT FOR THIS GROUP YOU CAN BE SUCH A RESOURCE SO MANY -- SETTING UP SEPARATE MEETINGS OUTSIDE CONTEXT OF NCRA WITH YOUR OWN ORGANIZATIONS. IS SOMETHING THAT WOULD BE SUPER HELPFUL. >> THANK YOU. >> THAT'S GREAT. WE WOULD LOVE TO HAVE HER. THAT'S HELPFUL COMMENT FOR ANJEE AND I. I WANT TO FLAG ONE MORE QUESTION OR PROGRAM THAT YOU MENTIONED, DR. CROYLE, FOR THE BOARD AND THEN WE'LL MOVE TO OUR NEXT PRESENTATION. YOU MENTIONED WHEN YOU WERE TALKING THE CANCER CENTERS SORT OF THE NEW COMMUNICATION OUTREACH ENGAGEMENT CENTERS, AND THROUGH WORKING WITH SOME OF THE ADVOCATES AFFILIATED WITH DIFFERENT CANCER CENTERS I BECAME AWARE OF O THAT FROM THE ADVOCACY COMMUNITY A LITTLE BIT. COULD YOU TALK A LITTLE BIT ABOUT THE -- HOW MANY CENTERS EXIST NOW OR THE PURPOSE AND GOAL OF THOSE? I THINK THEY ARE INTERESTING BECAUSE SOME OF ADVOCATES ON THE BOARD NEED TO BE AWARE BECAUSE THEY MIGHT WANT TO PARTICIPATE. THAT IS ALSO A VEHICLE THAT I'M SEEING WHERE THE CANCER CENTERS ARE REACHING OUT INTO THE COMMUNITY TO BRING PATIENTS INTO THE CENTER AND TO ADVOCACY AND ANJEE AND I SPENT TIME TALK ABOUT GROOMING THE EX IN GENERATION OF ADVOCATES, WONDERING IF THERE IS A POTENTIAL CENTER THERE. >> ABSOLUTELY. JENNIFER CAN HELP WITH THIS THROUGH ACI AND THEN HENRY THROUGH OUR OFFICE OF CANCER CENTERS SO I THINK A GOOD ACTION HIGH THEM WOULD BE TO ENGAGE THE TWO DISCUSSIONS ABOUT HOW TO BRIDGE NCRA WITH THE -- EVERY CANCER CENTER NOW HAS A IMMUNITY ADVISORY BOARD. SOME HAVE MULTIPLE COMMUNITY ADVISORY BOARDS AND THEY ARE EXPECTED TO AS PARTS OF THE IMMUNITY WITHOUT OUTREACH AND ENGAGEMENT OPPORTUNITIES, SO THERE'S -- ACTIVITIES SO'S OVERLAP WITH PEOPLE PARTICIPATE ORGANIZATIONS, AT THE NATIONAL LEVEL HERE AT NCI AND LOCAL LEVEL AT THOSE CANCER CENTERS. COMMUNITY OUTREACH EDUCATION GROUPS OF THE CANCER CENTERS HAVE AN ENTITY, AN ORGANIZATION FORMAL CALLED THE COMMUNITY IMPACT FORM. AND WE HAVE A LIAISON TO THAT GROUP, ROBIN VAN DER POOL, AN ENTITY FROM DCCPS WHO WAS ASSOCIATE DIRECTOR FOR COMMUNITY OUTREACH AND EDUCATION BEFORE WE -- WOULD BE A KEY CONTACT PERSON. SO ROBIN AND HENRY AT NCI AND THEN NOMINATING JENNIFER, BECAUSE THE -- EVERY NCI DESIGNATED CENTERRER HAS THIS BUT EVEN THE NON-NCI DESIGNATED CENTERS BY AND LARGE HAVE COMMUNITY ADVISORY BOARDS AND SIMILAR PROGRAMS AND ACTIVITIES. >> TERRIFIC. THANK YOU. I APPRECIATE IT. THANK YOU SO MUCH FOR YOUR TIME TODAY AND FOR ALL YOUR EXPERTISE OVER THE YEARS AND FOR SUMMARIZING IT SO NICELY FOR US AND ITS IMPACT ON PATIENTS. ANJEE, I WILL TURN IT BACK TO YOU. >> THANKS, AMY AND ANJEE, THANKS EVERYBODY. >> NEXT WE HAVE DR. SHARPLESS WHO WILL PROVIDE UPDATES LOOKING FORWARD TO HAVING YOU HERE, DR. SHARPLESS AND HEARING WHAT YOU HAVE. >> GREAT. GOOD AFTERNOON, EVERYONE. GREAT TO BE WITH NCRA AGAIN. I APOLOGIZE FOR NOT HEARING ALL OF BOBs TALKS, I WOULD HAVE LIKED TO, I HAD TO GIVE KICK OFF SPEECH. BUT WE ARE IN A -- WHERE TO START WITH BOB, SUCH IMPORTANT LEADER FOR THE NATIONAL CANCER INSTITUTE I THINK A LOT WE WILL PROBABLY HAVE TIME TO TALK ABOUT THE IMPACT BOB HAD ON THE HEALTH SERVICES CANCER HEALTH DISPARITIES PORTFOLIO AT NCI AND YOU PROBABLY HEARD A LOT OF HIS THOUGHTS ON THAT TOPIC EARLIER. ONE THING I MIGHT ADDITIONALLY ADD ABOUT BOB I THINK IS WELL APPRECIATED IS WHAT IS IMPORTANT HOW IMPORTANT IS LEADERSHIP WITHIN THE NATIONAL CANCER INSTITUTE ACROSS ALL AREA CONSIST OF NCI SO ONE OF THOSE PEOPLE NCI DIRECTORS CAN SIT DOWN AND SAY IS THIS A GOOD IDEA, THE RIGHT STRATEGIC PLACE WE SHOULD BE GOING AND HOW SHOULD WE DO THIS. I THINK HE BRIEFLY TOUCHED UPON THE IMPACT BOB HAD ON THE CANCER CENTER PROGRAM AND I THINK THE MAJOR TRANSFORMATION OF CANCER CENTER IN TERMS OF CATCHMENT AREAS AND IMMUNITY OUTREACH ENGAGEMENT WAS PIONEERED BY BOB AND THAT I THINK HAS BEEN A VERY IMPORTANT DEVELOPMENT FOR THE NATIONAL CANCER INSTITUTE AND HEALTH DISPARITIES RESEARCH IN GENERAL. BEEN INNOVATIVE THINKER HOW TO USE OUR MECHANISMS, SO WE DO THINGS IN FEDERAL GOVERNMENT IN TERMS OF DISPERSING FUNDS, SUPPLEMENTS, NOVEL AWARDS, BOB HAS VERY WHICH ERE HELPING US WORK BETTER. BOB WAS INSTRUMENTAL IN OUR CENTER FOR RURAL HEALTH, HE RESTRUCTURED THIS ENTITY AND WAS ACTING DIRECTOR FOR A WHILE. UNTIL WE HIRED -- PAUL, I LEFT IT EXTRAORDINARILY GOOD SHAPE AND THEN BOB HAS BEEN OUR LEADING CONDUIT TO TRANSGOVERNMENTAL ENTITIES. SO HE'S THE BEST FDA AND CDC AND SURGEON GENERAL HHS CONNECTIONS. IN THE NATIONAL CANCER INSTITUTE SO IN ADDITION TO THOUGHT LEADER HEALTH DISPARITY RESEARCH AND POPULATION SCIENCES, HE'S ALSO I THINK BEEN A TREMENDOUS FORCE WITHIN THE NCI. AND WE WILL MISS HIM GREATLY. NEXT SLIDE PLEASE. BUT IT IS AN OPPORTUNITY TO WELCOME OUR NEW DIRECTOR OF DCCPS KATRINA GODDARD WHO WILL START IMMENTALLY THE NEXT FEW WEEKS DEPENDING WHETHER THE GOVERNMENT SHUT DOWN THAT WE WON'T SPEAK OF, KATMAI IS I THINK A FABULOUS INDIVIDUAL TAKING THIS ON. BOB COMMENTS HAVE BEEN ON HER BACKGROUND BUT SHE'S DIRECTOR OF DEPARTMENT OF DEPARTMENT OF TRANSLATIONAL GENOMICS KEISER PERMANENTE HER DUTIES ASSOCIATE DIRECTOR OF SCIENCE PROGRAMS, AT THE CENTER FOR HEALTH RESEARCH AT KEISER PERM MEN DAY, ARE INCLUDE SCIENTIFIC EFFORTS ENTITY. SHE'S BEEN A LEADING INSTITUTION IMPLEMENTATION OF NCI CONNECT FOR CANCER WITHIN THE STUDY, SHE'S A PRINCIPLE INVESTIGATOR CANCER HEALTH ASSESSMENTS REACHING MANY CHARM STUDY TO EXPLORE GERM LINE DATA USAGE IN COLORADO AND OREGON. SO I THINK SHE'S REALLY WELL SUITED TO TAKE ON THIS ROLE AND WE ARE VERY EXCITED TO HAVE HER START SOON. AS BOB SAID HIS RETIREMENT WILL NOT REALLY BEGIN UNTIL JANUARY 2022, THAT ALLOWS A COUPLE OF MONTHS OVERLAP WHICH WE ARE HELPING KATRINA HAS SHE LEARN IT IS ROPES OF FEDERAL EMPLOYEE. DR. GODDARD APPOINTMENT IS PENDING WITH COMMITTEE REVIEW AND APPROVAL BUT I STILL THINK IT IS NOT TOO EARLY FOR BIG WELCOME, LOOK FORWARD TO KATRINA JOINING FORMALLY AS I SAID VERY SOON. NEXT SLIDE. I THINK I HAVE TALKED TO THIS GROUP BEFORE ABOUT OUR EFFORTS TO COMMEMORATE THE NCA A 15 ANNIVERSARY. WANT TO UPDATE HOW THAT IS GOING. ONE OF THE THINGS WE GRATIFIED TO SEE THE THIS GROUND SWELL OF ENTHUSIASM AROUND THIS CANCER COMMUNITY SO HERE ARE SOME OF THE SOCIAL MEDIA AND OTHER THINGS THAT HAS HAPPENED WITH THE CANCER CENTERS AND FROM OTHER CANCER ORGANIZATIONS AND GOVERNMENT ORGANIZATIONS, ALSO HAD SUCCESSFUL KIND OF INITIATIVE ON SOCIAL MEDIA ABOUT INDIVIDUALS DESCRIBING WHY THE CANCER RESEARCH WORKING CANCER CARE IS HASH TAG THIS IS WHY. I THINK THIS IS A TOPIC THAT HAS GOTTEN FOCUS, AND IT IS COMING SORT OF TO A TON COLLUSION. ANNIVERSARY AND SIGNING IS DECEMBER. SO WE ARE SORT OF REACHING CRESCENDO OF EVENS IS THE PLAN. WANT TO INVOLVE A. ACROSS ACADEMIA, ADVOCACY, PHILANTHROPY, ET CETERA. NEXT SLIDE. NOT LONG AGO WE POSTED THE SECOND IN OUR COLLECTION OF VIDEOS, AS PART OF THE 50TH AND SINCE IT IS SHORT I THOUGHT I WOULD SHOW IT TO YOU TODAY. WE ENCOURAGE YOU AND GROUPS YOU WORK WITH NETWORKS LIEU SOCIAL MEDIA, WE CAN SHARE SECOND. >> I KNOW WHAT IT FEELS LIKE TO BE YOUNG AND APPEAR HEALTHY AND HAVE THINGS DISMISSED. UNTIL YOUR GRANDMOTHER SAYS SOMETHING IS WRONG AND YOU NEED TO GO TO A DOCTOR, IT TURNS OUT TO BE CANCER. >> I SAW A DOCTOR AFTER THINKING I HAD SYMPTOMS ONLINE. AEDINE EXPECT CANCER. >> THE WORLD STOPS WITH CANCER DIAGNOSIS. BUT THAT'S WHERE THE STORY BEGINS. MILLIONS OF PEOPLE LIVING WITH THROUGH AND AFTER CANCER ARE CHOOSING TO PARTNER WITH RESEARCHERS TO PARTICIPATE IN CLINICAL TRIALS AND CONTRIBUTE TO RESEARCH DATA. FURTHER OUR UNDERSTANDING OF CANCER AND HOW TO PREVENT IT. ADVOCATE FOR IMPROVED POLICIES AND PRACTICES. AND MAKE PRECISION MEDICINE A REALITY FOR EVERYONE. A LOT HAS HAPPENED IN 50 YEARS BUT ONE THING IS CLEAR. KEEPING PEOPLE AT HEART OF RESEARCH FUELS PROGRESS AND REMINDS US WHAT AND WHO THIS WORK IS FOR. THE NATIONAL CANCER ACT OF 1971 OPENED THE DOOR TO 50 YEARS OF PROGRESS. BUT NONE OF IT WOULD BE POSSIBLE WITHOUT EACH PATIENT, EACH CAREGIVER, EACH SURVIVOR WHO CONTRIBUTED TO BETTER PREVENTING DIAGNOSIS, TREATING AND ULTIMATELY ENDING CANCER AS WE KNOW IT FOR ALL PEOPLE TOUCHED BY THIS DISEASE. >> WE HAVE AN OBLIGATION TO BE THERE FOR THE NEXT -- TO BUILD AND BE PART OF IMMUNITY OF PEOPLE PUSHING TO MAKE THINGS BETTER FOR ANYONE DIAGNOSED WITH CANCER. AND NOTHING WILL STOP US. >> THANK YOU. IF YOU CAN PUT THE SLIDES BACK UP. SO THAT'S SOME OF OUR CONTINUED EFFORTS AROUND NATIONAL CANCER ACT OF 1971 -- >> EACH MONTH THESE SEMINARS FEATURE -- THANK YOU. >> SO NEXT SLIDE WILL SHOW DETAILS FROM NATIONAL -- FROM THE POSSESSION IFNAL JUDGMENT BUDGET, MANY OF YOU ARE AWARE, ONE OF THE THINGS THE NATIONAL CANCER ACT MANDATES IS ANNUAL BUDGET PROPOSAL WHICH IS THE BUDGET KNOWN AS THE BYPASS BUDGET. I'M PLEASED TO ANNOUNCE NCI ANNUAL PLAN AND BUDGET PROPOSAL FISCAL 2023 IS AVAILABLE AT CANCER.GOV AND IT HAS HIGHLIGHTS OF AREAS WE THINK OF RESEARCH OPPORTUNITY, I WANT TO FOCUS ONE OF THE ASPECTS OF THIS PLAN. NEXT SLIDE PLEASE. WITH REGARD TO OUR BUDGET PROPOSAL KEY PRINCIPLE IS OUR COMMITMENT TO INVESTIGATOR INITIATED RESEARCH. AND SO HERE WE IDENTIFY SOME $7.8 BILLION TO ENABLE NCI TO INCREASE RO1 TO 13 PERCENTILE, WE INCREASED THE PAY LINES FOR ESTABLISHING INVESTIGATORS FOR RO1s FROM THE 8 PERCENTILE TO THE 11TH SO A GOOD INCREASE BUT THE GOAL IS TO GET TO THE 50 PERCENTILE BY 2025. THIS IS WE THINK A NUMBER THAT WOULD BE SUSTAINABLE AND HAVE BENEFIT TO THE BROADER RESEARCH COMMUNITY. WE CAN'T DO THAT IN ONE YEAR BECAUSE THE WAY THE NCI BUDGET WORKS AND COST OF THESE GRANTS. BUT SO THE GRADUA PLAN FOR THE -- TO IMPROVE OUR FUNDING PAY LINES ARE SHOWN HERE ON THE LEFT. OBVIOUSLY THIS IS VERY EXPENSIVE EFFORT FOR THE NCI YOU CAN SEE THAT THE BAR GRAPH HAVE SHOWED SIGNS OF FUNDING THAT ARE NEEDED SO ONE YEAR CERTAINLY CAN'T DO THIS WITHOUT THE EXPLICIT SUPPORT SO HELP CONGRESS TO ACHIEVE THIS GOAL BUT WE THINK IT IS IMPORTANT FOR RESEARCH COMMUNITY. THIS SORT OF FUNDING WOULD ALLOW US TO ADVANCE MANY PRIOR NCI INCLUDING COMMITMENT TO HEALTH EQUITY AND ELIMINATION OF CANCER HEALTH DISFAIRS SO THE BUDGET RAMP UP COMMITMENT TO DIVERSE INCLUSIONSIVE CANCER STRATEGIC WORK FORCE AND FUND CANCER DISPARITIES RESEARCH. AND WE THINK THAT THESE -- THIS IS A VERY GOOD LEVEL OF INVESTMENT FOR THE NATION UNDERTAKING CANCER RESEARCH. MARY LASKER, PRINCIPLE COMPONENT OF THE NATIONAL CANCER ACT HAD A NICE LINE ABOUT THIS. IF YOU THINK RESEARCH IS EXPENSIVE TRY DISEASE. SO WE ESTIMATED COSTS ON THE LEFT YOU CAN SEE THE CARE COST OF CANCER ALONE ARE $200 BILLION OR MORE IN 2021. THE LOSS PRODUCTIVITY IS A COMPARABLE SUM, $150 BILLION ESTIMATE IN TERMS OF MORTALITY AND LOST PRODUCTIVITY FROM WORK, ET CETERA. AND NONE -- NEITHER OF THESE NUMBERS ACCOUNT FOR THE TRAGEDY SOCIETAL BURDEN OF CANCER, TOLL IT TAKES ON PATIENTS AND LOVE ONES NOR FINANCIAL TOXICITY CAUSES THE PATIENTS, ET CETERA. SO THE COST OF CARE ARE -- TOTAL APPROPRIATION TO THE NCI THAT WE ARE SEEKENING 2023 IS ON THE ORDER OF LITTLE LESS THAN $8 BILLION SO WE HI THE CANCER RESEARCH GIVEN IT IS SHOWN SUCCESS IN DEVELOPING NEW THERAPY AND NEW APPROACHES TO CANCER WE THINK NOT REALLY JUST WORTHWHILE BUT QUITE A BIT OF BARGAINING GIVEN THE NEEDS OF NATION. NOW, THAT'S ENOUGH ABOUT PROFESSIONAL JUDGMENT BUDGET AND I THINK WE -- BEFORE WE TURN TO 22 I WOULD LIKE TO MENTION ALSO WE'LL HAVE -- IT IS A NICE INTERESTING TIME TO BE TALKING NATIONAL CANCER ACT, 50 YEARS IN AND SOME WAYS THE NCA WAS VISIONARY, PROVIDED ALL THESE NEW RESEARCH CAPABILITIES, NATIONAL LAB, KAREN CENTER PROGRAM, ET CETERA. SO IMPORTANT CURE FOR CANCER WOULD BE DEVELOPED IN FIVE TO TEN YEARS AFTER NATIONAL CANCER ACT. HERE WE ARE 50 YEARS IN, STILL 600,000 AMERICANS DYING OF CANCER EVERY YEAR. TRYING TO NARRATE ALL THAT PROGRESS TO TALK ABOUT WHAT HAPPENS NOW. HOW DO WE FURTHER ALONG OUR GOALS OF ELIMINATING CANCER SUFFERING AS THE PRESIDENT LIKES TO SAY. AND SO YOU CAN THINK OF THE FIRST 50 YEARS AS THE REPERCUSSIONS OF THE NIXON INITIATIVE AND NOW WE HAVE THE BIDEN ADMINISTRATION IS VERY INTERESTED IN LAYING OUT ITS PLANS FOR CANCER RESEARCH. WE ARE FORTUNATE TO LATER ON DANA CARNIVAL COME AND TALK A BUILT ABOUT THAT. SEVERAL THINGS BIDEN ADMINISTRATION PLANS TO REALLY MAKE GOOD ON THAT INTEREST OF IN THE CANCER REALM. NEXT SLIDE. LET ME TURN TO THE GOINGS ON IN THE ACTUAL APPROPRIATION PROCESS FOR THE MOMENT. HERE IS THE NCI BUDGET SHOWN THE LAST YEARS, I SHOW THE SLIDE VIRTUALLY EVERY TIME I SPEAK TO THIS GROUP. YOU CAN SEE A GOOD GRADUAL INCREASE FOR FUND FROM THE NCI REFLECTING THE BIPARTISAN SUPPORT FOR THE UNITED STATES. YOU CAN SEE THE CANCER MOON SHOT FUNDING IN ORANGE STARTING IN 2017. PEAKED IN 19 AND SUNSET BY 2023. APPEARING IN 2020 WHICH IS THE CHILDHOOD CANCER INITIATIVE. I WILL SAY MORE ABOUT THOSE EFFORTS. HOLLY GIBBONS FROM GOVERNMENT CONGRESSIONAL RELATIONS WILL SHARE MORE ABOUT THE APPROPRIATIONS PROCESS IN GENERAL, SUFFICE TO SAY THERE IS A LOT GOING ON IN CONGRESS AT THE MOMENT, THERE IS A RECONCILIATION PACKAGE, INFRASTRUCTURE PACKAGE, A GENERAL APPROPRIATION, ISSUE, THERE'S DISCUSSION OF THE NEW INITIATIVE OF ARPA H WHICH IS WELL AS THE REST OF THE NIH FUNDING SO A LOT IN PLAY AND WE WILL HEAR MORE ABOUT THAT FOR BOTH DANIELLE AND HOLLY. NEXT SLIDE. THIS SLIDE SHOWS THE OVERALL DISTRIBUTION OF HOW THE NCI SPENDS MONEY, WE HAVE BEEN ASKED BY SEVERAL OF OUR EXTERNAL ADVISORS TO PROVIDE MORE INFO ON THAT, SO THIS IS IN RESPONSE TO THOSE REQUESTS. AND YOU SEE THE RPG POOLS THE SINGLE LARGEST PART OF OUR BUDGET AT 43%, THAT IS GROWN A LITTLE BIT OVER THE LAST FEW YEARS. CERTAINLY A LITTLE BIT ON PERCENTAGE BASIS, A LOT ON ABSOLUTE DOLLAR BASIS WITH INCREASE IN FUNDING. 75% OF BUDGET IS FOR EXTERNAL FUNDING ONE QUARTERS IS FOR INTRAMURAL FUNDING. YOU SEE THE PROGRAMS HERE NOT WITHIN THE RPG POOL, CENTERS AND SPORE PROGRAMS, AND VARIOUS TRAINING AND RESEARCH CONTRACTS. NEXT SLIDE. THIS IS A FURTHER INFORMATION ABOUT THE RPG POOL THE 40% OF BUDGET FUNDS PROVIDED INVESTIGATOR INITIATED AWARDS. ABOUT 50% OF THAT POOL GOES TO RO1s, SORT OF WORK FORCE GRANT FOR INVESTIGATOR INITIATED RESEARCH. ADDITIONAL 3% FOR RO1 RFAs SO REALLY IT IS ABOUT 60% OF THE BUDGET GOES TO RO1 THAT WAY. YOU CAN ALSO SEE OTHER THINGS LIKE PO 1 AND U MECHANISM AWARDS, ET CETERA, ALSO GOING TO BE RPG POOL. SBIR AND STTR GRANTS ARE PART OF THE RPG POOL AS DESIGNATED BY FEDERAL LAW. NEXT SLIDE. AS YOU KNOW, SEPTEMBER WAS CHILDHOOD CANCER AWARENESS MONTH, IT WAS NOW COMING TO AN END, I WANT TO MAKE A FEW HIGHLIGHTS. ONE IS THE CHILDHOOD CANCER DATA INITIATIVE WHICH IS A FEW YEARS OLD NOW AND MOVING ALONG IN A TERRIFIC PACE AND WE ARE EXCITED ABOUT THIS INITIATIVE, TO REMIND YOU THIS IS THE $50 MILLION A YEAR PROGRAM FOR TEN YEARS SO $500 MILLION EFFORT TO CREATE AN INFRASTRUCTURE IN THE COMMUNITY TO AGGREGATE DATA AND SHARE DATA SO THE WE CAN LEARN FROM EVERY CHILDHOOD CANCER IN THE UNITED STATES. WE BELIEVE THIS IS ALSO IMPORTANT EFFORT FOR ADULT CANCER RESEARCH. THE NCBI IS A PROVING GROUND WHERE WE DEVELOP POLICIES AND TECHNOLOGY THAT ALLOW DATA SHARING AND MAXIMAL USE OF DATA USAGE. WHAT WE LEARNED FROM THE SMALLER PROBLEM WITH CHILDHOOD CANCER, WE HAVE BEEN USING THE LARGER PROBLEM ADULT CANCER RESEARCH SO THIS IS A BENEFICIAL EFFORT FOR ALL CANCER PATIENTS EVENTUALLY. EARLIER THIS MONTH WE HAD A WEBINAR OF THIS INITIATIVE PLUS UPDATE ON CCBI ACTIVITIES WHEN PEMBERTHY SPOKE THE, MANAL CHILDHOOD CANCER REGISTRY, AND JACK SEERIMOR N SPOKE ABOUT UPCOMING PROTOCOL, THERE WAS SOME TECHNICAL ACTIVITIES VIDEO IS AVAILABLE FOR -- LEARN MORE, CCBI ALSO DISCUSSED RECENT BLOG I CO-AUTHORED ON PROGRESS OF CANCER CHILDHOOD CANCER RESEARCH AND SEVERAL AREAS WE ARE WORKING HERE AND IF YOU ARE INTERESTED IT IS ON YOU AR OUR WEBSITE. T NOW TURNING TO CANCER MOON SHOT ON THIS SLIDE. I MENTION THIRD DEGREE IS CREATED UNPRECEDENT RID SEARCH OPPORTUNITIES, YOU WILL RECALL THE MOON SHOT WAS FOCUSED ON TRANSLATIONAL RESEARCH SO IDEAS THAT WE ARE JUST ABOUT READY FOR PATIENT USAGE, GOAL OF THE MOON SHOT WAS TO TRANSLATE THIS NEAR PATIENT IDEAS AN TECHNOLOGIES THE CLINICAL APPLICATION. THERE IS CONGRESSIONAL CANCER MOON SHOT 2.0 MIGHT LOOK LIKE AND DISCUSSION A I ALONG LINE GOING ON. FIVE UNITED NATIONS SINCE WE PEDDLED THE REPORT WE HAD A SPECIAL WEBINAR ON THE TOPIC RECENTLY U THAT INCLUDED LIZ JAFFY FROM HOPKINS WHO IS CO-CHAIR OF BLUE RIBBON PANEL, TIER JACKS FROM THE MIT CO-HAIRED THE PANEL, ELENA PARTY THESE A PANEL MEMBER AND DANA SINGER, WE TALKED ABOUT WHAT THE MOON SHOT HAS DONE TO DATE AND WHAT IS LEFT OF THE MOON SHOT, EVEN SOME OF WHAT COMES NEXT. YOU CAN SEE THE MOON SHOT DOES UNSET IN 23 SO A BIG PROBLEM OR ISSUE WE ARE WORKING THROUGH NCRA IS HOW TO TRANSITION THE GREAT WONDERFUL SCIENTIFIC INFRASTRUCTURE CREATED BY THE MOON SHOT, FOR THOSE THINGS WE CONTINUE BEYOND 23, REGULAR PRONEIATION. ALSO I SHOULD MENTION REVIEW ON THE TOPIC, ON CANCER CELL AS A LOT OF SPECIFICS ABOUT WHAT SORTS OF PROGRAMS AND INITIATIVES THE MOON SHOT HAS FUNDED. AND SUPPORTED TODAY. LET ME TALK ABOUT SOME RESEARCH NEWS FROM THE NATIONAL CANCER INSTITUTE. OUR EXTRAMURAL FUN DEES. MEEK SLIDE. THE TRIAL AN INTERESTING TRIAL WORTH MENTIONING FOR COUPLE OF REASONS, SO I THINK SOME OF YOU WILL BE FAMILIAR WITH THE STUDY, THE IDEA OF MAKING -- COMBINING THERAPY APPROACH SO CTLA 4 INHIBITORS AND PD 1 CHECK 1 INHIBITORS AVAILABLE TO PATIENTS WITH RARE CANCER THROUGH COLLECTION OF SMALL PHASE 2 BASKET TRIALS IF YOU WILL. AN OPEN LABEL STUDY, MULTI-CENTER AND ALLOWS ENROLLMENT OF VARIETY OF PATIENTS, RARE TUMORS ON STUDIES. SO THIS IS ONE RECENT RESULT FROM THE DARK TRIAL IN ANDREW SARCOMA A RARE AGGRESSIVE SARCOMA THAT HAS BEEN QUITE FRAGMENT THERAPY SO YOU CAN SEE THAT THIS COMBINED ANTI-THER APPROACH PRODUCES NICE RESPONSES IN A SMALL MODEST FRACTION OF PATIENTS, 25% OFFER PATIENTS ROUGHLY. THIS IS GREAT NEWS FOR THE PATIENTS TO IDENTIFY NEW MODALITY THERAPY. IT ALSO IS EXCITING BECAUSE SARCOMA WAS THE FOCUSES OF THE COUNT ME IN INITIATIVE THE NOVEL APPROACH TO PATIENT EBB GAUGEMENT PIONEERD BY THE BROAD INSTITUTE AND OTHERS.% THAT SEQUENCING IDENTIFIED A SUBSET OF SARCOMA THAT SEEM TO HAVE MOLECULAR CHARACTERISTICS HIGH MUTATIONAL BURDEN TO MAKE IT AMENABLE TO IMMUNOTHERAPY. TO HAVE THAT THERAPY AND HAVE TRIAL SUPPORTING THE SAME CONCLUSION IS INTERESTING. BUT ALSO INTERESTING IN THE TRIAL IS PROVIDES THIS IDEA THAT THIS WORK -- WE CAN DO THIS KIND OF APPROACH FOR MANY OTHER MALIGNANCIES AND OTHER THERAPY MODALITIES. IT IS OF INTEREST THE NCI MATCH TRIAL WHICH ALLOCATED PATIENT THERAPIES BASED ON SEQUENCING OF TUMOR. ENROLLING 6,000 INDIVIDUALS IN TWO YEARS, ONE OF THE FASTEST TRIALS DONE, THAT TRIAL HAD A HUGE PARTICIPATION OF PATIENTS WITH QUOTE UNQUOTE RARE CANCER AS WELL. WHO THEN WERE ALLOCATED AS MANY AS 40 ARMS OF THERAPY ON MOLECULAR PHENOTYPING SO APPROACH THAT WORKS IN CANCER, USING SPECIFIC CHARACTERIZATION IN EXQUISITE CHARACTERIZATION OF TUMOR, AND ALLOCATE PATIENT THERAPY BUT NOT NECESSARILY TISSUE TYPE SPECIFIC WAY. NEXT SLIDE. ALSO MENTION SHERLOCK TRIAL, SHERLOCK LUNG STUDY, THIS IS AN ONGOING SET OF STUDIES, THIS REPORT IS THE FIRST DATA WE HAVE SEEN FROM SHERLOCK THIS STUDY CONTINUES, IT'S WORK WITHIN THE INTRAMURAL DIVISION OF EPIDEMIOLOGY ANNEX SO WE KNOW HOW MUCH EFFORT CANCER RESEARCH CARE COMMUNITIES PUT IN TOBACCO CESSATION, IMPORTANT PART OF OUR PROGRESS WITH CANCER RESEARCH AND SINCE PROGRESS IN MAY THERE BUT THERE'S STILL QUITE A LOT OF LUNG CANCER THAT IS NOT ASSOCIATED WITH SMOKING. SO 10 TO 20% OF PEOPLE IN THE UNITED STATES FOR DYING OF LUNG CANCER ARE NON-SMOKERS AND NEVER SMOKERS SO CANCER IN THIS POPULATION IS OF INTEREST AND SO RESEARCH TEAM FROM NCI USED A VERY CUTTING EDGE GENOMIC SEQUENCING ANALYSIS TO CODE THROUGH THE HUMAN GENOMES OF THE PATIENTS IN TERMS OF RNA, COPY NUMBERS. AND IN PARTICULAR, THERE WAS A FOCUS ON MUTATIONAL SIGNATURES, THESE MUTATIONAL EVENTS THAT ARE ASSOCIATED IN SPECIFIC PATTERNS WITH SPECIFIC PERCENTAGES -- CARCINOGENS SO MUTATION SIGNATURE MUTATIONAL SIGNATURE OF AGING, THERE'S MUTATIONAL SIGNATURE OF TOBACCO SMOKE. AND WE APPLY THESE TECHNOLOGIES TO PATIENTS WHO HAD NON-SMALL CELL LUNG CANCER TO TROY TO UNDERSTAND MORE ABOUT TUMORS THE SUBTYPES OF THE TUMORS, THAT MAYBE IDENTIFY THINGS PROGNOSTICALLY AND THERAPEUTICALLY INFORMED BY PATIENTS BUT TRYING TO UNDERSTAND WHAT CAUSE THE CANCERS TO BEGIN WITH. NEXT SLIDE. SO ONE -- THERE ARE MANY FIND INFORMATION THIS PUBLICATION IN NATURE GENICS AND PAPER IF YOU ARE INTERESTED BUT ONE THING THAT WAS INTERESTING IS TO USED ON SECOND HAND OR PASSIVE SMOKING IN INDIVIDUALS WITH LUNG CANCER WHO WERE NEVER SMOKERS. THE DATA SHOWN HERE. YOU SEE THIS IS THESE MOLECULAR SIGNATURES, FOR SBS 4, THE MOLECULAR SIGNATURE ASSOCIATED WITH TOBACCO SMOKE. YOU SEE THE SO CALLED PASSIVE SMOKERS ARE PEOPLE WHO EXPOSED CIGARETTE SMOKING FOR WHATEVER REASON COMPARED TO NON-PASSIVE SMOKERS. AND YOU REALLY SEE VERY LITTLE DIFFERENCE IN THEIR -- NUMBER OF PATIENTS THAT HAVE APPEARANCE OF THIS SIGNATURE ASSOCIATED WITH TOBACCO SMOKE. SO THAT IS A BIT OF SURPRISE. WE KNOW THAT INDIVIDUALS WITH STRONG EXPOSURE AND SECOND HAND SMOKE HAVE INCREASE RISK FOR LUNG CANCER, MODEST INCREASE FOR LUNG CANCER, THERE WAS NO EVIDENCE FROM THIS TO THINK SMOKE IS BEING INHALED IN ANY DIRECT MUTAGEN THE WAY PRIMARY SMOKING IS BUT THIS IS SMALL STUDY, WE OBVIOUSLY DEAL WITH MORE PATIENTS TO SEE IF FINDING HOLES UP WITH GREATER ANALYSIS. ONE CONCERN IMMEDIATELY IS IN THE NEXT SLIDE WHICH IS THE TECHNOLOGIES TO DETECT MUTATIONAL SIGNATURES ARE RELATIVELY NEW. THEREFORE A SUDDEN EFFECT OF 10 TO 20% INCREASE IN RELATIVE RISK MIGHT BE HARD TO DETECT USING THIS APPROACH, FOR COMPARISON ACTIVE SMOKERS HAVE A 20 FOLD INCREASE RISK OF CANCER COMPARED TO NEVER SMOKERS. SO THAT IT IS POSSIBLE THAT THERE IS AN EFFECT HERE ON SIGNATURE NOT ABLE TO DETECT AT THIS TIME SO WHAT IS SHOWN HERE IS IF THERE'S DETERMINATION DETECT LIMITS SO GRAPH SHOWS IF WE DOPE IN DNA WITH THESE SMOKING SIGNATURE IN GENOMES WHAT LEVEL QUESTION START TO SEE EVIDENCE FOR THAT AND IT HAS TO BE AROUND THE SORT OF 15% MARK. SO IT MAY JUST BE -- ONE OF THESE REASONS WHY WE HI THIS IS IS IMPORTANT QUESTION FOR STUDY. OBVIOUSLY THIS RESULTED IN A BROAD IMPLICATION FOR AMERICAN LIFE POLICY IMPLICATIONS FOR PLACES LIKE THE FDA AND EPA AND OTHER PARTS OF THE US GOVERNMENT. SO REALLY NAILING THIS QUESTION IS VERY IMPORTANT. ALSO I THINK THIS MAKES ANOTHER POINT INTERESTING WHICH IS NOW BECAUSE OF MOLECULAR APPROACHES, THESE POSSIBLE LINKS TO SPECIFIC CARCINOGENS TO SPECIFIC CANCER SO THIS IS ONE EXAMPLE YES DON'T SEE EVIDENCE OF THAT TODAY. THERE IS A DIFFERENT SET OF CANCER RENAL CANCER IN CENTRAL EUROPE ASSOCIATED WITH CARCINOGEN ACID THROUGH THIS APPROACH IS A NOVEL ASSOCIATION. SO THE CHALLENGE OF ENVIRONMENTAL AGENCY CANCER IS VERY CHALLENGING A REAL PROBLEM FOR THE NCI WHEN WE THINK THESE TECHNOLOGIES PROVIDE SOME ABILITY TO MAKE PROGRESS IN THAT IMPORTANT SEARCH QUESTION. NEXT SLIDE. A FEW WORDS ABOUT PANDEMIC. WE WILL TALK ABOUT THIS BEFORE. SUFFICE IT TO SAY THAT THINK YOU ARE SAYING DECREASE CANCER SCREENING AN DIAGNOSIS, CONTINUE TO BE TRUE. WE SAW THIS HUGE GAP IN DIAGNOSIS OF CANCER IN THE EARLY STAGES OF 2020, NOW A BIT MORE DATA ABOUT THE IMPACT OF THIS ON AMERICAN PUBLIC, THESE DATA SHOWN FROM EPIC ANALYSIS ELECTRONIC HEALTH RECORD EPIC. AND THEY NOTE DRAMATIC INCREASE IN COLON CANCER SCREENING THAT IS SEMIRECOVERS BY TOWARDS THE END OF 2020 AND NOW IT IS ACTUALLY DROPPED DOWN A LITTLE BIT AGAIN. WE ARE LOOKING TO SEE IF WE SEE SIMILAR DATA IN OTHER DATA SETS, SO THE CROSS CONSORTIUM DATA SHOWS EXACTLY THE SAME VERY DRAMATIC DECREASE EARLY IN THE PANDEMIC AND WE ARE WORKING TO REALLY TRY TO UNDERSTAND WHAT IS GOING ON WITH CANCER SCREENING AND DIAGNOSIS NATIONALLY. NOW. IT IS IMPORTANT TO NOTE THAT NATIONAL CAPACITY FOR CANCER DETECTION CANCER SCREENING CANCER TREATMENT IS SUCH WE DON'T BELIEVE IT IS POSSIBLE THOUGH CATCH THIS UP IF YOU WILL. WE THINK THAT THESE MISSED SCREENING EVENTS ON ORDER OF 10 MILLION MISS SCREENING EVENTS IN 2020 AND 20 # 1 WILL LEAD TO PATIENTS BEING DIAGNOSED WITH LATER STAGE CANCER, PRESUMABLY WOULD HAVE WORST PROGNOSIS SO WE THINK THAT IT IS REALLY INCUMBENT ON CANCER RESEARCH COMMUNITY AND CANCER CARE COMMUNITY TO TRY TO TAKE COLLECTIVE ACTION TO MITIGATE THIS EFFECT AND TRY TO MAKE UP FOR THESE SCREENINGS WHERE POSSIBLE OR TO DIAGNOSE PATIENTS BY ANY MEANS POSSIBLE AND TRY TO WORSENED STAGES IF THAT OCCURS. WE ARE SEEING SOME EXAMPLES SENATOR CLOBESHAR HAS WRITTEN TO HER RECENT BREAST DIAGNOSIS AND HER BRAVERY TALKING ABOUT THIS PUBLIC IS IMPORTANT TO NATIONAL MESSAGING. NEXT SLIDE. THE IMPACT HASN'T JUST BEEN ON CANCER DIAGNOSIS AND SCREENING IT IS ALSO ON CANCER RESEARCH AND PROBABLY THE THINGS MOST EFFECTIVE IN TERMS OF CANCER RESEARCH BY PANDEMIC HAS BEEN CLINICAL TRIALS ENROLLMENT SO YOU CAN SEE A FEW YEARS OF DATA MANY THE NATIONAL CLINICAL TRIALS NETWORK FOR 1920, 21, WE SEE THIS BIG DROP IN ACCRUAL WEEKLY ACCRUALS FOR THE FIRST COUPLE OF WEEKS OF 20. THE YEAR 20 ENDED UP BEING A GOOD YEAR FOR AVERAGE YEAR FOR ACCRUAL, NOT NEARLY AS BAD AS MARCH APRIL MAY PERIOD BECAUSE WE OVERACCRUED THE END OF THE YEAR FOR VARIETY OF REASONS HAPPEHAPPY TO US CUSS THE PANDEMIC SLOWED PROCESS BY 80% ACCRUAL, ALSO AFFECT ACROSS THE INDUSTRY, CERTAIN TRIALS MORE EFFECTIVE THAN OTHER TRIALS, THIS WILL LEAD TO DELAYED DEVELOPMENT OF THESE NEW APPROACH TO TREAT AND DIAGNOSE PATIENTS AND THAT SORT CANCER PROGRESS AS WELL. NEXT SLIDE. I MENTION A FEW ACTIVITIES AND I THINK I TOLD THIS GROUP ABOUT BEFORE, UPDATE YOU A FEW ZOOLOGY ACTIVITIES, APPROPRIATED $360 MILLION FOR CONGRESS FOR SERO LOGIC RESEARCH. LARGELY DRIVEN IN PART BY EFFORTS AT NATIONAL LAB ONE OF THE WORLD'S LEADING SEROLOGY LABS. HERE ARE SOME OF THE THINGS WE HAVE DONE WITH THOSE FUNDING WITH FDA WE DEVELOP -- EVALUATE HUNDREDS OF ANTIBODY TESTS THAT ARE COMMERCIALLY AVAILABLE. THIS IS PROFICIENCY TESTING EXPERIENCE IS DESCRIBED IN REVIEW BY JEFF SHYRIN IN NEW JOURNAL OF MEDICINE AND NCI WAS THAT WORK, WORKING WITH THE ALL OF US STUDY NIH WE SHOWED THAT THE TIME LINE OF SERO CONVERSION IN THE UNITED STATES, ONE OF THE FIRST INDIVIDUALS IN THE UNITED STATES INFECTED WITH SARS COV-2 INTERESTING STUDY PUBLISHED IN CLINICAL INFECTIOUS DISEASE RECENTLY. WE HAVE DATABASE, THE SEER HUB DATABASE WITH MILLIONS OF USERS IN THE U.S. INTERNATIONALLY. WHICH REALLY SHOWS THE SERO PREVALENCE BY STATE AND REGION OVER TIME. AND DIFFERENT DATA, DATA FROM BLOOD BANKS AND OTHER TYPES OF STUDIES AND MAKES A POINTS THAT DETECTION IN DIFFERENT STATES OF TIME, WE CREATED INTERNATIONAL REFERENCE WE NOW SENDS OUT MANY REQUESTERS IN SEVERAL COUNTRIES OR CLOSELY WORKING WITH WHO CREATE A REFERENCE TO ALLOW RESULTS OF SERO LOGIC TESTING OF LABS BE PREPARED, WE WERE ONE OF THE FIRST TO DEMONSTRATE ANTIBODY STATUS CORRELATES WITH INFECTION, REALLY IMPORTANT FACT EARLY IN THE PANDEMIC PEOPLE WHO ARE ANTIBODY POSITIVE LESS LIKELY IN THE FUTURE. AND OBVIOUS CLINICAL RELEVANCE NOW. WE ARE THE ONGOING STUDY DESCRIBED BEFORE ABOUT 1200 PATIENTS ENROLLED. THIS IS VERY IMPORTANT UNDERSTANDING THE USE COME OF CANCER AND LONG COVID LATE SEQUELAE FOR THE INFECTION IN PATIENTS WITH CANCER AND COMPROMISE. NEXT SLIDE. ONE OF THE MOST IMPORTANT THINGS WE HAVE DONE IN NCI WITH SEROLOGY FUNDING IS EXTRAMURAL NET WORK SEER NET WHICH 25 ACADEMIC INSTITUTIONS THROUGH U MECHANISM NETWORK FUNDING IMMUNOLOGICAL RESEARCH THAT UNDERPINS UNDERSTANDING SEROLOGY AS WELL AS OTHER ASPECTS OF IMMUNE RESPONSE CORONA VIRUS AND IT'S BECOME A REAL FACTOR WE HAVE PAPERS NOW, A NEW NETWORK PUBLISHING REALLY IMPORTANT SCIENTIFIC ADVANCES RELATED TO CORONA VIRUS RESEARCH AND IMMONEYTY AND FEW OF THESE IN -- IMMUNITY, AND NATURE JOURNAL MEDICINE. HAPPY TO TALK ABOUT THIS WORK IF MORE INTEREST. I WOULD LIKE TO MENTION A FEW THINGS GOING ON IN THE NCI EFFORTS TO PROMOTE HEALTH EQUITY. I DESCRIBED TO THIS GROUP BEFORE THE NCI EQUITY INCLUSION PROGRAM AND -- THAT I SHARE THE COUNCIL AND FIVE WORKING GROUPS IN THIS STRUCTURE AND NOW WE ARE STARTING THE TALK ABOUT SOME OF THE PRODUCTS OF THIS INITIATIVE. SO ONE EXAMPLE IS SHOWN HERE, WHICH IS THE CT INITIATIVE FUNDING ANNOUNCEMENT THAT WENT LIVE VERY RECENTLY. AND THE IDEA WAS TO FOCUS ON BARRIERS TO CLINICAL TRIALS ACCRUALMENT OF -- CLINICAL TRIALS ACCRUAL MINORITY PATIENTS. AND TRY ADDRESS THESE BARRIERS TO SEE IF WE CAN ENHANCE CLINICAL TRIALS ACCRUAL FOR SPECIFIC POPULATIONS. SO THE FUNDING IS ALIVE AND APPLICATIONS WILL BE SOON, FUND NETWORK OF CENTERS THAT WILL TAKE ON THIS PROBLEM ENTHUSIASTICALLY ENDORSED BY THE BOARD OF SCIENTIFIC ADVISORS. NEXT SLIDE. ANOTHER IMPORTANT EFFORT THAT THE NCI HAS HELPED TO LEAD IS THE FIRST INITIATIVE. I THINK I DESCRIBED THE FIRST INITIATIVE BEFORE, THIS IS AN EFFORT FROM THE COMMON FUNDS OF THE NATIONAL INSTITUTE OF HEALTH; THE NIH TO SUPPORT CREATE COHORT OF DIVERSE FACULTY AT INSTITUTIONS THAT ARE TO PROMOTED TO THE CAREER DEVELOPMENT AND IDEA OF INCLUSIVE EXCELLENCE, CREATING A REAL ENVIRONMENT WHERE FACULTY FROM VARIOUS BACKGROUNDS CAN BE SUCCESSFUL AND PROCEED IN CAREERS. THE IDEA IS THREE YEARS OF THIS SO THIS IS YEAR ONE, THE NCI LARGELY ADMINISTERS THIS PROGRAM FOR OUR CENTER FOR CANCER RESEARCH HEALTH DISPARITIES. IS LEADING ADMINISTRATIVE EFFORT PANEL PATIENT REVIEWING THEM WORKING ALSO CLOSELY WITH THE NATIONAL INSTITUTE OF MINORITY HEALTH AND HEALTH DISPARITIES NICHD THE FIRST ROUNDS OF FUNDING ANNOUNCED HERE, SO YOU SEE MOREHOUSE COORDINATING EVALUATION CENTER AND OTHER INSTITUTIONS ARE THE FIRST AWARDEES. AND WE HI IT IS A VERY EXCITING NEW WAY OF DOING THINGS. TO TRY APPLY THIS COHORT MODEL AT SCALE. THIS FUNDLING ALLOW THE INSTITUTION TO RECRUIT SIGNIFICANT NUMBERS OF FACULTIES, AS MANY AS TEN A YEAR IN SOME INSTANCE. OFTEN MATCHING FUNDS AND OTHER SUPPORT INSTITUTION AND CREATE THESE ENVIRONMENTS THAT ALLOW THESE FACTORS SUCCESSFUL, ONE EFFORT TO TRY TO ADDRESS LACK OF DIVERSITY IN OUR FUNDING COHORT. WE DON'T HAVE ENOUGH PIs GETTING RO1s AND OTHER GRANTS RELATED TO NCI THAT ARE DIVERSE BACKGROUNDS SO THE FIRST INITIATIVE IS AN INTERESTING WAY THE APPROACH THAT CHALLENGE. NEXT SLIDE. TWO WEEKS AGO WE FORMALIZED THIS INTERESTING COLLABORATION WITH HRSA AND THE FDA, WE ARE EXCITED ABOUT. THIS IS COLLABORATION ACROSS THE THREE AGENCIES, DESIGNED THE OVERCOME RESEARCH AND REGULATORY CHALLENGES THAT ARE IMPORTANT. THIS COLLABORATION WILL BE REALLY IMPORTANT FOR PATIENTS IN RURAL AND UNDERSERVED COMMUNITIES. AND THE IDEA IS TO COLLABORATE AMONG THE THREE AGENCIES, BOTH SCIENTIFIC DEVELOPMENT REGULATORY REVIEW OF NEW CANCER DEVICES AND DIAGNOSTICS, FOR NEAR PATIENT USE, CMS IS ALSO INVOLVED WITH THIS AND PLAY AD LOT OF GAMES, GIVEN ADVICE INITIATIVE BECAUSE THE IDEAS ONCE DEVELOPED AND APPROVED AND THEN DISPERSED BY HRS A AND PAID FOR BY CMS INTEGRATE AID APPROPRIATE FOR DEVELOPING SPECIFIC (INAUDIBLE) CANCER STAGES. NEXT SLIDE. I MENTION CENTER FOR GLOBAL HEALTH EARLIER INVOLVES IMPORTANT ROLE IN LEADING THAT DURING TRANSITION PERIOD. LAST WEEK THE LAST FRIDAY WAS WORLD CANCER RESEARCH DAY. SO GOOD TIME TO SAY A FEW WORDS ABOUT GLOBAL RESEARCH IN NCI. ANOTHER THING THE NATIONAL CANCER ACT OF 1971 DID LESS WELL KNOWN NCI ADDRESSED BURDEN OF CANCER NOT JUST UNITED STATES BUT INTERNATIONALLY GLOBALLY SO NCI IS IMPORTANT WAY THAT WE ADDRESS THAT. NCI CENTER FOR GLOBAL HEALTH DEVELOPED RESOURCES WITH THOSE GOALS AND LED BY PAUL AS I MENTIONED. INSTITUTION I RECENTLY WROTE A REVIEW OF THESE CENTER FOR GLOBAL HEALTH ON 10TH ANNIVERSARY IN JAMA SHOWN HERE. DESCRIBES SOME OF THE CHALLENGES THAT THE BURDEN OF CANCER IN LOW AND MIDDLE INCOME COUNTRIES IN PARTICULAR IS GROWING DRAMATICALLY. BUT WE STILL DON'T HAVE AS MUCH RESEARCH IN CANCER GLOBAL -- WE PERHAPS WOULD LIKE. WE THINK WE ARE REALLY IS VERY IMPORTANT THE NCI AND OTHER STAKEHOLDERS TRY TO ADDRESS THIS ISSUE. THROUGH APPROPRIATE MECHANISMS. SO WE HAVE A LOT OF DISCUSSION HOW TO DO THIS, TARGETING AREAS FOR EXTRAMURAL FUNDING ON SCIENTIFIC GAPS AND GLOBAL CANCER CONTROL. AND PROMOTING EQUITY AND GLOBAL CANCER RESEARCH SUPPORTING INDEPENDENT SCIENTIFIC CAPACITY OF INVESTIGATORS AND INSTITUTIONS WITHIN THOSE LOW AND MIDDLE INCOME COUNTRIES THEMSELVES. NEXT SLIDE. ALSO RELEVANCE TO THE GLOBAL CANCER RESEARCH IS THIS EXCITING STATEMENT BY PRESIDENT BIDEN AND PRIME MINISTER JOHNSON, THE G 7 TO BRINGING TO RESEARCHERS AND PATIENTS TO STAKEHOLDERS FROM BOTH COUNTRIES TO LOOK FOR AREAS TO ACCELERATE CANCER PROGRESS IN BOTH U.S. AND UK AND THIS LED TO THE BILATERAL CANCER SUMMIT WILL BE KICKING THIS OFF WITH AN EVENT IN NOVEMBER AND WE ENVISION THE ACTIVITIES WILL CULMINATE IN SPRING OF '22. WE BELIEVE THERE ARE MANY GREAT OPPORTUNITIES FOR THE U.S. AND UK O WORK TOGETHER TO TRY TO END CANCER SUFFERING AND MAKE PROGRESS WITH CANCER PATIENTS. NEB SLIDE. -- NEXT SLIDE. IT IS GOOD TO UPDATE THIS GROUP ABOUT TRAINING. WE BELIEVE THAT TRAINING IN EXTRAMURAL RESEARCH IS PERHAPS THE MOST IMPORTANT THING THE NATIONAL CANCER INSTITUTE DOES OUR DIRECTOR OF THE TRAINING HAS GREAT BLOG ON CHALLENGE AND OPPORTUNITIES TO TRAIN THE RIGHT CANCER RESEARCH WORK FORCE IN THE FUTURE, E IT HAS DETAILS OF EFFORTS TO STIMULATE INCLUSION INNOVATION WITH THE HUGH PROGRAM AND TALKS ABOUT EARLY STAGE SURGEON SCIENCES PROGRAM, DEVELOPMENT OF ACADEMIC CANCER RESEARCH CHALLENGE MS. THE MODERN AREA, NCI IS TRYING TO PROVIDE A NEW TOOL TO INVIGORATE SURGEON IN CANCER. I WANT TO CLOSE MY REMARKS WITH ACKNOWLEDGING THE EXCELLENT SERVICES OF TWO OF THE PARTY MEMBERS DANIELLE LEACH, DANIELLE IS A TREMENDOUS ADVOCATE FOR THE CHILDHOOD CANCER COMMUNITY, SHE IS CHIEF OF COMMUNITY GOVERNMENT RELATIONS TO NATIONAL SOCIETY, CO-CHAIR OF THE PATIENT ADVOCACY STEERING COMMITTEE AND MEMBER OF THE PEDIATRIC PANELIST AND STEERING COMMITTEE. AND ALSO -- RICK BANKS, A MEANINGFUL VOICE FOR CLINICAL TRIALS AND LEAD PATIENT ADVOCATE AND FORMER CHAIR OF STEERING COMMITTEE AS WELL AS PUBLIC CHAIR OF NCRA GLOBAL TRIALS WORKING GROUP. I WANT TO OFFER A A WARM WELCOME, PRESIDENT AND COALITION AGAINST CHILDHOOD CANCER AND CEO OF AMERICAN INDIAN CANCER FOUNDATION. WELCOME TO THE NCRA NEW MEMBERS. THANK YOU FOR DOING THIS. NEXT SLIDE. WITH THAT, I WILL CLOSE AND TAKE ANY QUESTIONS. THANK YOU FOR THE OPPORTUNITY TO SPEAK. >> EXCELLENT. THANK YOU. DO WE HAVE ANY QUESTIONS? I DO WANT TO SAY JUST A COUPLE OF THINGS ABOUT DANIELLE AND RICK. AMAZING ADVOCATES, REALLY CHAMPIONS FOR NCI AND WORK BEING DONE AS RELATES TO RESEARCH ADVOCACY. SO I WANT TO ECHO DR. SHARPLESS'S COMMENTS THAT Y'ALL ARE AMAZING RESEARCH ADVOCATES, I KNOW YOU ARE AROUND AND YOU ARE HERE FOREVER IN OUR COMMUNITY BUT YOU HAVE BEEN A GREAT MENTOR TO ME PERSONALLY COMING ON TO NCRA AND I HOPE YOU WILL CONTINUE TO STAY ENGAGED AND HELP NEW ADVOCATES JOINING AS WELL. DO WE HAVE ANY QUESTIONS FOR DR. SHARPLESS AS RELATES TO THE UPDATE TODAY? VICKIE? >> SO THANK YOU FOR THE WARM WELCOME, DR. SHARPLESS AND I JUST WANTED TO MENTION WITH REGARD TO THIS GROUP THAT BOTH DANIELLE AND I HAVE THE OPPORTUNITY TO WORK ON THE CCDI AND I'M ON THE ENGAGEMENT COMMITTEE SO I WOULD LIKE TO PUT MYSELF UP AS A RESOURCE TO THIS GROUP AS W WE ARE, AS DR. SHARPLESS MENTIONED EXPERIMENTALLY TRYING TO UNDERSTAND HOW DATA IS GOING TO WORK AND HOW TO COMMUNICATE NOT JUST WITH THE SCIENTISTS BUT WITH THE BROADER COMMUNITY AND HOW THEY ENGAGEMENT IS GOING TO WORK, I FEEL LIKE I WOULD LIKE TO OFFER MYSELF AS A GUINEA PIG FOR YOU GUYS GOING FORWARDS. TO SHOW THINGS THAT ARE WORKING FOR US AND ENGAGING BROADER COMMUNITY AND SUCCESS STORY OVER TEN YEARS WITH THIS INITIATIVE. >> THANK YOU FOR THAT OFFER. IT IS A REALLY IMPORTANT TO KNOW THAT IN SOME INSTANCES, SOMETHING ABOUT NCCI IS DIFFERENT THAN NCI DOES. TO FUND A NEW CELL BIOLOGY OR MOLECULAR BIOLOGY RESEARCH AT NCI BUT THE CCDI IS REALLY TRYING TO WORK THROUGH SOME OF THESE ISSUES AROUND DATA ACCESS AND DATA PRIVACY AND DATA SHARING AND THEY ARE HARD ISSUES. NO OBVIOUS RIGHT ISSUE IN SOME INSTANCE THIS IS WHY PATIENT ENGAGEMENT COMMUNITY IS SO IMPORTANT. THERE ARE ARGUMENTS TO BE MADE ON BOTH SIDES. EVERYONE WANTS TO PROTECT PATIENT PRIVACY AND LIMIT DATA SHARING IN THE SAME WAY BUT SAME TIME PROGRES IN CANCER CHILDHOOD RESEARCH, WE LEARN FROM EVERY CHILD COLLECTION OF RARE DISEASE. THE MORE DATA SHARING THE BETTER BUT THERE IS A NATURAL TENSION BETWEEN THOSE TWO VIEWS. I THINK A FALSE PROMISE TO SAY WE CAN HAVE BOTH. NO PROBLEM HERE. THERE ARE SOME -- IMPORTANT ISSUES TO WORK THROUGH. SO THIS IS WHY I THINK THE INPUT OF ADVOCACY VOICES AT THE EARLIEST STAGES IN CONTINUING WITH IS CRITICAL BECAUSE WE HAVE TO EXPLAIN WHY WE DO THIS AND ALSO WHAT STEPS WE CAN TAKE TO PROTECT THE INDIVIDUALS WHOSE DATA WE ARE HOLDING. SO I THANK YOU FOR WORKING ON BENEFIT HALF OF CCBIC AND MORE WORK THERE, INTERESTING ISSUES. >> I HAVE A QUESTION ABOUT CD 2 I HAVE CURIOUS WITH THAT INTERAGENCY TASK FORCE, WILL THE TESTS RECEIVE LOOKING AT HEALTHCARE DELIVERY FOR PATIENTS WITH KNEW DIAGNOSTICS AND TECHNOLOGY INTRODUCED AND SINCE HRSA IS AT THE TABLE WILL THERE BE ACCELERATION OF COVERAGE OR ARE YOU TALKING ABOUT THE IMPACT ON PATIENTS FROM A HEALTHCARE DELIVERY AND COST PERSPECTIVE? >> IT IS AN INTERESTING EFFORT. CMS IS ADVISING THEY ARE NOT SIGNING THE THE MOU IN PART BECAUSE THEY HAD TO THINK THROUGH THESE ISSUES AROUND COVERAGE. WITH THIS COMMIT. OR IMPLIES SOME SORT OF NEW TRACK FOR COVERAGE DECISIONS. THAT'S STILL SOMETHING THAT WE HAVE TO THINK THROUGH. AND CSMS IN PARTICULAR HAS TO THINK THROUGH. SO WE VALUE THEIR ADVICE AN INPUT. BUT HOW FORMAL THE RELATIONSHIP SHOULD BE WITH THIS IS STILL TO BE DETERMINED. BUT I THINK THE VISION AS YOU DESCRIBE IS THE NCI HAS THESE IDEAS, WE HAVE THESE TECHNOLOGIES. WE HAVE DATA FOR CLINICAL TRIALS WE THINK IS OF VALUE, WE ALREADY TRY TO WORK WITH THE FDA A LOT IN -- AROUND DRUGS AND BIOLODGEICS AND THIS IS MORE FORMALIZE SOME OF THE WORK AROUND DEVICES AN DIAGNOSTICS AND WHAT IS ALSO INTERESTING HERE IS FOCUS ON DEVICES AND DIAGNOSTICS APPLICABLE PARTICULARLY APPLICABLE TO RURAL COMMUNITIES UNDERSERVED COMMUNITIES EGO THE INVOLVEMENT WITH HRSA AS WELL. SO I THINK IT IS IT'S THE EFFORT, IT HAS GREAT POTENTIAL. WE HAVE HAD LOTS AND LOTS OF SUCCESSFUL INTERACTIONS WITH THE FDA OVER THE YEARS. I THINK WHAT WE CAN DO WITH HRSA AND HOW BECK USE THIS IS THE WORK BEING ADDRESSED BY THIS SO THIS GROUP NOW PLAN INITIATIVE BUT WE ARE ALL FULLY COMMITTED KICK OFF MOU SIGNING WAS REALLY EXCITING AND SO I'M VERY OPTIMISTIC THIS ACCELERATE DEVELOPMENT OF DEVICE AND AUTHORIZATION OR APPROVAL BY THE FDA BUT INTERACTION -- USAGE IN THE POPULATION BENEFIT FROM THAT. >> HELPFUL BUT THAT IS -- OTHERS MAY HAVE OPINIONS ABOUT THAT AS WELL THEY MIGHT WANT TO SHARE BUT GIVEN WHAT DR. COIL SHARED POVERTY AND WHERE CANCER IS HAPPENING IN RURAL COMMUNITIES BEING ABLE TO HAVE A TASK FORCE FOCUSED ON MAKING SURE THAT IMPLEMENTATION INCLUDES THAT COST COVERAGE IS SO IMPORTANT BECAUSE I THINK WITH RURAL COMMUNITIES SPECIFICALLY ADOPTION TO MU TECHNOLOGIES IS ALREADY A BARRIER TO GET HEALTHCARE PROVIDERS TO ADOPT AND HAVE THE RIGOR OF SCIENCE BEHIND IT BUT THEN IT'S JUST ENOUGH BARRIER TO SAY IT IS NOT COVERED SO WE ARE NOT GOING TO DO IT SO PATIENTS RURAL COMMUNITIES DON'T GET THE BEST OF CARE AVAILABLE TO THEM. SO APPRECIATE THE WORK THAT'S BEING DONE BY THAT TASK FORCE AND HOPEFULLY OUR COMMITTEE CAN BE INVOLVED IN INFORMING ANY DISCUSSIONS AROUND RURAL COMMUNITIER, THE CARE HAPPENING IN RURAL COMMUNITY. >> YOU CAN IMAGINE ONE OF THE -- WE ARE DISCUSSING WHAT DID WE HAVE IN MINDS, ONE PROBLEM TRYING TO ADDRESS, COLORECTAL CANCER SCREENING IS ONE OF THOSE THINGS, IT IS A DIFFERENT PROBLEM IF YOU LIVE IN A URBAN COMMUNITY, EASY ACCESS TO COLONOSCOPY A RURAL COMMUNITY A MALE INTESTINE WOULD BE A BETTER SUITED FOR MANY REASONS. SO THAT PARADIGM IS REALLY ONE OF THE THINGS DRIVING THIS WHOLE INITIATIVE IS WE THINK PROBABLY A LOT OF INSTANCES LIKE THAT WHERE HOW YOU USE DIAGNOSTIC IN TERTIARY CARE CENTER MIGHT BE DIFFERENT FROM PATIENT POPULATIONS AND ONE OF THE THINGS FOR DRIVING NEED. FDA APPRECIATED THE NEED AS WELL. THEY AUTHORIZE THIS TECHNOLOGIES AND IF THEY ARE NOT USED IN APPROPRIATE WAY IT IS NOT HELPFUL TO THE PATIENT COMMUNITY. WIDESPREAD ENTHUSIASM. >> YOU BRING UP AN EXCELLENT POINT AS RELATES TO -- SPECIFICALLY DOWNSTREAM THE COLON OSCOPY IS NOT COVERED AS A SCREENING SO AS WE TALK ABOUT THE FULL SPECTRUM OF THE DEFINITION OF SCREENING, BEING ABLE TO SAY WE HAVE A NEW DIAGNOSTIC AND THE TOTAL PROCESS FOR SCREENING IS COVERED, IS REALLY IMPORTANT. I THINK OTHER CANCERS GET DIAGNOSTIC TESTS THAT FOLLOW-UP THAT CONCLUSIVE COLONOSCOPY NEEDS TO BE COVERED BECAUSE WE ARE SEEING THAT IN OUR COMMUNITY. WHERE THAT FOLLOW-UP AND MET WITH HHS AND OTHERS TO NCMS AND EVERYONE WE CAN TO SAY THAT FOLLOW-UP IS INCREDIBLY IMPORTANT TO GET COVERED. AS WE HAVE TECHNOLOGY WE'LL GET IT COVERED FRONT END. DO WE HAVE ADDITIONAL QUESTIONS FROM OTHERS? >> I HAVE ONE QUESTION. WHAT HAS BEEN OR HAVE IMPACT OF COVID ON CLINICAL TRIAL ACCRUAL ACCRUALS, IN MATURITY OR READ OUT? >> WE ARE STILL COLLECTING THOSE DATA SO WE IN A WAY NATIONAL INSTITUTE IS IMPORTANT PART OF ADDRESSING THIS QUESTION BECAUSE WE COLLECT SOME OF THE BEST DATA AROUND CLINICAL TRIALS WITH FEDERAL GOVERNMENT SO WE HAVE THE CLINICAL TRIALS WHAT IS THE -- CLINICAL TRIALS REPORTING PROGRAM, THAT IS DESIGNATED FROM THE CANCER CENTER AS WELL AS OTHER SOURCES AND THAT KIND OF GETS ON THE VAST MAJORITY OF PATIENTS THAT ARE ON NCI SUPPORTED TRIALS. WE COLLECT DATA IN A REGULAR WAY, SO THAT'S WHY I CAN SHOW THE NCTN DATA IN A STRAIGHT FORWARD WAY. WE HAVE SIMILAR DATA FROM NCOR, DATA FROM DIFFERENT KINDS OF TRIALS, IT IS NOT SIMPLE. THE SLIDE I SHOWED DIDN'T LOOK QUITE AS BAD AS OTHER DATA. ALL DATA SHOW A BIG DOCK IN ACCRUAL MARCH APRIL MAY. SOME TRIALS REBOUNDED NICELY SOME OF HER TRIALS OVERACCRUED LATTER HALF OF 2020, 2021, BUT SOME OTHERS ARE NOT, WE HAD OTHER TRIALS NOT RECOVERED AND WE ARE TRYING TO UNDERSTAND WHY CERTAIN TRIALS SEEM MORE EFFECTIVE THAN OTHERS. WE HAVE NOW STARTED TO SEE REPORTS FROM INDUSTRY AND INDUSTRY IS I THINK A LITTLE CAGEY ABOUT DATA. WE WANT TO ADMIT THIS HAS BEEN A PROBLEM AND THEREFORE IT MIGHT SLOW CLINICAL DEVELOPMENT PROGRAMS BUT AT THE SAME TIME FOR OTHER REASONS DON'T WANT TO ADMIT THE SCOPE OF THE PROBLEM. BUT THERE IS DATA FROM THE UK IN FACT FOR A FEW LARGE PHARMACEUTICAL MANUFACTURERS DESCRIBED. THEIR PROBLEMS IN TERMS OF ACCRUAL OVER THE PENDING PERIOD. I THINK WE NEED A LITTLE MORE TIME TO REALLY AGGREGATE DATA AT WHAT HAPPENED HERE AND DESCRIBE WHAT KINDS OF TRIALS PARTICULAR WHAT KINDS OF TRIALS WHAT KINDS OF PATIENTS MOST EFFECTIVE. MY OVERARCHING SUMMARY TO DATA, THERE'S CLEARLY A BIG IMPACT. WE WILL NO DOUBT SEE SOME TRIALS DELAYED, TAKE LONGER THAN THEY WOULD HAVE TAKEN. WE ALSO I SUSPECT SEE SOME TRIALS TERMINATED BECAUSE OF POOR ACCRUAL AND TRIALS IN, THAT'S VERY UNFORTUNATE. ALL THAT WILL ADD UP TO DELAYED DEVELOPMENT OF NEW THERAPY AND DIAGNOSTICS. SO WE ARE WORRIED ABOUT THIS, WE ARE TRYING TO THINK ARE THERE ADDITIONAL THINGS WE CAN DO TO TRY TO ACCELERATE ACCRUAL AND MAKE UP THIS IF NOT EASY AS YOU KNOW, CLINICAL TRIALS ACCRUAL IS SOMETHING NCI TRIES TO DO. SO IN PARTICULAR WHEN THERE'S STILL LINGERING EFFECTS OF PANDEMIC WE THINK THIS IS A PROBLEM WE ARE JUST GOING TO HAVE TO WORK THROUGH. I DO THINK AT LEAST IN THE NEAR TERM WE WILL HAVE BETTER SUMMARIES STATISTICS OF WHAT KIND OF TRIAL WHAT PATIENT THAT WILL BE I THINK HELPFUL. >> THERE IS A FOLLOW-UP TO THAT I ASSUME MAYBE SOMEONE OR SOME ARM OF AGENCY IS USING THE NATURAL EXPERIMENT THAT HAPPENED EARLIER, SOME STATES KEPT FOLKS AT HOME LONGER, HAVING THE 50 STATES ACTING DIFFERENTLY OR EVEN ACROSS THE WORLD DIFFERENT COUNTRIES ACTING DIFFERENT I ASSUME WE WILL BE ABLE TO DRAW CONCLUSIONS ABOUT SCREENING AND CLINICAL TRIALS BECAUSE WE HAVE THIS NATURALLY OCCURRING WEIRDNESS THAT HAS A DEFINITE. >> WE HAVE A MECHANISM TO FUND THESE NATURAL -- THESE WHEN POLICY CHANGE OCCURS AN CHANGES ADHERENCE TO WAY, AND THAT PRE-DATED THE PANDEMIC. I DON'T THINK WE ENVISION THE SCALE OF THE PANDEMIC FOR THAT MECHANISM BUT WE DEFINITELY HAVE BEEN THINKING ABOUT HOW WE CAN USE THE DRAMATIC CHANGES IN CANCER CARE DELIVERY THAT OCCURRED FOR THESE IMPORTANT POLICY RESTRICTIONS, HEALTH SERVICES RESEARCH, SO THE ROLE OF SCREENING IF 10 MILLION SCREENING EVENS WERE MISSED, THAT PROVIDES AN OPPORTUNITY TO POINT OUT HOW BIG A DEAL THAT IS. IS THAT A REALLY BIG PROBLEM IN THIS SCREENING OR IS THAT NOT SUCH A BIG DEAL. FOR THE MORE FOUR MAJOR CANCERS SCREENED LUNG BREAST CERVICAL AND COLON. SO THAT IS ONE. THE OTHER NATURAL EXPERIMENT PANDEMIC WE ARE VERY EXCITED ABOUT IS CLINICAL TRIALS HAD TO CHANGE HOW TO DO CLINICAL TRIALS SO WE REALLY EMBRACE TELEHEALTH IS WE STARRED DOING CONSENT BY PHONE OR ZOOM CHAT. WE STARTED SENDING IMD DRUGS DIRECTLY TO THE PATIENT HOME RATHER THAN REQUIRING COMING TO THEVATIONAL PHARMACY. WE STARTED DOING CLINICAL TRIALS WITH BIG AUDITING COMPONENT TO VISIT THE SITE AND DO THE AUDITING BY TELEBUSINESS. THESE CHANGES HAVE BEEN BROADLY EMBRACED. THE VAST MAJORITY OF CLINICAL TRIALS STARTED USING THEM AND HAVE BEEN VERY POPULAR, RESEARCHERS LIKE THEM AND PATIENTS LIKE THAT, THE PATIENT DON'T WANT TO HAVE TO COME IN TO CONSENT EITHER WHEN YOU CAN DO BY PHONE. THINGS WE HAVE BEEN DONE IN CLINICAL TRIALS MANY YEARS IN CLINICAL TRIALS WE DON'T NEED TO CONTINUE DOING THINGS THE WAY THE PANDEMIC TAUGHT US. BEST WE DON'T HAVE TO BRING THE FDA ALONG, THEY LIVED THIS WITH US AND THEY WERE VERY GOOD PARTNERS IN HELPING US THINK ABOUT WHAT A PROTOCOL DEVIATION WOULD BE DURING PANDEMIC AND ALLOWING US TO CHANGE OUR RULES AND PROGRAMS. THAT IS A -- ANOTHER SOMETHING WE LEARNED FOR THE PANDEMIC THAT WILL CONTINUE ON. WE ARE NOW STARTING TO FUND GRANTS TO RESEARCH SPECIFICALLY TELEHEALTH. WHAT DOES THE CHANGES IN TELEHEALTH MEAN FOR CANCER CARE, WHAT IS EFFECT ON THINGS LIKE CANCER HEALTH DISPARITIES. WE HAVE LOOKED AT TELEHEALTH USAGE IN RURAL POPULATIONS VERSUS URBAN POPULATION AND NOT SURPRISINGLY IT IS NOT THE SAME. TELEHEALTH IS EASIER TO EMBRACE IN URBAN POPULATIONS WITH INCREASE ACCESS. I PRESUME SOME CANCER CARE ARE PROBABLY NOT EVERYTHING TO DO WITH CANCER RESEARCH IDENTIFYING WHAT IS SAFE BY ELLE THE HEALTH WHICH REQUIRES VISIT IS REALLY IMPORTANT. I ALSO POINT OUT IT IS NOT THE NCI REAL CONTROL STATE LICENSING AND MAL PRACTICE AND PAYERS BUT WE ARE VERY INTERESTED IN WHAT IS HAPPENING THERE. YOU CAN SEE A LOT OF STATE LINE RULES WERE RELAXED DURING THE PANDEMIC SO PATIENT IN KENTUCKY GO TO DOCTOR IN TENNESSEE IN A RELATIVELY STRAIGHT FORWARD WAY BY TELEHEALTH. THOSE RULES ARE NOW REAPPEARING. PAIR AND LIE SENTENCING BOARD RULES ARE BARRIERS CREATED. THIS IS I THINK UNFORTUNATE FOR PATIENTS, PATIENTS ENJOY FLEXIBILITY OF PANDEMIC IN TERMS OF GETTING CARE ACROSS STATE LINES BUT ALSO RESEARCH OPPORTUNITY FOR NCI WITH THE IMPACT OF THOSE POLICY DECISIONS IN THE STATE LEVEL ON PATIENT CARE AND OUTCOME. >> ALONG THOSE LINES I'M WONDERING YOU HAVE SHOWN THAT GRAPH WHERE YOU AD OVERACCRUAL IN CLINICAL TRIALS. IS THAT DEPENDENT, RELATED TO TELEHEALTH, RELATED TO OTHER FACTORS THAT YOU ARE AWARE OF? WHAT DO YOU THINK -- >> THE AVERAGE TPN DATA, THAT'S NOT -- THOSE KINDS OF TRIALS THAT ARE DONE IN NATIONAL CANCER CLINICAL TRIALS NETWORK. THE DATA WOULD NOT LOOK QUITE THE SAME IF I SHOWED YOUR SCREENING TRIALS OR OUR CLINICAL TRIALS ACCRUAL HASN'T RECOVERED QUITE AS WELL. WE DON'T KNOW EXACTLY WHAT I MENTION ONGOING ANALYSIS OF CTRP DATA AS TO WHAT HAPPENED TO CLINICAL TRIALS HAWAII HA IS THE KIND OF QUESTION TO ANSWER IS WAS CERTAIN TRIALS OR CERTAIN PHASE 2 VERSUS PHASE 3 MORE AFFECTED. AND MAYBE WE CAN LEARN WHAT WE'LL DO DIFFERENTLY. WE HOPE CHANGES WE MADE AMELIORATED THE PROBLEM BUT CERTAINLY NOT PREVENTED THE PROBLEM SO NEW PRACTICES THAT WE TOOK ON AT NCI TO HELP ACCRUAL DURING THE PANDEMIC. WE BELIEVE AND HOPE -- WE KNOW THERE ARE WILDLY POPULAR SO WE HAVE ASKED THE PATIENTS AND DOCTORS BUT WE MIGHT BE LITTLE DIFFICULT TO TEASE OUT HOW MUCH IMPACT THEY MADE SINCE WE DID THEM AT ONCE. SO THIS IS ONGOING RESEARCH IN PORTFOLIO THAT WE ARE ACTIVELY CONDUCTING AT THIS MOMENT. >> I THINK THAT IS AN INCREDIBLY IMPORTANT. I MOW PATIENTS WE WORK WITH GOT CAUGHT IN UNEXPECTED POLICY CHANGES IS AS HAIR TRYING TO ACCRUE TO CLINICAL TRIAL THEY WERE -- THEY LOST COVERAGE AS RELATES TO THEIR TELEHEALTH VISITS AND BEING ABLE TO ACCRUE. OUR RESEARCH COMMUNITY SEEM TO LOVE THE ADOPTION BUT OUR ONCOLOGY COMMUNITY, THE PRIVATE PRACTICES THERE WAS CONSIDERABLE LOBBY TO RETAIN THEIR PATIENTS. SO A LOT OF PATIENTS STRUGGLED AND HAD TO GO ACROSS STATE LINES TO FIGHT THESE POLICY CHANGES AND HOP AROUND THE COUNTRY TO MAKE SURE THEY WERE AVAILABLE TO ACCRUE TO TRIALS THEY WERE ACCRUING TO OR TRYING TO ACCRUE TO. SO I THINK WHAT YOU SAID IS IMPORTANT, I THINK IT IS REALLY INTERESTING IMPACT OF ADOPTION OF TELECONSENT AND TELEHEALTH IN CLINICAL TRIAL ACCRUAL WITH INDUSTRY WONDERING INCONSISTENCIES FROM OUR COMMUNITIES AND I DON'T KNOW IF THOSE INCONSISTENCIES ARE THE SAME BUT ANNIE, DO YOU WANT TO SPEAK TO THAT? >> HEARING SOME FRUSTRATION WHEN DR. SHARPLESS MENTIONED NOT HEARING FEEDBACK FROM INDUSTRY AS MUCH ABOUT HOW THEY WERE -- THEIR TRIALS WERE AFFECTED, HEARING FROM DIFFERENT PEOPLE WITHIN OUR COMMUNITIES THAT CERTAIN THINGS WEREN'T ALLOWED LIKE SO MUCH HAD TO BE DONE IN PERSON, SO MUCH WAS STILL STRICT. ON THE INDUSTRY SIDE OF THINGS BUT HA IS OUT OUR CONTROL BUT GREAT COMPARISON TO SAY HEY, NCTN TRIALS APPROVED BECAUSE THEY MADE CHANGES AND IF CERTAIN PLACES WEREN'T MAKING CHANGES, BE NICE WAY TO SHOW THAT IT WORKS. >> REALLY GOOD POINT. THERE WERE I DON'T MEAN TO SOUND CRITICAL. I KNOW THERE ARE REASONS WHY THEY ARE HANDLED THE DATA THE WAY THEY DO. BUT THERE IS A MOVE IN CERTAIN QUARTERS TO BE MORE TRANSPARENT WITH THEIR DATA. WE SEE COMPANIES VARIETY GOOD AND BAD REASONS BECOME MORE INTERESTED IN PEDIATRIC CANCER AND INSURANCE DATA AROUND PEDIATRICS CANCER, Q. IT MIGHT BE POSSIBLE I MENTIONED -- SOMEBODY ELSE RELEASED DATA IN THE UK WITH THEIR ACCRUAL AND MIGHT BE POSSIBLE SURE YOU WANT TO TALK MORE ABOUT THIS. AND I THINK HELPFUL. WE HAVE SAME ISSUE AROUND MINORITY PATIENT ACCRUAL TO CLINICAL TRIALS. WE KNOW WHAT'S GOING ON IN THE NCI WELL, WE LIKE TO KNOW MORE ABOUT INDUSTRY, WE HERE STATEMENTS MADE THAT OUR DATA ARE BETTER THAN THEIRS BUT THEY HAVEN'T PUBLISHED A LOT OF DATA THROUGH FORMAL COMPARISON. SO I THINK BOTH TOPICS WE WOULD LIKE MORE DATA ABOUT WHAT IS GOING ON IN INDUSTRY AND MAYBE THAT BECAUSE OF THE VARIETY OF REASONS TIMES CHANGED A LITTLE BIT IN THE INDUSTRY AND MIGHT BE MORE FORTHCOMING. THAT WOULD BE GOOD FOR GOOD MESSAGE FOR AD HAVE CAN CHASSI TO BRING FORWARD. -- ADVOCACY. SERVING SHARED DATA BUT YOU GUY CONSIST DO THAT, THAT IS A GOOD THING TO TALK ABOUT. THERE ARE LOT OF REALLY GREAT PEOPLE IN THE INDUSTRY WHO WANT TO MAKE PROGRESS FOR ALL PATIENTS WITH CANCER AND I THINK THEY WOULD BE SENSITIVE TO THAT COMMENT BY SHARING DATA AROUND THINGS LIKE CLINICAL TRIALS ACCRUAL DURING THE PANDEMIC OR MINORITY ACCRUAL OVERALL. THAT HELPS THE ENTIRE NATIONAL RESEARCH ENTERPRISE. >> THANK YOU SO MUCH, DR. SHARPLESS FOR JOINING US. APPRECIATE EVERYBODY'S ENGAGEMENT, I KNOW WE HAVE OUR NEXT SPEAKER DR. DANIELLE CARNIVALE FROM THE WHITE HOUSE OFFICE OF SCIENCE AND TECHNOLOGY POLICY. REALLY APPRECIATE YOU JOINING US. TODAY. I WILL TURN IT OVER TO YOU FOR YOUR PRESENTATION -- AMY DID YOU WANT TO JURY IN IN TO SAY SOMETHING? >> WELCOME, DR. CARNIVALE. >> ANJE AND I HAVE BEEN MESSAGING TO SEE IF PEOPLE NEED AD BREAK OR MUSCLE THROUGH. I THINK WE WILL KEEP ON SCHEDULE. THANK YOU SO MUCH, DR. CARNIVALE FOR JOINING US TODAY. NCI DIRECTORS UPDATE WE WERE TALKING A LITTLE BIT ABOUT CLINICAL TRIALS AND TELEHEALTH THE NATURAL EMPERIMENTS AS A RESULT OF THE PANDEMIC AND IMPACT AND IMPLICATION FOR PATIENTS AND THE ROLE ADVOCATES PLAY MOVING ISSUE,, VERY HAPPY TO JOIN US TODAY. WE WILL ADVANCE THE SLIDES, I KNOW YOU HAVE THOSE AND I WILL URN THE IT OVER TO YOU. >> THANK YOU. FOLLOWING NED IS NEVER MY FIRST OPTION BUT HAPPY TO BE HERE GIVING PERSPECTIVE FROM THE WHITE HOUSE SPECIFICALLY THE WHITE HOUSE OFFICE OF SCIENTIFIC POLICY HOW WE ARE THINKING ABOUT THE ADMINISTRATION APPROACH AND PRIORITY ON CANCER. I KNOW THERE'S A LOT OF INTEREST THOUGH MANY OF YOU HAVE BEEN ENGAGED AT LEVELS WITH MY COLLEAGUE, THERE'S CONTINUED INTEREST IN ARPAH AND BE SURE TO TOUCH ON THAT AND HAVE A BROADER PERSPECTIVE ON A LITTLE INCITE HOW I THINK ABOUT THE APPROACH FROM THE WHITE HOUSE AND HEARING INPUTS FROM ALL OF YOU ON WHAT YOU THINK IS MOST USEFUL AND MOST PRODUCTIVE ESPECIALLY FOR THE PEOPLE DIRECTLY IMPACTED BY CANCER PATIENTS AND CAREGIVERS AND FAMILIES. SO ONE HAS BEEN A LOT OF TIME IN CONVERSATION SO HOPE TO GET THROUGH THE FEW SLIDES I PUT TOGETHER QUICKLY. JUST IT IS GOOD TO SEE A LOT OF FAMILIAR NAMES AND FACES ON HERE. MY BIO SHARED BUT I SPENT TIME WITH NOW PRESIDENT BIDEN AS PART OF THE CANCER MOON SHOT AND THE BIDEN CANCER INITIATIVE. BUT ON NEUROSCIENTIST BY TRAINING AND I SPENT LAST WHO YEARS RUNNING A PATIENT ADVOCACY ORGANIZATION IN THE ALS BASE CALLED I AM ALS. SO HAVE A LOT MORE ACT VICTIM IN THESE DAYS AND REALLY EXCITED TO BE BACK WITH LIKE MINDED FOLKS ON THE ONCOLOGY SIDE. IN REPRESENTING THE URGENCY AND SOMETIMES FRUSTRATION BUT VERY MUCH THE DIRECT EXPERIENCE OF THOSE WHO LIVE WITH THIS DISEASE EVERY DAY. AND WHO WE SHOULD BE LISTENING TO LEARNING FROM AND REALLY RESPECTING THE EXPERTISE. FROM PATIENTS AN CAREGIVERS AND THE ORGANIZATIONS AND THOSE WHO REPRESENT. SO GLAD TO BE WITH THIS AUDIENCE. I WANT TO GIVE HOW MY DIRECT BOX, THE PRESIDENT SCIENCE ADVISOR IS HIKING AN'T OUR ROLE AT OSTP. I LOVED THIS QUOTE. THE AMOUNT OF YES SCIENCE AND TECHNOLOGY IS IMPORTANT BUT WHEN APPLY VISION AN OPTIMISM WISDOM ABILITY RIGOR AND INTEGRITY AND COMMITMENT TO ENGAGE IN EVERYONE. SO THAT IS HOW WE ARE THINKING ABOUT EVERY PART OF OUR PORTFOLIO. I BRING THE WORD HUMANITY IN. SCIENCE AND TECHNOLOGY AND THE ADVANCES THAT WE CAN MAKE AND THE INCREDIBLE INVESTMENT THAT NCI AND NIH AND OTHER FEDERAL RESEARCH AGENCIES MAKE POSSIBLE IS INCREDIBLY IMPORTANT BUT THE PEOPLE THAT ARE IMPACTED BY THOSE ADVANCES AND REACH HOPEFULLY IN AN EQUITABLE WAY BY ADVANCES, ARE ESSENTIAL PART HOW WE THINK ABOUT THE JOB THAT WE DO. AND COMPLETE THE PROGRESS THAT WE MAKE TOGETHER. ON THE NEXT SLIDE, I WILL TOUCH ON THE VISION AND OPEN FOR ANY ADDITIONAL COMMENTS OR QUESTIONS ON ARPA H. I KNOW THERE'S IN SOME PARTS OF THE COMMUNITY THERE'S CONCERN IN SOME PARTS OF THE COMMUNITY THERE'S EXCITEMENT. WHAT I SEE THIS IS IS THE PRESIDENT HAS BEEN VERY CLEAR ON HIS WHOLE HEARTED SUPPORT FOR AND BELIEF MT. WORK THAT NIH DOES. IN PARTICULAR THE SUPPORT AND BELIEF FOR WHAT NCI SUPPORTS. AND WAS A HUGE PROPONENT OF ADDITIONAL FUNDING AND CURES ACT AND CONTINUED ONE TIME FUNDING IS HELPFUL BUT NOT PREDICTABLE AND SUSTAINABLE SO CONTINUED BROAD SUPPORT FOR FUNDING OF THE BIOMEDICAL RESEARCH ENGINE THAT IS THE NIH AND IN PARTICULAR NCI. PUT THE PROPOSAL FOR ARPA H OUT THERE AS A VISION FOR ENHANCING WHAT WE ALREADY DO NOT REPLACING IT. I WANT TO BE VERY CLEAR ABOUT THAT. AS I THINK WHAT PART OF THIS IS RECOGNITION IS THAT THERE ARE ASPECTS OF ARPA MODEL THAT WORKED REALLY WELL IN DIFFERENT AGENCIES NOT JUST THE DEPARTMENT OF DEFENSE AND BRINGING THAT VISION AND THAT MODEL TO HEALTH. THERE WAS A LOT OF OPPORTUNITY THERE. IF YOU GO TO THE NEXT SLIDE. SO LAID THIS OUT IN HIS FIRST ADDRESS TO CONGRESS. YOU WILL SEE CANCER MENTIONED SPECIFICALLY BUT REALLY THE IDEA HERE IS TO EVERYTHING THAT WE KNOW AND THAT LAW BEEN UNDERSTOOD ABOUT CANCER AND OTHER DISEASES AND THE BASIC RESEARCH AND EARLY TRANSLATIONAL RESEARCH DONE TO GET US TO THE POINT WHERE WE HAVE EFFECTIVE TREATMENTS IN SOME AREAS IS BECAUSE OF THE NIH. AND YET THERE ARE STILL QUESTIONS THAT WE HAVE NOT ANSWERED. THERE ARE STILL FROM RESEARCH ALL THE WAY TO SOCIETAL APPROACHES REACHING EVERYONE TO EQUITY LENS, THERE ARE STILL THINGS OUT THERE THAT ARE UNKNOWN IN THAT WE HAVEN'T PROVIDED ALL OF THE RIGHT TOOLS AND ANSWERS TO. SO THAT IS THE VISION HERE TO PAIR A VERY SUCCESSFUL NIH AND NCI WITH THIS NEW MODEL THAT NOW ADDRESS THESE THING THAT ARE STILL OUTSTANDING QUESTIONS. THE NEXT TWO SLIDES GOES THROUGH WHAT MANY OF YOU HAVE SEEN IN EITHER ARTICLES WRITTEN AND ERIC AN TARA AND OTHERS I THINK LARRY WAS ON THAT LINE OR OTHER PRESENTATIONS IS REALLY BRINGING TO AN ARPA FOR HEALTH THE VISION THAT HAS BEEN USED ACROSS AS I SAID THE DEPARTMENT OF DEFENSE. IARPA ON INTELLIGENCE SIDE OR EN ENERGY SLIDE SOME ASPECT OF BARTA WHICH MAYBE MORE FAMILIAR WITH BUT BRINGING THIS ADDITIONAL APPROACH TO RESEARCH. AND TO BRINGING THESE NEW SOLUTIONS TO NATIONAL LEVEL. SO FLAT AND DYNAMIC REALLY BRINGING IN LEADERSHIP WHO IS PUT IN A POSITION FOR A AMOUNT OF TIME ENABLED WITH THE ABILITY TO TAKE BIGGER RISKS MAKE BIG BETS AND BRING AN OUTSIDE PERSPECTIVE AND THEN NOT HAVE THEIR CAREER RELIANT UPON THIS SUCCESS OF TWO YEARS IN THIS JOB SO KIND OF FREE THEM IN A DIFFERENT WAY THAN ON MOST OF THE REST OF THE NIH STRUCTURED TO REALLY FOCUS ON BIG PICTURE QUESTIONS AND REALLY STRATEGIC APPROACHES TO SOLVING THEM. AS YOU SEE HERE CREATE DIVERSE COHORT OF PROGRAM MANAGERS, WHO WILL ALSO BE COMING IN, WORKING ON REALLY FOCUSED PROJECT AREAS AND THEN GOING BACK TO WHERE THEIR EXPERTISE BROUGHT THEM TO US FROM, AS I SAID USING AS MANY OF YOU ARE WORKING ON THE SPECIFICS HOW TO DO THIS WITH THE WITHIN EXISTING STRUCTURE OF THE NIH BUT THE VISION OF USING DIFFERENCE MODELS DIFFERENT AUTHORITIES DIFFERENT ABILITIES, OUTSIDE OF THE RO1 STRUCTURE TO ADDRESS SOME OF THESE REMAINING QUESTIONS AND CHALLENGES. HOPING THAT WE GET SOME OF THE BENEFIT WE HAVE SEEN IN OTHER AREAS OF THIS MODEL, NEXT SLIDE. WHAT THIS STRUCTURE WILL ENABLE IS FOR US TO ACHIEVE SOME OF THE GOALS YOU SEE HERE. SUPPORTING TRANSFORMATIVE RESEARCH, THINK SPEEDING APPLICATION AND IMPLEMENTATION OF BREAK THROUGHS, ALLOWING AS I SAID TO GO FROM UNDERSTANDING CHALLENGES BIOMARKER CHALLENGES MOLECULAR CHALLENGES, BUT ALSO SOCIETAL CHALLENGES. BEING ABLE TO BREAK UP THOSE BIGGER QUESTIONS AROUND HEALTH AND NUTRITION OR DISEASE EPIDEMIOLOGY, AND BE ABLE TO BREAK THAT DOWN IN A WAY THAT THE CURRENT SYSTEM CAN'T DO FROM END TO END. BUILDING CAPABILITIES HAVE PLATFORMS, SO THINKING ABOUT ACROSS DISEASE WHAT ARE SOME OF THE CHALLENGES THAT WE HAVE IN OUR ABILITY TO MOVE FROM BASIC UNDERSTANDING TO BREAK THROUGHS THAT MATTER TO PATIENTS AND HOW WE CAN BUILD MORE OF THOSE CAPABILITIES, AND AS YOU SEE HERE THE LAST TWO I'M USING, USE DRIVEN IDEAS AND OVERCOMING FAILURES THROUGH CRITICAL SOLUTIONS OR INCENTIVES. SO I THINK THE TAKE AWAY THAT I WANT TO PUT FORTH HERE IS WHILE A LOT OF PROVIDE FEEDBACK WHILE A LOT OF THESE DETAILS ARE BEING WORKED THROUGH, THE VISION REALLY IS HOW DO WE MAKE PROGRESS WHERE WE HAVEN'T BEEN ABLE TO BEFORE AND WORK REALLY CLOSE WITH OTHER PARTS OF NIH THAT DO INCREDIBLE JOB, EVERYTHING THAT WE KNOW TODAY, AND REALLY THIS WAS A BOLD VISION TO ADD TO THE VERY STRONG SUPPORT PRESIDENT BIDEN HAS FOR THE BIOMEDICAL RESEARCH ENTERPRISE. THE NEXT AREA AND THEN I WANT TO OPEN FOR CONVERSATION ON BOTH PARTS BUT NEXT AREA, NEXT SLIDE. IS WHAT I'M GOING TO BE SPENDING MOST OF MY TIME ON. WHICH IS THINKING WHERE WE ARE IN OUR APPROACH TO CANCER TODAY. WITH THE CENTRAL TENANTS WHAT THE PRESIDENT SUPPORTED PREVIOUSLY AS PART OF CANCER MOON SHOT, URGENCY, FOCUS ON MAKING PATIENT DRIVEN PROGRESS IN THIS GOAL ENDING CANCER AS WE KNOW IT, HOW DO WE ORGANIZE FROM THE FEDERAL GOVERNMENT AND WORK WITH OUTSIDE GROUPS AND ORGANIZATIONS AND PARTNERS TO REALIZE THIS VISION. HOW DO WE WHAT HAVE WE LEARNEDED FROM THE LAST 50 YEARS SINCE SIGNING OF NATIONAL CANCER ACT. WHAT HAVE WE LEARNEDDE LEARNEDDED IN THE LAST FIVE YEARS SINCE LAUNCH OF THE CANCER MOON SHOT ABOUT WHAT IS POSSIBLE, WHAT WORKS WELL, WHERE WE REMAINING ISSUES AND CHALLENGES ARE, AND HOW CAN A FOCUS PRIORITY FROM THIS ADMINISTRATION WHITE HOUSE AND ALL OF FEDERAL AGENCIES CONTINUE TO MAKE PROGRESS FOR PEOPLE THAT MAY LIVE WITH THIS DISEASE. THE WAY I THINK ABOUT THE CENTRAL TENANTS THAT ER GOING TO BE APPLYING FROM THE CANCER MOON SHOT IF WE GO TO THE NEXT SLIDE. IS REALLY THIS AS I SAID URGENCY TO OUR COLLECTIVE APPROACH TO END CANCER AS WE KNOW IT A. BRINGING ALL PARTNERS AND SOLUTIONS TO THE TABLE AS WE KNOW THE CANCER RESEARCH SIDE IS CRITICALLY IMPORTANT BUT MAKING SURE THAT THE RESULTS AND OUTCOMES OF THAT RESEARCH REACH ALL PARTS OF COUNTRY, REACH ALL TYPES OF CANCER AS MUCH AS POSSIBLE IS REALLY IMPORTANT. SO BRINGING IN ALL ASPECTS OF CANCER COMMUNITY AND HEARING THE BEST IDEAS, THE REMAINING ISSUES THAT WE HAVE AND THEIR WILLINGNESS TO TAKE ACTION WITH US IS GOING TO BE AN IMPORTANT PART OF HOW WE THINK ANT OUR APPROACH. PROVIDING AVENUE TO PRIORITIZE WHAT PATIENT AN CAREGIVERS IDENTIFY BEING MOST IMPORTANT. WE ARE GOING TO BE DOING A BROAD ENGAGEMENT EFFORT AND WHILE WE WILL HAVE EVERY ORGANIZATION WE CAN COMING IN AND PROVIDING THEIR PERSPECTIVE WE ALSO WANT THEM TO BRING WITH THEM PEOPLE WHO THEY REPRESENT, PROFESSIONAL SOCIETY, RESEARCHERS AT TABLE, WE WANT PATIENTS AND CAREGIVERS, I THINK TOO OFTEN NOT ANYONE HERE BUT AS A BROAD COMMUNITY, WE TOO OFTEN STRIP AWAY EXPERTISE AND LIVED EXPERIENCES THAT PEOPLE HAVE BEFORE DIAGNOSE WITH CANCER. THEY BECOME PATIENT. AND I THINK WHAT I'M HOPING TO DO IS CHANGE OUR APPROACH AT LEAST FROM OUR WORK HERE AT THE WHITE HOUSE ON THIS AND MAKE SURE THAT WE ARE RESPECTING AND CARING AND BENEFITING FROM FULL RANGE OF EXPERIENCES OF PEOPLE LIVING WITH THE CANCER DIAGNOSIS AND GETTING THEM AT THE TABLE EARLY TO HEAR THEIR NEEDS THEIR IDEAS, THEIR SUCCESSES, CHALLENGES, AS PART OF WHAT WE ARE ORGANIZING, WHAT WE ARE BUILDING, FROM THIS ADMINISTRATION IS IMPORTANT SO LOVE YOUR THOUGHTS ON HOW TO DO THAT REALLY WELL. I HAVE SOME IDEAS BUT YOU ALL KNOW THIS COMMUNITY REALLY WELL. CHANGING THE SYSTEM AND CULTURE TO MEET THE MOMENT I THINK MANY OF YOU WHO HAVE HEARD PRESIDENT BIDEN SPEAK ABOUT HIS PRIORITY O CANCER YOU HEAR SYSTEM WAS BUILT 50 YEARS AGO, WE BENEFITED GREATLY BUT WHAT SHOULD THE SYSTEM LOCK LIKE TODAY AND VISION FOR GOING FORWARD THAT WILL DELIVER ON THE PROMISE WHAT WE HAVE OVER LAST 50 YEARS. THEN LAST DELIVER MILLIONS OF FACING A DEVASTATING DIAGNOSIS AND IN PARTICULAR CANCER DIAGNOSIS IN THIS CASE. THIS IS A PRY YOUR I TORR THE PRESIDENT INCREDIBLE WORK BEING DONE ACROSS THE FEDERAL AGENCIES IN PARTICULAR NCI. BUT I AM HERE TO MAKE SURE WE ARE REALLY LASER FOCUSED ON THIS GOAL OF ENDING CANCER AS WE KNOW IT. DEFINING WHAT THAT MEANS AND GETTING SPECIFIC ABOUT THAT. AND ON MAKING SURE THAT WE ARE AS COORDINATED AS POSSIBLE ACROSS THE FEDERAL EFFORT WHILE HAVING IT OPEN DOOR TO PRIVATE PHILANTHROPIC NON-PROFIT ACADEMIC AND INDUSTRY SECTORS TO HEAR WHAT MORE THEY ARE WILLING TO MAKING SURE THAT AS A COLLECTIVE WE ARE MOVING MANY THE RIGHT DIRECTION TO DELIVER EQUITABLE EXCELLENT SUPPORT AND CARE FOR PEOPLE LIVING WITH CANCER. JUST TO BE REALLY CLEAR, WHEN I SAY THAT LIKE WE HAVE DONE BEFORE WE ARE THINKING ABOUT THE FULL SPECTRUM OF EXPERIENCE FROM PREVENTION THROUGH EARLY DETECTION AND DIAGNOSIS. THROUGH THE TREATMENT AND SUPPORT AND NAVIGATION THROUGHOUT THE TREATMENT PROCESS AND THROUGH SURVIVORSHIP MAKING SURE ALL PARTS OF THAT ARE BEST SUPPORTED WHICH IS WHY IT IS A WHOLE OF GOVERNMENT EFFORT. MAKING SURE WE ARE CONNECTED TO THE BEST EFFORTS MOVING FORWARD FROM THE OUTSIDE AND THAT WE ARE DELIBERATING EQUITABLY ACROSS THE COUNTRY FOR PEOPLE. FACING THIS DISEASE. THAT IS WHAT I WANTED TO PRESENT, THAT'S KIND OF FRAMING BUT ON THE NEXT SLIDE I HAVE A FEW QUESTIONS FOR YOU ON THE BROADER FOCUS ON IMAGINING HOW TO END CANCER AS WE KNOW IT BUT I'M HAPPY TO ANSWER QUESTIONS ON THE FIRST PART AS WELL. JUST TO FRAME WHAT I HAD HERE, AS I SAID, ENDING CANCER IS WE KNOW IT COULD BE TAKEN AS A BROAD STATEMENT THAT DOESN'T HAVE A LOT OF SUBSTANCE AND WE ARE INTERESTED IN CHANGING THAT TO GET VERY SPECIFIC ON HOW DO WE KNOW CANCER, IS IT A DISEASE WE DON'T DO ENOUGH TO PREVENT OR WE DIAGNOSE TOO LATE OR THERE'S INEQUITIES IN SPEECH DIAGNOSIS AND INTO ACCESS TO TREATMENT AND CARE. WE WOULD LOVE YOUR ADDITIONAL THOUGHTS ON IF WE WERE TO MAKE THAT LIST, WHAT YOU THINK SHOULD BE FEATURED THERE BECAUSE THEN THE GOAL WOULD BE TO MAKE ALL THOSE STATEMENTS FALSE AND WE ENDED CANCER AS WE KNOW IT, IT'S -- IF WE HAVE DEFINED ALL WAYS WHICH WE KNOW IT. THAT MAY SEEM TOO SPECIFIC OR MAY NOT HIT IN THE RIGHT WAY WHERE YOU UNDERSTAND OR REALLY CLEAR ON WHAT THE RESPONSE WOULD BE. BASICALLY WHAT ARE THE MOST IMPORTANT CHALLENGES AND I THINK GIVEN URGENCY WE WANT, WHAT ISSUES ARE THEY MOST POISED FOR PROGRESS, WHERE ARE WE REALLY NOT MAKING -- TAKING ADVANTAGE OF A GREAT OPPORTUNITY TO MAKE IT A DIFFERNCE FOR PEOPLE. SO THAT IS A FRAME I WANTED TO PROVIDE BUT I WANTED TO SPEND MOST OF TIME IN CONVERSATION. HAPPY TO HEAR YOUR THOUGHTS. >> SURPRISED NOT EVERYONE HAS THEIR HAND UP BUT KRISTEN YOU CAN TAKE THE FIRST QUESTION. >> I HAVE A QUESTION AND THEN QUICK COMMENT. YOU HIT ON ALL AREAS THAT WE ALL THINK ARE IMPORTANT SO CATCHING CANCER EARLY IS NOTHING NEW. WE ALL WORK ON, I DON'T KNOW HOW YOU PRIORITIZE THOSE. FOR LUNG CANCER. EARLY DETECTION SCREENING. PAYING FOR THAT. ADDRESSING INEQUITIES AND THEN EQUIPPED TO PRECISION MEDICINE AND CLINICAL TRIALS BIOMARKER TESTING. THOSE ARE MY MAIN BUCKET ISSUES BUT JUST ANOTHER SEPARATE QUESTION LIKE HOW DO YOU -- OR DO YOU PLAN -- DO YOU THINK ARPA H WILL INVOLVE PATIENT ADVOCACY ORGANIZATION, FOR DARE GIVES IN THE PROCESS FOR SELECTING PROJECTS OR IS IT JUST GENERAL LIKE INITIAL CONVERSATION. >> THANK YOU FOR THE LIST. I NEVER LEAVE CLINICAL TRIALS GENETICS OR BIOMARKERS ON THE LIST BUT I DIDN'T SEE THEM. THEY SHOULD BE MAJOR PERMANENTLY. SO THANK YOU FOR THAT. TWO THINGS IN RESPONSE. ONE IN DIRECT RESPONSE TO YOUR QUESTION, IT IS THERE WILL BE A WAY FOR PATIENT ADVOCATES AND OUTSIDE ORGANIZE AND GROUPS TO HAVE A CONTINUED SAY. IN WHAT IS HAPPENING AT ARPA H, THOSE STRUCTURE HAVEN'T BEEN, THERE IS A LOT OF STRUCTURAL SIDE AND SOME OF THAT CONGRESS HAS SOME OPINIONS ON AND PERSPECTIVES ON A LOT OF THAT IS YET TO BE DETERMINED, BUT I KNOW IN EVERY CONVERSATION THAT I HAVE HEARD TARA WHO IS LEADING THOSE EFFORTS HERE OR ERIC OR LARRY, FRANCIS HAVE ANY TIME I HEARD HEM TALK ABOUT IT ARE'S BEEN THAT THOUGHT BUILT IN THAT'S A REALLY IMPORTANT PART. >> NICOLE. >> THANK YOU. WE WANT TO BE PART OF THAT. >> EXCELLENT. GOOD TO SEE. >> HI, EVERYBODY. HI, DANIELLE, THANK YOU FOR THAT PRESENTATION. I WANTED TO TRY AND ADDRESS A FEW QUESTIONS ASKED ABOUT WHAT IS THE MOST IMPORTANT OR WHAT ARE THE MOST IMPORTANT CHALLENGES AND THEN WHAT ISSUE AREAS ARE MOST POISED FOR PROGRESS. COMING FROM I WORKED WITH THE AACR AND SUSAN CO-MEN, I WORKED IN DIFFERENT CANCER AREAS WHAT I NOTICE IN BREAST CANCER SCREENING EARLY DETECTION IS KEY. PREVENTION KEY. THE BRAIN TUMOR FIELD, THERE ISN'T PREVENTION ESSENTIALLY. THERE IS NOT EARLY DETECTION. THERE'S NO SCREENING. SO WILL IS A HUGE UNMET NEED. NEED ONE THING SPEAKING FROM THE BRAIN TUMOR PERSPECTIVE BUT ALL CANCERS AS YOU ARE SEEING METASTATIC SURVIVORS. INCREASING INCIDENCE OF METASTATIC BRAIN TUMORS. THE ESTIMATES ARE 100,000 TO 200,000 YEAR, WE DON'T KNOW BECAUSE THERE'S NO STANDARD COLLECTION OF THAT HAVE INFORMATION. WHAT WE DO KNOW IS THERE IS NOT A LOT OF SCREENING FOR BRAIN TUMORS ESPECIALLY PATIENTS HIGHER RISK CANCER LIKE BREAST OR MELANOMA OR LUNG, THEY ARE NOT CONTINUALLY BEING SCREENED. FORWARD METASTATIC BRAIN TUMORS. ASYMPTOMATIC PATIENTS THAT HAVE METASTATIC BRAIN TUMORS, ARE ACTUALLY BETTER RESPOND, THERE'S A BETTER OVERALL SURVIVE FOR IMMUNOTHERAPIES AND TARGETED THERAPIES. SO HUGE UNMET NEED THERE AS WELL AND COULD BENEFIT A LOT OF PATIENTS. >> DO WE HAVE ADDITIONAL COMMENTS? I WANTED TO ASK A QUESTION AND MAKE THE COMMENT, I HAVE CURIOUS ARPA H IS THERE CONSENSUS AROUND WHAT ARE THE UNIVERSAL CANCER ISSUES WHERE WE ALL CAN WRAP OUR HANDS AROUND IT, BIOMARKERS CLINICAL TRIALS, THOSE ARE KNOWN THINGS THAT COMMUNITY IS INTERESTED AND WE HAVE A LEVEL OF URGENCY BEHIND THAT. BUT THERE ARE SPECIFIC CANCER SPECIFIC NEEDS AND CONCERNS AND I'M CURIOUS IF ARPA H WILL BE ABLE TO GARNER CONSENSUS AROUND BIG ONES AN WORK WITH SPECIFIC CANCER GROUPS THAT ARE WORKING IN SPECIFIC DISEASE AREAS THAT HAVE UNIQUE NEEDS WHEN WE DEFINE WHAT IS THAT CANCER, WHAT ARE THOSE BIGGEST CHALLENGES, SOME OF THEM ARE INCREDIBLY UNIQUE TO OUR DISEASE. >> IT IS A GOOD QUESTION. I THINK THERE IS GOING TO BE THAT BALANCE IN ARPA H YOU ALREADY SEE PLAYING OUT IN THAT THERE WERE SOME DISEASES NAMED BECAUSE OF THE IMPACT AND BECAUSE WE KNOW SOME OF THE VERY SPECIFIC CHALLENGES AROUND ALZHEIMER'S DISEASE OR NEURODEGENERATIVE DISEASE AND CANCER SO IT WOULD MAKE SENSE THAT A BOLD NEW APPROACH TO RESEARCHING HEALTH WOULD INCLUDE INVESTIGATION INTO THOSE DISEASES BUT WE ARE ALSO VERY FOCUSED ON MAKING SURE THAT ARP A H IS SET UP IN A WAY THAT IT TAKES ON THE MOST IMPORTANT CHALLENGES AND THE CHALLENGES WHERE THAT MODEL IS BEST APPLIED. I THINK THERE IS A GRATEFUL NEED THAT SOME OF THOSE WILL BE IN SPECIFIC AREAS OF CANCER WON'T JUST BE LOOKING FOR PLATFORM TECHNOLOGIES THAT WILL WORK ACROSS NEUROSCIENCE, NEUROLOGY AND OTHER THINGS. SO A LOT OF THAT IS YET TO BE DETERMINED AND I HATE TO SAY THAT -- YES, THERE'S GOING TO BE A WHOLE PROJECT YEAH FOCUSED ON CANCER AND KNOW THAT'S GOING TO BE TRUE. I HAVE A GOOD FEELING THAT THAT IS GOING TO BE TRUE BUT WE ARE VERY MUCH FOCUSED ON BUILDING THIS MODEL SUCCESSFULLY AND FINDING THE BEST QUESTIONS TO SOLVE OR BEST ISSUES TO SOLVE WITH THIS MODEL. BUT LIKE BACK TO KRISTEN'S QUESTION, ALL OF THIS IS GOING TO INVOLVE CONTINUED INPUT FROM THE BROAD DISEASE COMMUNITY AND ADVOCACY COMMUNITY. AND MANY MEMBERS OF CONGRESS WHO KNOW YOUR PERSPECTIVES VERY WELL BECAUSE YOU ARE GOOD AT WHAT YOU DO. SO I THINK THAT IS GOING TO BE INCORPORATED INTO HOW IT IS SET UP BUT IT IS DIFFICULT, IT IS IMPOSSIBLE RIGHT NOW TO SAY SPECIFICALLY HOW IT IS GOING TO FOCUS ON DIFFERENT AREAS OF CANCER RESEARCH. I KNOW THAT'S UNSATISFYING BUT I'M SORRY. >> GREAT PRESENTATION SO WHEN I THINK OF MAKING PROGRESS IN THIS AREA, I FEEL LIKE IT IS A SPECTRUM THAT WE NEED TO LOOK UP FROM DISEASE PROGRESSION WHICH INCLUDES PREVENTION IF POSSIBLE, BEST THING IS NOT CANCER BUT THEN BEING TREATED AND ACTUALLY BE CURED OF THAT WILL BE THE NEXT BEST OPTION IN MY OPINION, THE LAST OPTION IS NOT DYING OF CANCER, WITH CANCER WITH SOME ONGOING TREATMENT. IN ORDER TO BE ABLE TO USE THAT WE NEED TO THINK ABOUT WHAT DO WE NEED TO DO PREDIAGNOSIS SCREENING TREATMENT VACCINATION PREVENTION. ALSO THE TIMELY DIAGNOSIS AND TREATMENT AND WHAT TO DO POST TREATMENT. SOME CANCER IF NOT MOST HAVE POTENTIAL TO RELAPSE AND BE TREATED FOR THAT AS WELL. THAT IS ALSO THINKING ABOUT THE CANCER BUT AT THE SAME TIME PROBABLY SHOULD THINK ALSO ABOUT DRUG DEVELOPMENT PIPELINE IN HOW TO RESEARCHERS DO RESEARCH FOR DRUG DEVELOPMENT DEVELOPMENT PORTION OF IT, THE CLINICAL TRIAL, IMPLEMENTATION OF THAT DRUG AND ACCESS DISPARITIES FOR THAT AND THEN THE LAST BUDGET I THINK IS SURVIVORSHIP ASPECT OF IT. SO I'M GLAD YOU ARE CAPTURING THAT WORK AND I UNDERSTAND IT IS NOT EASY BUT THANK YOU. >> VICKIE. >> THANKS, DANIELLE. I GUESS ONE OF THE THINGS THIS GROUP CAN DO AND TRY TO COMMIT TO IS WHAT I UNDERSTAND ABOUT OTHER AGENCIES LIKE THIS TRYING TO INCENTIVIZE AND ALIGN MISSION ON HIGH RISK HIGH REWARD PROJECT AND FROM MY BACKGROUND UNDERSTAND THAT HIGH RISK HIGH REWARD PROJECTS HAVE PRETTY BIG PAY OFFS THAT THEY ALSO HAVE THE OPPORTUNITY TO HAVE DISAPPOINTMENTS. THAT'S WHOLE POINT. SO I FEEL LIKE PART OF WHAT WE NEED TO DO IS ADVOCACY COMMUNITY IS BEING EDUCATED AND BE EDUCATORS ABOUT WHAT HAPPENS WHEN YOU DO -- WHEN YOU GO FOR THE BIG HIGH RISK HIGH PRIORITY HIGH REWARD KINDS OF THINGS AND YOU HAVE A SOLINDR,A, WE DON'T WANT TO CAST DISPERSIONS ON PROGRAM IF SOMETHING WE TRY DOESN'T PAN OUT AND I THINK INVOLVING ADVOCATES EARLY AND HAVING US BE EDUCATED ABOUT WHAT YOU ARE TRYING FOR AND WHY IT'S IMPORTANT SO THAT WE CAN TALK TO OUR COMMUNITIES IS IMPORTANT AS ANYTHING YOU CAN BE DOING IN TERMS OF DECIDING WHICH THINGS YOU ARE GOING TO DO, WHICH YOU ARE NOT GOING TO DO. >> I USE TRANSFORMATIVE ON THE SLIDE AND I THINK IN OTHER PLACES IT IS SAID HIGH RISK HIGH REWARD, I ALWAYS HESITATE TO USE THAT NOMENCLATURE BECAUSE I DON'T THINK JUST BECAUSE A PROJECTED OR A PROBLEM HASN'T BEEN SOLVED BY EXISTING SYSTEM, IT DOESN'T MEAN IT WOULD TAKE A HIGH RISK APPROACH. I THINK THE HIGH REWARD PART IS STILL TRUE. BUT I THINK IT COULD SOMETIMES JUST MEAN THAT IT NEEDS A DIFFERENT MODEL DIFFERENT APPROACH AND THAT IS PART OF WHAT ARPA H PROPOSAL IS TO GET TO. THERE IS A LOT OF THE LANGUAGE YOU ARE 100% RIGHT THAT TAKES FAILING FAST IF YOU ARE GOING TO FAIL AND BEING ABLE TO MOVE ON AND TAKING A DIFFERENT RISK ASSESSMENT THEN OTHER PARTS OF THE BIOMEDICAL RESEARCH SYSTEM FROM FEDERAL GOVERNMENT CAN. I WOULD LIKE TO INSERT THAT, IT DOESN'T ALWAYS MEAN IT IS HIGH RISK. OR THAT WE ARE GOING TO FAIL MORE. JUST MEANS THE MODEL -- THE CURRENT MODELS WE HAVE, DON'T SOLVE THIS PROBLEM WELL. SO BALANCING THAT WITH A NEW MODEL IS PART OF THE APPROACH. >> THERE ARE GOING TO BE DISAPPOINTMENTS. AND WE JUST NEED TO RECOGNIZE THAT WE HAVE TO BE WORKING TOWARDS SOLUTIONS EVEN THOUGH IT MIGHT NOT BE A STRAIGHT PATH. >> THE OTHER ASPECT OF THE COMMUNICATION WITH ADVOCACY AND BROADER CANCER AND DISEASE FOCUS COMMUNITY IS THAT WE RECOGNIZE AND OTHERS HAVE SPOKEN TO THIS BUT JUST TO PUT A POINT TO IT, WE RECOGNIZE THE DARPA MODEL IN PARTICULAR THERE IS A CLEARER PRODUCT AND PURCHASER MARKET RELATIONSHIP IN A LOT OF THE TECHNOLOGY DEVELOPMENTS AND SOLUTIONS THAT ARE DEVELOPED BY DARPA ARE THEN PURCHASED BY THE DEFENSE DEPARTMENT. THAT'S THE POINT. SO HAVING A MUCH MORE GROUNDED CONVERSATION WITH THOSE WHO WILL BE THE RECIPIENTS OF THE PRODUCTS AND ADVANCES THAT COME OUT OF AN ARPA H IS GOING TO BE REALLY IMPORTANT PART OF THAT IS WHAT ARE THE CONNECTIONS AND INTERSECTIONS AND CONVERSATIONS THROUGHOUT DEVELOPMENT PROCESS THAT ARE BEING HAD WITH FDA. AND IF REGULATOR AND CMS IS KIND OF THE PURCHASER. AND IN A LOOSE WAY, BUT FULLY RECOGNIZING THAT CMS IS PARTLY THE PURCHASER BUT PATIENT IN THAT CONVERSATION WITH THEIR CLINICIAN, IS REALLY RARE IF DECISION MADE TO WHETHER DIAGNOSTICS OR PREVENTION METHODS OR TREATMENTS ARE GOING TO BE USED. WE CANNOT FOLLOW THOSE THINGS UP FRONT IN THE COMPLEX SYSTEM OF PROBLEMS THAT ARPA H IS TAKING ON BUT I KNOW THAT I RECOGNIZE THAT AND WE HAVE HAD CONVERSATIONS WITH MY COLLEAGUES TOO THINKING AN'T HOW TO SOLVE FOR THAT OR AT LEAST APPRECIATE THAT COMPLEXITY ON THE PROJECT LEVEL IF NOT AT THE BROADER AGE LEVEL SO THAT THAT VOICE OF WHAT IS GOING TO HAPPEN IN THAT CONVERSATION BETWEEN THAT PHYSICIAN AND THE PERSON IN THE ROOM IS THOUGHT OF AND HA WE DON'T END UP CREATING THINGS THAT AREN'T USEFUL TO THE HEALTHCARE SYSTEM IS REALLY IMPORTANT. >> SO GLAD YOU BROUGHT UP TECHNOLOGY I WAS GOING TO PIGGY BACK ON WHAT YELAK HAD SAID ABOUT THE PRIORITY, FIRST WE WOULD LIKE THE PREVENTION DETECTION TREATMENT AND ON THE SURVIVOR END WE WANT TO LIVE WELL, WITH OR WITHOUT CANCER IF YOU ARE A MUTATION CARRIER, YOU WOULD LIKE RISK REDUCING OPTIONS CASTRATION, BUT WHY SEEING THE PROGRESS JUST SINCE I WAS DIAGNOSED IN 2004 WE GOT HPV VACCINATION FOR CERVICAL CANCER ON THE GYN SIDE AND PEOPLE WITH OVARIAN CANCER, PRETTY MUCH DEADLY DISEASE AND IS NOW CONTROLLED. THROUGH TARGETED THERAPIES AND WHAT WE ARE WILLING TO DO FOR CONTROL WHAT WE ARE WILLING O DO FOR CARE, THE TOXICITIES ARE -- CAN BE DIFFERENT SO I THINK THAT IS PART OF THE CONVERSATION, AS THINGS ROLL OUT BUT WHAT I ALSO THINK OF WHO HASN'T BEENED FROM THE TECHNOLOGY, THIS EXPLOSION, TECHNOLOGY EDEN HAVE A FEW YEARS AGO SHOWS HOW COMPLICATED THINGS CAN BE. WHO HASN'T HAD DIRECT ACCESS TO SOME OF THESE THINGS AND I REMEMBER SEEING SOMETHING AT AACR A FEW YEARS AGO, THERE WAS A MICROSCOPE THAT HAD AI AND YOU CAN LOOK PATHOLOGIST IN A REMOTE PLACE LOOK AT SOMETHING AND THE OVERLAY OF GENOMICS SIGNATURES AND WHATEVER AND I JUST THOUGHT HOW WONDERFUL IF THAT COULD BRING CANCER CENTERS TO EVERYWHERE. WORLDWIDE AND BECAUSE BASICALLY YOU DON'T GET TREATMENT UNTIL YOU GET YOUR DETECTION. UNTIL YOUR DIAGNOSED. JUST GETTING BASIC -- YOU WANT TO GET DETECTED WHEN CURE IS STILL ON THE TABLE SO WE WANT EARLY DETECTION, WE WANT THE BEST DETECTION, WE WANT THINGS THAT WILL HELP INFORM WHAT THAT FIRST TREATMENT SHOULD BE FOR US. WE KNOW IT CAN BE WIDELY VARIABLE. THANK YOU FOR THE WORK AND THANK YOU FOR INCLUDING THE PEOPLE WHOLE ARE LIVING WITH CANCER. AS PART OF THIS COMPONENT. THANK YOU. >> HANKS FOR THE COMMENTS. KEVIN WE'LL GET TO YOU IN A SECOND. I WANT TO SAY ONE THING. AMY IS FREE TO SHARE MY CONTACT INFORMATION IF SOMEONE WANTS FOLLOW-UP ON THIS WHILE ON ANYTHING BUT IN PARTICULAR WE ARE IN CONVERSATION WITH OUR NCI COLLEAGUES AND CDC COLLEAGUESES AND TRYING TO FIGURE OUT WHAT MORE FEDERAL GOVERNMENT CAN DO, ALSO ARE LOOKING FOR EFFORTS WORKING TO EXPAND EFFORTS THAT ARE GOING ON, ON THE OUTSIDE TO COMBAT THIS DEFICIT THAT PANDEMIC GETTING THE RECOMMENDED SCREENING AND WE KNOW NCI PUT OUT THE NUMBERS AT LEAST IN BREAST AND COLON CANCER OF UP TO 10,000 ADDITIONAL IN THE NEXT DECADE ALREADY BECAUSE OF DETECTING CANCER LATER THAN WE WOULD HAVE OTHERWISE WHEN LESS TREATABLE. THERE IS A LOT TO BE WORKING ON RIGHT NOW, PUBLIC HEALTH SYSTEMS ARE OVER TAXED AND PUT THE PANDEMIC. BUT THERE IS STILL AN URGENCY CATCHING BACK UP AND BRINGING THIS MESSAGE TO AS MANY PEOPLE AS SO WE WANT TO BE GOOD PARTNERS AND USING THE MEGA PHONE WHERE WE CAN TO SHARE THE GREAT WORK THAT IS HAPPENING FROM ORGANIZATIONS AND COMPANIES AN HEALTHCARE PROVIDERS ACROSS THE COUNTRY. SO IN PARTICULAR ON THE SCREENING SIDE ACROSS ALL SCREEN EASILY SCREENED CANCERS THAT HAVE THAT RECOMMENDATION FOR FOLKS, PLEASE SEND ME WHAT Y'ALL ARE ALREADY DOING OR WILLINGNESS TO DO MORE AND WE ARE GOING TO BE STARTING THERE. NO MATTER WHAT IS HAPPENING WITH THE PANDEMIC THIS IS GOING TO COST LIVES IF WE DON'T GET BACK TO WHERE WE SHOULD BE. THANKS FOR GIVING ME THE OPPORTUNITY TO SAY THAT. KEVIN. >> THANKS FOR GREAT PRESENTATION. THIS IS A CONCEPT OF BOLD AND EXCITIN AND HOPEFUL ADVANCEMENT AND A DAUNTING TASK TO SAY THE LEAST. I ENJOYED YOUR LAST STATEMENT THAT SAID DELIVER I'M HOPEFUL BY MILLIONS OF FAMILIES THEY SEE THE DEVASTATING DIAGNOSIS. AT HEART OF THE MATTER FOR A LOT OF US DRIVES THE PATIENTS. AND THE CHALLENGES THEY FACE AND OPTIONS THAT ARE BEING OFFERED TO THEM. I ENYOUD THE NIMBLENESS OF THIS PROGRAM. MY QUESTION MIGHT BE A LITTLE VAGUE. BUT I AM LOOK FOR A LITTLE DIRECTION. CAN YOU TELL US WHAT THE NEXT STEPS ARE NOR ARPA TO FULFILL ITS AMBITION MAYBE IN PROCESS OR TIMING? >> YEAH. I THINK THAT IS A PRETTY DIRECT QUESTION, THE ANSWER MAY BE A LITTLE LESS DIRECT BECAUSE THERE WAS A LOT OF ASPECTS THAT HAVE TO COME TOGETHER TO MAKE THIS REAL. SUBMITTED TO THIS AND NIH FULLYE- COMMITTED TO THIS BEING REALIZED. THE REQUEST IN THE SHORT TERM IN APPROPRIATION AS WAS SHOWN EARLIER, 6.5 BILLION WOULD BE AVAILABLE OVER SEVERAL YEARS TO GET THIS SET UP AND GET PROJECTS GOING. THERE'S BEEN A LOT OF INTERESTING CONGRESS AS WE ALL SIT ON SEPTEMBER 29 WE DON'T HAVE AN APPROPRIATION BILL OR CONTINUING RESOLUTION FOR NEXT YEAR SO THERE'S LOTS OF BUDGETS THINGS TO BE FIGURED OUT. THE GOOD NEWS IS BECAUSE OF ADVOCACY FOR MANY OF YOU AND BELIEVE FROM MANY REPRESENTATIVES IN CONGRESS IN MAKING PROGRESS ON THESE ISSUES, THERE IS SUPPORT FOR LEAST SOME INITIAL FUNDING IN INVESTMENT OF $3 BILLION RANGE. FOR ARPA H STARTING MENTION YEAR. WE HAVE A REALLY HOPEFUL THAT IT ENDS UP MANY THE PACKAGE MOVING FORWARD. AND GIVES THE ADMINISTRATION AND THE LEADERSHIP AT NIH THE OPPORTUNITY TO GET PEOPLE IN PLACE TO GET THE LISTENING AND THE FEEDBACK IN A MORE CONCRETE WAY FROM THE EXTERNAL GROUPS AND TO START TO DEVELOP SOME INITIAL PROJECTS. SO I THINK THERE IS NOT A DEFINITIVE TIME LINE BUT THE PROSPECT IS THAT THIS COULD BE INITIATED IN THE COMING FISCAL YEAR AND THAT WE CAN SEE SOME PROJECTS START TO MOVE EVEN IN THAT TIME LINE WHILE THE MORE FULLSOME PLAN AND STRUCTURE AND LEADERSHIP IS DETERMINED. >> THANK YOU. >> OF COURSE. >> YOU HAVE A CRYSTAL BALL TO NOTE THAT'S GOING TO HAPPEN IN THE NEXT 48 HOURS I WOULD LOVE TO KNOW. I PREFER TO COME TO WORK ON FRIDAY. >> I WISH WE DID. I WISH WE DID. AS A FOLLOW-UP QUESTION TO KEVIN I'M CURIOUS, WHAT IS THE ROLE DO YOU SEE FOR NCRA FOR THIS COUNCIL AS COUNCIL OF ADVOCATEDS IN A GROUP THAT'S VERY INVOLVED WITH NCI RESEARCH PROJECTS ACROSS THE RESEARCH ENVIRONMENT FOR ACROSS DISEASES AND IN CANCER. HOW CAN WE SEE ENGAGED DO YOU SEE US STAYING ENGAGED. AND/OR WOULD YOU LIKE US TO HAVE YOUR EMAIL AND SENT TO YOU SPECIFIC QUESTIONS AFTER. >> HAPPY TO HOW WE DO THAT ALWAYS. WE WORK FOR AMERICAN PUBLIC BUT MOST SPECIFICALLY YOU AND PEOPLE YOU REPRESENT. SO ALWAYS HAPPY TO ANSWER QUESTION AND PROVIDE AS MUCH INFORMATION A Z WE CAN. I THINK RIGHT NOW TARA SWETS IS TAKING THE INCOMING AND WOULD HAVE AN IDEA HOW TO BEST ENGAGE OVER THE COMING MONTHS FROM THE WHITE HOUSE PERSPECTIVE BUT VERY QUICKLY, THAT'S GOING TO BE TURNING TO LEADERSHIP AT NIH AND QUICKLY EVEN IN THE SHORT TERM INITIAL LEADERSHIP OF AN AR PARKS H. SO -- ARPA H. SO I DON'T HAVE THE FULL ANSWER ON THAT EXCEPT THAT I KNOW FROM MY OFFICEND MY COLLEAGUE TARA, SPECIFICALLY FOCUSED ON ARPA WERE HERE TO HEAR YOUR INPUT AND TO UNDERSTAND WHAT YOU THINK IS THE BEST WAY TO INTERSECT GOING FORWARD. HAPPY TO CONNECT BACK TO LOCAL LEADERSHIP MORE FOCUSED LEADERSHIP AS THAT GETS DEVELOPED. >> THANK YOU. >> I DIDN'T JUST SAY TELL AMY. SO I TOOK RESPONSIBILITIES. >> VERY EXCITING. HOW -- DO WE HAVE ANY ADDITIONAL COMMENTS OR THOUGHTS FROM THE GROUP? >> I APPRECIATE THE OPPORTUNITY TO TALK TO Y'ALL, THIS IS MY FIRST GROUP I HAVE SPOKEN TO SINCE I HAVE BEEN BACK. I CAME TO THE SOURCE TO START, EXCITED TO BROADEN OUR ENGAGEMENT AND START WORKING WITH MANY OF YOU ON ONGOING BASIS. >> YOU CAN FIND ME. >> >> THANKS TO DANIELLE FOR DOING THIS, APPRECIATE FRIEND SO CLOSE TO PRESIDENT AND WHITE HOUSE ADVOCATING FOR CANCER PATIENTS AND THE NCI IS LUCKY SUCH AGREEING COLLEAGUE AND YOU CAN SEE FROM HER TALK TODAY APPRECIATE HER COMING AN MAKING THIS HER FIRST PUBLIC, SO THANK YOU O MUCH FOR DOING THIS. >> THANK YOU. >> THANK YOU, DANIELLE, SURE THAT ANJEE WILL AGREE, THE BOARD WILL KEEP IN TOUCH AND DON'T TO CHECK IN AS THINGS EVOLVE AND WE WILL PASS ALONG YOUR CONTACT INFORMATION. TO THE MEMBERS. VINGLY. -- INDIVIDUALLY. >> FANTASTIC. THANKS. >> THANK YOU. I FEEL LIKE WE CAN HEAR YOUR ADVOCACY VOICE ON BEHALF OF CANCER PATIENTS SO I THINK THAT GIVES US HOPE. THANK YOU VERY MUCH >> IT'S VERY MUCH THERE. I APPRECIATE THAT. YOU COMBIES ARE DOING INCREDIBLE WORK -- GUYS ARE DOING INCREDIBLE WORK. THE HARDEST WORK. THANK YOU FOR DOING IT. >> RY IF I CAN. THANKS -- TERRIFIC. THANKS FOR A GREAT KISS CUSS AND THINKING THROUGH WHAT DR. CARNIVAL PRESENTED AND COMING BACK HELPFUL AND REEL RENT FEEDBACK. I WILL TURN IT TO, ANJE TURN IT TO YOU FOR THE NEXT STEP. >> GREAT PRESENTATION REALLY APPRECIATE GETTING THAT UPDATE. A LOT OF US ARE INTERESTED IN WHAT'S HAPPENING AT ARPA H. NEXT WE HAVE MS. GIB BONNES DEPUTY DIRECTOR OF NCI OFFICE OF GOVERNMENT CONGRESS A RELATIONS. AND WE INVITE HER TO PROVIDE HER PRESENTATION. I THINK YOU ARE ALSO WAITING PROBABLY ON PINS AND NEEDLESS AS RELATES TO WHAT'S HAPPENING. >> GOOD AFTERNOON, EVERYONE. THANKS SO MUCH AS ALWAYS FOR THE OPPORTUNITY TO SHARE AN UPDATE. A DR. SHARPLESS ALLUDED TO AND LIKELY FOLLOWING IN THE PAST IT'S A PARTICULARLY BUSY >> NEXT SLIDE PLEASE. SO I WANT TO START HERE, THIS IS WHERE I STARTED THIS WEEK AS I THOUGHT ABOUT HOW TO SORT THROUGH AND LAY OUT ALL THIS THIS INFORMATION STRAIGHT FORWARD WAY POSSIBLE. SO THIS SELECTION OF HEADLINES FROM MONDAY DOES A DESEPTEMBER JOB OF DESCRIBING WHAT A -- ADECENT JOB DAUNTING SERIES OF TASKS CONGRESS HAD AHEAD OF THEMSELVES AT START OF THE WEEK AND HOW UNCERTAIN THE OUTLOOK WAS AND PRIORITIES STILL IS AS WE MAKE OUR WAY THROUGH THE WEEK. I COULD ONLY FIT SO MANY HEADLINES ON ONE SLIDE FROM ON BRINK HANGING BY A THREAD. NONE OF THE NEWS COVERAGE IS PARTICULARLY REASSURING. BUT I DO WANT TO SAY CAUTIOUSLY OPTIMISTIC PROSPECTED FOR CONTINUE RESOLUTION AS I REFERENCE CR LOOK MORE PROMISING BUT BEFORE I GO INTO MORE DETAIL, I WANT TO WALK THROUGH THE FOUR COMPETING AND SOMEWHAT INTERTWINED PRIORITIES THAT CONGRESS IS WRESTLING WITH. NEXT SLIDE PLEASE. SO MANY THE INTEREST OF TIME I WILL TRY TO KEEP IT FAIRLY BIG PICTURE. AND HAPPY TO ANSWER QUESTIONS IF WE HAVE TIME. ESSENTIALLY THERE ARE FOUR KEY LEGISLATIVE PRIORITIES THAT HAVE COME TO A HEAD THIS WEEK. ALL WITH VARYING LEVELS OF URGENCY AND PAR ZAHNSHIP. FIRST -- PARTISANSHIP. THE PROSPECTION OF FUNDING THE GOVERNMENT AAVERTING A SHUTDOWN AS WE DISCUSSED FISCAL 2021 ENDS TOMORROW AND CONGRESS MUST PASS A CONTINUING RERESOLUTION. WE DO HAVE SOME GOOD NEWS. SENATE IS PREPARING FOR A VOTE ON THE CR. THEY HOPED FOR THAT VOTE TODAY. IT MIGHT SLIP TO TOMORROW WHERE HOUSE VOTES IMMEDIATE TO FOLLOW EXPECTED TOPAZ BOSS CHAMBERS BUT THEY ARE WORKING OUT BUMPS ANADEM TAILING BUT HOPEFULLY AVERTING A SHUT DOWN THE US IS EXPECTED TO REACH DEBT LIMIT MID OCTOBER. IF DODGE CAM COME THE AGREEMENT OR RAISE OR SUSPEND THE DEBT LIMIT THE U.S. RISK RUNNING OUT MONEY PAY BILLS WITH SERIOUS IMPLICATIONS FOR THE CRY'S CREDIT AND MORE BROADLY THE GLOBAL ECONOMY. THE SENATE PASSED ADMINISTRATION BIPARTISAN INFRASTRUCTURE BILL AND TRANSPORTATION AND AMERICA ACT OTHERWISE KNOWN AS INVEST IN AMERICA ACT OR THE BIF YOU MIGHT HAVE HEARD THAT PREFERENCE. THEY REACHED CONSENSUS ON $1.2 TRILLION PACKAGE WHICH SENATE PASSED IN AUGUST. BIPARTISAN BILL OF 69-30. INCLUDES $550 BILLION OF NEW MONEY SET ASIDE FOR RHODES BRIDGES TRANSIT AMTRAK CLEAN DRINKING WATER ACCESS TO HIGH-SPEED INTERNET AND CLIMATE CHANGE IS ALSO A FOCUS. FOURTH DEMOCRATS BEGUN THE BUDGET RECKOR RECONCILIATION PROCESS. AFRO SEE DO YOU RECALL MOVER THAT BEGINS ADOPTING RESOLUTION AND ENDS WITH SENATE HAVING THE ABILITY TO PASS THE FINAL RECONCILIATION PACKAGE BY SIMPLE MAJORITY VOTE. ALLOWING THEM TO SIDE STEP THE SENATE FILL BUSTER AND 60 BILL THRESHOLD. MAKING A VERY, VERY LONG STORY VERY SHORT, THE DEMOCRATS HAVE CRAFTED A RECONCILIATION PACKAGE INITIALLY AT A SCOPE OF 3.5 TRILLION BUT NOW SHRINKING. THAT INCLUDES THE ADMINISTRATION HUMAN INFRASTRUCTURE PRIORITIES FROM EDUCATION TO PAY FAMILY LEAVE, PROVISION ADDRESSING ARPA H. POTENTIAL EXPANSION OF CERTAIN COMPONENTS OF MEDICARE AND MEDICATED. AMONG MANY OTHER PROVISIONS. SO THOSE ARE THE COMPETING PRIORITIES. SO HOW AND WHEN EACH OF THESE PRIORITIES MOVE FORWARD CHANGED SIGNIFICANTLY OVER THE PAST WEEK. DEMOCRATS HAD HOPED TO MOVE A DEBT LIMIT INCREASE FORWARD AS PART OF THE CR PACKAGE, HOWEVER, REPUBLICANS OPPOSED TYING THEM TOGETHER. AND INITIALLY TO ADDRESS VARYING INFRASTRUCTURE PRIORITIES AS WELL AS DIFFERENT ACTIONS, OF THE DEEM CALFIC CAUCUS IN THE HOUSE, THE HOUSE HAD PLANNED ON ADVANCING THE INVEST IN AMERICA ACT AND BUDGET RECONCILIATION WITH VOTES ON THE SAME DAY. MODERATES ASSISTING UPON A VOTE ON THE INVEST ACT FIRST PROGRESSIVE CONTINUE TO INSIST REACH AGREEMENT ON THE BUDGET RECONCILIATION PACKAGE AND HUMAN INFRASTRUCTURE PRIORITIES BEFORE MOVING TO THE INVEST ACT. SO THOSE PARALLEL TRACKS ON THE LEFT ARE NO LONGER POSSIBLE. AS THE WEEK GOES ON THE OUTLOOK IS MORE LIKE THE IMAGE ON THE RIGHT. I DECIDED NOT TO GO WITH THE COLLISION AND TWISTED TRACKS I HOPE THERE'S STILL TIME TO AVOID THAT. NEXT SLIDE PLEASE. BEFORE I MOVE TO TALK MORE ABOUT THE CR AND FY 2 # 2 APPROPRIATION MORE BROADLY I DID WANT TO REVISIT HEADLINES TO GIVE A SENSE HOW THINGS ARE EVOLVING SINCE MONDAY MORNING. SO ON MONDAY EVENING SPEAKER PELOSI HELD A CLOSED DOOR MEETING AND INDICATED NO LONGER POSSIBLE FOR THE TWO INFRASTRUCTURE PAPA DAMAGES TO MOVE FORWARD TOGETHER AND THEN A VOTE ON RECONCILIATION PACKAGE WOULD BE DELAYED. MANY PROGRESSIVE DEMOCRATS COMMITTED TO VOTE AGAINST THE BIPARTISAN PRODUCT PACKAGE IS IF THERE IS NOT CONSENSUS AROUND THE LARGER RECONCILIATION PACKAGE FIRST SO IT IS MUCH LESS LIKELY NOW THAT HOUSE DEMOCRATS WOULD HAVE THE VOTES TO PASS THE INVEST ACT ON THEIR OWN TOMORROW. UNCLEAR WHETHER VOTE WILL HAPPEN OR BE DELAYED IN ORDER TO CONTINUE MOVING THE INVEST ACT AND RECONCILIATION PACKAGE FORWARD ON PARALLEL TRACKS. ALSO ON TUESDAY MORNING, TREASURY SECRETARY JANET YELLEN TOLD CONGRESS THE U.S. WILL BEFAULT ON DEBT ON OCTOBER 18 IF CONGRESS DOES NOT TAKE ACTION TO RAISE THE DEBT CEILING. SO AFTER THAT ANNOUNCEMENT SENATE MAJORITY LEADER HUMANER TOOK STEPS TO SEEK A BIPARTISAN AGREEMENT, JUST 50 VOTES. WOULD HAVE REQUIRED ALL 50 REPULICANS SENATORS TO CONSENT AND SENATOR TED CRUISE OF TEXAS INDICATED HE OBJECTED. SO MENTION STEPS ARE STILL UNCLEAR. AS EVIDENCE FROM THIS TWEET FROM BUDGET REPORTER YESTERDAY AFTERNOON, IT IS A BIT OF A MASH UP OF THINGS SHE WAS HEARING FROM DEFERENT MEMBERS OF THE CONGRESS. BUT RECONCILIATION IS OFFICIALLY ON THE TABLE FOR RAISING DEBT LIMIT BUT IS ALSO NOT A GREAT OPTION AND ALSO A NON-STARTER AND MAY ALSO MAY NOT BE ON THE TABLE. THAT'S WHERE WE WERE ON TUESDAY AFTERNOON. HERE ARE A FEW OF THE HEADLINES WE WOKE UP TO THIS MORNING. SO AS I HAVE ALLUDED TO PARTISAN AND INTERPARTY DIVIDES COMPLICATE THE INFRASTRUCTURE BILL STRATEGY. GOOD NEWS IS THAT A CR IS MOVING FORWARD. SENATE INITIATED THAT PROCESS LAST NIGHT WE EXPECT TO SEE A VOTE VERY SOON POTENTIALLY TOMORROW, FOLLOWED BY A VOTE IN THE HOUSE SO LOOKING MORE LIKELY WE WILL AVERT A SHUT DOWN HOPEFULLY SEVERAL HOURS IN ADVANCE OF FISCAL YEAR COMING TO A CLOSE. HOUSE ALSO EXPECTED TO ON SEPARATE DEBT LIMIT INCREASE. WHILE LIKELY PASSENING THE HOUSE IT APPEAR UPS UNLIKELY IN THE SENATE. SO THIS IS JUST A RECAP OF VARIOUS CONTINUING RESOLUTION PACKAGES THAT TRIED AND FAILED TO MOVE FORWARD THE PAST WEEK, WE'LL WATCH CLOSELY THIS AFTERNOON THIS EVENING AND TOMORROW AND AGAIN HOPEFUL THINGS WILL MOVE BEFORE MIDNIGHT DEADLINE TOMORROW 67. I ALSO WANT TO STEP BACK FROM THIS WOKE'S LEGISLATIVE FRENZY FOR A MOMENT AND HIGHLIGHT THE CURRENT PROPOSALS FOR FY 22 FUNDING FOR NIH. SO THE PRESIDENT'S BUDGET PROPOSAL RELEASED IN MAY PROPOSED TOTAL INCREASE OF $9 BILLION FOR NIH. INCLUDES A PROPOSED 6.5 BILLION TO ESTABLISH ARP A H AND 3 BILLION FOR NIH INSTITUTES AND CENTERS INCLUDING AN INCREASE OF 174 MILLION FOR NCI. IN JULY THE HOUSE APPROPRIATION COMMITTEE PASSED HHS BILL OUT OF COMMITTEE AND HOUSE PASS THAT BILL AS PART OF PACKAGE OF APPROPRIATIONS MEASURES IN EARLY AUGUST. THE HOUSE PROPOSED A $6.5 BILLION INCREASE FOR NIH WHICH WOULD INCLUDE 3 BILLION TO ESTABLISH ARPA H AND 3.5 BILLION FOR NIH INSTITUTES AND CENTERS. INCLUDING APPROXIMATELY 434 MILLION FOR NCI. THE SENATE APPROPRIATION COMMITTEE HAS NOT RELEASED LABOR HHS BILL YET NOR OTHER BILLS EARLIER THIS MONTH COMMITTEE CHAIR SENATOR PATRICK LEHY POSTPONED MARKET UPS AND AS A RESULT OF PARTISAN DISAGREEMENT LEARNED OVERALL DEFERENCE AN NON-DEFENSE SPENDING LEVELS, IT IS UNCLEAR WHETHER AND WHEN THE COMMITTEES AND SUBCOMMITTEES RELEASE THEIR REMAINING DRAFT BILLS. NEXT SLIDE PLEASE. SO I WON'T SPEND TOO MUCH TIME HERE SINCE WE HAVE ALREADY HEARD LOT OF LEGISLATIVE ACTIVITY AND SHORT AMOUNT OF TIME BUT I DO WANT TO FLAG A FEW OTHER AUTHORIZING BILLS WE ARE TRACKING. THE FIRST IS OUR PROPOSAL THAT PASSED IN SENATE AND AS LARGELY DIRECTED TOWARDS OTHER SCIENCE AGENCIES. LIKE THE NATIONAL SCIENCE FOUNDATION. THE NATIONAL INSTITUTE FOR STANDARDS AND TECHNOLOGY. IT AIMS TO IMPROVE NATIONAL COMPETITIVENESS AND SCIENCE RESEARCH AND INNOVATION. TO SUPPORT NATIONAL SECURITY STRATEGY AND SENATE MAJORITY LEADER HUMANER. ADDITIONALLY THE CONNECT ACT ONE OF THE MOSTLY SUPPORTED TELEHEALTH PROPOSALS AND WAS REINTRODUCED IN BOTH CHAMBERS IN APRIL. THIS EFFORT IS BEING LED BY SENATE OF HAWAII A LONG TIME ADVOCATE FOR EXPANDED TELEHEALTH GIVEN GEOGRAPHY OF HIS STATE AND HOUSE BY REPRESENTATIVE THOMPSON OF CALIFORNIA. THE LEGISLATION HAS 59 BIPARTISAN CO-SPONSOR MS. THE SENATE NOTABLY MAKING ALMOST FILIBUSTER PROOF AND 102 BIPARTISAN SPONSORS IN THE HOUSE. SO THIS BILL IN ADDITION TO REMAINING CERTAIN GEOGRAPHIC REQUIREMENTS FOR TELEHEALTH SERVICES AND WAVING CERTAIN TELEHEALTH REQUIREMENTS DURING PUBLIC HEALTH EMERGENCIES WOULD ALSO REQUIRE HHS TO CONDUCT A STUDY ON TELEHEALTH UTILIZATION DURING THE COVID-19 PANDEMIC. AND TEST MODELS TO EXAMINE THE USE OF TELEHEALTH MEDICARE. OF COURSE, REPRESENTATIVES OF COLORADO AND MICHIGAN, CONTINUE TO DEVELOP AND CHAMPION CURES 2.0. THEY RELEASED A DISCUSSION BACK IN JUNE INCLUDING A PLACE HOLDER SECTION TO AUTHORIZE ARPA H HOWEVER THE LEGISLATION IS STILL IN DEVELOPMENT AND WILL HAVE TO SEE WHERE THAT SECTION LANDS AS WELL AS WHETHER ANY OTHER PROVISIONS WOULD DIRECTLY AFFECT NCI. WE WANTED TO MAKE SURE YOU KNEW ALL A AMID THE DRAMA IN CONGRESS WE ARE IS STILL HAVING OPPORTUNITIES TO SHARE THE IMPORTANT WORK UNDERWAY AT NCI. THE PAST COUPLE OF MONTHS WE HAD OPPORTUNITIES TO WELCOME MEMBERS OF CONGRESS AND SATISFY TO THE FRED -- STAFF FOR FREDERICK NATIONAL LAB FOR CANCER RESEARCH. SOME OF THE COMPONENTS OF FREDERICK NATIONAL LABEL ARE LOCATED IN MARYLAND. ARMY ORGANIZED A VISIT IN OFFICE OF MEMBERS OF MARYLAND CONGRESSIONAL DELEGATION AND THEY INVITED NCI NIAID CDC AND OTHER FEDERAL PARTNERS TO PARTICIPATE. DR. KRISTEN, THE DEPUTY DIRECTOR FOR THE YOU HAVE APHIS OF SCIENTIFIC OPERATIONS, PARTICIPATED IN THAT VISIT VIRTUALLY. AND THEN COUPLE OF WEEKS LATER SENATOR CHRIS HOLLAND AS YOU PROBABLY KNOW IS ONE OUR SENATORS FROM MARYLAND HAD THE OPPORTUNITY TO VISIT THE FREDERICK NATIONAL LAB. DR. SHARPLESS JOINED HIM FOR THAT VISIT WHICH INCLUDED A TOUR OF THE COVID-19 SEROLOGY LAB. NEXT SLIDE PLEASE. LAST FRIDAY DR. WEEDMAN, CHIEF OF THE PEDIATRIC ONCOLOGY BRANCH IN THE CENTER FOR CANCER RESEARCH. PARTICIPATED IN A VIRTUAL BRIEFING ON CHILDHOOD CANCER RESEARCH ORGANIZED BY DR. JENNIFER WEXTON OF VIRGINIA. SHE IS A CHAMPION FOR CHILDHOOD CANCER RESEARCH INCLUDING THE GABRIELLE MILLER KIDS FIRST RESEARCH PROGRAM AS THE MILLER FAMILY ARE CONSTITUENTS OF HERS. FINALLY, TOMORROW DR. BILL DAHU CLINICAL DIRECTOR CENTER FOR CANCER RESEARCH WILL BE PRESENCING AT A BRIEFING ORGANIZED BY THE CONGRESSIONAL HEALTH CAUCUS AND MEN'S HEALTH NETWORK ON PROSTATE CANCER RESEARCH. IF YOU ARE INTERESTED LET US KNOW AND WE WILL SEND YOU A LOT MANY DETAIL. NOW, I WILL TURN IT BACK OVER TO HOLLY WHO IS GOING TO GIVE AN OVERVIEW OF THE REST OF THE 2021 CONGRESSIONAL CALENDAR. >> A FEW DATES WE COVERED TODAY AND TOMORROW FISCAL YEAR OCTOBER 18 BY TREASURY SECRETARY PROJECTING THE DEBT LIMIT. DECEMBER 3 IS WHEN CR IS PASSED TOMORROW WOULD EXPIRE ON DECEMBER 3 SO WE WILL BE HAVING ANOTHER DISCUSSION AROUND FY 2022 FUNDING IN DECEMBER IF THAT IS THE CASE. WE ARE RUNNING A FEW MINUTES OVER BUT HAPPY TO EITHER TAKE QUESTIONS IF WE HAVE A MINUTE OR NEXT SLIDE HAVE OUR CONTACT INFO ALWAYS PEEL FREE TO REACH OUT HAPPY TO CONNECT AND FOLLOW-UP M. >> ANY QUESTIONS? ALL RIGHT. THANK YOU SO MUCH FOR THIS PRESENTATION. IT WAS REALLY HELPFUL, ALWAYS GOOD TO HEAR FROM YOU ALL AND WE WILL BE THINKING OF YOU THIS WEEK. HOPEFULLY WE WILL HEAR GOOD NEWS. >> THANKS FOR HAVING US. >> THANK YOU. >> IN CLOSING I APPRECIATE EVERYBODY'S TIME ON THIS CALL. AND BEING ENGAGED. BE HONEST I LOVE TO GETTING TO HEAR UPDATES FROM EVERYONE TODAY, I THINK THEY ARE THOUGHTFUL INSIGHTFUL UPDATES AND APPRECIATE EVERYBODY'S COMMENTS AND QUESTIONS AND INSIGHTS THAT WERE SHARED. I DO WANT TO GIVE A QUICK IF THIS SO KAY, FOR OUR NEW NCRA MEMBERS CAN WE TAKE A MOMENT NOW, I KNOW WE ARE RUNNING OVER TO JUST DO MAYBE A MORE FORMAL INTRODUCTION TO HEAR -- I HAVEN'T MET Y'ALL MANY PERSON SO I WANTED TO -- >> WE'LL DO THAT. >> HAVE A MOMENT TO INTRODUCE YOURSELVES AND SHARE YOUR GOALS ARE. AS A MEMBER OF THE COMMITTEE. >> >> THAT WOULD BE GREAT, ANJEE. IF YOU CAN INTRODUCE AND TALK ABOUT YOUR -- THE HAT MANY THE ADVOCACY COMMUNITY, TYPE OF WORK YOU DO, WHAT YOUR PASSION, THIS IS A GROUP THAT COMES TOGETHER THREE TIMES A YEAR AN TRADES IDEAS AND A LOT OF TIMES WORKING WITH EACH OTHER OUTSIDE OF THE WORD WHERE THE BOARD IS A GOOD PLACE TO MAKE CONNECTIONS AND DO THINGS OUTSIDE OF IT SO THAT IN A VIRTUAL WORLD IS HARDER WHEN WE MEET IN PERSON PEOPLE DID CHATTING BEFORE AND AFTER IN THE HALLWAYINGS OUR WAY TO SAY HI AND GET TO KNOW YOU AS YOU GET STARTED WITH US. >> I WILL START WITH YOU. >> >> I WAS WAITING FOR MELISSA. >> >> MY NAME IS VICKIE -- YOU DON'T HAVE TO WORRY ABOUT PRONOUNCING THAT. I'M PRESIDENT OF EMERITUS OF THE CO-ALSO AGAINST CHILDHOOD CANCER, THE LARGEST COALITION FOUNDATION IN THE UNITED STATES. WE HAVE ABOUT 110 ORGANIZATIONS THAT ARE PAYING MEMBERS FOUNDATIONS THAT SUPPORT CHILDREN AN ADOLESCENTS WITH CANCER. WE ALSO HAVE THE OTHER MEMBERSHIP CATEGOY FOR INDIVIDUALS AND STUDENTS. I AM ALSO ACADEMIC, I'M A BUSINESS SCHOOL PROFESSOR WHICH IS WHY I WAS VERY INTERESTED MANY THE HIGH RISK HIGH REWARD INCENTIVE QUESTIONS THAT I ASK DANIELLE CARNIVAL. I'M A PARENT WITH A DAUGHTER WITH NEUROBLASTOMA WHICH IS IN THE SYMPATHETIC NERVOUS SYSTEM WITH A SEVEN YEAR COURSE OF TREATMENT BEFORE SHE DIED IN 2009. I'M REALLY VERY PROUD TO BE SERVING HERE AND BE PART OF ADVOCACY COMMUNITY THAT REALLY THINKS ABOUT CANCER ACROSS ALL SPECTRUMS THAT WERE MENTIONED EARLIER NOT JUST PHYSICAL BUT PSYCHOSOCIAL AND NOT JUST IN TREATMENT BUT FOR PREVENTIVE DIAGNOSTIC AND SURVIVING. THANK YOU FOR INCLUDING ME. >> THANK YOU, VICKIE, FOR GOING FIRST. GOOD AFTERNOON, EVERYONE. SO HONORED THANKFUL TO BE ON THIS ADVISOR ADVISORY GROUP. MY NAME IS MELISSA BUFFALO, NATION IDAHO DAKOTA FROM THE TRIBES IN SOUTH DAKOTA. I RECENTLY STEPPED UP AS THE PERMANENT CHIEF EXECUTIVE OFFICER WITH THE AMERICAN INDIAN CANCER FOUNDATION I SERVE AS INTERIM AFTER OUR FOUNDING CEO STEPPED DOWN LAST DECEMBER. EXCITED TO CONTINUE PREVIOUS CEO BUILT AS A NATIONAL NON-PROFIT TO ADDRESS THE CANCER BURDENS FACED BY OUR INDIGENOUS RELATIVES ACROSS THE UNITED STATES. LOOK AT THERE ARE 574 FEDERALLY RECOGNIZED TRIBES SO LOOKING AT LIENENING ON WHAT ARE POLICIES THAT -- LEANING IN ON POLICIES THAT HELPED AND NOT HELPED AMERICAN INDIANS WHERE THEY ARE IN TERMS OF HEALTH DISPARITIES AND WHAT INEQUITIES OF LIVING ON A RESERVATION AND WHAT IS THAT ACCESS TO CARE. WAS ON A PANEL YESTERDAY IN AMERICAN INDIANS HAVE THE LONGEST TRANSPORTATION TIME TO GET TO CANCER CARE SO THOSE DISPARITIES AND WANTING TO BE A VOICE ON THIS PANEL AND GROUP OR ON THIS ADVOCACY GROUP FOR AMERICAN INDIANS AND ALSO SEEING THE WORK THAT WE DO HERE IS NOT ONLY PROFESSIONAL FOR MANY OF OUR STAFF AND COMMUNITY MEMBERS BUT ALSO PERSONAL. I LOST MY MOM TO CANCER WITHIN THREE MONTHS ONLY WHEN I BECAME A MOM SO SEEING THAT GREATEST PRIDE IN WHO I AM WAS PART OF THE GREATEST TRAUMA. SO SEEING THIS WORK AS IMPORTANT AS IT DOES IMPACT US VERY PERSONALLY. SO AGAIN THANK YOU FOR THIS TIME TO INTRODUCE MYSELF. >> MICE TO HAVE YOU ON THE COUNCIL. LOOK FORWARD TO FUTURE MEETINGS. I KNOW NEXT WE HAVE A MOTION TO APPROVE THE MINUTES -- THE SUMMARY OF THE MEETING SUMMARY SO WE WILL NEED A MOTION TO APPROVE AND A SECOND. >> SO MOVED. >> THANK YOU, ANNIE. SO I THINK TECHNICALLY -- >> I'LL SECOND. >> I THINK YOU WERE JUST SUCCESSFUL, ANJEE. >> GREAT JACQUES, EVERYONE. GOOD DEAL. >> GREAT JOB WITH NOTE TAKING. WE HAD A LOT OF DISCUSSION LAST TIME. I JUST WANTED TO POINT OUT WHOEVER DOES THAT, IS AMAZING. >> GREAT. THANK YOU, ANNIE. WE RARELY GET FEEDBACK ON THE NOTES SO IT IS MUCH APPRECIATED. AND RECENTLY -- WE SEND THOSE AFTER EVERY MEETING AND IF EVERYBODY COULD LOOK AT THE GENERATES IDEAS FOR THINGS YOU ARED IN CONTINUING ON OR REVISITING IN FUTURE MEETING ADVOCACY OFFICE IS WELCOME THE THAT FEEDBACK. PERHAPS NOW THAT WE ARE VOTING WE WILL BE ABLE TO EXTRA ENSIGNTIVE TO LOOK BUT WE APPRECIATE THAT. -- INCENTIVE TO LOOK BUT APPRECIATE THAT. ALONG THE SAME LINES WE FOUR HAVE SOME DATES FOR UPCOMING 2022 MEETINGS. I THINK WE ARE BROKING TO PUT UP A SLOT TO MAKE YOU GUYS AWARE OF THOSE. THESE ARE PROPOSED DATES. WE WILL OBVIOUSLY BE SENDING YOU GUYS SAVE THE DATES FOR THESE IN ADVANCE BUT WE SORT OF BY WAY OF ADMINISTRATION WANTED TO MAKE YOU AWARE OF THESE SINCE WE ARE ENDING 2020 AND WILL BE MEETING AGAIN MANY 2022. >> DO YOU KNOW WHETHER WE WILL BE MEETING IN PERSON? >> I DON'T. I DO KNOW -- I THINK WE -- I BELIEVE I GOT AN EMAIL JUST A COUPLE OF DAYS AGO ALERTING US TO THE FACT THAT BOARD MEETINGS FOR DECEMBER AND JANUARY WILL BE VIRTUAL. IT MIGHT BE FEBRUARY BUT I KNOW IT IS AT LEAST THROUGH JANUARY, THAT IS OBVIOUSLY BEING A MOVING TARGET SO WE WILL KEEP YOU GUYS POSTED. AGAIN CAN'T THANK YOU ENOUGH FOR EVERYBODY'S JUGGLING DIFFERENT THINGS FOR MAKING THE TIME FOR THESE VIRTUAL MEETINGS AND BEING REALLY PRESENT AND AS DEMONSTRATED BY DISCUSSION WE HAD TODAY WITH DR. CARNIVAL AND WITH DR. SHARPLESS AND WITH DR. CROYLE YOU GUYS ARE THINKING AND PUTTING TIME IN TO CONTRIBUTE TO THE DISCUSSION AND I DO THINK IT MAKES A DIFFERENCE AND I APPRECIATE IT. >> GREAT. SORRY. >> WE CAN MOVE ON FROM THAT ONE. >> I KEEP FORGETTING TO UPDATE MY CALENDAR. BAD THIS WEEK BUT USUALLY AFTERNOONISH? >> USUALLY 12 TO 3, 12 TO 4. IF YOU HAVE -- YOU CAN LET US KNOW OUR GOAL IS TO HELP EVERYONE AS THEY ARE JUGGLING SO MANY THINGS IN THIS VIRTUAL WORLD. >> THANK YOU. >> IN CLOSING I WANT TO REMIND EVERYONE FOR THE NEXT COUPLE OF MEETINGS OR THE NEXT MEETING WE ARE STILL GOING TO KEEP ON OUR AGENDA BUILDING EQUITY IN THE CANCER ADVOCAY COMMUNITY AND SO I KNOW WE HAVE BROUGHT UP THE WORK FORCE CANCER ADVOCATES AND RESEARCH ADVOCATES, WE ARE STILL GOING TO KEEP THAT ON OUR RADAR REALLY LOOKING AT EXCEPTIONAL PROGRAMS OTHER ORGANIZATIONS THAT YOU MAY KNOW OF THAT ARE PRIORITIZING RESEARCH ADVOCACY, PLEASE SHARE THAT WITH AMY OR MYSELF OR PATRICK. IDEA OR SUGGESTION YOU MAY HAVE RELATING TO DISCUSSION POINTS PRESENTATION UPDATES AROUND RESEARCH ADVOCACY AND HOW WE CAN ADDRESS HAVING DIVERSITY WITHIN RESEARCH ADVOCACY COMMUNITY. JUST THINK IT'S IMPORTANT WE ARE THINKING ABOUT SUCCESSION AND WHO IS THE NEXT GENERATION OF RESEARCH ADVOCATES TO KEEP THAT PULSE OF WHAT IS THE CANCER COMMUNITY LOOKING LIKE, NEEDS AND VALUES AND MAKE SURE THE RESEARCH COMMUNITY IS REFLECTING THAT, ONLY AS GOOD WAS PUT INTO IT SO THE MORE THAT WE CAN PROVIDE INSIGHT INTO THIS I THIS I THE BETTER. AS THESE OTHER AGENCIES ARE DEVELOPING AND NCI IS GROWING AND FOCUSING ON THIS, I REALLY APPRECIATE WHAT DR. CROYLE SAID ABOUT THE NEW DIRECTOR COMING IN AN PROUS CONSIST ON SURVIVORSHIP SO IF WE CAN PUT OUR THINKING HATS AROUND THAT AND CONTINUE TO BE THINKING ABOUT THAT BETWEEN MEETINGS AND SHARING WITH AMY HOW WE CAN ENRICH THAT CONVERSATION, THAT WOULD BE GREAT. THANK YOU ALL SO MUCH. FOR YOUR ENGAGEMENT AND SPENDING YOUR PRECIOUS FOUR HOURS ON ZOOM WAS. >> THANKS, ANJEE AND TO ECHO WHAT ANJEE WAS SAYING THE EQUITY ISSUE WAS SOMETHING WE TALKED ABOUT IN PREVIOUS MEETINGS, WE TALKED ABOUT WHAT NCI IS DOING ACROSS THE CANCER RESEARCH COMMUNITY. AND I DO THINK IT IS SOMETHING THAT IS IMPORTANT TO ALL OF US AND THAT NO ONE CAN REALLY DO IT ALONE AND ONE OF THE THINGS THAT ANJEE AND I TALKED ABOUT PRIOR TO MEETING WAS HAVING A SMALL FOCUSED DISCUSSION ABOUT WHO IS DOING SOMETHING WELL IN THE COMMUNITY. WHO ARE THE EXCEPTIONAL PROGRAMS OR PLAYERS. IF YOU GUYS CAN THINK ABOUT THAT. WE WANT TO BITE OFF DISCUSSION THAT IS FOCUSED ENOUGH THAT WE CAN COME TOGETHER AND MOVE SOMETHING FORWARD IN THIS SPACE. IT IS SORT OF OWNED AS RICK BANGS WAS TALKING ABOUT IN PREVIOUS MEETING IT COMES DOWN O WHO OWNS WHAT. THIS IS WHAT WE ALL OWN. SO TRYING THE GET A SENSE OF WHAT THE PLAYERS ARE AND HOW WE DEFINE NCRA IN THIS SPACE IN FORCE IS IMPORTANT. AS ANJEE WAS SAYING AND DR. DR.LESS AND -- DR. SHARPLESS AND NCI, THANK YOU FOR PUTTING THE TIME IN TODAY AND BEFORE AND FOR YOUR CONTRIBUTIONS TODAY. WE WILL GET MEETING NOTES OUT TO YOU. IN THE NEAR FUTURE AND LOOK FORWARD TO WORKING WITH YOU IN ADVANCE OF THE NEXT MEETING. IF YOU HAVE IN MY THOUGHTS, RELATED -- ANY THOUGHTS RELATED TO CONTENT WE COVERED TODAY YOU ARE INTERESTED IN OR YOU FEEL LIKE SOMEONE IN THE ADVOCACY COMMUNITY NEEDS TO KNOW ABOUT PLEAT LET US KNOW. ONE BIG ROLE IS CONNECTING THE DOTS AND NETWORKING ACROSS THIS BIG LANDS SCAPE THAT IS CANCER ON BEHALF OF MAKING CONNECTIONS THAT WILL ULTIMATELY MAKE A DIFFERENCE FOR PATIENTS AND ICU -- I SEE YOU GUYS DOING THAT ALL THE TIME AND WE WANT TO BE PART OF IT SO THANK YOU TO THE STAFF AND THE ADVOCACY OFFICE. >> THANK YOU.