Supporting Young Breast Cancer Survivors, Metastatic Breast Cancer Patients, and their Families

Breast cancer is the most commonly diagnosed cancer and second leading cause of cancer death among women. Breast cancer diagnosed in women younger than 45 is often more aggressive1, presents at an advanced stage, impacts life expectancy, and oftentimes result in physical, psychosocial, and financial challenges stemming from diagnosis and treatment. Additionally, a significant proportion of young women diagnosed with breast cancer will eventually develop metastatic breast cancer (mBC) and about 30% of women with metastatic breast cancer live 5 years2. A recent study reported that the incidence of mBC in young women has increased by more than 2% per year, each year since 1976 to present3. The intensity of care for mBC is significant and expensive, particularly in younger women with more aggressive and harder to treat tumors. Psychosocial and structural support services, which are services designed to help meet mental, emotional, social, and spiritual needs of survivors and their families, have the propensity to improve the quality of life among this population4,5. Within this population, there are communities who would benefit from additional survivorship support. These priority populations include, but are not limited to, women in racial/ethnic groups (e.g., African American, Asian/Pacific Islanders, Hispanic, Ashkenazi Jewish, Native American women, etc.), LGBT communities, low socio-economic groups, and women with physical or mental/emotion disabilities. This Notice of Funding Opportunity (NOFO) seeks to provide support to organizations and entities whose actions will improve the quality of life among young breast cancer survivors (YBCS) and young metastatic breast cancer patients (mBC). The outcomes of this NOFO are to 1) increase equitable access and availability of psychosocial and structural support services for YBCS, mBC patients, and their families and 2) improve patient-provider interactions during follow up and subsequent care. The approach that undergirds this NOFO focuses on fostering collaborative relationships with organizations that represent and serve priority populations and Comprehensive Cancer Control coalitions for the purposes of providing equitable access to psychosocial and structural support for survivors and their families and educational opportunities to this priority population, healthcare providers, community health workers (CHW), and patient navigators (PN). This NOFO will also support implementation of health equity strategies that will aid in closing the disparity gap needed to support both YBCS and mBC patients in care. Care for YBCS and mBC patients should move beyond physical treatment of the disease. Psychosocial and structural support services can help survivors express and manage disease-related emotions and social concerns, thus improving quality of life. The full integration of psychological and behavioral resources in survivorship care is stymied due to complex billing requirements, minimally qualified staff, complex care settings and the wide variety of patient needs1. The prescribed approach of this NOFO seeks to leverage the collaborative power of organizations serving YBCS and mBC patients to improve the availability of psychosocial support services and facilitate more meaningful patient-provider interactions through the education of survivors, their families, healthcare providers, CHWs, and PNs.In March 2010, Congress passed the Education and Awareness Requires Learning Young Act, Sec. 10413, which directed the Centers for Disease Control and Prevention (CDC) to develop and implement national campaigns to educate young women, particularly those at increased risk, and health care providers about breast cancer risk and breast health and implement programs to support young women living with a breast cancer diagnosis. In response to this Act, CDC developed a portfolio that included research, health promotion campaigns, and traditional public health programs. Since this time, there's been three cycles of YBCS support program. This NOFO marks the fourth program cycle and is built on the successes and lessons learned from the previous cycles. Findings from previous program evaluations showed fostering meaningful collaborative relationships with organizations aided in implementation of interventions that successfully resulted in policy, systems, and environmental changes. Other lessons learned underscored the importance of educating and providing access to survivors and their loved ones to emotional and psychosocial support systems and resources in managing disease-related emotions, enhancing relationships with family and healthcare providers, and improving symptom control. This NOFO seeks to use both proven and new innovative program strategies to achieve program goals.