Improving and upscaling primary prevention of cancer through implementation research

For an increasing number of cancer indications potential mechanisms and means to prevent the onset of cancer have been identified^[1]. However, with cancer incidence steadily increasing across all age groups, parts of society, European Member States, Associated Countries and elsewhere^[2], decisive action on primary prevention should be stepped up and made a collective responsibility. Implementing and upscaling of primary cancer-centred prevention programmes would contribute to achieving this goal.

Adoption and efficacy of primary cancer prevention programmes in real-life has been insufficient, due to factors related to local context, such as organisation and digitalisation of healthcare services, resources, cultural, and geographical situation. To appropriately adapt interventions and scale-up to different geographical, economic and cultural settings, proposals should aim at delivering results through implementation research^[3], which are directed, tailored towards and contributing to all of the following expected outcomes:

• Citizens will benefit from the outcomes of evidence-based, tailored and affordable primary prevention programmes targeting known cancer risk factors and health determinants, including behavioural factors, that are tailored to the specific needs of local communities and effectively adopted;
• Healthcare professionals and patient organisations will be able to provide evidence-based information targeted at individuals and families on cancer prevention, including through vaccination, improved health literacy, issuing of better guidelines and counselling;
• Regional and national policymakers and authorities will engage in implementing and scaling-up the most suitable prevention programmes, including possible legislative policies;
• Civil society, charities, foundations, and innovators will seize opportunities to further upscale and innovate primary prevention programmes at local, urban, rural, regional, national or international level.

Investments are needed to establish, scale-up or improve primary cancer prevention programmes. The barriers that prevent their uptake and effective implementation should be identified and addressed. Also, primary cancer prevention programmes should be tailored to the particular needs of the target populations, taking into account socio-economic, cultural and geographical conditions. Digital tools and datasets may be considered where needed.

Proposals should address all of the following:

• Focus on implementation and upscaling of evidence-based primary cancer prevention interventions, at local, regional or national level, addressing known risk or protective factors and determinants^[4]. Proposals should clearly justify and describe the existing evidence supporting the chosen intervention, including evidence of cost-effectiveness and affordability, across health or other sectors.
• As effective prevention includes behavioural change, due consideration should be given to the factors that facilitate or impede behavioural change.
• Identify and address the bottlenecks and barriers that might influence uptake and implementation of cancer prevention programmes in accessible, affordable and equitable ways, and their impact in a defined public health context.
• Provide evidence and recommendations to inform policy and decision-makers and propose a pathway to integrate the intervention into local, regional or national health systems, policies and practices.
• Applicants are required to co-create with relevant stakeholders, including representatives of citizens, people at risk of cancer, patients, survivors, health practitioners, payers, and policymakers in the design and conduct of research and evaluation of its outcomes. Such partners will be integral to the success and sustainability of the programme and it is essential that they are engaged early in the definition of problems and barriers.
• Proposals should align with commitments or planned commitments at a regional or country level to implement evidence-based interventions. Researchers should collaborate closely with responsible authorities. The latter should provide the interventions and the financial means.
• Approaches, methodologies and frameworks used should be specific to implementation science, and based on appropriate outcomes, such as feasibility, acceptability, sustainability, uptake and cost effectiveness.
• The design of the proposed interventions should take the gender dimension and ethics into account, and contribute to reducing health inequalities.
• The organisational and resource requirements (data, digital tools, personnel and financing) necessary for the implementation of the intervention must be described, tracked and evaluated in detail. The research and system-wide scientific monitoring should allow future users (researchers, healthcare providers, policy makers, and the public) to review the step-by-step, partial outcomes of the intervention, thus facilitating a wider adoption of these practices. The appropriate contextual, financial and political-economic analyses should be provided.

Clinical trials and translational research are not within the scope of this topic.

This topic requires the effective contribution of social sciences and humanities (SSH) disciplines and the involvement of SSH experts, institutions as well as the inclusion of relevant SSH expertise, in order to produce meaningful and significant effects enhancing the societal impact of the related research activities.

Applicants should demonstrate awareness of relevant projects on implementation research in primary cancer prevention^[5]. Successful applicants will be asked to liaise with these different initiatives where applicable^[6], with the Commission acting as a facilitator. Where applicable, funded actions should make use of resources made available by the Knowledge Centre on Cancer^[7].

Furthermore, all projects funded under this topic are strongly encouraged to participate in networking and joint activities with other ongoing projects under the mission on cancer and other cancer relevant projects, as appropriate. These networking and joint activities could, for example, involve the participation in joint workshops, the exchange of knowledge, the development and adoption of best practices, or joint communication activities. This could also involve networking and joint activities with projects funded under other clusters and pillars of Horizon Europe, or other EU programmes, as appropriate.

The Commission may facilitate Mission-specific coordination through future actions. Therefore, proposals should include a budget for the attendance to regular joint meetings and may consider covering the costs of any other potential joint activities without the prerequisite to detail concrete joint activities at this stage. The details of these joint activities will be defined during the grant agreement preparation phase and project duration. In this regard, the Commission will take on the role of facilitator for networking and exchanges, including with relevant initiatives and stakeholders, if appropriate.

[1] Depending on geographical, economic and cultural settings, ~26-50% cancers are preventable and ~20% cancers can be detected early.

[2] European Cancer Information System (ECIS), GloboCan (https://gco.iarc.fr/)

[3] Implementation research uses scientific methods to investigate and address the various factors that affect the implementation in real-life settings and help evidence-based interventions or policies to be optimally implemented and scaled-up. See also: https://www.gacd.org/about/what-we-do/implementation-science.

[4] All known risk factors and health determinants, including socio-economic and commercial ones, e.g.: tobacco; alcohol; genetics; bacterial and viral pathogens; chemicals from air, soil, water, and food; physical inactivity; diet and nutrition; gut dysbiosis; behavioural patterns; exposure to ionising radiation, UV, radon; occupational exposure; socio-economic background, education, employment.

[5] For example CANCERLESS, CBIG-SCREEN, CHILI, EQUITYCANCER-LA, EU-TOPIA-EAST, PRESCRIP-TEC. See also: https://www.gacd.org/community/research-network/projects?diseases=cancer&programme-countries=

[6] Applicants are not expected to contact these initiatives before the submission of proposals.

[7] Especially through the ’European Guidelines and Quality Assurance Schemes for Breast, Colorectal and Cervical Cancer Screening and Diagnosis‘, and the ’European Cancer Information System (ECIS)’, see https://knowledge4policy.ec.europa.eu/cancer_en