The White House’s Moonshot Program and Navigation

The idea of a “moonshot” comes from a 1962 speech that John F. Kennedy gave in which he challenged the nation to work together and reach the Moon in less than 10 years,¹ a goal that seemed impossible to the public. But 7 years later, American astronaut Neil Armstrong became the first person to walk on the Moon. Over time, this has led to a moonshot culture or way of thinking where an insurmountable problem is tackled by multiple individuals and organizations to identify and pursue achievable goals to improve or solve the problem. It is a team approach to face a challenging and innovative project or undertaking.

The idea of a “moonshot” comes from a 1962 speech that John F. Kennedy gave in which he challenged the nation to work together and reach the Moon in less than 10 years.

The Moonshot for oncology healthcare professionals is the Beau Biden Cancer Moonshot Initiative that began in 2016 with $1.8 billion funding from the 21st Century Cures Act that was passed by Congress.² The 2016 aim had 3 major goals: (1) accelerate scientific discovery in cancer, (2) foster greater collaboration, and (3) improve the sharing of cancer data. Among the 3 goals, there were 2 cross-cutting features that emphasized the need for transparency to move forward: enhanced data sharing and open access publications. Other features were an emphasis on teamwork with collaboration and networks and a focus on addressing cancer health disparities.

After 6 years, the Moonshot program supports more than 250 new projects, fostering progress across a broad range of research topics in 12 priority areas² (Table). All the projects can be found on the National Cancer Institute (NCI) website (www.cancer.gov/research/key‑initiatives/moonshot‑cancer‑initiative/implementation), but a select review of the cross-cutting features shows progress in programs that may be of interest to all navigators and their clients.

Sharing Data

Enhanced data sharing and open access publications have allowed more than 1000 Moonshot-supported research papers to be made publicly available immediately.³ This was due to a stipulation that all Moonshot-supported grant publications have open access. With open access “anyone can read, download, copy, distribute, print, search for and search within the information, or use it in education or in any other way within the legal agreements.”4 In contrast, articles that are not open access are initially only visible to people at institutions that have a license for these specific journals. And often an author must pay a fee to get the article classified as open access. This stipulation allowed rapid sharing of data from the Moonshot projects. As navigators, it can be frustrating to look for evidence-based practice and find limited access to the research as well as financial constraints to purchase an article. With this Moonshot feature, a navigator’s access is increased, application of innovative ideas can be adapted or used in teaching, and there could be a business benefit if applicable to navigation return on investment.

Collaborating with People Affected by Cancer

A major focus of collaboration is the recognition that to understand the biology of cancer to enhance prevention and treatment will take the participation of people with cancer, cancer survivors, and healthy volunteers. The Network for Direct Patient Engagement (www.cancer.gov/research/key‑initiatives/moonshot‑cancer‑initiative/implementation/patient-engagement) is an avenue where patients can learn about cancer research as well as how they can become a partner in cancer research by taking part in a study.⁵ The selection includes prevention, tumor types, age categories, cancer genome sequencing, and other engagement programs developed through the Moonshot initiative. This opens another avenue for sharing with patients, since navigators are instrumental in increasing education and participation in clinical trials.

Healthcare Disparities

With a focus on addressing cancer health disparities, each Moonshot initiative and funded project raises questions on opportunities to better understand or address health disparities. One example is a study showing that patient navigation has been instrumental in increasing colorectal cancer (CRC) screening rates. The American Indian (AI) CRC Screening Consortium, formed by the NCI-designated cancer centers at the universities of Arizona, New Mexico, and Oklahoma, tailored navigator intervention for facilitating CRC screening, which was readily adapted with provider and community input.⁶ Specific navigator training around CRC, AI disparities, and motivational interviewing was conducted in person or virtually due to the COVID pandemic. As navigators contacted eligible patients individually by phone or in person at the clinic, interpersonal communication style used during the intervention was left up to each navigator. The community was involved with AI community leaders and cultural consultants to address specific needs of AIs, and the patient navigators were fluent in the language of their tribe. Adaptations were made as the study progressed in recognition that an approach in one community setting may not be the correct fit in another setting.

Moonshot in 2022

With the great progress from the initial 2016 Moonshot initiative, President Joe Biden reignited the Cancer Moonshot in February 2022.7 This Moonshot thinking will focus on 2 major goals: (1) reduce the death rate from cancer by at least 50% over the next 25 years, and (2) improve the experience of people and families living with and surviving cancer. General themes were continued, such as to diagnose cancer sooner; prevent cancer; address inequities; target the right treatments to the right patients; speed progress against the most deadly and rare cancers, including childhood cancers; support patients, caregivers, and survivors; and learn from all patients.

Patient Navigation

Patient navigation will be at the forefront in the pediatric area as the White House announced a partnership with the NCI to create patient navigation services for families facing pediatric cancer.⁸ Childhood Cancer – Data Integration for Research, Education, Care, and Clinical Trials (CC-DIRECT) will be the vehicle to deliver navigation support to pediatric patients and adolescents and young adults. This age group will be connected to clinical care, access to patient navigation services, and increased patient data access such as their own health information.

With the ambitious new goal of reducing cancer mortality by at least 50% over the next 25 years, oncology patient navigators will be a critical asset to the healthcare team. For cancer prevention, all navigators, but especially those working in the outreach or survivorship continuum of care, will be leading education on lifestyle changes, such as a healthy diet, consistent exercise routine, avoiding tobacco products, and promoting vaccinations against certain viruses that increase the risk of developing cancer. In the screening care continuum, navigators will promote appropriate screening procedures while offering free or low-cost services to those in need. They will address structural and cultural barriers to community services and promote appropriate genetic services, as well as tumor site–specific monitoring such as low dose CT screening for lung cancer. In the treatment continuum, where lives can be saved by timely completion of standards of care, navigators will continue their approaches for shared and informed decision-making to promote management.

Enhanced data sharing and open access publications have allowed more than 1000 Moonshotsupported papers to be made publicly available immediately. This was due to a stipulation that Moonshot-supported grant publications have open access.

Oncology patient navigation has been and continues to be a part of the Beau Biden Cancer Moonshot Initiative and the reignited Cancer Moonshot. In 2017, Danelle Johnston, MSN, RN, HON-ONN-CG, OCN, Academy of Oncology Nurse & Patient Navigators (AONN+) Chief Nursing Officer, Senior Director of Strategic Planning and Initiatives, was named to the Biden Cancer Initiative’s 25-member Advisory Committee.⁹ Danelle participated in the Biden Cancer Initiative’s “Conversations with Dr. Biden,” as conversations were being held across the country in intimate community settings to provide members of the patient support network—families, caregivers, patient navigators, and others—with the opportunity to share their perspectives on the cancer journey. It was an opportunity to further the mission of AONN+ to advance the role of patient navigation in the cancer care continuum and bring to the table the contribution navigation can make to the Moonshot goals.

The patient navigation working group of the Biden Cancer Initiative was also an early intervention that included selected representatives of professional organizations relevant to navigation.¹⁰ This group consisted of:

The Professional Oncology Navigation Task Force

In 2020, this group transitioned into the Professional Oncology Navigation Task Force (PONT). PONT was created to serve as the voice of professional oncology organizations with the goal of solidifying definitions, scopes, and roles of navigators across the care continuum. It was a network of cross-disciplinary partnerships including nursing, social work, and nonlicensed navigators. In the spirit of Moonshot’s focus to foster greater collaboration and share cancer input, the document was distributed in the navigation community for stakeholder feedback, and an open comment period was available to any interested parties. This commitment to define, refine, and disseminate their work identified best practices to promote an elevated level of navigation quality and include the knowledge and skills all professional navigators should possess to deliver high-quality, competent, and ethical services to people affected by cancer. Their persistence and diligence over the years led to the creation of the Oncology Navigation Standards of Professional Practice—a document to provide professional oncology navigators with clear information regarding the standards of professional practice—which was released in March 2022.¹¹

Moonshot and Navigation: A Natural Fit

Oncology patient navigation is a natural fit to enhance both Moonshot initiatives. As for collaboration, a patient navigator is a trusted member of the local community who is employed by community organizations or healthcare systems to work directly with individuals. They facilitate timely access to healthcare by eliminating or traversing barriers that may impede access to care or treatment. The process of patient navigation is an evidence-based intervention to eliminate health disparities and improve health equity across the cancer continuum.^12,13 Navigators can support patients, caregivers, and survivors; decrease time to diagnosis; and enhance the right treatments to the right patients.¹⁴ And a critical strength of patient navigators is their ability to share, educate, and enhance participation in clinical trials…a consistent focus of the Moonshot initiatives.¹⁵

References

1. Kennedy JF. Address at Rice University on the nation’s space effort. John F. Kennedy Presidential Library and Museum. www.jfklibrary.org/learn/about-jfk/historic-speeches/address-at-rice-university-on-the-nations-space-effort. September 12, 1962.
2. National Cancer Institute. About the Cancer Moonshot. www.cancer.gov/research/key-initiatives/moonshot-cancer-initiative/about. September 11, 2022.
3. Sharpless NE, Singer DS. Progress and potential: The Cancer Moonshot. Cancer Cell. 2021;39:889-894.
4. Open Access. What is open access? www.openaccess.nl/en/what-is-open-access.
5. National Cancer Institute. Establish a Network for Direct Patient Engagement. www.cancer.gov/research/key-initiatives/moonshot-cancer-initiative/implementation/patient-engagement. Updated June 13, 2022.
6. Coronado GD, Ferrari RM, Barnes A, et al. Characteristics of patient navigation programs in the Cancer Moonshot ACCSIS colorectal cancer screening initiative. J Natl Cancer Inst. 2023;djad032.
7. The White House. Fact Sheet: President Biden Reignites Cancer Moonshot to End Cancer as We Know It. www.whitehouse.gov/briefing-room/statements-releases/2022/02/02/fact-sheet-president-biden-reignites-cancer-moonshot-to-end-cancer-as-we-know-it/. February 2, 2022.
8. Heath S. On Cancer Moonshot Anniversary, White House Unveils Patient Navigation Plans. TechTarget. https://patientengagementhit.com/news/on-cancer-moonshot-anniversary-white-house-unveils-patient-navigation-plans. February 2, 2023.
9. Academy of Oncology Nurse & Patient Navigators. AONN+ Takes a Seat at the Table for the Biden Cancer Initiative. https://aonnonline.org/press/996-aonn-takes-a-seat-at-the-table-for-the-biden-cancer-initiative. March 22, 2018.
10. Franklin EF, Dean MS, Johnston DM, et al. Solidifying roles, responsibilities, and the process of navigation across the continuum of cancer care: The Professional Oncology Navigation Task Force. Cancer. 2022;128(suppl 13):2669-2672.
11. The Professional Oncology Navigation Task Force. Oncology navigation standards of professional practice. Journal of Oncology Navigation & Survivorship. 2022;13(3):74-85.
12. Dixit N, Rugo H, Burke NJ. Navigating a path to equity in cancer care: the role of patient navigation. Am Soc Clin Oncol Educ Book. 2021;41:1-8.
13. Cykert S, Eng E, Manning MA, et al. A multi-faceted intervention aimed at black-white disparities in the treatment of early stage cancers: the ACCURE Pragmatic Quality Improvement trial. J Natl Med Assoc. 2020;112:468-477.
14. Budde H, Williams GA, Scarpetti G, et al. What are patient navigators and how can they improve integration of care? European Observatory on Health Systems and Policies. Policy Brief, No. 44. Executive summary. https://eurohealthobservatory.who.int/publications/i/what-are-patient-navigators-and-how-can-they-improve-integration-of-care. 2022.
15. Gentry S, Burhansstipanov L. Navigation and Clinical Trials. In: L Shockney (ed). Team-Based Oncology Care: The Pivotal Role of Oncology Navigation. Springer; 2018:251-274.

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