Abstract/Project Summary: This application is being submitted in response to the Notice of Special Interest (NOSI) identified as "NOT-CA-24-041.” Dartmouth Cancer Center (DCC) is one of the only NCI-designated Comprehensive Cancer Center serving a primarily rural catchment area, with 81% of patients living in rural areas. The catchment population has a higher cancer incidence relative to the U.S—leading to a relatively large population of cancer survivors served by DCC. With the 2024 release of the National Standards for Cancer Survivorship Care, cancer centers—including DCC—now have a framework by which to assess and implement survivorship programming to improve outcomes in care, including engagement of survivors in follow-up care. Several studies show that engagement in survivorship care is associated with better overall well-being and cancer-related outcomes. Yet, survivorship care must tackle a diverse set of clinical and non- clinical needs, including risk of cancer recurrence, increased risk of developing other cancers, late treatment effects, impacts to mental health, and reduced quality of life and functional capacity. Receipt of survivorship care is inversely associated with distance to care, an issue further compounded by transportation and financial challenges common among rural survivors. Though care has traditionally been provided in-person, the new national standards acknowledge the importance of telehealth and digital delivery of care, which may be especially important in rural areas with longer travel times to in-person services. In this proposed study, we will assess the alignment of DCC’s survivorship program with the 2024 standards, identify gaps, and examine opportunities for expanding engagement of survivors through promising digital health interventions. Using a quality improvement framework, we will conduct an environmental scan of DCC’s survivorship program to identify gaps and opportunities by inventorying program components, the extent to which components have been fully implemented, and use by survivors. In assessing utilization, we will summarize and compare demographic (e.g., age, gender, rurality) and clinical (e.g., cancer stage/type, time since treatment) characteristics between survivors engaging in survivorship care with those not engaging. We will also conduct surveys (n=200) and qualitative interviews (n=25) with cancer survivors to elucidate perceived barriers and facilitators to receiving survivorship care, unmet needs, input on how DCC’s survivorship program could best meet survivor needs, and perspectives on digital health tools to incorporate into DCC’s survivorship program. To ensure sustainability and translation of the findings, we will convene a broad group of cancer survivorship stakeholders to review and interpret the study findings. Through consensus building sessions stakeholder groups will develop recommendations for enhancements to DCC’s survivorship program, including implementation of digital t...