Examples of Prior CRN Projects

With a cadre of experienced scientists, representing a variety of disciplines, the CRN is able to apply diverse expertise across the spectrum of cancer control. The integrated nature of the health plans facilitates studies at the patient, provider and organization level. Descriptions of CRN studies conducted in these various domains are found in the sections below.

Behavioral Research

The health care delivery systems of the Cancer Research Network (CRN) comprise nearly 10 million covered lives, affording a unique opportunity to evaluate major modifiable cancer risk behaviors. CRN projects have thus far explored tobacco use and dietary behaviors, each using very different approaches.

The tobacco use projects conducted under CRN auspices have examined delivery of smoking cessation services at the organization-, clinician- and patient-level. Improving clinician adherence to national tobacco control guidelines, and assuring that patients receive appropriate guidance for quitting smoking, is the overarching goal of this area of research.

A newly-funded study is focusing on dietary behavior change at the individual level, using the Internet as the modality for delivery of tailored health communication to determine optimal risk reduction strategies.

Cancer Biology & Etiology

The CRN sites and resources provide an exceptional setting for conducting studies on biologic factors that influence cancer development, as well as research on the causes of various tumors. The memberships are stable, diverse, and receive virtually all their health care from the medical care programs, allowing for assessment of association between clinical factors and disease progression, and procurement of biologic specimens. CRN-affiliated epidemiologists are initiating studies of the etiology of rare and/or highly fatal cancers.

Screening Research

Identifying and optimizing appropriate cancer screening strategies is a key aspect of cancer control. Many questions about the frequency of cancer screening have not yet been answered conclusively. With each of the research centers participating in this consortium embedded in healthcare delivery systems, applied screening research studies are at the heart of the CRN portfolio.

Cancer Care & Treatment Research

While there have been many advances in cancer detection and treatment, more research is still needed to fill in gaps in our knowledge about optimal cancer care. Understanding how co-morbid conditions impact response to therapy, determining whether adjuvant treatments prolong survival, and assessing ways to improve accrual to cancer clinical trials are just a few of the questions the CRN is exploring.

End-of-Life Care

Optimal supportive care in the final stages of advanced cancer is an imperative. However, determination of factors that influence the course of care for cancer patients at the end-of-life is an evolving process. Particularly in managed care environments, a clear picture of the experiences of the terminal cancer patient has not yet been fully explored. Two CRN HMOs have been funded to evaluate care at the end of life for both prostate and ovarian cancer. In addition to providing a picture of the care these patients receive, the research teams are gaining important experience with their hospice data systems.

Health Services & Outcomes Research

Health system factors are a critical feature of cancer control. Utilization of services, patterns of care, and access to care, must all be understood in the context of the prevention, diagnosis and treatment of cancer. These facets and related methodologic aspects of assessing and analyzing data on the cancer patient's experience are all part of the coordinated research program in the CRN.

Survivorship Research

With advances in cancer treatment and control, more and more patients are surviving this disease and living longer. Yet the psychosocial burden exacted by cancer is far-reaching, and impacts patients throughout the process of detection, treatment and survivorship. Opportunities are manifold for enhancing the research base on survivorship issues, including physiologic, psychological and neurological consequences of cancer; shared decision-making about treatment; screening and other preventive behaviors among family members of cancer patients; and the impact of lifestyle factors on quality of life among survivors.

CRN behavioral scientists and clinician researchers are collaborating on a proposal (under review) to study long-term survivors of colorectal cancer to assess the inter-relationship between aspects of their initial care and subsequent physical, functional and psychological outcomes. Other work is described in this section.