of Healthof Health

National National 

U.S. DEPU.S. DEPARTMENT

OF HEALTH AND

HUMAN SERVICES

National Institutes National Institutes 

CAPA

COLLABORAT

AND INVESTIGA

APRIL 2010 

http://crn.cancer.gov

Network (CRN) 

CAPACITY, 

COLLABORATION, 

AND INVESTIGATION 

2 List of Abbreviations 

3 Foreword 

4 Overview 

5 History 

8 Research Themes 

10 Comparative Effectiveness Research (CER) 

12 Collaborating with the CRN 

14 Examples of CRN Collaborations 

16 Capacity 

20 Informatics and Research Tools 

22 Organizational Structure 

24 Site Principal Investigators 

26 Research Projects by CRN Research Theme and Year 

38 Enhancing CRN Research Capacity and Collaborations 

46 Publications by CRN Research Theme, 1999–2009 

http://crn.cancer.gov 
ONS


BCSC = Breast Cancer Surveillance Consortium 

caBIG® = Cancer Bioinformatics Grid 

CanCORS = Cancer Care Outcomes Research and 

Surveillance Consortium 

CCRC = Cancer Communication Research Center 

CDC = Centers for Disease Control and Prevention 

CECCR = Center of Excellence in Cancer 

Communication Research 

CER = Comparative Effectiveness Research 

CERT = Center for Education and Research in Therapeutics 

CISNET = Cancer Intervention and Surveillance Modeling Network 

CRN = Cancer Research Network 

cTAKES = Clinical Text Analysis and Knowledge 

Extraction System 

CTSU = Cancer Trials Support Unit 

CVRN = Cardiovascular Research Network 

DCIS = Ductal Carcinoma in situ 

ECOG = Eastern Cooperative Oncology Group 

EMR = Electronic Medical Record 

FDA = Food and Drug Administration 

GHC = Group Health Cooperative 

(Group Health Research Institute) 

GHS = Geisinger Health System 

(Geisinger Center for Health Research) 

GO Grant = Grand Opportunity Grant 

HFHS = Henry Ford Hospital and Health System/ 

Health Alliance Plan 

(Department of Biostatistics and Research 

Epidemiology and Center for Health Services Research) 

HIPAA = Health Insurance Portability and Accountability Act 

HMORN = Health Maintenance Organization Research Network 

HPHC = Harvard Pilgrim Health Care Institute 

and Harvard Medical School 

(Department of Population Medicine) 

HPRF = HealthPartners 

(HealthPartners Research Foundation) 

(Institute for Health Research) 

KPG = Kaiser Permanente Georgia 

(Center for Health Research–Southeast) 

KPH = Kaiser Permanente Hawaii 

(Center for Health Research–Hawaii) 

KPNC = Kaiser Permanente Northern California 

(Division of Research) 

KPNW = Kaiser Permanente Northwest 

(Center for Health Research–Northwest

KPSC = Kaiser Permanente Southern California 

(Department of Research and Evaluation

LCF = Lovelace Health System 

(Lovelace Clinic Foundation Research) 

MCRF = Marshfield Clinic/Security Health Plan 

(Marshfield Clinic Research Foundation) 

MPCI = Fallon Community Health Plan 

(Meyers Primary Care Institute) 

NCI = National Cancer Institute 

NHGRI = National Human Genome Research Ins

NHLBI = National Heart, Lung and Blood Institut

NIH = National Institutes of Health 

NLP = Natural Language Processing 

NLST = National Lung Screening Trial 

NSABP = National Surgical Adjuvant Breast and 

PA = Program Announcement 

PLCO = Prostate, Lung, Colorectal and Ovarian 

Screening Trial 

RFA = Request for Applications 

RTOG = Radiation Therapy Oncology Group 

SEER = Surveillance Epidemiology and End Res

SELECT = Selenium and Vitamin E Cancer Preven

SIG = Scientific Interest Group 

SWOG = Southwest Oncology Group 

VDW = Virtual Data Warehouse 

WHI = Women’s Health Initiative 

2 The HMO Cancer Resea
Institute’s (NCI) strategic vision. In the 11 years since 

the HMO Cancer Research Network (CRN) was 

initiated as a cooperative agreement, the network has 

provided a framework for leading and working with 

others to address some of the most perplexing cancer 

research challenges. 

The CRN has evolved to encompass research 

organizations affiliated with 14 large health care 

delivery systems covering nearly 11 million individuals, 

conducted dozens of joint research projects, and 

published over 175 peer-reviewed papers. It has 

become a national cancer research resource through 

increased support for data standardization and 

dissemination that facilitates collaboration with 

researchers outside the network. 

Originally conceived as a “population laboratory” 

centered in community-based health care systems, the 

CRN is able to harness these organizations’ data and 

health information systems, as well as their clinical staff 

and enrolled populations to conduct cancer etiology, 

epidemiology, and health services research. It allows 

for large, multicenter, multidisciplinary intervention 

research that addresses the spectrum of cancer control, 

including studies of prevention, early detection, 

treatment, survivorship, surveillance, and end-of-life 

care. The CRN is also uniquely positioned to study the 

quality of cancer care in community-based settings. 

The generation of new research ideas is a core value of 

the CRN, and partnership is at the heart of every 

project. Through innovative research initiatives, strong 

leadership, and teamwork with top cancer experts 

across the country, the network has come to stand as a 

model for data sharing and collaborative research. 

accomplishments, capacity, and future researc

potential as well as serving as a “user’s guide

potential collaborators. It is our hope that read

gain a greater understanding of how to becom

in this scientific community, how to work suc

with CRN members, and how to utilize the C

unique research resources and scientific expe

Readers will then have a greater capacity to u

research projects that will both benefit the res

community and advance knowledge crucial to 

progress of cancer control in the United State

I thank the many colleagues and investigators 

in the CRN, and our partner, the Agency for H

Research and Quality, for their expertise, ded

and enthusiasm in ensuring that the CRN con

respond to NCI’s priorities for the diffusion o

care innovations into practice and health serv

Robert T. Croyle, Ph.D. 

Director, Division of Cancer Control and 

Population Sciences 

National Cancer Institute 

http://crn.cancer.gov 
3 

11 

10 

7 

5 

14 

6 

2 

8 

1 4 

13 

12 

9 

1 Fallon Community Health Plan, 

Meyers Primary Care Institute (MPCI) 

2 Geisinger Health System, 

Geisinger Center for Health Research 

(GHS) 

3 Group Health Cooperative, 

Group Health Research Institute (GHC) 

4 Harvard Pilgrim Health Care 

Institute and Harvard 

Medical School, 

Department of Population Medicine 

(HPHC) 

5 HealthPartners, 

HealthPartners Research Foundation 

(HPRF) 

6 Henry Ford Hospital and Health 

System/Health Alliance Plan, 

Department of Biostatistics and 

Research Epidemiology and Center 

for Health Services Research (HFHS) 

7 Kaiser Permanente Colorado, 

Institute for Health Research (KPCO) 

8 Kaiser Permanente Georgia, 

The Center for Health ResearchSoutheast (KPG) 

9 Kaiser Permanente Hawaii, 

The Center for Health ResearchHawaii (KPH) 

10 Kaiser Permanente 

Northern California, 

Division of Research (KPNC) 

11 Kaiser Permanente N

The Center for Health R

Northwest (KPNW) 

12 Kaiser Permanente 

Southern California, 

Department of Researc

Evaluation (KPSC) 

13 Lovelace Health Syst

Lovelace Clinic Founda

(LCF) 

14 Marshfield Clinic/ 

Security Health Plan, 

Marshfield Clinic Resea

Foundation (MCRF) 

4 The HMO Cancer Resea
consortium of 14 nonprofit research centers 

based in large, integrated 

health care delivery 

organizations. Collectively, 

these organizations 

provide care to nearly 

11 million individuals. 

To achieve its scientific goals, the 

CRN fosters collaborations among 

CRN investigators and with 

investigators and research 

institutions outside of the CRN 

member organizations. 

http://crn.cancer.gov 

The CRN is funded through a 

National Cancer Institute (NCI) 

cooperative agreement grant that 

ensures substantial NCI 

involvement in attaining research 

goals and catalyzing new 

collaborations. The Agency for 

Healthcare Research and Quality 

(AHRQ) also supports the CRN, 

especially in the area of protecting 

research data for the purposes under

which they were originally collected.

CRN research focuses on examining

the characteristics of patients, 

families, clinicians, communities, 

and healthcare systems that lead to 

the best possible outcomes in cancer

prevention, treatment, survivorship, 

and end-of-life care. The CRN also 

develops and uses standardized 

foundation of integrated health care 

delivery systems with defined 

populations and comprehensive 

health informatics systems, the CRN 

is able to measure complete episodes 

of all types of care, including 

prevention, screening, diagnosis, 

treatments (neoadjuvant, primary, 

adjuvant), surveillance for metastases 

and recurrence, secondary preventive 

care, and end-of-life care. 

Beginnings 

In 1997, the National Cancer 

Institute (NCI) issued a Request for 

Applications (RFA) entitled “Cancer 

Research Network Across Health 

Care Systems.” In doing so, it 

acknowledged the need for data 

from representative populations 

with lengthy follow-up periods and 

a comprehensive range of patient 

information to examine important 

questions about prevention, 

diagnosis, treatment, long-term 

outcomes, costs, and other issues 

important to cancer care delivery, 

cancer patients, and overall health. 

By virtue of their organized care 

structures, defined populations, and 

extensive data systems, health 

maintenance organizations (HMOs) 

were seen as promising venues and 

as a strategic resource to address 

unmet research needs. Previously, 

comprehensive health care 

utilization and cost information 

related to cancer prevention and 

care was largely limited to the NCIsupported Surveillance 

and older. However, NCI e

a research network that wo

include population-based d

people younger than 65 an

risk for cancer, including c

The CRN’s response to the 

grew out of discussions am

leaders of the established H

Research Network (HMOR

now includes 14 of the 16 

members, all of which hav

established program in can

research and are based in i

healthcare delivery system

CRN1: 1999–2003 

The first CRN grant cycle 

included 10 funded sites a

affiliate site. CRN1 aimed 

improve the effectiveness 

prevention and care throug

research that identified sys

provider, and patient facto

affecting outcomes. The C

initial core research projec

on three areas paramount t

control: effectiveness of br

cervical cancer screening i

community practice; exten

adherence to tobacco contr

guidelines at the system, p

and patient levels; and effi

prophylactic mastectomy a

screening among women a

increased risk for breast ca

Several administrative sup

R01 grants, and other fund

projects added to the CRN

research portfolio. 
The HMO Cancer Resea

() 

and two affiliate sites. Core research 

projects included in CRN2 

broadened the scope of the original 

investigations to include 

randomized trials examining the use 

of electronic medical records 

(EMRs) to improve adherence to 

tobacco control guidelines, and the 

effectiveness of an individually 

tailored, Web-based program to 

promote daily fruit and vegetable 

consumption. A third project studied 

the clinical and pathologic 

predictors of recurrence among 

women with ductal carcinoma in 

situ (DCIS). As with the previous 

center study of pancreatic cancer 

etiology and several information 

technology studies aimed at 

improving the research capacity of 

the CRN’s data and informatics 

resources. The Virtual Data 

Warehouse (VDW), a pivotal tool to 

facilitate multi-site cancer research 

through development of 

standardized, interoperable data files 

across multiple CRN sites, was a 

key product of CRN2. In addition, 

the DCIS and pancreatic cancer 

population-based studie

was also marked by for

collaborations with canc

and increased efforts to 

professional developme

investigators through m

and availability of pilot 

small studies. 

1997 

> Request for 

Applications, “Cancer 

Research Network 

Across Health Care 

Systems” 

1999 

> First Cancer 

Research Network 

grant (CRN1) funded 

through cooperative 

agreement 

2002 

> Second competitive 

Request for 

Applications issued 

2003 

> Second Cancer 

Research Network 

grant (CRN2) funded 

> AHRQ becomes 

co-sponsor of CRN 

initiative 

> Comp

of CR

publis

Journa

Nation

Institu

> CRN f

Summ

System

Platfor

6 rcThe HMO Cancer Resea
http://crn.cancer.gov

in CRN3 involve increasing 

collaboration with external 

researchers, research institutions, 

and networks outside the CRN 

member organizations; further 

development of standardized data 

resources, particularly informatics; 

increasing support and focus on 

career development for junior 

investigators through a formalized 

CRN Scholars Program; and the 

initiation of a pilot grant program 

with more funding opportunities 

than during CRN2. In addition, core 

research projects are investigating 

the economic burden of cancer, 

developing and testing measures of 

oral health literacy, and examining 

the potential for applying metrics to 

capacity, CRN3 also provides an 

ideal research platform for 

addressing the newly emerging area 

of Comparative Effectiveness 

Research (CER). In 2009, CRN 

investigators and collaborators 

successfully competed for multiple 

CER grants, including three NCI 

Grand Opportunity (GO) grants to 

support initial development of 

Centers for CER in the areas of 

screening, treatment, and genomic 

medicine and three NCI Challenge 

grants in the areas of data 

and improving surgical qu

breast cancer. The success 

has inspired other NIH Ins

adopt and replicate this mo

their own research needs. 

2006 

> External, independent 

evaluation conducted 

> Third competitive 

Request for 

Applications issued 

> CRN recognized by 

NIH Roadmap 

Inventory & 

Evaluation of 

Clinical Research 

Networks (IECRN) 

as a “Best 

Practices” site 

2007 

> Third Cancer 

Research Network 

grant (CRN3) funded 

2008 

> CRN Cancer 

Communication 

Research Center 

established as an NCI 

Center of Excellence 

2009 

> Three GO grants funded 

through ARRA 

> Three Challenge grants 

funded through ARRA 

> Most CRN sites included in 

FDA’s Sentinel System pilot 

project for assuring safety 

of the nation’s drug supply 
advisors, non-CRN cancer researchers, and 

patient advocates participated in a concept 

mapping process to identify scientific 

priorities for the CRN. The following eight 

CRN priority research themes that emerged 

from this exercise, although not exclusive, 

include most of the CRN’s current work, as 

well as areas of particular interest for 

future research. 

health care delivery pro

quality, cost, and outcom

foundation of CRN rese

Studies in this area addr

nature and quality of se

cancer prevention, scree

treatment, supportive ca

survivorship care, and t

on health outcomes and 

relatively large number 

sites and the size and di

CRN patient population

studies of practice varia

disparities in care and o

well as intervention stud

Health Insurance Bene

and Patterns of Care U

Innovations in benefit s

improve care can be adv

research that examines 

relationships among pat

design, in the form of c

or out-of-pocket costs f

services (e.g., copaymen

coinsurance, deductible 

patient use of cancer pr

screening, and treatmen

and outcomes. 

8 The HMO Cancer Resea
diverse populations for conducting 

cross-sectional, case-control, cohort, 

and randomized controlled 

intervention studies to examine 

numerous cancer-related conditions, 

including rare outcomes. Studies of 

health promotion strategies, lifestyle 

changes, and risk factor assessment 

and identification all benefit from 

being conducted in the HMO 

setting. This setting enhances the 

ability to define populations to 

facilitate recruitment and follow-up, 

work with the health care system to 

improve retention of study 

participants, and provide detailed 

information on medical care and 

comorbid conditions that may 

impact patient outcomes of interest. 

Enhancing Cancer Communication 

and Decision-Making 

With its extensive data on patients, 

providers, health care delivery, and 

patient outcomes, a key CRN 

strength is the capacity to examine 

and optimize the quality of patient 

communication and decisionmaking about cancer screening, 

diagnosis, treatment, and 

survivorship in diverse populations. 

CRN studies in this area examine a 

wide range of issues—from shared 

clinical decision-making to 

Web-based consumer information. 

The CRN’s population size, 

diversity, and data resources provide 

rich opportunities to study cancer 

prevention and care in different care 

settings, patient populations, and 

regions of the country over time. Of 

particular interest are studies of the 

introduction of new diagnostic and 

treatment modalities and their 

diffusion into practice, as well as 

the conduct of 

pharmacoepidemiologic and 

pharmacogenomic studies of the 

effectiveness of cancer drugs and 

related prognostic markers as 

delivered in community practice. 

Psychosocial Factors and Burden 

of Cancer 

Factors such as education, financial 

assets, literacy, psychosocial 

distress, and costs of treatment have 

an impact on cancer care, patient 

outcomes (such as quality of life), 

and patient care experiences. 

Studies that characterize these 

effects are the basis for identifying 

and developing interventions to 

ameliorate them. Examining 

disparities in cancer access, 

outcomes, and treatment, as well as 

in the effectiveness of psychosocial 

interventions for cancer patients, are 

priority research areas. 

patient Web sites with secu

communication access to p

and rich arrays of current a

historical electronic data o

populations. A major prior

continued improvement of 

standardized data infrastru

the development and testin

research, surveillance, and 

practice innovations built up

patient Web portals, comp

physician order entry syste

automated records of comp

health service utilization. 

Building Capacity to Sup

Emerging Areas of Canc

Control Research 

CRN investigators and hea

organizations have tremen

potential to advance resear

activities to develop, enhan

test health informatics, dat

and biospecimen tools and 

to support research in area

cancer risk assessment and 

modeling; studies of behav

environmental, and genetic 

and personalized health ca

approaches to preventive c

screening, diagnosis/progn

treatment. In addition, the 

aims to develop activities 

increase the timeliness, eff

and effectiveness of recrui

phase 2 and phase 3 preve

treatment trials. 

http://crn.cancer.gov 
CTIVENESS RESEARCH (CER)


it remains a high priority within the Network.


What is CER? 

CER is the conduct and synthesis of 

research comparing the benefits and 

harms of interventions and 

strategies to prevent, diagnose, treat, 

and monitor health conditions in 

“real world” settings. The purpose 

of this research is to improve health 

outcomes by developing and 

disseminating evidence-based 

information to patients, clinicians, 

and other decision-makers, 

responding to their expressed needs 

about which interventions (e.g., 

medications, procedures, medical 

and assistive devices and 

technologies, diagnostic testing, 

behavioral change, delivery system 

strategies) are most effective for 

which patients under specific 

circumstances. 

CER is generally conducted using: 

• Randomized controlled clinical 

trials 

• Observational studies of 

retrospective and prospective 

cohorts, including secondary data 

analysis of registries and linked 

databases 

• Simulation modeling 

As part of the 2009 American 

Recovery and Reinvestment Act 

(ARRA), the Department of Health 

and Human Services received $400 

million to invest in CER. CRN sites 

and their collaborators successfully 

competed for ARRA funds, resulting 

in almost $10 million in additional 

awards. Most of these additional 

dollars will be used to conduct CER 

studies. The CRN continues to 

respond to federal funding 

announcements to work on 

CER-related studies. 

CER in the CRN 

Much of the work that t

conducted in CER to da

through observational s

particularly secondary d

or primary data collecti

with secondary data. In 

forward, however, the C

committed to developin

infrastructure to conduc

prospective, pragmatic 

in CER, which will like

critical tools for evidenc

decision-making. The C

ideally poised to develo

infrastructure in the inte

health care delivery sett

allow investigators to ra

efficiently mount trials 

real-world questions in 

laboratory models. 

The HMO Research Network, a consortium of large health maintenance organizations... 

may serve as a model for its capacity to implement studies and capture data within the c

of usual care. 

Sean R. Tunis; Daniel B. Stryer; Carolyn M. Clancy. Practical Clinical Trials: Increasing the Value of Clinical Resear

for Decision Making in Clinical and Health Policy. JAMA. 2003;290(12):1624–1632. 

10 The HMO Cancer Resea
The following two-year projects 

pertaining to CER were proposed by 

CRN investigators and funded by 

NIH using 2009 ARRA funds: 

Research on the Effectiveness of 

Advanced Cancer Treatments 

(REACT) 

Principal Investigators: Jane C. 

Weeks (Dana-Farber Cancer Institute) 

and Debra Ritzwoller (KPCO); CRN 

Sites: KPCO, KPG, KPNC, KPNW, 

GHC; Non-CRN Site: Dana-Farber 

Cancer Institute 

This project will use the CRN VDW 

and other large databases to evaluate 

alternative therapeutic approaches 

for patients with advanced cancer, 

and to build capacity within the 

CRN to conduct large, efficient 

prospective CER trials. 

Comparative Effectiveness in 

Genomic and Personalized Medicine 

for Colon Cancer 

Principal Investigators: Katrina 

Goddard (KPNW), Evelyn Whitlock 

(KPNC), and Lawrence Kushi (KPNC); 

CRN Sites: KPNW, HFHS, HPRF, 

KPCO, KPH, KPNC, MCRF, KPH, 

KPG; Non-CRN Sites: Georgetown 

University, Oregon Health & 

Sciences University 

This project will use primary and 

secondary data to investigate the 

comparative effectiveness of two 

tests related to colorectal cancer, the 

KRAS test and the Lynch syndrome 

prediction test, and will evaluate the 

utilization of these tests. 

Principal Investigators: Diana Buist 

(GHC) and Chyke Doubeni (MPCI); 

CRN Sites: GHC, GHS, HPRF, KPH, 

KPNC, KPNW, GHS, MCRF, MPCI; 

Non-CRN Sites: University of 

Massachusetts, University of Washington 

This project will study effective 

cancer screening delivery approaches 

to enhance colorectal and cervical 

cancer detection, diminish morbidity 

and other adverse effects, and 

reduce mortality; develop a stronger 

CRN collaboration with the NCIsponsored Cancer Intervention and 

Surveillance Modeling Network 

(CISNET); and, develop 

methodological capacity for future 

large-scale, population-based CER 

studies in the area of cancer 

screening to address important 

evidence gaps. 

Natural Language Processing for 

Cancer Research Network 

Surveillance 

Principal Investigator: David Carrell 

(GHC); CRN Sites: GHC, HFHS; 

Non-CRN Sites: University of 

Pittsburgh Medical Center, 

Vanderbilt University, Mayo Clinic 

This project will develop new 

measurement technologies for 

extracting disease and treatment 

information from text data available 

in EMRs to advance epidemiologic 

and clinical breast cancer research 

and will develop an algorithm to 

identify recurrent breast 

cancer diagnoses. 

Principal Investigator: Lau

McCahill (Van Andel Resear

Institute); CRN Sites: GHC

MCRF; Non-CRN Sites: V

Research Institute, Univer

Vermont 

This project will develop a 

cancer surgery outcomes d

enabling CER studies to b

conducted, particularly as 

current controversies in th

management of breast can

as an appropriate patholog

of clearance in partial mas

which can be used to impr

outcomes and reduce health 

Cost-Effectiveness of Horm

Therapy for Clinically Loca

Prostate Cancer 

Principal Investigators: Ste

Van Den Eeden (KPNC), Ma

Ulcickas Yood (HFHS), and A

Potosky (Georgetown Univer

CRN Sites: KPNC, HFHS

CRN Site: Georgetown Un

This project will provide 

information on the risks an

potential benefits of imme

androgen deprivation thera

men diagnosed with locali

prostate cancer, and will h

estimate costs, calculate th

effectiveness, and determin

cost-utility of this treatmen

http://crn.cancer.gov 
TH THE CRN


to learn about CRN data 

resources and research 

priorities, and to see how 

well they fit your research 

interests and data needs. 

If you are interested in collaborating 

with the CRN, you will need to 

complete the Web inquiry form 

found on the CRN Web site. This 

form is used to describe: 

• Any current or previous 

involvement with the CRN 

• A statement of your main research 

questions and hypotheses 

• The nature of the data needed from 

the CRN to address your research 

questions 

• A description of your project team 

or potential collaborators 

• An estimated timeline for proposal 

development and submission 

• The type of proposal you are 

planning to submit (e.g., an NIH 

R01), and whether it is in response 

to a particular Request for 

Applications (RFA) or Program 

Announcement (PA) 

or affiliates to determine whether 

your interests and/or data needs 

align with the CRN. 

Promising collaborations generally 

lead either directly to the 

development of a research proposal, 

or to participation by external 

collaborators in a CRN Scientific 

Interest Group (SIG). The CRN has 

developed guiding principles for 

initiating and participating in CRN 

SIGs, which are forums that enable 

investigators interested in a 

particular topic to discuss research 

interests and ideas. 

For collaborations leading to 

proposals, the following resources 

assure effective communication and 

increase the likelihood of a 

successful proposal. 

• The CRN New Proposals 

Committee has outlined policies 

and procedures for reviewing and 

submitting new collaborative 

proposals. The Committee assesses 

feasibility, potential for overlap 

with existing projects, and 

appropriateness of the CRN as 

the setting to answer your 

research questions. 

including research des

analysis, and dissemin

• CRN sites contributing 

your project will revie

comment on your resea

• The CRN Publications 

has outlined policies a

procedures for authors

publication of CRN-rel

This has been an ou

opportunity to broad

collaborations with 

researchers beyond 

University and to co

faculty to population

study of cancer. Fro

Cancer Center’s per

our clinicians (in pa

will have new oppor

study various aspect

cancer prevention, e

detection, treatment, 

survivorship questio

DeAnn Lazovich, P

Professor, Division 

Epidemiology and 

Health, University 

12 The HMO Cancer Resea
Visit 

http://crn.cancer.gov 

Use the Web inquiry form to 

connect with the CRN 

Principal Investigator’s office. 

The CRN P

Investigator

identify pote

collaborator

initial meetin

the progress 

collaboratio

2 

A 

Work with CRN staff to 

assess interest level 

and feasibility. 

If your ideas are a good 

fit...Participate in an initial 

conference call to discuss 

your ideas with interested 

collaborators. 

B C 

Work with C

collaborator

Scientific Int

(SIG) to dev

project prop

3 

A 

Work with internal CRN 

collaborators to finalize 

research questions and 

develop and execute 

proposals. 

B 

Submit your proposal to 

the CRN New Proposals 

Committee for review 

and approval. 

When ready to publish, follow 

the policies and procedures of 

the CRN Publications 

Committee regarding 

authorship and publication. 

C D 

Use the We

to provide fe

CRN collabo

http://crn.cancer.gov 
COLLABORATIONS


of growth through 

collaboration with both 

internal and external 

research partners and has 

made this a high priority 

since its inception. 

Collaboration with external partners, 

such as affiliated cancer centers, 

other academic institutions, research 

consortia and networks, and NCI 

researchers has enabled the CRN to 

initiate studies that might not have 

otherwise been possible. Fruitful 

collaborations among large, 

established entities require thoughtful 

negotiation and recognition of the 

interpersonal, technical, and 

financial considerations of all parties. 

The CRN has developed a large 

knowledge base on how to 

successfully collaborate with other 

groups, as evidenced by the myriad 

partnerships in which they are engaged. 

Collaboration with Cancer Centers 

The NCI-designated Cancer Centers 

are a major source of discovery 

regarding the nature of cancer and 

the development of more effective 

approaches to cancer prevention, 

diagnosis, and therapy. They also 

deliver medical advances to patients 

and their families, educate health 

care professionals and the public, 

and reach out to underserved 

populations. The CRN’s growing 

triaging research inquiries and also 

provide access to critical scientific 

expertise. In particular, external 

biomedical and clinical collaborators 

(e.g., oncology researchers, 

pathologists) have played critical 

scientific roles in CRN research 

projects. Eight CRN sites currently 

have active collaborations with 

Cancer Centers. 

Harvard Pilgrim Health Care 

Institute in Boston was the first group 

to initiate an affiliation agreement 

on behalf of the CRN with the 

Dana-Farber Cancer Institute/Harvard 

Cancer Center (DF/HCC). The 

agreement was signed in 2005 and 

has since served as a model for other 

CRN-Cancer Center partnerships with 

the following universities: Oregon 

Health Sciences, Hawaii, Emory, 

California–San Francisco, Wisconsin, 

Minnesota, and New Mexico. 

Example: Through a partnership 

between the CRN and DF/HCC, 

investigators funded through a CER 

grant are developing a resource to 

support high quality cancer CER 

that addresses two key knowledge 

gaps: (1) treatment of advanced 

disease and (2) patterns and 

outcomes of cancer care for patients 

not represented in the SEERMedicare database (e.g., patients 

younger than 65, patients receiving 

their care through an HMO). This 

project will generate new and 

improved methods to help advance 

patterns of cancer care. 

Collaboration with Ac

Institutions 

The reach and visibility 

has extended into the ac

research community, wh

increased access to supe

investigators and biologic 

Collaborations are facil

Academic Liaison Com

which was designed to 

CRN on overall objectiv

guidance on directions f

research, and identify p

collaborators outside of 

Many new collaboration

have developed as a res

Committee’s involveme

Example: Researchers fr

have teamed up with in

Van Andel Research Ins

the University of Vermo

the University of Vermo

electronic breast cancer 

outcomes database to th

sites. Researchers will u

database to develop and 

measures of surgical qu

examining variation in o

initial breast cancer surg

patient, surgeon, hospita

geographic levels. They 

how this system can be 

in other CRN sites, with 

goal of facilitating comp

effectiveness research th

the network, especially 

of breast cancer manage

14 The HMO Cancer Resea
California–San Francisco to 

investigate patterns and variability 

of medical imaging over time and 

patterns of radiation exposure 

associated with medical imaging. 

These data will provide critical 

information that will allow 

researchers to estimate the increased 

risk of radiation-sensitive cancers 

associated with medical radiation 

exposure as a result of imaging. 

Collaboration with Federally 

Funded Research Consortia and 

Networks 

The CRN provides a platform for 

rapidly conducting population-based 

studies, which has been leveraged by 

federally funded research consortia 

and scientists within the government. 

The Clinical and Translational 

Science Awards (CTSA) program, 

which is funded by the NIH National 

Center for Research Resources, uses 

a consortium model to create 

academic homes for clinical and 

translational science across the 

country by developing teams of 

researchers to bring laboratory 

science into the clinic. The CRN is 

well positioned to collaborate with 

this national consortium because it 

provides a population-based health 

care environment in which to 

conduct further research. Eight CRN 

sites currently are members or have 

partnerships with members of the 

CTSA consortium. 

CTSA collaboration. Oregon Health 

Sciences University and Kaiser 

Permanente Northwest have teamed 

up to accelerate the translation of 

research from bench to bedside to 

populations and develop feedback 

loops from clinical trials and 

population science back to basic 

scientists. By bringing together a 

strong biomedical research university 

and an innovative practice-based 

research center associated with a 

large patient population, OCTRI is 

attempting to remove barriers to the 

pace and growth of research and 

improve patient care. 

Example: Nine CRN research 

programs participate in an AHRQfunded Center for Education and 

Research in Therapeutics (CERT). 

For the past few years, CRN and 

CERT leadership have met regularly 

to discuss the development of the 

VDW to ensure that it can meet the 

needs of both networks. The proposed 

program to study the diffusion, cost, 

and outcomes of new cancer therapy 

innovations takes advantage of the 

pharmacoepidemiologic experience 

and skills of our CERT colleagues. 

Example: The CRN is also involved 

with other NCI research consortia 

and cooperative groups. CRN work 

includes actively enrolling patients 

to cancer treatment clinical trials 

through cooperative groups such as 

the: National Surgical Adjuvant 

Breast and Bowel Project (NSABP), 

Surgeons Oncology Group 

(ACOSOG), Eastern Coop

Oncology Group (ECOG), 

Cancer Trials Support Uni

Investigators affiliated wit

CRN also have helped to r

patients into prevention and 

trials such as the Prostate, 

Colorectal and Ovarian (P

Cancer Screening Trial, th

Lung Screening Trial (NL

the Selenium and Vitamin 

Prevention Trial (SELECT

CRN is a participating rese

of the NCI Cancer Care O

Research and Surveillance 

Consortium (CanCORS). 

Example: CRN investigato

also formed collaborations 

intramural researchers at N

Researchers from both org

are teaming up to investiga

association between chron

immune stimulation and ri

lymphomas and related pre

conditions. Conducting thi

within the CRN framewor

improve on previous studi

because the results will be 

generalizable to the U.S. p

and researchers will be bet

capture exposures through 

both inpatient and outpatie

Incorporation of laboratory

medication, and survival d

also provide a more compr

picture of the issues surrou

lymphomagenesis. 

http://crn.cancer.gov 
large, integrated health 

care delivery organizations

nationwide, the CRN is 

heavily influenced by 

its proximity to and 

familiarity with the dayto-day provision of cancer 

prevention, diagnosis, 

and care. 

All CRN sites are longstanding 

organizations with a stable presence 

their enrollee populations, the 

organization and delivery of care, 

and the associated data systems. 

Population Coverage 

CRN member organizations have a 

combined population of nearly 

11 million enrollees. The age and 

sex distributions of enrollees 

collectively reflect those of the 

general U.S. population, although 

individual plans vary widely. The 

CRN includes population centers 

with a high percentage of African 

Americans (Henry Ford Hospital 

and Health System/Health Alliance 

(Kaiser Permanente Haw

Permanente Northern C

and Kaiser Permanente 

California); Hispanics (

Health System, Kaiser P

Southern California, Ka

Permanente Northern C

and Kaiser Permanente 

and rural and under-serv

populations (Geisinger 

System and Marshfield 

Racial, ethnic, and socio

diversity is an importan

the CRN, which permit

emphasizing effectivene

focused on these subpop

QUICK FACTS 

> Between 1999 and 2009, CRN researchers have published more than 175 peer-reviewed 

journal articles on CRN-related projects. 

> Across the CRN sites, there are over 200 scientific and program staff conducting and 

supporting cancer research. 

> Most of the CRN sites actively enroll patients to cancer treatment clinical trials through 

cooperative groups, such as the NSABP, SWOG, RTOG, ACOSOG, ECOG, and CTSU. 

Investigators affiliated with the CRN also have helped to recruit patients into prevention and 

screening trials such as the PLCO Cancer Screening Trial, the NLST, and the SELECT. 

> CRN partnerships and affiliations include the HMO Research Network, many NCI-designated 

Cancer Centers, and several federal agencies, including NCI, NHLBI, NHGRI, CDC, and AHRQ. 

> The CRN has significantly leveraged its core funding since the original grant to develop and 

receive many infrastructure or core research grants; administrative or minority supplements; 

pilot studies; challenge grants; and GO grants. 

> Investigators from the CRN have participated in other funded work, including R21, R01, U01, 

P50, and training grants as well as career awards. 

16 The HMO Cancer Resea
Year Established 1983 2003 1948 1969 1989 1991 1998 1991 1961 1964 1975 1990 195

2009 Funding, Millions 36 8.9 60.9 30 10.5 

(2008) 

14.4 2.3 4 73 35 

(2008) 

25.9 4.9 2

(200

% Extramural 92 90 81 84 69.6 54 75 90 80 90 72 100 4

# Full-time M.D./Ph.D. 

-level staff 

36 18 80 38 19 30 3 4 46 54 20 6 2

# Programmers 42 2 23 8 15 23 3.5 4 88 24 31 3 

Total Staff 297 120 484 140 88 111 12 34 509 250 186 31 19

Research Facilities 

Survey Research • • • • • • • • • • 

Clinical Center • • • • • • • • • 

Chart Abstraction • • • • • • • • • • • • 

Key (table column heads, pages 17–18): 

GHC = Group Health Cooperative (Group 

Health Research Institute) 

GHS = Geisinger Health System 

(Geisinger Center for Health Research) 

HFHS = Henry Ford Hospital and Health 

System/Health Alliance Plan (Department 

of Biostatistics and Research 

Epidemiology and Center for Health 

Services Research) 

HPHC = Harvard Pilgrim Health Care 

Institute and Harvard Medical School 

(Department of Population Medicine) 

HPRF = HealthPartners (HealthPartners 

Research Foundation) 

KPCO = Kaiser Permanente Colorado 

(Institute for Health Research) 

KPG = Kaiser Permanente Georgia 

(Center for Health Research-Southeast) 

KPH = Kaiser Permanente Hawaii 

(Center for Health Research-Hawaii) 

KPNC = Kaiser Permanente Northern 

California (Division of Research) 

KPNW = Kaiser Permanente Northwest 

(Center for Health Research-Northwest) 

KPSC = Kaiser Permanente S

California (Department of Rese

Evaluation) 

LCF = Lovelace Health System 

Clinic Foundation Research) 

MCRF = Marshfield Clinic/Sec

Plan (Marshfield Clinic Research 

MPCI = Fallon Community He

(Meyers Primary Care Institute

http://crn.cancer.gov 
Preferred Provider 0 0 0 0 85 0 0 0 0 0 0 0 

Clinic Sites 33 60 27 14a 45 18 10 17 159 28b 150 20c 

Total enrollment, 

x 1,000d 617 229 208 762 717 451 271 216 3,130 471 3,324 194 

1-year retention 84 82 99.5 78 73 83 87 85 87 82 87 78 

3-year retention 66 54 86.4 47 46 66 67 72 75 66 70 66 

5-year retention 55 41 62.6 35 38 56 54 63 66 57 59 57 

Age, Years, % 

0-17 20 19 18 24 25 22 24 22 22 23 25 39 

18-44 33 29 29 39 38 34 39 35 35 34 36 25 

45-64 33 28 35 33 30 30 31 30 29 31 28 20 

65+ 13 24 18 4 8 14 7 13 13 13 11 15 

Female, % 53 52 55 52 51 53 53 50 52 52 52 55 

Race, % 

White 82 96 54 75 81 74 63 25 51 84 38 55 

African American 3 <1 33 16 9 5 33 <1 8 3 8 1 

Asian American 6 0 3 5 5 3 <1 63 17 5 10 1 

American Indian 1 <1 <1 <1 1 1 <1 <1 <1 1 <1 2 

Hispanic 4 1.4 1 4 2 15 <1 3 19 6 41 38 

Other 3f <1 8 0 2 2 4 17 5 1 <1 0 

a HVMA (Harvard Vanguard Medical Associates) 

b Does not include KPNW’s 16 dental offices 

c ABQ Health Partners 

d Total enrollment, all sites combined: 10,872,000 

e Retention among cancer survivors only 

f Includes persons reporting more than one race 

18 The HMO Cancer Resea
legacy data systems that date back 

many years. There data systems 

include informations about: 

• HMO enrollment 

• Outside claims and referrals 

• Patient scheduling and registration 

• Births and deaths 

• Cost of services 

• Outpatient visits 

• Hospitalizations 

• Emergency room visits 

• Prescriptions 

• Laboratory tests 

• Long-term care 

these data varies by CRN site. 

These data systems have been used 

for research for decades for both 

single-site and multisite studies. The 

number of collaborating sites and 

the complexity of CRN research 

questions required the CRN to 

create a more efficient and 

standardized approach to data 

aggregation. The CRN chose to 

create a VDW, consisting of 

databases with a common set of 

standardized variables in each CRN 

site. The variability of the legacy 

data systems has made developing 

the VDW the CRN’s most 

formidable challenge. 

http://crn.cancer.gov 
RESEARCH TOOLS


ethical and legal 

obligation to safeguard the 

confidentiality of medical 

information of their 

individual members. 

Thus, it is natural that CRN 

scientists and their home 

organizations have long been 

concerned about the sensitivity of 

health system data, especially 

medical information about 

leaders have legitimate concerns 

that without careful stewardship, 

such data could be compromised or 

misrepresented. Because of these 

concerns, the CRN Steering 

Committee rejected the notion of 

establishing a centralized repository 

of generic data on the enrollees of 

each HMO for use in current and 

future studies. However, the CRN 

proposed developing standardized 

data resources to increase the 

quality and efficiency of research 

using automated data: the VDW, 

patient or provider iden

protected from third-par

by federal statute. 

The Virtual Data 

Warehouse (VDW

The VDW is a distribut

warehouse, a federated 

is made up of standardi

stored behind separate s

firewalls at each particip

site. The datasets includ

with identical names, fo

specifications (including 

Emerging Partnerships in Informatics 

The CRN is coordinating its informatics development efforts with NCI’s Cancer Biomedical Informatics Grid 

to facilitate collaboration. The aim of the caBIG® collaboration is to use caBIG® tools to improve the VDW’s 

compatibility and interoperability with national standards. The CRN also is an active contributor to the caBIG

Population Sciences Special Interest Group and the cross-cutting Data Sharing and Intellectual Capital Wo

both of which are working on strategies to facilitate multisite collaboration, data collection, and stewardship

The CRN has also partnered with the SEER Program to pilot a project in Hawaii in which VDW data is elect

transmitted to the geographically co-existing central cancer registry. This unique partnership will enable inve

to conduct analyses relating to comorbidities, such as examination of the association between the number 

severity of comorbidities present during the year prior to diagnosis and treatment modalities, survival, and o

patient outcomes. It will also allow investigators to determine whether CRN records are able to enhance SE

registry data, and vice versa. If the pilot proves useful to CRN and SEER investigators, periodic transmissio

from the CRN to SEER registries at multiple sites may be considered. 

Finally, the CRN has partnered with Harvard University to test a system developed by Harvard that locates 

retrieves tissue specimens and pertinent clinical and outcome data on an as-needed (just-in-time) basis. Te

this system is being conducted within the CRN to determine how well it functions in a large HMO setting a

it can reliably remove all personal health data identifiers while maintaining usable data extracted from medic

This system has the potential to substantially enhance the capability of the CRN to conduct multisite cance

research projects involving pathological specimens and associated clinical/outcome data. 

20 The HMO Cancer Resea
written at one site, to be run against 

all participating sites’ databases. 

Person-level data at each CRN site 

remains under local control at that 

site. The VDW is supported by a set 

of informatics tools—hardware and 

software—that facilitate storage, 

retrieval, processing, and managing 

of VDW datasets; a set of access 

policies and procedures governing 

use of VDW resources; and 

documentation of all elements of the 

VDW. The VDW is a cornerstone of 

today’s “rapid-cycle” research 

environment, because it allows for 

responsiveness and efficiency while 

maintaining data privacy and 

security, as well as local autonomy 

over the data at each site. 

The VDW files cover the following 

areas of information: 

• Demographics and vital signs 

• Enrollment into the health care plan 

• Utilization, including inpatient and 

outpatient visits, emergency 

department visits, long-term care 

admissions and home health visits, 

and communications with health 

professionals via phone 

• Diagnoses, procedures, and lab 

tests/results 

• Incident cancer 

• Pharmacy data 

• Provider information 

• Census data 

• Birth and death data 

can receive more detailed and 

specific information about the 

content of the VDW once an official 

collaboration has been established. 

Cancer Counters 

To facilitate efficient study 

planning, CRN staff developed 

virtual data marts or “counters.” 

The Cancer Counter includes 

summarized, de-identified data that 

can produce counts of patients with 

cancer aggregated by tumor site, 

morphology, stage, health plan, vital 

status, race, gender, and Hispanic 

ethnicity, and that allows users to 

select one- and two-way frequencies 

of these variables. The Cancer Counter 

has proven to be invaluable for 

estimating study population sizes 

for new cancer research proposals. 

Electronic Medical 

Records (EMRs) 

EMRs allow researchers to 

manipulate and standardize free-text 

clinical data such as clinical 

assessment findings, image 

interpretations, surgical operative 

reports, pathology evaluations, 

hospital discharge summaries, and 

consultant evaluations. In addition 

to the standard physician userinterface, many of the EMRs also 

have a patient interface, where 

patients can view items in their 

medical record (such as visit 

summaries and laboratory test 

results), send secure messages to 

instrument. This provides 

with opportunities for inno

interventions. Several EM

are employed across CRN 

organizations, although Ep

the most commonly used. 

Oncology Information Sys

an Epic software product, 

used by at least eight of th

sites to document patient c

and chemotherapy infusion 

and manage patient treatm

Natural Language 

Processing (NLP) 

NLP helps investigators co

variety of sentences, claus

symbols, and abbreviation

represent synonyms into m

concepts of research intere

informaticists developed a

tool called MediClass® to 

standardized information a

tobacco control counseling 

“Using Electronic Medical 

to Measure and Improve A

to Tobacco Treatment Gui

Primary Care.” In 2009, th

was awarded ARRA stimu

to integrate the Clinical Te

Analysis and Knowledge E

System (cTAKES), a powe

expandable NLP system, i

infrastructure of the CRN 

coordinating site and test a 

NLP algorithm for identify

recurrent breast cancer dia

clinical text. 

http://crn.cancer.gov 
TRUCTURE


collaborate actively. The CRN’s administrative structure is made up of four cores, a Clin

Applications and Translation Program, and research projects including a pilot studies program

The four cores include Administrative Committees, an Evaluation Core, a Scientific 

and Data Resources Core, and the CRN Scholars Program. The Clinical Applications 

and Translation Program emphasizes work in two major areas: improving enrollment 

in cancer clinical trials and studying diffusion of innovations in cancer prevention 

and care. Scientific Interest Groups (SIGs) are initiated and led by 

investigators with shared interests in emerging areas of 

high-priority research. 

> Obesity 

> Family History 

> Cancer Survivorship 

> Pharmacogenomics 

> Patient-Centered Communication 

in Cancer Care 

> Racial Disparities 

> Others 

CRN S CIENTIFIC INTEREST 

GROUPS (SIGs) 

The Pharmacogenomics SIG is organized th

larger HMORN and led by CRN scientists. M

CRN researchers are active participants. Th

interested researchers together to learn abo

pharmacogenomics projects within the HMO

as upcoming research opportunities. The S

facilitates collaboration between the HMOR

external investigators on pharmacogenomic

The Pharmacogenomics SIG laid the founda

GO grant funded by NCI in 2009 entitled Co

Effectiveness Research in Genomic and 

Personalized Medicine of Colorectal Ca

by principal investigators Dr. Katrina Godda

Dr. Evelyn Whitlock (KPNW), and Dr. Lawren

(KPNC). The grant will use the CRN health s

platforms to explore the comparative effecti

genomic and molecular tests, including thos

and Lynch Syndrome, related to colorectal c

Researchers will also measure psychosocia

related to testing to help inform understand

test results in decision making. This researc

the experience, data systems, and methods 

applied to other cancer-related genetic or m

tests in the future. 

22 The HMO Cancer Resea
Academic 

Liaison 

Committee 

COMMITTEE 

& 

STEERING 

COMMITTEE 

Principal 

Investigator’s 

Office 

NCI Pro

Staf

Cores 

> Administrative Committees 

> Evaluation 

> CRN Scholars Program 

> Scientific & Data Resources 

Clinical 

Applications & 

Translation 

Program 

> Clinical Trials 

> Diffusion of Innovations 

Research Proje

> CRN Projects 

>> Pilot Projects 

> Affiliated Projects 

> Supplements 

> Other Funded Work 

http://crn.cancer.gov 
ESTIGATORS


Edward H. Wagner, M.D., M.P.H. 

CRN Principal Investigator 

Senior Investigator,


Group Health Research Institute 


Director, MacColl Institute 


Research Interests: studies of interventions


to reduce disability in seniors and to


enhance the care of persons with cancer


and other chronic illnesses; cluster


randomized trials 


wagner.e@ghc.org 


Lawrence H. Kushi, Sc.D. 

CRN Co-Principal Investigator 

Associate Director for Etiology and 

Prevention Research, 

Kaiser Permanente Northern California 

Research Interests: role of diet and nutrition 

in the etiology of breast and other cancers; 

epidemiologic studies of cancer prognosis 

larry.kushi@kp.org 

Mark C. Hornbrook, Ph.D

CRN Co-Principal Investigato

Senior Investigator and Chief 

Kaiser Permanente Northwes

Health Research 

Research Interests: health ca

utilization analysis; economic 

methods; patient classificatio

health status measurement; 

modeling; health-based paym

mark.c.hornbrook@kpchr.org 

Fallon Community Health Plan, 

Meyers Primary Care Institute (MPCI) 

Terry S. Field, D.Sc. 

Associate Director,


Meyers Primary Care Institute 


Associate Professor of Medicine, University


of Massachusetts Medical School 


Research Interests: providing safe and


effective health care for adults who are


disabled, chronically ill, or elderly;


racial disparities 


tfield@meyersprimary.org 


Geisinger Health System, 

Geisinger Center for Health 

Research (GHS) 

Azadeh Stark, Ph.D., M.Sc. 

Senior Staff Scientist, Henry Hood Center for 

Health Research, Geisinger Health System 

Adjunct Associate Professor, Center for 

Clinical Epidemiology and Biostatistics, School 

of Medicine, University of Pennsylvania 

Adjunct Associate Professor, Department of 

Internal Medicine, Wayne State School of 

Medicine 

Research Interests: cancer control and early 

detection; prevention of obesity; breast 

cancer prevention; screening mammography 

improvement; use of biomarkers for early 

detection and recurrence; prevention of 

chronic health problems secondary to 

cancer treatment; long-term cancer care 

communication 

astark1@geisinger.edu 

Harvard Pilgrim Health 

Institute and Harvard 

Medical School, 

Department of Populat

(HPHC) 

Suzanne W. Fletcher, M.D

Professor Emerita of Ambula

Prevention, Harvard Medical 

Harvard Pilgrim Health Care 

Research Interests: preventio

related to breast cancer scre

quality of life issues 

suzanne_fletcher@hms.harva

24 The HMO Cancer Resea
thomas.j.flottemesch@HealthPartners.com 

Kaiser Permanente Georgia, 

Center for Health ResearchSoutheast (KPG) 

Douglas W. Roblin, Ph.D. 

Senior Investigator, Kaiser Permanente 

Southeast Center for Health Research 

Adjunct Assistant Professor of Health Policy 

and Management, Rollins School of Public 

Health at Emory University 

Research Interests: organizational and 

financial characteristics of health care 

systems affecting patient outcomes, such 

as medical services use and cost; visit 

satisfaction; quality of chronic disease care 

douglas.roblin@kp.org 

Lovelace Health System, 

Lovelace Clinic Foundation 

Research (LCF) 

Herbert (Bert) T. Davis, Ph.D. 

Senior Research Scientist, 

Lovelace Clinic Foundation Research 

Research Interests: comparative 

effectiveness for cancer therapies; ethnic 

disparities in cancer treatment, alcohol 

abuse, and diabetes 

bert.davis@lcfresearch.org 

Research Epidemiology; Director, Henry Ford 

Hospital and Health System, Epidemiology, 

Prevention, and Control Program, Josephine 

Ford Cancer Center, Henry Ford Health System; 

Director, Center for Allergy, Asthma, and 

Immunology Research, Henry Ford Health System 

Research Interests: cancer epidemiology 

and prevention; pharmacoepidemiology; 

etiologies of allergy and asthma 

cjohnso1@hfhs.org 

Kaiser Permanente Hawaii, Center 

for Health Research-Hawaii (KPH) 

Andrew E. Williams, Ph.D. 

Investigator, Kaiser Permanente Center for 

Health Research 

Adjunct Assistant Professor, Department of Public 

Health Sciences, University of Hawaii at Manoa 

Research Interests: medical judgment and 

decision making; health services 

andrew.e.williams@kp.org 

Marshfield Clinic/Security Health Plan, 

Marshfield Clinic Research 

Foundation (MCRF) 

Robert T. Greenlee, Ph.D., M.P.H. 

Marshfield Epidemiologic Study Area Lead 

Scientist, Marshfield Clinic Research Foundation 

Research Interests: cancer surveillance and 

control; sociodemographic disparities in 

prevention, early detection, and treatment; 

clinical epidemiology of cardiovascular 

disease, particularly arrhythmias and 

conduction disorders 

greenlee.robert@mcrf.mfldclin.edu 

Institute for Health Research, Ka

Permanente Colorado 

Research Interests: costs and cost

of behavioral interventions; the u

disease management interventio

effectiveness; public health surv

systems; physician compensatio

comorbidities; cost estimation; cost

debra.ritzwoller@kp.org 

Kaiser Permanente Sout

California,


Department of Research 

Evaluation (KPSC)


Virginia P. Quinn, Ph.D. 

Research Scientist, Department 

and Evaluation, Kaiser Permane

Southern California 

Research Interests: lifestyle and 

behavior change; prevention, sc

adherence; adolescents and de

quality of cancer-related care 

virginia.p.quinn@kp.org 

National Cancer Institute 

Martin L. Brown, Ph.D. 

CRN Program Director 

Chief, Health Services and Econ

Branch, Applied Research Prog

of Cancer Control and Populatio

National Cancer Institute 

Research interests: health services

of cancer; cost effectiveness of c

mbrown@mail.nih.gov 

http://crn.cancer.gov 
Growth in Funded CRN Research Projects, 1999–20

TS BY CRN RESEARCH THEME AND YEAR


1999 to more than 25 active projects in 2008–2009. This increase in research proje

reflects the many successful collaborations and ongoing efforts to address importan

control questions in the CRN population laboratory. Research projects are listed ac

themes described on pages 8 and 9, and selected studies are highlighted in each sec

GROWTH IN FUNDED CRN RESEARCH PROJECTS, 1999-2009 

40


35


30


Number 25 

of 

projects 20 

15 

10


5


0


1999	 2000 - 2002 - 2004 - 2006 - 2008 

2001 2003 2005 2007 2009 

Year project funding started 

26 The HMO Cancer Resea
Electronic Cancer Surgery Database NCI Challenge Grant 

Preventing Errors in the Home Care of Children with Cancer NCI CRN Pilot Project 

Long-Term Survivorship in Older Women with 

Early Stage Breast Cancer (BOW II) NCI R01 Grant 

Opportunistic Colorectal Cancer Screening: Providing FIT with Annual Flu Shots NCI CRN Pilot Project 

Systems Failures Contributing to Chemotherapy Error: 

A Project of the HMORN Center of Education in Research & Therapeutics AHRQ Contract 

4CQuality: Quality of Patient-Centered Cancer Care, 

Communication, and Coordination NCI Contract 

Do Acute and Chronic Illness Trump Preventive Care? 

A Case Study of Breast and Colon Cancer Screening NCI CRN Pilot Project 

Research Supplement for Underrepresented Minorities Program: 

Patterns of Preventive Services Utilization of Cancer Survivors NCI CRN Administrative Supplement 

Evaluation of Hospice Referral and Palliative Care for Ovarian Cancer 

in the Managed Care Environment CDC Task Order 

Breast Cancer Treatment Effectiveness in Older Women (BOW I) NCI R01 Grant 

Lung/Colon Cancer Outcomes: Cancer Care Outcomes 

Research and Surveillance Consortium (CanCORS) NCI Cooperative Agreement 

A Pilot Study of Disenrollment among HMO Patients with Cancer NCI CRN Administrative Supplement 

Design, Implementation & Analysis of a Clinician Survey (DETECT supplement) NCI CRN Administrative Supplement 

HMOs Investigating Tobacco (HIT) NCI CRN Core Research Project 

Toward Reducing Cervical and Late-Stage Breast Cancer: 

Detecting Early Tumors Enables Cancer Therapy (DETECT) NCI CRN Core Research Project 

Selected research projects are highlighted below. 

Breast Cancer Treatment 

Effectiveness in Older Women 

(BOW I) and Long-Term 

Survivorship in Older Women 

with Early Stage Breast Cancer 

(BOW II) 

Dr. Rebecca Silliman (Boston 

University), a member of the CRN 

Academic Liaison Committee, led 

this large-scale cohort study of the 

care and outcomes of 1,859 older 

women with breast cancer at six CRN 

sites. By reviewing medical records 

and using administrative data, 

information was collected on initial 

surgery, adjuvant treatments, longterm surveillance, and recurrence 

and mortality outcomes. The team 

compared the effectiveness of 

different treatment and surveillance 

patterns, and identified the 

characteristics of providers, tumors, 

and patients associated with various 

treatment choices. The study found 

that less-than-standard treatment is 

associated with increased rates of 

recurrence and breast cancer-specific 

mortality, while mammography 

surveillance during the firs

years after diagnosis is ass

with a reduced rate of brea

cancer mortality. 

Following successful comp

BOW I, study investigator

a renewal to collect additio

information about this coh

breast cancer survivors thr

years after diagnosis. This 

will evaluate the effectiven

mammography surveillanc

recurrence and second prim

beyond five years; the cos

http://crn.cancer.gov 
This study assessed turnover among 

enrollees with cancer diagnoses in five 

HMOs and how turnover may affect 

longitudinal cancer outcomes research. 

The Principal Investigator, Dr. Terry 

Field (MPCI), and colleagues studied the 

retention rates among cancer survivors 

over a six-year period. Enrollees were 

followed from diagnosis through death, 

disenrollment, or end of follow-up. The 

and longterm outcomes. This led to a 

follow-up study that assessed racial 

disparities in cancer care and survival 

in more than 130,000 cancer patients. 

Toward Reducing Cervical and 

Late-Stage Breast Cancer: 

Detecting Early Tumors Eases 

Cancer Therapy (DETECT) 

This eight-HMO project, led by 

Dr. Stephen Taplin (NCI; formerly 

pj

considering quality issu

care. They also profiled 

screening practices and 

the HMOs and surveyed 

attitudes about screenin

and practices. The absen

screening accounted for 

late-stage breast and cer

Health Insurance Benefit Design and Patterns of Care Utilization 

CRN studies examine the relationship between patients’ benefit design and use of cancer screening and treatm

PROJECT TITLE FUNDING SOURCE YE

Medical Care Burden of Cancer: System and Data Issues Supplement NCI R01 Grant 

Administrative Supplement 

High Deductible Health Plans and Receipt of Cancer Prevention Services ACS Research Scholar Grant 

Chemotherapy and Coinsurance: 

The Effect of Cost Sharing on Cancer Care NCI CRN Pilot Project 

Economic Burden Pilot Study NCI CRN Core Research Project 

Medical Care Burden of Cancer: System and Data Issues NCI R01 Grant 

Selected research projects are highlighted below. 

Chemotherapy and Coinsurance: 

The Effect of Cost Sharing on 

Cancer Care 

Dr. Debra Ritzwoller (KPCO) is 

leading this multiyear, multisite 

CRN pilot study to assess the 

impact of coinsurance on receipt of 

cancer chemotherapy services 

among breast, colorectal, and lung 

cancer patients. This observational 

study will compare the rates of 

chemotherapy regimen use for a 

cohort of HMO cancer patients, 

before and after the implementation 

of 20% coinsurance on all infused 

chemotherapy services, at one of the 

sites. This study will leverage the 

ongoing efforts of the CRN VDW 

chemotherapy working group, and it 

is an unparalleled opportunity for 

the CRN to help inform 

policymakers of the potential impact 

of cost–sharing changes on cancer 

care. Given the potentially large 

economic and clinical consequences 

of new cancer therapies and greater 

patient cost-sharing requirements, 

this study will inform our 

28 

understanding of how th

may impact cancer treat

compliance, outcomes, 

Medical Care Burden 

System and Data Issue

Most cancer cost estima

NCI's SEER cancer reg

to Medicare claims (SEE

These data only represe

experience of the more 

aged Medicare benefici

enrolled in the fee-for-s

indemnity option; no in

available about the rem

The HMO Cancer Resea
y 

and omission biases in cancer cost 

estimates based on either group alone. 

This project, led by Dr. Mark 

Hornbrook (KPNW), will extend 

() g 

of cancer costs across HMO and 

FFS systems, correcting for 

selection and omissions biases. 

The study team received an NCI 

supplement to estimate the costs of 

p

infrastructure that will enh

CRN VDW for other uses, 

efforts focused on the diss

of pharmacotherapy amon

patients over time. 

Cancer Epidemiology, Prevention, and Health Promotion


CRN populations are the basis for conducting cross-sectional, case-control, cohort, and intervention studies t

numerous cancer-related conditions, including rare outcomes. Studies of health promotion strategies, lifesty

change, and risk factor assessment and identification benefit from the HMO setting, and particularly from th

information on medical care and comorbid conditions that may impact patient outcomes. 

PROJECT TITLE FUNDING SOURCE YEAR 

http://crn.cancer.gov 

Establish a Prospective Cohort to Investigate Obesity, Diabetes and NCI CRN Pilot Project 

the Metabolic Syndrome as Risk Factors in Young Adult Cancer 

Lymph Node Examination in Colorectal Cancer: Predictors of 

Adequate Staging and Its Influence on Cancer Survival in Community Practice NCI CRN Pilot Project 

Non-Melanoma Skin Cancer Ascertainment in the HMO Setting NCI CRN Pilot Project 

Statins and Lymphoid Malignancy Risk in 

a Large Multi-Site Population-Based Cohort NCI R01 Grant 

Medical Radiation Induced Cancers NCI CRN Pilot Project 

Development of a Model for Predicting Prostate Cancer NCI CRN Pilot Project 

Is Stroke a Late Effect of Chemotherapy? NCI R01 Grant 

Residential Segregation, Housing Status, and Prostate Cancer 

in African American and White Men Department of Defense Training Grant 

New Markers: Clinical & Pathologic Predictors of Ductal Carcinoma in Situ NCI CRN Administrative Supplement 

Medications and Colorectal Cancer Risk NCI R03 

Statins and Risk of Site-Specific Cancers NCI R03 

Investigation of Age-Specific Differences and Cancer of the Cecal Colon NCI CRN Pilot Project 

African American Disparities in Lung Cancer Outcomes NCI CRN Pilot Project 

Multicenter Study of Pancreatic Cancer Etiology NCI R01 Grant 

Making Effective Nutritional Choices (MENU) NCI CRN Core Research Project 

Clinical and Pathologic Predictors of Ductal Carcinoma in Situ NCI CRN Core Research Project 

Optimizing Breast Cancer Outcomes: BMI, Tumor Markers, and Quality of Care ACS Career Development Grant 

Medication Use and Risk of Esophageal Adenocarcinoma and Barrett’s Esophagus NCI Contract 

Colon Cancer Survivors—Medications and Risk of Recurrence NCI R01 Grant 

The Impact of Endocrine Therapy on Survival in Men 

with Local or Regional Prostate Cancer—Feasibility Study NCI CRN Administrative Supplement 

Program Testing Early Cancer Treatment and Screening (PROTECTS) NCI CRN Core Research Project 

Selected research projects are highlighted on the following page. 
Promotion (cont.) 

Is Stroke a Late Effect of 

Chemotherapy? 

This grant, led by Dr. Ann Geiger 

(Wake Forest University; formerly 

of KPSC), explores the hypothesis 

that chemotherapy may increase 

stroke risk for years afterward. The 

study team will estimate the relative 

risks of stroke as a result of 

chemotherapy among ethnically 

diverse patients with bladder, female 

breast, colorectal, Hodgkin’s 

lymphoma, adult leukemia, multiple 

myeloma, non-Hodgkin’s lymphoma, 

and ovarian cancers, adjusting for 

numerous demographic and clinical 

characteristics. 

Making Effective Nutritional 

Choices for Cancer Prevention 

(MENU) 

Dr. Christine Cole Johnson (HFHS) 

led the development and evaluation 

of an individually tailored, Webbased program to promote daily 

fruit and vegetable (F&V) 

consumption. Its efficacy was tested 

in a randomized trial of five HMOs. 

The online intervention was shown 

to be effective in the diverse sample 

of healthy adults who enrolled. All 

three intervention arms (untailored 

and tailored Web program and 

tailored Web program plus email 

support) showed early and sustained 

increases of more than two F&V 

servings per day. The untailored 

F&V servings, the retention rate 

was high, and reported satisfaction 

with the online program overall was 

high. Analyses exploring the effects 

of additional variables on dietary 

behaviors are ongoing. 

Clinical and Pathologic Predictors 

for Recurrence after Ductal 

Carcinoma in Situ (DCIS) 

In this project, led by Dr. Laurel 

Habel (KPNC), investigators at 

three CRN sites are studying clinical 

and pathologic factors that could be 

used to identify DCIS patients at 

high and low recurrence risk. From 

medical records, investigators have 

identified DCIS patients treated 

with breast-conserving surgery 

(BCS) and followed for recurrence. 

Recurrence rates after BCS for 

DCIS have declined as treatment 

with adjuvant radiotherapy and 

tamoxifen have increased; adjuvant 

treatment use does not appear to 

differ markedly across racial/ethnic 

groups; and surveillance 

mammography after BCS for DCIS 

declines over time and becomes 

inadequate. This large, 

help in developing indiv

tailored DCIS treatment 

It also serves as a mode

project that benefits fro

electronic and biologic 

available in the CRN he

Effectiveness of Early 

and Prophylactic Mas

Women at Increased R

Breast Cancer: Progra

Early Cancer Treatme

Screening (PROTECT

This project, led by Dr. 

Fletcher (HPHC), evalu

efficacy of bilateral pro

mastectomy (BPM) and 

contralateral prophylact

mastectomy (CPM) amo

with unilateral breast ca

30 The HMO Cancer Resea
these surgeries. The women who 

underwent BPM had a significant 

reduction in breast cancer risk, but 

approximately two-thirds 

experienced significant adverse 

effects. Compared with breast 

cancer patients without CPM, the 

risk of contralateral breast cancer in 

these women was also reduced 

significantly. The project also 

contributed methodologic 

innovations and analyses. 

Multicenter Study of Pancreatic 

Cancer Etiology 

The Pancreatic Cancer Investigation: 

Finding Causes (PACIFIC) study is 

a large, comprehensive case-control 

study with recruitment from two HMOs 

Dr. Margaret Mandelson (G

Dr. John Potter (Fred Hutch

Cancer Research Center), 

Stephen Van Den Eeden (K

this study’s methods allow 

enrollment of patients who 

the full spectrum of disease

those typically omitted fro

epidemiologic research be

death shortly following dia

Enhancing Cancer Communication and Decision-Making 

Increasingly, CRN projects are leveraging the extensive data on patients, providers, health care delivery, and 

to examine and optimize the quality of communication with and among patients; patient decision-making abou

screening, diagnosis, treatment, and survivorship in diverse populations; and the communication and coord

that characterize the best health care teams in support of their patients. CRN studies in this area examine a w

of issues, from shared clinical decision-making to outreach strategies, high-risk members, and Web-based 

consumer information. 

PROJECT TITLE FUNDING SOURCE YEAR 

Studying Communication over the Cancer Continuum: A Feasibility Study NCI CRN Pilot Project 

Development of an Online Dissemination Planning Tool CCRC Administrative Supplement 

CRN Cancer Communication Research Center NCI P20 

Effective Communication for Preventing and 

Responding to Oncology Adverse Events CCRC RO1 Project 

Improving Physician-Parent Communication to Reduce Home Medication Errors 

and Improve Adherence in Children with Cancer CCRC Developmental Project 

Oral Health Communication and Latinos in a Managed Care Organization: 

Does Understanding Vary by Knowledge Level of Colorectal Cancer and Acculturation? CCRC Developmental Project 

Health Literacy and Cancer Prevention: 

Do People Understand What They Hear? NCI CRN Core Research Project 

Use of an Interactive Voice Response System, with Physician Feedback, 

to Reduce Cancer Symptoms: A Pilot Study NCI CRN Pilot Project 

Michigan Center for Health Communications Research NCI P50 Grant 

Selected research projects are highlighted on the following page. 

http://crn.cancer.gov 
DecisionMaking (cont.) 

CRN Cancer Communication 

Research Center 

The CRN Cancer Communication 

Research Center (CCRC) was 

funded by NCI in 2008 as a 

program project (P20) to advance 

research about cancer 

communication in clinical settings. 

Led by Dr. James Dearing (KPCO), 

this is the first communication 

research center founded within the 

CRN. The Center identifies, tests, 

and applies optimal communication 

and coordination processes that 

facilitate patient-centered cancer 

care. Two initial core R01 projects 

are Testing an Optimal Model of 

Patient-Centered Cancer Care and 

Effective Communication for 

Preventing and Responding to 

Oncology Adverse Events. Eighteen 

investigators at eight CRN sites 

participate in the Center. The CCRC 

also ties the CRN into the Center of 

research centers at Washington 

University, the University of 

Pennsylvania, the University of 

Michigan, and the University of 

Wisconsin. Through its shared 

resource cores that study and 

explore new practice-based 

approaches to cancer 

communication across the CRN as 

well as how to most effectively 

disseminate effective cancer 

communication interventions across 

clinical settings, the Center is 

heavily involved in translational 

research from the processes of 

innovation to the processes of 

replication and diffusion. 

Communication and care 

coordination processes are assessed 

across the cancer care continuum 

from prevention to early detection, 

diagnosis, treatment, survivorship, 

and end of life as well as across 

types, including breast, cervical, 

colorectal, lung, and prostate cancers. 

This study, led by Dr. K

of the Meyers Primary C

at the University of Mas

developing a test of com

of oral (i.e., spoken) me

cancer prevention and s

Current measures of hea

involve comprehension 

material, which is not h

health information is tran

team will examine the r

between health literacy 

prevention using both qu

qualitative methods. Find

the foundation for future 

the prevalence of inadeq

health literacy, identific

groups and individuals 

inadequate comprehens

and identification of ris

causes of limited compre

project will develop reco

for modifying oral mess

they are easily comprehen

test the impact of specific 

in a randomized experim

Managed care research networks have several potential advantages for studying questio

cancer care in older women. First, access to care is removed from the equation in surviv

outcomes. Second, they include large proportions of the population from almost all regio

United States, providing an alternative universe for population-based studies. Third, the 

availability of computerized administrative databases linked to laboratory and patholog

often electronic medical records allows careful delineation of disease and interventions a

comprehensive, cost-efficient long-term follow-up. Thus, this network provides high-qua

for observational research and can fill critical gaps in our knowledge, especially in situ

where large-scale clinical trials are not likely to be mounted. 

Mandelblatt J. To Screen or Not to Screen Older Women for Breast Cancer: A New Twist on an Old Question or Will 

Invest in Getting the Answers? J Clin Oncol 2007;25(21):2991–2992. 

32 The HMO Cancer Resea
ppgpgg

community practice are priority research areas. 

PROJECT TITLE FUNDING SOURCE YEAR 

Media Coverage and Direct-to-Consumer Advertising of Genetic Tests NCI CRN Pilot Project 

Ovarian Cancer Treatment Diffusion Study NCI CRN Administrative Supplement 

Anti-Estrogen Therapies for Breast Cancer NCI CRN Infrastructure Project 

Diffusion of Breast MRI Technology in Community Clinical Settings NCI CRN Administrative Supplement 

HRT Initiation and Cessation after WHI Results NCI CRN Administrative Supplement 

Selected research projects are highlighted below. 

Anti-Estrogen Therapies for 

Breast Cancer 

As early as 2001, several 

randomized trials demonstrated that 

adjuvant aromatase inhibitor 

treatment is superior to tamoxifen 

for decreasing breast cancer 

recurrence among women with 

estrogen receptor positive breast 

cancer. CRN investigators used 

automated pharmacy data from 

seven CRN sites to assess the use of 

aromatase inhibitors and tamoxifen 

between 1996 and 2003. This study, 

co-led by Dr. Edward Wagner 

(GHC) and Ms. Erin Aiello Bowles 

(GHC), also included an oncologist 

survey to assess whether and how 

CRN organizations and oncology 

groups made policy decisions about 

cancer interventions. Aromatase 

inhibitor use rose dramatically after 

2001, while tamoxifen use 

decreased. Regardless of whether 

their site had formal treatment 

guidelines, almost all oncologists 

reported prescribing aromatase 

inhibitors under various 

circumstances: metastatic breast 

cancer, after completion of 

tamoxifen, or in lieu of tamoxifen. 

HRT Initiation and Cessation 

after WHI Results 

On May 31, 2002, the Women’s 

Health Initiative (WHI) randomized 

trial of hormone therapy (HT) was 

stopped early because the risks of 

HT were found to outweigh the 

benefits. Women randomized to 

estrogen plus progestin therapy 

(EPT) experienced an excess risk of 

invasive breast cancer, coronary 

heart disease, stroke, venous 

thromboembolism, and pulmonary 

embolism compared to women 

randomized to placebo. To ascertain 

the effect of this pivotal 

announcement in community-based 

delivery settings, the CRN received 

an NCI administrative supplement 

to conduct an observational cohort 

study using automated pharmacy 

dispensing data. This study, led by 

Dr. Diana Buist (GHC), provided 

important information on the rapid 

translation of the WHI resu

clinical practice, use of HT 

relation to current clinical 

recommendations, and pat

re-initiation after cessation

prevalence of EPT and est

alone declined 46% and 28

respectively, after the WH

announcement. These find

demonstrate the CRN’s ab

rapidly examine changes i

therapies over time. A foll

study being conducted by 

investigators in collaborati

two CRN sites is examinin

data at the individual patie

determine the association b

patterns of HT usage and 

subsequent breast cancer 

occurrence. The results of 

will be utilized to improve 

specification of breast can

history used in the prevent

component of breast cance

simulation models (Cancer 

Intervention and Surveillan

Modeling Network [CISN

http://crn.cancer.gov 
, g y j

Socioeconomic Diversity in Integrated Healthcare Delivery Systems NCI CRN Pilot Project 

Testing an Optimal Model of Patient-Centered Care CCRC R01 Project 

Intestinal Ostomies and Informal Caregiving for Colorectal Cancer Survivors NCI R21 Grant 

Understanding Racial and Ethnic Differences in Survival from Colorectal Cancer NCI K01 Grant 

Informing an R01 Application: Interviewing Long-Term Colorectal Cancer Survivors NCI CRN Pilot Project 

Patient-Oriented Outcomes of Prophylactic Mastectomy NCI R01 Grant 

Evaluation of End-of-Life Care for Prostate Cancer in the Managed Care Environment CDC Task Order 

Selected research projects are highlighted below. 

Testing an Optimal Model of 

Patient-Centered Cancer Care 

The goal of this study is to develop 

an Oncology Nurse Care 

Management program for newly 

diagnosed breast, colorectal, and 

lung cancer patients that will 

address patient questions, 

symptoms, and psychosocial needs, 

and facilitates timely, coordinated 

care. Led by Dr. Edward Wagner 

(GHC), the study team will develop 

an early notification system of 

cancer diagnosis using automated 

data; develop and implement the 

case management system; and test 

its effectiveness in improving 

patient quality of care, psychosocial 

distress, and depression. This 

innovative care management 

program to enhance patient-centered 

care will help to fill an important 

gap in efforts to improve quality of 

cancer care surrounding diagnosis 

and treatment decision making. 

Intestinal Ostomies and Informal 

Caregiving for Colorectal Cancer 

Survivors 

Many colorectal cancer survivors 

are living with intestinal ostomies, 

which can lead to bowel 

incontinence, unless managed daily 

with special equipment, diet, and 

behavior. Losing the ability to 

manage one’s ostomy independently 

can transform an ostomy from a 

manageable impairment to a source 

of profound disempowerment, 

stigma, and disability. This study, 

led by Dr. Carmit McMullen 

(KPNW), uses a social model of 

disability framework to better 

understand the interrelationships 

among disability and caregiving in 

this population, and identifies 

strategies that ostomates and their 

caregivers employ to cope with 

caregiving challenges. This study 

builds on a longstanding research 

program on the quality of life of 

long-term colorectal cancer survivors. 

Patient-Oriented Outc

Prophylactic Mastecto

This study, led by Dr. A

(Wake Forest University

of KPSC), used the prop

mastectomy efficacy stu

nearly 800 women who 

undergone contralateral 

mastectomy, bilateral pr

mastectomy, or neither o

surgeries (comparison g

CRN sites. A survey asc

willingness to recomme

prophylactic mastectom

satisfaction, breast canc

related stress, body imag

sexual activity. Most wo

undergoing prophylactic 

were satisfied with their 

reported quality of life c

to similarly at-risk wom

comparison group. Inve

examined decision-mak

questions and contribute

papers pertaining to med

data validity and the imp

reviews on study operat

response rates. 

34 The HMO Cancer Resea
y gy yj

Cancer Biomedical Informatics Grid (caBIG®) Data Sharing NCI caBIG® Participant Contract 

and Intellectual Capital Workspace 

Development of a Versatile Geospatial Database within the CRN NCI CRN Pilot Project 

HMO Cancer Research Network: Infrastructure NCI CRN Infrastructure Grant 

caBIG® Population Sciences Special Interest Group NCI caBIG® Participant Contract 

Development of a Shareable Analytic Dataset for Studies of Racial Disparities NCI CRN Administrative Supplement 

Comparing Pancreatic Cancer Identification Using Health Plan 

Automated Data and SEER Cancer Registry NCI CRN Administrative Supplement 

Virtual Data Warehouse (VDW) Enhancement NCI CRN Administrative Supplement 

Increasing Technology to Maximize Use of the Virtual Data Warehouse (VDW) NCI CRN Administrative Supplement 

Accuracy of Automated Data on Colorectal Cancer Screening NCI CRN Pilot Project 

Using Electronic Medical Records to Measure and Improve 

Adherence to Tobacco Treatment Guidelines in Primary Care (HIT2) 

NCI CRN Core Project 

and Administrative Supplement 

HMO Cancer Research Network: Infrastructure NCI CRN Infrastructure Grant 

Investigating Medical Patient Records and Administrative Data 

in Case Identification and Treatment (IMPACT) NCI R01 Grant 

HMO Cancer Research Network: Infrastructure NCI CRN Infrastructure Grant 

Selected research projects are highlighted below. 

Development of a Versatile 

Geospatial Database within the 

CRN 

Geographic information associated 

with health records and facilities has 

a broad range of applications, 

including calculation of geographic 

access to health services, examination 

of service areas for health care systems, 

and measurement of geographicallybased exposures. This project, led 

by Dr. Andrea Cook (GHC) and 

Dr. Tracy Onega (Dartmouth Medical 

School), will expand existing 

geocoding infrastructure to create a 

versatile geospatial database that will 

include individual, demographic, and 

facility-level geographic variables. 

The geocoded facility and member 

data will be used to examine the 

influences of travel time to facility, 

facility availability, and 

socioeconomic indicators on receipt 

of surveillance mammography. 

Using Electronic Medical Records 

to Measure and Improve 

Adherence to Tobacco Treatment 

Guidelines in Primary Care (HIT2) 

EMRs offer an attractive method for 

evaluating guideline implementation 

and improving quality of care. This 

study, led by Dr. Victor Stevens 

(KPNW), developed a met

coding tobacco-cessation a

(the “Five A’s”) in four HM

EMRs. Data were obtained f

fields, and information ent

free-text fields (e.g., progr

was coded using MediClass

language processing progr

team evaluated the accuracy 

Class in assessing whether 

adhered to the national tob

treatment guidelines (the “

with patients. MediClass p

as well as the human abstr

was found to be practical f

assessing primary care adh

the tobacco treatment guid

http://crn.cancer.gov 
enhance, and test health informatics, database, and biospecimen tools. Moreover, they have the resource

research in areas such as cancer risk assessment and modeling; studies of behavioral, environmental, an

factors; and personalized health care approaches to preventive care, screening, diagnosis/prognosis, and 

relation to patient outcomes. Currently, the CRN is developing activities to increase the timeliness, effic

effectiveness of recruitment to phase 2 and phase 3 prevention and treatment trials. 

PROJECT TITLE FUNDING SOURCE YE

SEARCH: Screening Effectiveness and Research in Community-Based Healthcare NCI GO Grant 

Comparative Effectiveness Research in Genomic and 

Personalized Medicine of Colorectal Cancer NCI GO Grant 

Building CER Capacity: Aligning CRN, CMS and State Resources to Map Cancer Care NCI GO Grant 

Building a Population Laboratory for Pharmacoepidemiologic and 

Pharmacogenomic Studies in Cancer: Cardiotoxicity following 

Systemic Therapy for Breast Cancer 

NCI CRN Administrative Supplement 

Cancer Prevention Index: Using Electronic Records 

to Improve Cancer Prevention NCI CRN Core Research Project 

DEcIDE Distributed-Data Network: Comparative Effectiveness 

and Safety of Second-Line Anti-Hypertensive Agents AHRQ Contract 

Effect of HIPAA Privacy Rule on Health Research IOM Contract 

Increasing Patient Participation in Clinical Trials NCI R01 Grant 

Multiplex Genetic Susceptibility Testing: An Interdisciplinary Collaboration NHGRI Administrative 

Supplement to CRN 

Outcomes of Genetic Counseling for Heritable Breast/Ovarian Cancer: 

Feasibility of Identifying Cohort Through EMR NCI CRN Administrative Supplement 

Development of a Method to Assess Obesity and Treatment via EMR NCI CRN Administrative Supplement 

Enrolling Vietnamese and Chinese Women in 

Breast Cancer Treatment and Prevention Trials NCI CRN Administrative Supplement 

Pilot Study to Identify Organizational Barriers 

to HMO Participation in Clinical Trials 

Selected research projects are highlighted on the following page. 

36 The HMO Cancer Resea

NCI CRN Administrative Supplement 
Cancer: Cardiotoxicity following 

Systemic Therapy for Breast Cancer 

This CRN proposal represents the 

collaborative efforts of four multicenter 

efforts involving members of the HMO 

Research Network (HMORN)—the 

AHRQ-funded HMORN Center for 

Education and Research in 

Therapeutics (CERTs), the NHLBIfunded Cardiovascular Research 

Network (CVRN), the 

Pharmacogenomics Scientific Interest 

Group of the HMORN, and the CRN. 

These networks contribute to and 

use a common data infrastructure. 

This project, led by Dr. Edward 

Wagner (GHC), is creating a 

population research laboratory to 

conduct pharmacoepidemiologic 

and pharmacogenomic studies, and 

will use this laboratory to examine 

important questions about the 

cardiotoxicity of systemic agents 

used to treat invasive breast cancer. 

Capacity development will assess 

the validity of electronic data on 

chemotherapy infusion; adapt and 

test alternative strategies for 

identifying cardiotoxicity using 

VDW data or other electronic data; 

explore the feasibility of strategies 

for assembling biological specimens 

and collecting DNA samples on 

study subjects; and add analytic 

variables for chemotherapy dose, 

route, and type and cardiotoxicity 

outcomes data to improve the VDW 

among the eight participating 

HMORN sites. 

This two-year pilot study, led by 

Dr. Thomas Vogt (KPH), will use 

the Prevention Index methodology 

and the CRN VDW to develop and 

apply a set of Cancer Prevention 

Index (CPI) metrics to assess the 

quality of primary and secondary 

preventive care for cancer. The study 

will identify the variation in CPI 

scores across clinics and practices, 

determine the association of these 

variations with selected event rates 

several years later, and evaluate the 

association of clinician adherence to 

guidelines with subsequent events 

among their patients. The study will 

assess the CPI for secondary 

prevention (i.e., screening for breast, 

cervical, colorectal, and prostate 

cancers) and relate this index to 

stage at diagnosis, survival, and 

medical care utilization with 5- and 

10-year follow-up for all persons by 

practice-level performance. A 

complementary CPI study that 

incorporates preventive practices 

relevant to cardiovascular disease 

was recently funded as part of the 

CVRN, sponsored by NHLBI. 

Increasing Patient Participation in 

Clinical Trials and Pilot Study to 

Identify Organizational Barriers 

to HMO Participation in Clinical 

Trials 

Clinical trials are the primary mechanism 

by which new approaches to cancer 

treatment can be evaluated, yet only 

a very small proportion of eligible 

cancer patients are offered the 

attitudinal and organization

to clinical trial participation 

CRN sites in a pilot study. 

revealed enthusiasm for clin

but also a critical need for in

to support trials, better intr

organizational communica

consideration of a trial desig

on health plan resources. T

team next received a large

increase patient participati

clinical trials, known as C

Understanding Clinical Tri

Treatment Option. This stud

a cluster randomized trial t

the effectiveness of a telep

counseling intervention to 

enrollment, knowledge, an

satisfaction with treatment 

The intervention will be ta

patient language (English 

Spanish), ethnic and cultur

background, knowledge, a

and beliefs about clinical t

Multiplex Genetic Suscep

Testing: An Interdisciplin

Collaboration 

The Multiplex Initiative, le

Dr. Colleen McBride (NH

collaborative effort betwee

NCI, HFHS, and GHC that w

through a CRN supplemen

NHGRI. The objectives are 

individual response to bein

the Multiplex Genetic Test f

common diseases and rece

results, and to develop an 

infrastructure through whi

research participants can b

the Multiplex Genetic Test 

http://crn.cancer.gov 
SEARCH CAPACITY AND COLLABORATIONS


This will be accomplished through:


> 	Enhancement of the CRN VDW, including continual incorporation of data elements from the EMR sy

CRN member integrated health care systems. 

> 	Development, evaluation and implementation of informatics tools to enhance the research utility of C

research materials, including: NLP tools for extracting and standardizing EMR data elements, the use 

administrative and EMR data to rapidly and efficiently identify subjects for observational studies and 

prospective trials, and the evaluation of informatics tools for inventory control and retrieval of biospe

material. 

> 	Increasing CRN human scientific resources by supporting career development of junior investigators 

CRN Scholars Program and increased support for pilot projects, with a special emphasis on collabora

between CRN junior investigators and outside investigators. 

In addition, CRN-related grants and other research projects are utilizing the multisite collaborative appro

pioneered by the CRN to extend research into new areas. Examples include: CRN-affiliated Challenge a

grants in CER, the CRN CCRC, and the CVRN. Increasingly, HMO-based cohorts are being developed 

cancer-related outcomes, such as those related to human papillomavirus (HPV) vaccination and the influ

lifestyle factors and molecular markers on breast cancer recurrence and survival. 

It has been an absolute pleasure collaborating with CRN investigators. They have be

generous with their expertise as well as their data. The research that we are conducti

not be done in any other setting. Our pilot project has focused on understanding the 

of diagnostic imaging, and in particular CT, and its associated radiation exposure. A

this work we have been able to improve the standardization of the data regarding ima

contained within the virtual data warehouse (VDW), and we and other investigators a

submitting broader grant projects that will utilize these newly improved data. 

Rebecca Smith-Bindman, M.D. 

Professor in Residence, Radiology and Biomedical Imaging and Epidemiology & Biostatistics, Obstetrics, Gynecolog

Reproductive Medicine, UCSF Helen Diller Family Comprehensive Cancer Center 

38 The HMO Cancer Resea
consistent with the CRNs scientific priorities and leverage unique features 

of the CRN. The expectation is that the funded pilots will lead to larger 

fundable grants. Pilot activities involve at least one CRN site and have the 

potential to lead to research projects that involve multiple CRN sites. All 

investigators from within the 14 CRN sites are eligible to submit proposals. 

The CRN also welcomes new collaborators, including investigators external 

to the CRN. Projects that have already been funded using CRN 

developmental pilot funds are listed below by year. 

2010

> Establish a 

Prospective Cohort 

to Investigate 

Obesity, Diabetes 

and the Metabolic 

Syndrome as Risk 

Factors in Young 

Adult Cancer 

> Lymph Node Examination in Colorectal 

Cancer: Predictors of Adequate Staging 

and Its Influence on Cancer Survival in 

Community Practice 

> Non-Melanoma Skin Cancer 

Ascertainment in the HMO Setting 

> Studying Communication over the Cancer 

Continuum: A Feasibility Study 

2009

> Childhood, 

Adolescent and 

Young Adult Cancer 

Survivors: CRN 

Feasibility Pilot 

> Development 

of a Model for 

Predicting Prostate 

Cancer 

> Medical Radiation Induced Cancers 

> Preventing Errors in the Home Care of 

Children with Cancer 

2008

> Chemotherapy and 

Coinsurance: The 

Effect of Cost Sharing 

on Cancer Care 

> Development of a


Versatile Geospatial


Database within the 

CRN 

> Media Coverage and Direct-to-Consumer	

Advertising of Genetic Tests 

> Opportunistic Colorectal Cancer Screening: 

Providing FIT with Annual Flu Shots 

> Socioeconomic Diversity in Integrated 

Healthcare Delivery Systems 

2005 

> Informing an R01 

Application: 

Interviewing Longterm Colorectal 

Cancer Survivors

> Use of an Interactive 

Voice Response 

System, with 

Physician Feedback, 

to Reduce Cancer 

Symptoms: 

A Pilot Study 

2004	

> Accurac

Automa

Colorect

Screenin

> African A

Dispariti

Cancer O

> Do Acute and Chronic Illness 

Preventive Care? A Case Study 

and Colon Cancer Screening 

> Investigation of Age-Specific D

and Cancer of the Cecal Colon 

http://crn.cancer.gov 
and Project Leader of the PROTECTS project, and Dr. Robert Fletcher as Co-Principal Investigator of th

component of the CanCORS project. Drs. Suzanne and Robert Fletcher have extensive experience in inve

development. Other senior CRN investigators participate in the program to expose participants to leaders 

research beyond those at their home institutions, and to increase the breadth and depth of expertise availa

Highlighting CRN Scholar 

Chyke Doubeni, M.D., F.R.C.S., M.P.H. 

Dr. Chyke Doubeni is a physician researcher and epidemiologist who has built stro

collaborative ties with the CRN throughout his career. He was a member of the 200

CRN scholars and is currently an Assistant Professor in Family Medicine and Com

Health and Associate Vice Provost for Diversity at the University of Massachusetts 

School. In 2004, Dr. Doubeni received a CRN research supplement for underrepres

minorities to conduct a multicenter study evaluating patterns of cancer early detect

in women following diagnosis of breast or cervical cancer, and examining cancer d

these patients. Following completion of the CRN research supplement, Dr. Doubeni received a career de

award (Understanding Racial and Ethnic Disparities in Survival from Colorectal Cancer) from NCI in 2

research component of the career development program utilizes the integrated health care delivery syste

CRN to assess colorectal cancer care in vulnerable populations. Dr. Doubeni led a recently awarded CR

grant, Socioeconomic Diversity in Integrated Healthcare Delivery Systems, to assess the area-level socio

status and race structure of enrollees in integrated health delivery systems of the CRN. Building on this 

research and his CRN collaborations, Dr. Doubeni is currently the Co-Principal Investigator for a CER G

SEARCH: Cancer Screening Effectiveness and Research in Community Based Healthcare. 

Highlighting CRN Scholar 

Reina Haque, Ph.D., M.P.H. 

Dr. Reina Haque is an epidemiologist and member of the 2009 class of CRN schol

Research Scientist in the Department of Research and Evaluation, KPSC, and a Sc

Advisor to the KPSC Cancer Registry. In 2005, Dr. Haque led a CRN pilot study, C

Pancreatic Cancer Case Identification Using Health Plan Automated Data and SE

Registry, to develop methods for rapid case ascertainment. She has served as a co-i

and Site PI for several CRN studies, including Clinical and Pathologic Predictors f

Recurrence after Ductal Carcinoma in Situ, Molecular Epidemiology of Fatal Pros

and Outcomes of Prostate Cancer Androgen Deprivation Therapy. She has also received pilot funding fr

University of California Breast Cancer Research Program to examine adverse effects of combined tamo

antidepressants on breast cancer recurrence. Dr. Haque will build on this body of research and her CRN 

collaborations to lead a recently awarded multisite R01 grant, ABC: Antidepressants and Breast Cancer 

Pharmacoepidemiology, which will assess interactions between tamoxifen and antidepressant use in a la

of nearly 25,000 women. 

40 The HMO Cancer Resea
(Geisinger Center for Health Research) 

James B. Jones, M.B.A., Ph.D. 

Nirav Shah, M.D., M.P.H. 

Harvard Pilgrim Health Care 

and Harvard Medical School 

(Department of Population Medicine) 

Michael Klompas, M.D. 

Natasha K. Stout, Ph.D. 

HealthPartners 

(HealthPartners Research Foundation) 

Robin R. Whitebird, Ph.D., M.S.W. 

Henry Ford Hospital and Health System/ 

Health Alliance Plan 

(Department of Biostatistics and Research 

Epidemiology and Center for Health Services Research) 

Andrea E. Cassidy-Bushrow, Ph.D., M.P.H. 

Lovelace Health System 

(Lovelace Clinic Foundation Research) 

Scott B. Robinson, M.A., M.P.H. 

Kaiser Permanente Hawaii 

(The Center for Health Research–Hawaii) 

Andrew E. Williams, Ph.D. 

Kaiser Permanente Northern California 

(Division of Research) 

Maryam M. Asgari, M.D., M.P.H. 

Kaiser Permanente Northwest 

(The Center for Health Research–Northwest) 

Carmit K. McMullen, Ph.D. 

Kaiser Permanente Southern California 

(Department of Research and Evaluation) 

Reina Haque, Ph.D., M.P.H. 

Marshfield Clinic/Security Health Plan 

(Marshfield Clinic Research Foundation) 

Laura A. Coleman, Ph.D., R.D. 

Robert T. Greenlee, Ph.D., M.P.H. 

(Group Health Research Institute) 

Jessica Chubak, Ph.D. 

Harvard Pilgrim Health Care 

and Harvard Medical School 

(Department of Population Medicine) 

Lingling Li, Ph.D. 

HealthPartners 

(HealthPartners Research Foundation) 

Kenneth F. Adams, Ph.D. 

Henry Ford Hospital and Health System/ 

Health Alliance Plan 

(Department of Biostatistics and Research 

Epidemiology and Center for Health Services 

Melody Eide, M.D., M.P.H. 

Christine M. Neslund-Dudas, Ph.D. 

Kaiser Permanente Colorado 

(Institute for Health Research) 

Heather S. Feigelson, Ph.D., M.P.H. 

Borsika Rabin, Ph.D., Pharm.D., M.P.H. 

Kaiser Permanente Georgia 

(The Center for Health Research–Southeast) 

Pamela J. Mink, Ph.D. (Emory University) 

Kaiser Permanente Hawaii 

(The Center for Health Research–Hawaii) 

Katie M. Heinrich, Ph.D. (University of Hawaii 

Kaiser Permanente Northwest 

(The Center for Health Research–Northwest) 

Nangel Lindberg, Ph.D. 

Kaiser Permanente Southern California 

(Department of Research and Evaluation) 

Corinna Koebnick, Ph.D. 

Marshfield Clinic/Security Health Plan 

(Marshfield Clinic Research Foundation) 

Adedayo A. Onitilo, M.D. 

To me, the CRN has provided unparalleled opportunities to test systems interventions on im

cancer outcomes and cancer health disparities. I have had the opportunity to work and pa

with investigators at various levels of experience, develop mentoring relationships with ren

investigators, and build collaborative relationships. The combination of data resources, sy

support the development of new investigators, and the academic partnerships has made it po

for me to train and grow as an investigator. 

Chyke Doubeni, M.D., F.R.C.S., M.P.H., University of Massachusetts Medical School, Fallon Community Health Plan, Meyers Primary 

http://crn.cancer.gov 
In December of 2006, the NHLBI issued an RFA for a CVRN, with the 

goal of increasing scientific knowledge of cardiovascular diseases, 

including their epidemiology, risk and risk factors, prevention, detection 

and diagnosis, treatment, and prognosis, in the context of communitybased health care delivery, which is the environment in which most 

clinical and preventive care is delivered. The RFA further stated that the 

research should be designed to take advantage of existing integrated 

data systems and use complementary resources for collaborative 

activities relevant to the goal. 

A cooperative agreement grant totaling $7.5 million was awarded to an 

HMO-based CVRN led by Dr. Alan S. Go of KPNC. Research 

collaborators within the CVRN span all 14 of the CRN sites, as well as 

other external organizations. 

Initial CVRN research projects include studies of: 

• Hypertension recognition, treatment, and control. 

• Quality of care and outcomes of the blood thinner, warfarin, for atrial 

fibrillation and blood clots. 

• Use, outcomes, and costs of implantable cardiac defibrillators for 

primary prevention of sudden death in heart failure. 

Most collaborating research organizations in the HMO Research 

Network are participating in both the CRN and the CVRN. Through 

these common links, the CRN and the CVRN will have many 

opportunities to coordinate research activities of mutual interest, share 

complementary research infrastructure and expertise, and create many 

synergies between the two networks. 

The CVRN, like the CRN, was successful in competing for CER GO 

grants. The NHLBI awarded two CER GO grants to the CVRN, one to 

develop a cardiovascular surveillance system and one to study 

treatment and outcomes for atrial fibrillation. 

With its extensive data 

providers, health care d

patient outcomes, the H

ideally suited for the de

of large prospective coh

cancer-related outcomes

example, the Vaccine Sa

Datalink (VSD), funded 

CDC, is the primary me

population-based evalua

vaccine safety in the Un

Eight of the CRN sites p

the VSD to assess patte

of the human papilloma

vaccine, a significant ne

the control of cervical c

VSD is currently assess

capabilities for incorpor

procedure, pharmacy, cy

histology data necessary 

vaccine impact in routin

care into their infrastruc

project will also measur

cervical cancer precurso

genital warts, and type-

HPV infection in the pe

vaccine introduction (i.e

2000–2005). After the c

established, the CDC w

monitor outcomes such 

autoimmune reactions, t

HPV infection, age-spec

immunization rates, and 

long-term adverse effec

durability of the immun

Another HMO-based co

Pathways Study. Led by 

Lawrence Kushi (KPNC

has identified over 2,90

42 The HMO Cancer Resea
team of investigators from KPNC, 

the Roswell Park Cancer Institute, 

and the University of 

California–San Francisco will study 

the influence of lifestyle factors, 

such as diet and physical activity, 

the built environment, and 

molecular markers, including 

genetic factors and epigenetic 

modification of tumor DNAs on 

breast cancer recurrence and 

survival. Because disparities in 

prognosis by race may be influenced 

in part by these factors, the study is 

emphasizing enrollment of minority 

participants. Investigators will 

conduct studies in two areas that 

may provide insight into racial 

differences in prognosis, namely the 

role of inflammatory and immune 

factors, and vitamin D levels. With 

data from interviews and 

questionnaires, blood samples, 

saliva as a source of DNA, 

availability of tumor blocks, clinical 

data from KPNC resources and 

databases, and contextual-level data, 

the Pathways Study will be a major 

resource for the epidemiologic 

investigation of breast cancer 

prognosis. 

CRN scientists and oncologists are 

very interested in assuring optimal 

safety of cancer patients, most of 

whom are exposed to therapies with 

complex risk profiles. Starting in 

2009, most of the CRN sites were 

included in the Food and Drug 

using electronic health data. 

Ultimately, the FDA plans to expand 

use of this active surveillance system 

to monitor all FDA-regulated 

products continuously and in real 

time through a larger linked system. 

Biospecimen Resources 

Recognizing the growing 

importance of population-based 

normal tissue specimens as well as 

tumor specimens linked to rich 

demographic, risk factor, and 

medical history data, the CRN 

Genomics Working Group, which is 

part of the eight-site CRN 

Pharmacovigilance Administrative 

Supplement, has conducted an 

appraisal of current and potential 

CRN capacity in this area. Two sites 

(MCRF and KPNC) currently have 

large-scale repositories of banked 

blood or saliva specimens collected 

under protocols that allow broad 

access for future research. Multiple 

CRN sites have access to banked 

formalin-fixed paraffin-embedded 

tumor blocks, several of which date 

back multiple decades. Currently, 

one site (HFHS) stores fresh frozen 

tissue as a standard procedure. 

Infrastructure regarding access, use, 

and cost of these materials varies 

across sites and funding under 

which materials may have been 

collected. Three sites (GHC, HFHS, 

identified 33 past or curren

at CRN sites that included 

collection as part of protoc

CRN Cancer 

Communication Re

Center (CCRC) 

The CRN CCRC was estab

2008 at the Institute for He

Research of Kaiser Perman

Colorado and is a partners

among eight of the 14 CRN 

Funded by NCI, this CECC

to identify and describe op

communication structures 

processes in organizations 

facilitate patient-centered 

communication in cancer c

also extends the CRN in n

including research on heal

team-based approaches to 

communication about canc

reduction of patient uncert

anxiety, strategies for impr

physician-patient commun

about cancer, how organiz

aspects of our health care 

affect communication qual

the application of dissemin

science to evidence-based 

The strength of the CRN 

infrastructure, both interpe

and technologically, was cr

obtaining this award. 

http://crn.cancer.gov 
CER Capacity 

The NCI CER GO grant funding 

opportunity was issued with the 

specific intent of building capacity 

and accelerating scientific progress 

in cancer comparative effectiveness 

research. Its goal was to sponsor 

initial two-year efforts to build 

coherent teams of interdisciplinary 

researchers to leverage and integrate 

existing data and health system 

research resources through such 

activities as CER study 

prioritization; data and informatics 

development; development of CER 

trials resources and operating 

procedures; development of CER 

statistical, psychometric, 

econometric, and modeling 

methods; and conduct of proof of 

principle CER retrospective or 

prospective pilot studies. 

Through the competitive funding 

process, the CRN received three of 

the 13 CER GO grants awarded by 

the NCI. These CER capacity 

development projects will 

complement the general capacity 

development efforts of CRN over 

the next two years in the areas of 

breast, cervical, and colorectal 

cancer screening; clinical and 

genomic tests for colorectal cancer 

risk and chemotherapy response; 

and treatment approaches for 

recurrent and progressive cancer. 

The GO grants awarded to the 

CRN include: 

Through a partnership between 

investigators in the CRN and DanaFarber/Harvard Cancer Center, this 

study will support high-quality 

cancer CER by addressing two key 

knowledge gaps: (1) the treatment 

of advanced cancer; and (2) research 

on patterns and outcomes of cancer 

care for patients not represented in 

SEER-Medicare, the dominant data 

source in the field. Namely, these 

patients are less than 65 years of 

age, receive their health care 

through an HMO, and are ranked as 

‘poor’ based on select criteria. This 

study will use cancer patient-level 

data and region-specific data to 

support studies of patterns of care 

and outcomes among patients with 

advanced cancer, and will also look 

at the capacity and limitations of 

these datasets. A comparative 

effectiveness study for patients with 

advanced cancer will be specified, 

and an evaluation trial will be 

designed. The output of this activity 

will be used to engage stakeholders 

in building CER capacity in cancer. 

This study will investig

comparative effectivene

tests related to colorecta

KRAS test and the Lync

(LS) prediction test, and 

two main components: 

collection conducted thr

evidence synthesis and 

effectiveness analysis an

primary data collection 

through a proof-of princ

which will evaluate the 

KRAS and LS genetic t

several integrated health 

delivery systems and m

effectiveness of KRAS 

compared with a patien

that does not receive tes

and physician interview

conducted to assess psy

and decision-making iss

to KRAS testing. This s

create a unique research 

spanning several memb

the CRN as well as acad

partners. 

44 The HMO Cancer Resea
This study will create a 

multidisciplinary, multisite center 

for CER focused on the delivery of 

cancer screening in a communitybased setting. The SEARCH study 

will be used to conduct two proofof-principle studies, one comparing 

liquid-based vs. conventional 

cytology for cervical cancer 

screening and one comparing 

screening colonoscopy vs. fecalbased tests and flexible 

sigmoidoscopy for colorectal cancer 

screening. This project will also 

develop methodological capacity for 

future large-scale, population-based 

CER studies, make comparisons of 

the performance and impact of 

available and emerging options for 

population-based cancer screening, 

and demonstrate the ability to 

conduct research that addresses 

important evidence gaps. 

Comparative Effectiveness of 

Breast Imaging Strategies in 

Community Practice 

CRN investigators are collaborating 

with investigators from other 

institutions, including the University 

of Vermont, the University of 

California–San Francisco, 

Georgetown University, and the 

University of North Carolina to 

conduct CER on breast cancer 

imaging modalities and gather 

evidence on how to optimize breast 

cancer screening in community 

practice. Using the NCI-funded 

Breast Cancer Surveillance 

Consortium (BCSC), rigorous 

comparative effectiveness studies on 

conventional and new breast 

imaging technologies will inform 

how screening strategies can be 

personalized based on patient 

demographic and risk factor 

information, and aid in optimizing 

the balance of screening benefits 

and harms. In addition, BCSC data 

will be used to compare the clinical 

effectiveness of mammography 

screening intervals, decipher health 

care utilization and costs of digital 

vs. film-screen mammography, 

discern the cost-effectiveness of 

various breast cancer screening 

strategies, capture clinically and 

scientifically relevant data on breast 

MRI, and develop epidemiologic 

and statistical methods focused on 

conducting CER in community 

settings. 

(ADVICE) 

CRN investigators are coll

with researchers from the 

of Washington and the Fre

Hutchinson Cancer Resear

to establish a unique resea

platform designed to perfo

on cancer diagnostics to fi

evidence gap for technolog

in the diagnosis and post-t

monitoring of cancer. ADV

establish a multidisciplinar

cross-institutional network 

delivery systems and resea

western Washington State 

evaluating the comparative 

effectiveness of cancer dia

in real-world settings. Proo

principle studies will be co

to assess diagnostic tools u

establishing extent of disea

newly diagnosed Stage I–I

cancer and examine priorit

around in vitro diagnostic 

imaging modalities and the

applications. Over the long 

study will use the Puget Sou

ADVICE network to condu

retrospective and prospect

community-based CER wi

on rapid turnaround and 

observational and randomiz

http://crn.cancer.gov 
RN RESEARCH THEME, 1999–2009


2009 

Fenton JJ, Reid RJ, Baldwin LM, Elmore JG, Buist DS, Franks P. 

Influence of primary care use on population delivery of colorectal 

cancer screening. Canc Epidemiol Biomarkers Prev. 

2009;18(2):640–645. 

Fishman PA, Hornbrook MC. Assigning resources to health care 

use for health services research: options and consequences. Med 

Care. 2009;47(7 suppl 1):S70–75. 

Gold HT, Thwin SS, Buist DS, Field TS, Wei F, Yood MU, Lash 

TL, Quinn VP, Geiger AM, Silliman RA. Delayed radiotherapy for 

breast cancer patients in integrated delivery systems. Am J Manag 

Care. 2009;15(11):785–789. 

Nekhlyudov L. “Doc, should I see you or my oncologist?” A 

primary care perspective on the opportunities and challenges in 

providing comprehensive care for cancer survivors. J Clin Oncol. 

2009;27:2424–2426. 

Nekhlyudov L, Greenfield S. Cancer survivorship for the general 

internist: Have we paved the way for a smoother transition? J Gen 

Intern Med. 2009;24(suppl 2);381–382. 

Nekhlyudov L, Habel LA, Achacoso NS, Jung I, Haque R, Collins 

LC, Schnitt SJ, Quesenberry CP Jr, Fletcher SW. Adherence to 

long-term surveillance mammography among women With ductal 

carcinoma in situ treated with breast-conserving surgery. J Clin 

Oncol. 2009;27(19):3211–3216. 

Sukhanova A, Ritzwoller DP, Alexander GL, Calvi JH, Carlier C, 

McClure JB, Rolnick S, Johnson CC. Cost analyses of a web-based 

behavioral intervention to enhance fruit and vegetable consumption. 

Int J Behav Nutr Phys Activ. 2009;6:92. 

Walsh KE, Dodd KS, Seetharaman K, Roblin DW, Herrinton LJ, 

Von Worley A, Usmani GN, Baer D, Gurwitz JH. Medication errors 

among adults and children with cancer in the outpatient setting. 

J Clin Oncol. 2009;27(6):891–896. 

Care. 2008;46(1):58–62. 

Field TS, Doubeni C, Fox MP, Buist DS, Wei F, Gei

VP, Lash TL, Prout MN, Yood MU, Frost FJ, Sillim

utilization of surveillance mammography among old

survivors. J Gen Intern Med. 2008;23(2):158–163. 

Owusu C, Buist DS, Field TS, Lash TL, Thwin SS, 

Quinn VP, Frost F, Prout M, Ulcickas Yood M, Wei 

Predictors of tamoxifen discontinuation among older 

estrogen receptor positive breast cancer. J Clin Onco

2008;26(4):549–555. 

2007 

Buist DSM, Ichikawa L, Prout MN, Ulcickas Yood M

Owusu C, Geiger AM, Quinn VP, Wei F, Silliman R

breast cancer therapy and adjuvant therapy are not a

obesity in older women with access to health care. J 

2007;25(23):3428–3436. 

Fenton JJ, Cai Y, Weiss NS, Elmore JG, Pardee RE, 

Baldwin LM. Delivery of cancer screening: how imp

preventive health examination? Arch Intern Med. 

2007;167(6):580–585. 

Herrinton L, Hornbrook MC, Coughlin S, et al. Com

the end of life in ovarian cancer. J Pain Symptom M

2007;34(3):237–243. 

Rolnick SJ, Jackson J, Nelson WW, Butani A, Herrin

Hornbrook M, Neslund-Dudas C, Bachman DJ, Cou

management in the last six months of life among wo

of ovarian cancer. J Pain Symptom Manag. 2007;33(

2006 

Boudreau DM, Buist DS, Rutter CM, Fishman PA, B

Taplin S. Impact of hormone therapy on false-positiv

costs among women undergoing screening mammog

Care. 2006;44(1):62–69. 

46 The HMO Cancer Resea
2006;106(11):2482–2488. 

Enger S, Thwin S, Buist D, Field T, Frost F, Geiger A, Lash TL, 

Prout M, Yood M, Wei F, Silliman R. Breast cancer treatment of 

older women in integrated health care settings. J Clin Oncol. 

2006;24(27):4377–4383. 

Malin JL, Ko C, Ayanian JZ, Harrington D, Nerenz DR, Kahn KL, 

Ganther-Urmie J, Catalano PJ, Zaslavsky AM, Wallace RB, 

Guadagnoli E, Arora NK, Roudier MD, Ganz PA. Understanding 

cancer patients’ experience and outcomes: development and pilot 

study of the Cancer Care Outcomes Research and Surveillance 

patient survey. Support Care Canc. 2006;14(8):837–848. 

2005 

Fletcher SW, Elmore JG. False-positive mammograms—can the 

USA learn from Europe? Lancet. 2005;365(9453):7–8. 

Hornbrook MC. On the definition and measurement of the 

economic burden of cancer. In: Lipscomb J, Gotay CC, Snyder C, 

eds. Outcomes Assessment in Cancer: Findings and 

Recommendations of the Cancer Outcomes Measurement Working 

Group. Oxford: Cambridge University Press; 2005:480–502. 

Keating NL, Herrinton LJ, Zaslavsky AM, Liu L, Ayanian JZ. 

Variations in hospice use among cancer patients. J Natl Canc Inst. 

2006;98(15):1053–1059. 

Leyden WA, Manos MM, Geiger AM, Weinmann S, Mouchawar J, 

Bischoff K, Yood MU, Gilbert J, Taplin Sh. Cervical cancer in 

women with comprehensive health care access: attributable factors 

in the screening process. J Natl Canc Inst. 2005;97(9):675–683. 

Mouchawar J, Taplin S, Ichikawa L, Barlow WE, Geiger AM, 

Weinmann S, Gilbert J, Manos MM, Ulcickas Yood M. Late-stage 

breast cancer among women with recent negative screening 

mammography: do clinical encounters offer opportunity for earlier 

detection? J Natl Canc Inst Monogr. 2005;35:39–46. 

Eval Health Prof. 2005;28(3):310–327. 

Ritzwoller DP, Goodman MJ, Maciosek MV, Elston La

Meenan R, Hornbrook MC, Fishman PA. Creating stand

measures across integrated health care delivery systems

Canc Inst Monogr. 2005;35:80–87. 

Stevens VJ, Solberg LI, Quinn VP, Rigotti NA, Hollis J

KS, Zapka JG, France E, Vogt T, Gordon N, Fishman P

Relationship between tobacco control policies and the d

smoking cessation services in nonprofit HMOs. J Natl 

Monogr. 2005;35:75–80. 

Weinmann S, Taplin SH, Gilbert J, Beverly RK, Geiger 

MU, Mouchawar J, Manos MM, Zapka JG, Westbrook 

WE. Characteristics of women refusing follow-up for te

symptoms suggestive of breast cancer. J Natl Canc Inst 

2005;35:33–38. 

Zapka JG, Puleo E, Taplin S, Solberg LI, Mouchawar J

Geiger AM, Ulcickas Yood M. Breast and cervical canc

screening: clinicians’ views on health plan guidelines an

implementation efforts. J Natl Canc Inst Monogr. 2005

2004 

Ayanian JZ, Chrischilles EA, Fletcher RH, Fouad MN, 

DP, Kahn KL, Kiefe CI, Lipscomb J, Malin JL, Potosky 

Provenzale DT, Sandler RS, van Ryn M, Wallace RB, W

West DW. Understanding cancer treatment and outcome

Cancer Care Outcomes Research and Surveillance Con

J Clin Oncol. 2004;22(15):2992–2996. 


Field TS, Cernieux J, Buist D, Geiger A, Lamerato L, H

Bachman D, Krajenta R, Greene S, Hornbrook MC, An

Herrinton L, Reed G. Retention of enrollees following a 

diagnosis within health maintenance organizations in th

Research Network. J Natl Canc Inst. 2004;96(2):148–1

http://crn.cancer.gov 
g 

2004;10(3):193–198. 

Taplin SH, Ichikawa L, Yood MU, Manos MM, Geiger AM, 

Weinmann S, Gilbert J, Mouchawar J, Leyden WA, Altaras R, 

Beverly RK, Casso D, Westbrook EO, Bischoff K, Zapka JG, 

Barlow WE. Reason for late-stage breast cancer: absence of 

screening or detection, or breakdown in follow-up? J Natl Canc 

Inst. 2004;96(20):1518–1527. 

Zapka JG, Puleo E, Taplin SH, Goins KV, Ulcickas Yood M, 

Mouchawar J, Somkin C, Manos MM. Processes of care in cervical 

and breast cancer screening and follow-up—the importance of 

communication. Prev Med. 2004;39(1):81–90. 

2003 

Goins KV, Zapka JG, Geiger AM, Solberg LI, Taplin S, Yood MU, 

Gilbert J, Mouchawar J, Somkin CP, Weinmann S. Implementation 

of systems strategies for breast and cervical cancer screening 

services in health maintenance organizations. Am J Manag Care. 

2003;9(11):745–755. 

Solberg LI, Hollis JA, Stevens VJ, Rigotti NA, Quinn VP, Aickin 

M. Does methodology affect the ability to monitor tobacco control 

activities? Implications for HEDIS and other performance 

measures. Prev Med. 2003;37(1):33–40. 

Zapka JG, Taplin SH, Solberg LI, Manos MM. A framework for 

improving the quality of cancer care: the case of breast and cervical 

cancer screening. Canc Epidemiol Biomarkers Prev. 2003;12(1):4–13. 

2000 

Fletcher SW. Following up abnormal breast cancer screening 

results: lessons for primary care clinicians. J Am Board Fam Pract. 

2000;13(2):152–154. 

1999 

Fletcher SW. False-positive screening mammograms: good news, 

but more to do. Ann Intern Med. 1999;131(1):60–62. 

Wei F. Potential misinterpretations caused by collaps

categories of comorbidity indices: an illustration fro

older breast cancer survivors. Clin Epidemiol. 2009;

Asgari MM, Tang J, Epstein EH Jr, Chren MM, War

Quesenberry CP Jr, Go AS, Friedman GD. Statin use 

basal cell carcinoma. J Am Acad Dermatol. 2009;61

Bosco JL, Lash TL, Prout MN, Buist DS, Geiger AM

Wei F, Silliman RA, BOW Investigators. Breast can

in older women five to ten years after diagnosis. Can

Biomarkers Prev. 2009;18(11):2979–2983. 

Bosco JL, Silliman RA, Thwin SS, Geiger AM, Buis

MN, Yood MU, Haque R, Wei F, Lash TL. A most s

no adjustment method fully resolves confounding by 

observational studies. J Clin Epidemiol. 2010;63(1):

2009 May 19. 

Collins LC, Achacoso N, Nekhlyudov L, Fletcher SW

Quesenberry CP Jr, Puligandla B, Alshak NS, Golds

AM, Schnitt SJ, Habel LA. Relationship between cli

pathologic features of ductal carcinoma in situ and p

analysis of 657 patients. Am J Surg Pathol. 2009;33(

Eide MJ, Krajenta R, Johnson D, Long JJ, Jacobsen 

Lim HW, Johnson CC. Identification of patients with 

skin cancer using health maintenance organization c

J Epidemiol. 2010;171(1):123–128. Epub 2009 Dec 

Habel LA, Achacoso NS, Haque R, Nekhlyudov L, F

Schnitt SJ, Collins LC, Geiger AM, Puligandla B, A

Quesenberry CP Jr. Declining recurrence among duc

in situ patients treated with breast-conserving surger

community setting. Breast Canc Res. 2009;11(6):R8

Hexsel CL, Eide MJ, Johnson CC, Krajenta R, Jacob

Hamzavi I, Lim HW. Incidence of nonmelanoma ski

cohort of vitiligo patients. J Amer Acad Derm. 2009

Tewari A, Gold HT, Demers RY, Johnson CC, Yadav 

EH, Field TS, Divine G, Menon M. Effect of socioe

on long-term mortality in men with clinically localiz

cancer. Urology. 2009;73:624–630. 

48 The HMO Cancer Resea
Boudreau DM, Koehler E, Rulyak SJ, Haneuse S, Harrison R, 

Mandelson MT. Cardiovascular medication use and risk for 

colorectal cancer. Canc Epidemiol Biomarkers Prev. 

2008;17(11):3076–3080. 

Boudreau DM, Yu O, Buist DS, Miglioretti DL. Statin use and 

prostate cancer risk in a large population-based setting. Canc 

Causes Contr. 2008;19(7):767–774. 

Resnicow K, Davis RE, Zhang G, Konkel J, Strecher VJ, Shaikh 

AR, Tolsma D, Calvi J, Alexander G, Anderson JP, Wiese C. 

Tailoring a fruit and vegetable intervention on novel motivational 

constructs: results of a randomized study. Ann Behav Med. 

2008;35(2):159–169. 

Ulcickas Yood M, Owusu C, Buist DSM, Geiger AM, Field TS, 

Thwin SS, Lash TL, Prout MN, Frost FJ, Wei F, Quinn VP, 

Silliman RA. The mortality impact of less than standard therapy in 

older breast cancer patients. J Am Coll Surg. 2008;206:66–75. 

2007 

Boudreau DM, Yu O, Miglioretti DL, Buist DS, Heckbert SR,


Daling JR. Statin use and breast cancer risk in a large population-


based setting. Canc Epidemiol Biomarkers Prev.


2007;16(3):416–421.


Collins LC, Achacoso NA, Nekhlyudov L, Fletcher SW, Haque R,


Quesenberry CP Jr, Alshak NS, Puligandla B, Brodsky GL, Schnitt


SJ, Habel LA. Clinical and pathologic features of ductal carcinoma


in situ associated with the presence of flat epithelial atypia: an


analysis of 543 patients. Mod Pathol. 2007;20(11):1149–1155.


Epub 2007 Aug 31.


Fenton JJ, Rolnick SJ, Harris EL, Barton MB, Barlow WE, Reisch


LM, Herrinton LJ, Geiger AM, Fletcher SW, Elmore JG. Specificity


of clinical breast examination in community practice.


J Gen Intern Med. 2007;22(3):332–337. 


Geiger A, Thwin S, Lash T, Buist D, Prout M, Wei F, F

Ulcickas Yood M, Frost F, Enger S, Silliman R. Recurr

second primary breast cancers in older women with init

stage disease. Cancer. 2007;109(5):966–974. 

Geiger AM, Prout MN, Silliman RA. Adjuvant radiation 

hormonal therapy prevent recurrences and second prima

cancers in older women. Am J Hematol Oncol. 2007;6:4

Herrinton LJ, Liu L, Lafata JE, Allison JE, Andrade SE

Chan KA, Platt R, Hiatt D, O’Connor S. Estimation of 

prevalence of inflammatory bowel disease among nine 

using computerized diagnoses and outpatient pharmacy 

dispensings. Inflamm Bowel Dis. 2007;13(4):451–461. 

Lash TL, Fox MP, Buist DS, Wei F, Field TS, Frost FJ, 

Quinn VP, Yood MU, Silliman RA. Mammography surv

and mortality in older breast cancer survivors. J Clin O

2007;25(21):3001–3006. 

Lash TL, Fox MP, Thwin SS, Geiger AM, Buist DS , W

TS, Yood MU, Frost FJ, Quinn VP, Prout MN, Silliman 

probabilistic corrections to account for abstractor agree

medical record reviews. Am J Epidemiol. 2007;165(12)

Thwin SS, Clough-Gorr KM, McCarty MC, Lash TL, A

Buist DS, Enger SM, Field TS, Frost F, Wei F, Silliman 

Automated inter-rater reliability assessment and electro

collection in a multi-center breast cancer study. BMC M

Methodol. 2007;7(1):23. 

2006 

Feldstein AC, Vogt TM, Aickin M, Hu WR. Mammogra

screening rates decline: a person-time approach to evalu

Med. 2006;43(3):178–182. 

http://crn.cancer.gov 
gy pp

study of tumor gene expression and risk of breast cancer death among 

lymph node-negative patients. Breast Canc Res. 2006;8(3):R25. 

2005 

Barton MB, West CN, Liu IL, Harris EL, Rolnick SJ, Elmore JG, 

Herrinton LJ, Greene SM, Nekhlyudov L, Fletcher SW, Geiger AM. 

Complications following bilateral prophylactic mastectomy. J Natl 

Canc Inst Monogr. 2005;35:61–66. 

Elmore JG, Armstrong K, Lehman CD, Fletcher SW. Screening for 

breast cancer. JAMA. 2005;293(10):1245–1256. 

Elmore JG, Reisch LM, Barton MB, Barlow WE, Rolnick S, Harris 

EL, Herrinton LJ, Geiger AM, Beverly RK, Hart G, Yu O, Greene 

SM, Weiss NS, Fletcher SW. Efficacy of breast cancer screening in 

the community according to risk level. J Natl Canc Inst. 

2005;97(14):1035–1043. 

Fenton JJ, Barton MB, Geiger AM, Herrinton LJ, Rolnick SJ, 

Harris EL, Barlow WE, Reisch LM, Fletcher SW, Elmore JG. 

Screening clinical breast examination: how often does it miss lethal 

breast cancer? J Natl Canc Inst Monogr. 2005;35:67–71. 

Fletcher SW. Risk Stratification for Breast Cancer Detection: Better 

Quality Mammography for Women through Better Focusing of 

Services. Saving Women’s Lives: Strategies for Improving Breast 

Cancer Detection and Diagnosis. A Breast Cancer Research 

Foundation and Institute of Medicine Symposium. Washington, 

D.C.: National Academies Press; 2005:43–50. 

Geiger AM, Yu O, Herrinton LJ, Barlow WE, Harris EL, Rolnick S, 

Barton MB, Elmore JG, Fletcher SW. A population-based study of 

bilateral prophylactic mastectomy efficacy in women at elevated 

risk for breast cancer in community practices. Arch Intern Med. 

2005;165(5):516–520. 

Herrinton LJ, Barlow WE, Yu O, Geiger AM, Elmore JG, Barton 

MB, Harris EL, Rolnick S, Pardee R, Husson G, Macedo A, 

Fletcher SW. Efficacy of prophylactic mastectomy in women with 

unilateral breast cancer: a cancer research network project. J Clin 

Oncol. 2005;23(19):4275–4286. 

Tammemagi CM, Neslund-Dudas C, Simoff M, Kva

and lung cancer survival: the role of comorbidity an

Chest. 2004;125(1):27–37. 

2003 

Fletcher SW, Elmore JG. Clinical practice. Mammogr

for breast cancer. N Engl J Med. 2003;348(17):1672

Tammemagi CM, Neslund-Dudas C, Simoff M, Kva

comorbidity on lung cancer survival. Int J Canc. 

2003;103(6):792–802. 

2002 

Elmore JG, Miglioretti DL, Reisch LM, Barton MB, 

Christiansen CL, Fletcher SW. Screening mammogr

community radiologists: variability in false-positive 

Canc Inst. 2002;94(18):1373–1380. 

2000 

Christiansen CL, Wang F, Barton MB, Kreuter W, E

Gelfand AE, Fletcher SW. Predicting the cumulative 

positive mammograms. J Natl Canc Inst. 2000;92(20

Enhancing Cancer Communicat

and Decision-Making 

2010 

Fagerlin A, Zikmund-Fisher BJ, Smith DM, Nair V, 

McClure JB, Greene S, Stark A, Alford SH, Lantz P

Wiese C, Zweig SC, Pitsch R, Jankovic A, Ubel PA. 

decisions regarding tamoxifen for breast cancer prev

responses to a tailored decision aid. Breast Canc Res 

2010;119(3):613-20. 

50 The HMO Cancer Resea
2009 

Jackson JM, Rolnick SJ, Asche SE, Heinrich RL. Knowledge, 

attitudes, and preferences regarding advance directives among 

patients of a managed care organization. Am J Manag Care. 

2009;15(3):177–186. 

Nekhlyudov L, Braddock CH. An approach to enhance 

communication about screening mammography in primary care. J 

Women Health. 2009;18:1403–1412. 

2008 

Aiello Bowles EJ, Tuzzio L, Wiese CJ, Kirlin B, Greene SM, 

Clauser SB, Wagner EH. Understanding high-quality cancer care: a 

summary of expert perspectives. Cancer. 2008;112(4):934–942. 

Nekhlyudov L, Li R, Fletcher SW. Informed decision-making 

before initiating screening mammography: does it occur and does it 

make a difference? Health Expectations. 2008; 11:366–375. 

Strecher VJ, McClure JB, Alexander GL, Chakraborty B, Nair VN, 

Konkel JM, Greene SM, Collins LM, Carlier CC, Wiese CJ, Little 

RJ, Pomerleau CS, Pomerleau OF. Web-based smoking-cessation 

programs results of a randomized trial. Am J Prev Med. 

2008;34(5):373–381. 

Zikmund-Fisher PJ, Ubel PA, Smith DM, Derry HA, McClure JB, 

Stark A, Pitsch RK, and Fagerlin A. Communicating side effect 

risks in a Tamoxifen prophylaxis decision aid: the de-biasing 

influence of pictographs. Patient Educ Counsel. 2008;73:209–214. 

2006 

Rothert K, Strecher VJ, Doyle LA, Caplan WM, Joyce JS, Jimison 

HB, Karm LM, Mims AD, Roth MA. Web-based weight 

management programs in an integrated health care setting: a 

randomized, controlled trial. Obesity. 2006;14(2):266–272. 

;

Nekhlyudov L, Li R, Fletcher SW. Information and inv

preferences of women in their 40s before their first scre

mammogram. Arch Intern Med. 2005;165:1370–1374. 

2003 

Nekhlyudov L, Ross-Degnan D, Fletcher SW. Beliefs a

expectations of women under 50 years old regarding sc

mammography: a qualitative study. J Gen Intern Med. 

2003;18:182–189. 

Dissemination and Implementatio

Research in Cancer Prevention, 

Screening, and Treatment 

2009 

Beck A, Bergman DA, Rahm AK, Dearing JW, Glasgow 

implementation and dissemination concepts to spread 2

well child care at a health maintenance organization. 

The Permanente Journal. 2009;13(3):10–17. 

Dearing JW. Applying diffusion of innovation theory to 

intervention development. Res Soc Work Pract. 2009;19

Quinn VP, Hollis JF, Smith KS, Rigotti NA, Solberg LI

Stevens VJ. Effectiveness of the 5-As tobacco cessation 

in nine HMOs. J Gen Intern Med. 2009;24(2):149–154

2008 

Aiello EJ, Buist DS, Wagner EH, Tuzzio L, Greene SM

LE, Field TS, Herrinton LJ, Haque R, Hart G, Bischoff 

AM. Diffusion of aromatase inhibitors for breast cancer 

between 1996 and 2003 in the Cancer Research Networ

Canc Res Treat. 2008;107(3):397–403. 

Dearing JW. Evolution of dissemination and diffusion t

J Publ Health Manag Pract. 2008;14(2):99–108. 

http://crn.cancer.gov 
Permanente Journal. 2008;12(3):5860. 

Dearing JW, Kim DK. Diffusion of information and innovation. In: 

Donsbach W ed. The International Encyclopedia of 

Communication. Volume III. London: Blackwell; 2008:1299–1304. 

Newton KM, Buist DS, Yu O, Hartsfield CL, Andrade SE, Wei F, 

Connelly MT, Chan KA. Hormone therapy initiation after the 

Women’s Health Initiative. Menopause. 2008;15(3):487–493. 

2005 

Dearing JW. On the Gyant’s shoulders: purposive diffusion as an 

outcome of the diffusion paradigm. In: Griffen A , Otnes C, eds. 

16th Paul D. Converse Symposium. Chicago: American Marketing 

Association; 2000:152–162. 

Hartsfield CL, Connelly MT, Newton KM, Andrade SE, Wei F, 

Buist DS. Health system responses to the Women’s Health Initiative 

findings on estrogen and progestin: organizational response. J Natl 

Canc Inst Monogr. 2005;35:113–115. 

Mouchawar J, Laurion S, Ritzwoller DP, Ellis J, Kulchak-Rahm A, 

Hensley-Alford S. Assessing controversial direct-to-consumer 

advertising for hereditary breast cancer testing: reactions from 

women and their physicians in a managed care organization. Am J 

Manag Care. 2005;11(10):601–608. 

Mouchawar J, Hensley-Alford S, Laurion S, Ellis J, Kulchak-Rahm 

A, Finucane ML, Meenan R, Axell L, Pollack R, Ritzwoller D. 

Impact of direct-to-consumer advertising for hereditary breast 

cancer testing on genetic services at a managed care organization: a 

naturally-occurring experiment. Genet Med. 2005;7(3):191–197. 

Newton KM, Buist DS, Miglioretti DL, Beverly K, Hartsfield CL, 

Chan KA, Andrade SE, Wei F, Connelly MT, Kessler L. The impact 

of comorbidities on hormone use. After the 2000 release of the 

Women’s Health Initiative. J Gen Intern Med. 2005;20(4):350–356. 

Wei F, Miglioretti DL, Connelly MT, Andrade SE, Newton KM, 

Hartsfield CL, Chan KA, Buist DS. Changes in women’s use of 

hormones after the Women’s Health Initiative estrogen and 

progestin trial by race, education, and income. J Natl Canc Inst 

Monogr. 2005;35:106–112. 

Dearing JW. Improving the state of health programm

diffusion theory. J Health Comm. 2004;9:1–16. 

2003 

Mouchawar J, Valentine Goins K, Somkin C, Puleo 

Alford S, Geiger AM, Taplin S, Gilbert J, Weinmann 

Guidelines for breast and ovarian cancer genetic cou

referral: adoption and implementation in HMOs. Ge

2003;5(6):444–450. 

Winickoff JP, Glauber JH, Perrin JM, Boch B, Rigot

Improving tobacco dependence medication use in a 

managed care organization: a practical systems-leve

J Clin Outcome Manag. 2003;10:535–539. 

2002 

Rigotti NA, Quinn VP, Stevens VJ, Solberg LI, Holl

AC, Zapka JG, France E, Gordon N, Smith S, Monr

control policies in 11 leading managed care organiza

and challenges. Eff Clin Pract. 2002;5(3):130–136. 

Psychosocial Factors and Burde

of Cancer 

2009 

Altschuler A, Ramirez M, Grant M, Hornbrook M, H

Krouse R. The influence of husbands’ or male partne

women’s psychosocial adjustment to having an ostom

from colorectal cancer. J Wound Ostomy Continence 

2009;36(3):299–305. 

Baldwin, CM, Grant M, Wendel C, Hornbrook M, H

McMullen C, Krouse RS. Gender differences in slee

and fatigue on quality of life among persons with os

Sleep Med. 2009;5(4):335–343. 

52 The HMO Cancer Resea
2008 

among Medicare enrollees in 2000 to 2005. Canc Epidemiol 

Biomarkers Prev. 2009;18:2170–2175. 

Krouse RS, Herrinton LJ, Grant M, Wendel CS, Green SB, Mohler 

MJ, Baldwin CM, McMullen C, Rawl, SM, Matayoshi E, Coons 

SJ, Hornbrook MC. Health-related quality of life among long-term 

rectal cancer survivors with an ostomy: manifestations by sex. J 

Clin Oncol. 2009;27(28):4664–4670. 

Lundy JJ, Coons SJ, Wendel CS, Hornbrook MC, Herrinton LJ, 

Grant M, Krouse RS. Exploring household income as a predictor of 

psychological well-being among long-term colorectal cancer 

survivors. Qual Life Res. 2009;18(2):157–161. 

McClure JB, Divine G, Alexander G, Tolsma D, Rolnick SJ, 

Stopponi M, Richards J, Johnson CC. A comparison of smokers' 

and nonsmokers' fruit and vegetable intake and relevant 

psychosocial factors. Behav Med. 2009;35(1):14–22. 

Tolsma D, Calvi J, Davis RE, Greene SM, Resnicow K, Anderson 

J, Wiese C, Alexander G. Challenges in researching racially 

sensitive topics in HMOs. Health Psychol. 2009;28(4):389–390. 

Altschuler A, Nekhlyudov L, Rolnick SJ, Greene SM, Elmore JG, 

West C, Herrinton LJ, Harris EL, Fletcher SW, Emmons KM, 

Geiger AM. Positive, negative and disparate: women’s differing 

long-term psychosocial experiences of bilateral or contralateral 

prophylactic mastectomy. Breast J. 2008;14(1):25–32. 

McMullen CK, Hornbrook MC, Grant M, Baldwin CM, Ramirez 

ML, Wendel CS, Mohler MJ, Altschuler A, Krouse RS. The 

greatest challenges reported by long-term colorectal cancer 

survivors with stomas. J Support Oncol. 2008;6(4):175–182. 

Mohler MJ, Coons SJ, Hornbrook MC, Herrinton LJ, Wendel CS, 

Grant M, Krouse RS. The Health-Related Quality of Life in LongTerm Colorectal Cancer Survivors Study: objectives, methods and 

patient sample. Curr Med Res Opin. 2008;24(7):2059–2070. 

Geiger AM, Nekhlyudov L, Herrinton LJ, Rolnick SJ, G

West CN, Harris EL, Elmore JG, Altschuler A, Liu IL, 

Emmons KM. Quality of life after bilateral prophylactic 

mastectomy. Ann Surg Oncol. 2007;14(2):686–694. 

Rolnick SJ, Altschuler A, Nekhlyudov L, Elmore JG, G

Harris EL, Herrinton LJ, Barton MB, Geiger AM, Fletc

What women wish they knew before prophylactic mast

Canc Nurs. 2007;30(4):285–291. 

2006 

Geiger AM, West CN, Nekhlyudov L, Herrinton LJ, Liu 

Altschuler A, Rolnick SJ, Harris EL, Greene SM, Elmo

Emmons KM, Fletcher SW. Contentment with quality o

breast cancer survivors with and without contralateral p

mastectomy. J Clin Oncol. 2006;24(9):1350–1356. 

Jackson JM, Rolnick SJ, Coughlin SS, Neslund-Dudas 

Hornbrook MC, Darbinian J, Bachman DJ, Herrinton L

support among women who died of ovarian cancer. Sup

Canc. 2006;15(5):547–556. 

Lambing A, Markey CA, Neslund-Dudas CM, Bricker L

Completing a life: comfort level and ease of use of a CD

among seriously ill patients. Oncol Nurs Forum. 

2006;33(5):999–1006. 

2005 

Field TS, Buist DS, Doubeni C, Enger S, Fouayzi H, H

Korner EJ, Lamerato L, Bachman DJ, Ellis J, Herrinton 

Hornbrook MC, Krajenta R, Liu L, Yao J. Disparities an

among breast cancer patients. J Natl Canc Inst Monogr. 20

Nguyen TT, Somkin CP, Ma Y. Participation of Asian-A

women in cancer chemoprevention research: physician 

perspectives. Cancer. 2005;104(12 suppl):3006–3014. 

http://crn.cancer.gov 
yg

Quinn VP, Stevens VJ, Hollis JF, Rigotti NA, Solberg LI, Gordon 

N, Ritzwoller D, Smith KS, Hu W, Zapka J. Tobacco-cessation 

services and patient satisfaction in nine nonprofit HMOs. Am J Prev 

Med. 2005;29(2):77–84. 

Rolnick S, Hensley Alford S, Kucera GP, Fortman K, Ulcickas 

Yood M, Jankowski M, Johnson CC. Racial and age differences in 

colon examination surveillance following a diagnosis of colorectal 

cancer. J Natl Canc Inst Monogr. 2005;35:96–101. 

Rolnick SJ, Kopher RA, DeFor TA, Kelley ME. Hormone use and 

patient concerns after the findings of the Women’s Health Initiative. 

Menopause. 2005;12(4):399–404. 

Tammemagi CM, Nerenz D, Neslund-Dudas C, Feldkamp C, 

Nathanson D. Comorbidity and survival disparities among black 

and white patients with breast cancer. JAMA. 

2005;294(14):1765–1772. 

2002 

Ford ME, Hill DD, Nerenz D, Hornbrook M, Zapka J, Meenan R, 

Greene S, Johnson CC. Categorizing race and ethnicity in the HMO 

Cancer Research Network. Ethn Dis. 2002;12(1):135–140. 

Tammemagi CM, Neslund-Dudas C, Simoff M, Kvale P. Lung 

carcinoma symptoms—an independent predictor of survival and an 

important mediator of African-American disparity in survival. 

Cancer. 2004;101(7):1655–1663. 

2000 

Reisch LM, Barton MB, Fletcher SW, Kreuter W, Elmore JG. 

Breast cancer screening use by African Americans and Whites in an 

HMO. J Gen Intern Med. 2000;15(4):229–234. 

clinical data for capturing chemotherapy administrat

implications for future research. Med Care. 

2009;47(10):1091–1097. 

Rahm AK, Gaglio B, Bodily M, Palen TE, Ritzwolle

Sukhanova A, Glasgow RE. A tale of two projects: c

by research projects during a change in electronic m

systems. Electron Healthc. 2009;7(3):1–8. 

Rolnick SJ, Calvi J, Heimendinger J, McClure JB, K

Johnson C, Alexander GL. Focus groups inform a w

program to increase fruit and vegetable intake. Patie

Counsel. 2009;77(2):314–318. 

Stopponi MA, Alexander GL, McClure JB, Carroll N

GW, Calvi JH, Rolnick SJ, Strecher VJ, Johnson CC

et al. Recruitment to a randomized web-based nutrit

intervention trial: characteristics of participants com

participants. J Med Internet Res. 2009;11(3):e38. 

2008 

Strecher VJ, McClure J, Alexander G, Chakraborty B

Konkel J, Greene S, Couper M, Carlier C, Wiese C, 

Pomerleau C, Pomerleau O. The role of engagement 

web-based smoking cessation program: randomized 

J Med Internet Res. 2008;10(5):e36. 

2006 

Greene SM, Geiger AM. A review finds that multice

face substantial challenges but strategies exist to ach

Institutional Review Board approval. J Clin Epidem

2006;59(8):784–790. 

2005 

Greene SM, Hart G, Wagner EH. Measuring and imp

performance in multicenter research consortia. J Nat

Monogr. 2005;35:26–32. 

54 The HMO Cancer Resea
in any electronic medical record. J Am Med Inform Assoc. 

2005;12(5):517–529. 

Hornbrook MC, Hart G, Ellis JL, Bachman DJ, Ansell G, Greene 

SM, Wagner EH, Pardee R, Schmidt MM, Geiger A, Butani AL, 

Field T, Fouayzi H, Miroshnik I, Liu L, Diseker R, Wells K, 

Krajenta R, Lamerato L, Neslund Dudas C. Building a virtual 

cancer research organization. J Natl Canc Inst Monogr. 

2005;35:12–25. 

Wagner EH, Greene SM, Hart G, Field TS, Fletcher S, Geiger AM, 

Herrinton LJ, Hornbrook MC, Johnson CC, Mouchawar J, Rolnick 

SJ, Stevens VJ, Taplin SH, Tolsma D, Vogt TM. Building a research 

consortium of large health systems: the Cancer Research Network. 

J Natl Canc Inst Monogr. 2005;35:3–11. 

West CN, Geiger AM, Greene SM, Harris EL, Liu IL, Barton MB, 

Elmore JG, Rolnick S, Nekhlyudov L, Altschuler A, Herrinton LJ, 

Fletcher SW, Emmons KM. Race and ethnicity: comparing medical 

records to self-reports. J Natl Canc Inst Monogr. 2005;(35):72–74. 

2004 

Rolnick SJ, Hart G, Barton MB, Herrinton L, Flores SK, Paulsen 

KJ, Husson G, Harris EL, Geiger AM, Elmore JG, Fletcher SW. 

Comparing breast cancer case identification using HMO 

computerized diagnostic data and SEER data. Am J Manag Care. 

2004;10(4):257–262. 

Vogt TM, Elston-Lafata J, Tolsma D, Greene SM. The role of 

research in integrated healthcare systems: the HMO Research 

Network. Am J Manag Care. 2004;10(9):643–648. 

2003 

Geiger AM, Greene SM, Pardee RE III, Hart G, Herrinton LJ, 

Macedo AM, Rolnick S, Harris EL, Barton MB, Elmore JG, 

Fletcher SW. A computerized system to facilitate medical record 

abstraction in cancer research (United States). Canc Causes 

Control. 2003;14(5):469–476. 

Building Capacity to Support Em

Areas of Cancer Control Research 

2009 

Alexander GL, McClure JB, Calvi JH, Divine GW, Stop

Rolnick SJ, Heimendinger JB, Tolsma DD, Resnicow K

MK, Strecher VJ, Johnson CC. A randomized clinical tr

evaluating online interventions to improve fruit and veg

consumption. Am J Public Health. epub 2009 Dec 17. 

2008 

Alexander GL, Divine GW, Couper MP, McClure JB, S

MA, Fortman KK, Tolsma DD, Strecher VJ, Johnson C

incentives and mailing features on online health program 

enrollment. Am J Prev Med. 2008;34(5):382–388. 

Geiger AM, Buist DS, Greene SM, Altschuler A, Field 

Research Network. Survivorship research based in integ

healthcare delivery systems: the Cancer Research Netw

2008;112(11 suppl):2617–2626. 

McBride CM, Alford SH, Reid RJ, Larson EB, Baxevan

Brody LC. Putting science over supposition in the arena 

personalized genomics. Nat Genet. 2008;40(8):939–942

Vogt TM. Improving CRC screening requires innovativ

approaches: can electronic medical records help? Am J 

2008;35(3):317–318. 

2007 

Vogt TM, Feldstein AC, Aickin M, Hu WR, Uchida A. 

medical records and prevention quality: the prevention 

Prev Med. 2007;33(4):291–296. 

Wallace P. Reshaping cancer learning through the use o

information technology. Health Aff. 2007;26(2):w169–w

http://crn.cancer.gov 
Elmore JG, Fletcher SW. The risk of cancer risk prediction: “what 

is my risk of getting breast cancer?” J Natl Canc Inst. 

2006;98(23):1673–1675. 

Greene SM, Geiger AM, Harris EL, Altschuler A, Nekhlyudov L, 

Barton MB, Rolnick SJ, Elmore JG, Fletcher S. Impact of IRB 

requirements on a multicenter survey of prophylactic mastectomy 

outcomes. Ann Epidemiol. 2006;16(4):275–278. 

McClure JB, Greene SM, Wiese C, Johnson KE, Alexander G, 

Strecher V. Interest in an online smoking cessation program and 

effective recruitment strategies: results from Project Quit. J Med 

Internet Res. 2006;8(3):e14. 

2005 

Hazlehurst B, Sittig DF, Stevens VJ, Smith KS, Hollis JF, Vogt TM, 

Winickoff JP, Glasgow R, Palen TE, Rigotti NA. Natural language 

processing in the electronic medical record: assessing clinician 

adherence to tobacco treatment guidelines. Am J Prev Med. 

2005;29(5):434–439. 

Somkin CP, Altschuler A, Ackerson L, Geiger AM, Greene SM, 

Mouchawar J, Holup J, Fehrenbacher L, Nelson A, Glass A, 

Polikoff J, Tishler S, Schmidt C, Field T, Wagner E. Organizational 

barriers to physician participation in cancer clinical trials. Am J 

Manag Care. 2005;11(7):413–421. 

2002 

Field TS, Cadoret CA, Brown ML, Ford M, Greene SM, Hill D, 

Hornbrook MC, Meenan RT, White MJ, Zapka JM. Surveying 

physicians: do components of the “Total Design Approach” to 

optimizing survey response rates apply to physicians? Med Care. 

2002;40(7):596–605. 

Puleo E, Zapka J, White MJ, Mouchawar J, Somkin C, Taplin S. 

Caffeine, cajoling, and other strategies to maximize clinician survey 

response rates. Eval Health Prof. 2002;25(2):169–184. 

2008 

Kahn KL. Moving research from bench to bedside to 

there is still more to do. J Clin Oncol. 2008;26(4):52

Norman GJ. Answering the “what works?” question 

behavior change. Am J Prev Med. 2008;34(5):449–4

2007 

Mandelblatt J. To screen or not to screen older wom

cancer: a new twist on an old question, or will we ev

getting the answers? J Clin Oncol. 2007;25(21):299

Tuma R. Surveillance mammography extends overa

older breast cancer survivors. Oncol Times. 2007;29

56 The HMO Cancer Resea
http://crn.cance

Centers for Education & Research 

in Therapeutics (CERTs): 

http://www.certs.hhs.gov 

CRN Cancer Communication 

Research Center: 

http://www.crn-ccrc.org 

HMO Research Network (HMORN): 

http://hmoresearchnetwork.org 

NCI Division of Cancer Control 

and Population Sciences (DCCPS): 

http://cancercontrol.cancer.gov 

NCI Centers of Excellence in Cancer 

Communication Research: 

http://cancercontrol.cancer.gov/hcirb/ceccr 

CRN Research Themes 

• Health Care Delivery, Quality, Costs, 

and Outcomes 

• Health Insurance Benefit Design and 

Patterns of Care Utilization 

• Cancer Epidemiology, Prevention, and 

Health Promotion 

• Enhancing Cancer Communication and 

Decision-Making 

• Dissemination and Implementation 

Research in Cancer Prevention, 

Screening, and Treatment 

• Psychosocial Factors and Burden 

of Cancer 

• Data Resources and Infrastructure 

• Building Capacity to Support Emerging 

Areas of Cancer Control Research 

3 

Work with internal CRN 

collaborators to finalize 

research questions and 

develop and execute 

proposals. 

A 

Submit your proposal to 

the CRN New Proposals 

Committee for review 

and approval. 

B 

When ready to pub

follow the policies a

procedures of the C

Publications Comm

regarding authorsh

publication. 

C 

1 

Visit 

http://crn.cancer.gov 

A 

Use the Web inquir

to connect with the 

Principal Investigato

office. 

B 

2 

Work with CRN staff to 

assess interest level and 

feasibility. 

A 

If your ideas are a g

fit...Participate in a

conference call to d

your ideas with inte

collaborators. 

B 

HPRF = HealthPartners 

(HealthPartners Research Fou

KPCO = Kaiser Permanente Colorado 

(Institute for Health Research

KPG = Kaiser Permanente Georgia 

(Center for Health Research – S

KPH = Kaiser Permanente Hawaii 

(Center for Health Research – 

KPNC = Kaiser Permanente Northern 

(Division of Research) 

KPNW = Kaiser Permanente Northwe

Health Research – Northwes

KPSC = Kaiser Permanente Southern 

(Department of Research and 

LCF = Lovelace Health System 

(Lovelace Clinic Foundation Re

MCRF = Marshfield Clinic/Security He

(Marshfield Clinic Research Fo

MPCI = Fallon Community Health Plan 

(Meyers Primary Care Institute

Collaborating with the C
NIH Publication No. 10-6448 

Printed April 2010