U.S. DEPARTMENT

OF HEALTH AND

HUMAN SERVICES

National Institutes 

of Health

National 

U.S. DEPARTMENT

OF HEALTH AND

HUMAN SERVICES

National Institutes 

of Health

National 

CAPA

COLLABORA

& INVESTIGA
ii The HMO Cancer Resea

Network

CAPACITY, 

COLLABORATION 

& INVESTIGATION

3 History

6 Research Themes

8 Collaborating with the CRN

10 Capacity

13 Data Sources

14 Informatics & Research Tools

16 Organizational Structure

18 Site Principal Investigators

20 Contact Information

22 CRN Research & Project Portfolio

24 Scientific Studies & Selected Accomplishments

28 New Directions for CRN 3

32 Publications by Project 1999–2008
10 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.

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

100 peer-reviewed papers. It has become a national

cancer research resource by increasing 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 informatics systems to conduct cancer etiology,

epidemiology, and health services research. It allows

for large, multi-center, 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. 

http://crn.cancer.gov 

agenda, accomplishments, capacity, and futur

potential. Secondly, it aims to serve as a “use

for potential collaborators. It is our hope tha

will gain a greater understanding of how to b

partners in this scientific community, how to 

successfully with CRN members, and how to 

CRN’s unique research resources and scientif

expertise. Readers will then have a greater c

undertake research projects that will both ben

research community and advance knowledge 

the progress of cancer control in the United S

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
which ensures substantive NCI

involvement in attaining research

goals and catalyzing new

collaborations. The Agency for

Healthcare Research and Quality

(AHRQ) also supports the CRN.

CRN research focuses on the

characteristics of patients, clinicians,

communities, and health systems

that lead to the best possible

outcomes in cancer prevention and

care. The CRN also develops and

makes good use of standardized

approaches to data collection, data

management, and analysis across

health systems. 

2 The HMO Cancer Resea

2 Center for Health R

Northwest, Kaiser P

Northwest

3 Center for Health R

Southeast, Kaiser P

Georgia

4 Department of Res

Henry Ford Hospital 

System 

5 Department of Am

Care and Preventio

Pilgrim Health Care

6 Department of Res

Evaluation, Kaiser P

Southern California

7 Division of Researc

Permanente Norther

8 Geisinger Center f

Research, Geisinge

System

9 Group Health Cent

Health Studies, Gro

Cooperative

10 HealthPartners Re

Foundation, Health

11 Institute for Health 

Kaiser Permanente C

12 Lovelace Clinic Fo

Lovelace Health Sys

13 Marshfield Clinic R

Foundation, Marshf

14 Meyers Primary Ca

Fallon Community H

9

2

7

11

10

13

4

8

3

14 5

12

6

1

The Cancer Research Network(CRN) is a consortium of 14

nonprofit research centers based 

in 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. 

The CRN is funded through a

National Cancer Institute (NCI)

cooperative agreement grant,
http://crn.cancer.gov 

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 care, long-term

outcomes, costs, and other issues

important to cancer care delivery

and cancer patients. 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. NCI recognized the

important contribution of

information garnered from large

clinical trials and other databases

such as the Surveillance

Epidemiology and End Results

(SEER)-Medicare linked data for

non-HMO cancer patients aged 65

and older. But NCI also

acknowledged the limitations of

such selective information sources

and envisioned a research network

that would include population data

for people younger than 65, and

those at risk for cancer. NCI gave

highest priority to studies that

addressed the distribution of risk

impact of organizational factors on

access to and quality of cancer

prevention and care. The CRN

response to the RFA grew out of

discussions among leaders of the

established HMO Research Network

(www.hmoresearchnetwork.org).

The CRN now includes 14 of the 15

HMO Research Network members,

all of which have an established

program in cancer research and are

based in integrated health care

delivery systems. 

and treatment through rese

identifying system, provid

patient factors affecting ou

The CRN’s initial research 

focused on three areas par

cancer control: effectivene

breast and cervical cancer 

in community practice; ex

adherence to tobacco cont

guidelines at the system, p

and patient levels; and effi

prophylactic mastectomy 

screening among women a

increased risk for breast ca

Several administrative sup

R01 grants, and other fund

projects added to the CRN

research portfolio. These d

We haven’t known about the survival benefit of s

mammography in older women before, because o

women were not included in large numbers in th

screening trials of mammography, and no one ha

tested the effectiveness of screening after breast 

older women. Observational research is a very im

tool when you have a well-defined population tha

in the gaps from clinical trials. And given the tig

budgets, such health services research becomes a 

effective means of answering questions.

Tuma R. Surveillance Mammography Extends Overall Survival in O

Cancer Survivors. Oncology Times 2007; 29(20):24-25. [comment

from the CRN-affiliated research project, Breast Cancer in Older W
4 The HMO Cancer Resea

clinical trials, lung and colon cancer

outcomes, medications and risk of

colorectal cancer recurrence, and

breast cancer treatment effectiveness

in older women. CRN 1 included 10

funded sites and one affiliate site.

CRN 2: 2003–2007

Research projects included in 

CRN 2 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

grant, several supplements, R01

grants, and pilot funds augmented

the core research, including a

multicenter study of pancreatic

cancer etiology and several

information technology studies

aimed at improving the research

capacity of the CRN’s data and

informatics resources. Indeed,

CRN 2 responded to NCI’s call for

efforts to create widely accessible,

uniform health informatics resources

and tools for conducting populationbased cancer research. Priorities

during this time included further

developing and leveraging

standardized approaches to data

collection, management, and

analysis; and enhancing the ability

of the CRN to respond to NCI

> Request for

Applications, “Cancer

Research Network

Across Health Care

Systems”

> First Cancer 

Research Network

grant (CRN 1) funded

through cooperative

agreement

> Second competitive

Request for

Applications issued

> Second Cancer

Research Network

grant (CRN 2) funded

> AHRQ becomes cosponsor of CRN

initiative

> Comp

of CR

publis

Journ

Nation

Institu

> CRN f

Summ

Syste

Platfo

1997 1999 2002 2003 

Warehouse (VDW), a p

facilitate multi-site canc

was a key product of C

addition, the DCIS and 

cancer projects expande

scientific agenda to inc

of biomarker examinati

population-based studie

this period, CRN sites a

continued to collaborate 

large studies initiated o

CRN RFA, including th

Care Outcomes Researc

Surveillance Consortium

Michigan Center for He

Communications Resea

study of Multiplex Gen

Susceptibility Testing, s

the National Human Ge

Research Institute. CRN 
http://crn.cancer.gov 

> 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

> Third Cancer

Research Network

grant (CRN 3) funded

2006 2007

including a tailored mentoring

workshop for this purpose and the

initiation of CRN pilot funds to

support small studies. CRN 2

included 11 funded sites and two

affiliate sites.

CRN 3: 2007–2012

CRN investigators are embarking on

a new generation of activities for

CRN 3. Responding to

recommendations from an

independent, external evaluation

committee, CRN 3 activities involve

increasing collaboration with

external researchers, research

institutions, and networks outside

the CRN member organizations;

further development of data

Department of Health and Human

Services (DHHS) initiatives in this

area; increased support for junior

investigators; more research on

dissemination; and studying the

implementation of strategies to

increase enrollment in clinical trials.

Comprehensive infrastructure

support and enhancement remain the

primary focus of CRN 3. In

addition, three new studies will:

• Investigate the economic burden of

cancer, focusing on the impact of

age, stage, comorbidities, and

benefits

• Develop and test measures of oral

health literacy through the lens of

cancer prevention messages 

utility: the Cancer Preven

Several ancillary studies a

are underway. CRN 3 incl

14 funded sites.
6 The HMO Cancer Resea

electronic medical reco

patient Web sites, and r

current and historical el

on enrollee populations

priority is the continued

improvement of the CR

standardized data infras

the development and te

research, surveillance, a

practice innovations bu

electronic medical reco

Web portals, computer-

physician order entry sy

automated records of co

health service utilizatio

Enhancing Cancer

Communication and D

making 

With its extensive data 

and providers, a key CR

is the capacity to exami

optimize the quality of 

communication and dec

making about cancer sc

diagnosis, treatment, an

survivorship in diverse 

CRN studies in this are

wide range of issues—f

clinical decision makin

based consumer inform

staff, advisors, non-CRN cancer

researchers, and patient advocates

participated in a concept mapping

process to identify scientific priorities for

the CRN. The 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. Themes are described

in this section.
http://crn.cancer.gov 

health care processes on quality,

cost, and outcomes is a key

foundation of managed care

research centers. Studies in this area

address the nature and quality of

cancer prevention services,

screening, treatment, supportive

care, and survivorship care, and

their impacts on health outcomes

and costs. The relatively large

number of clinical sites and the size

and diversity of CRN patient

populations facilitate studies of

practice variation, disparities in care

and outcomes, and intervention

studies.

Health Insurance Benefit Design

and Patterns of Care Utilization 

Improvements in care and benefit

structure can be advanced with

research that examines the

relationship between patients’

benefit design, in the form of cost

sharing or out-of-pocket costs for

medical services (e.g., copayments,

coinsurance, and deductible rates)

and their use of cancer screening

and treatment services. Patients who

have higher cost sharing for medical

services typically are less likely to

use recommended medical care

services. Moreover, cost sharing has

disproportionate effects on low

income populations.

populations for conducting crosssectional, case-control, cohort, and

intervention studies to examine

numerous cancer-related conditions,

including health disparities and rare

outcomes. Studies of health

promotion strategies, lifestyle

change, and risk factor assessment

and identification benefit from the

HMO setting. This setting enhances

the ability to define populations to

facilitate recruitment and follow-up,

work with the health care system to

enhance retention of study

participants, and have available

detailed information on medical care

covariates and comorbid conditions

that may impact research outcomes

of interest. 

Psychosocial Factors and Burden

of Cancer 

Factors such as education, financial

assets, literacy, psychosocial

distress, and costs of treatment

impact cancer care, patient

outcomes such as quality of life,

and patient care experiences. This

research theme emphasizes studies

to characterize these effects better,

and to identify interventions to

ameliorate them. Examining

disparities in cancer access,

outcomes, and treatment, and the

effectiveness of psychosocial

interventions for cancer patients, are

priority research areas.

The CRNs population siz

diversity, and data resourc

rich opportunities to study 

prevention and care in diff

settings, patient population

regions of the country ove

particular interest are stud

introduction and diffusion 

diagnostic and treatment m

into practice, and the cond

pharmaco-epidemiologic a

pharmaco-genomic studie

effectiveness of cancer dru

Building Capacity to Sup

Emerging Areas of Canc

Control Research 

CRN investigators and hea

organizations have tremen

potential to advance resea

activities to develop, enha

test health informatics, da

and biospecimen tools and 

to support research in area

cancer risk assessment and

modeling; studies of behav

environmental, and geneti

and personalized health ca

approaches to preventive c

screening, diagnosis/progn

treatment. In addition, the 

aims to develop activities 

the timeliness, efficiency, 

effectiveness of recruitmen

2 and phase 3 prevention a

treatment trials. 
8 The HMO Cancer Resea

yourself with the CRN data sources

and research priorities to see how

well they fit your research interests

and data needs. The Principal

Investigator’s office will connect

you with appropriate partners at one

or more CRN sites or affiliates to

determine whether your interests

and/or data needs align with CRN.

Complete the Web inquiry form 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)

p

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.

• Experienced CRN investigators are

available for direct involvement in

all aspects of the research,

including research design, conduct,

analysis, and dissemination.

• CRN sites contributing data to

your project will review and

comment on your research

proposal.

• The CRN Publications Committee

has outlined policies and

procedures for authorship and

publication of CRN-related

research.

to broaden our

collaborations wi

researchers beyon

University and to 

our faculty to pop

for the study of c

From the Cancer 

perspective, our c

(in particular) wi

new opportunities 

study various asp

cancer prevention

detection, treatme

survivorship ques

DeAnn Lazovich, 

Associate Profess

Division of Epidem

and Community H

University of Minn

Visit the HMO Research Network (www.hmoresearchnetwork.org) to familiari

yourself with the various research centers and networks, including the CRN, 

to see which fits best with your research interests.
http://crn.cancer.gov 

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 publish,

follow the policies and

procedures of the CRN

Publications Committee

regarding authorship and

publication.

C

Use the W

tool to pro

on the CR

process.

D

Visit 

http://crn.cancer.gov

Use the Web inquiry form

to connect with the CRN

Principal Investigator’s

office.

The CRN 

Investigato

identify po

collaborato

initial meet

the progre

collaborati

2

Work with CRN staff to

assess interest level and

feasibility.

A

If your ideas are a good

fit...Participate in an initial

conference call to discuss

your ideas with interested

collaborators. 

B

Work with 

collaborato

Special Int

(SIG) to de

project pro

C
organizations nationwide, the CRN

is heavily influenced by its

proximity to and familiarity with the

day-to-day provision of cancer care.

All CRN sites are longstanding

organizations with a stable presence

in their communities. They also

have research centers and

investigators who understand their

enrollee populations, the

organization and delivery of care,

and the associated data systems. 

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

American enrollees (Henry Ford

Hospital and Health System,

Harvard Pilgrim Health Care, and

Kaiser Permanente Georgia); Asian

Americans (Kaiser Permanente

Hawaii, Kaiser Permanente

Northern California, and Kaiser

Southern California, Ka

Permanente Northern C

and Kaiser Permanente 

Racial and ethnic diver

important strength of th

which permits studies e

effectiveness research f

those subpopulations. 

QUICK FACTS

> Between 1999 and 2008, CRN researchers published m

than 100 peer-reviewed journal articles.

> CRN partnerships and affiliations include the HMO Resea

Network, many NCI-designated Cancer Centers, and sev

agencies, including NCI, the National Heart, Lung, and B

(NHLBI), the National Human Genome Research Institute 

and the Agency for Healthcare Research and Quality (AH

> The CRN has significantly leveraged its core funding sinc

original grant to develop and receive 12 infrastructure or 

research grants; 17 administrative or minority supplemen

7 pilot studies. 

> The CRN has participated in other funded work, includin

12 R01, U01, and P50 grants; 9 NCI, CDC, AHRQ, and

pharmaceutical company contract studies; and three trai

grants and career awards.

10 The HMO Cancer Resea
http://crn.cancer.gov 

Key (table column heads, pages 11–13)

GHC = Group Health Cooperative (Group

Health Center for Health Studies)

GHS = Geisinger Health System

(Geisinger Center for Health Research)

HPHC = Harvard Pilgrim Health Care

(Department of Ambulatory Care and

Prevention)

HPRF = HealthPartners (HealthPartners

Research Foundation) 

HFHS = Henry Ford Hospital and Health

System (Department of Research)

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 

(Center for Health Research-N

KPSC = Kaiser Permanente S

California (Department of Res

Evaluation)

LCF = Lovelace Health Syste

Clinic Foundation)

MCRF = Marshfield Clinic (Ma

Clinic Research Foundation)

MPCI = Fallon Community He

(Meyers Primary Care Institute

Year Established 1983 2003 1969 1989 1948 1987 1998 1991 1961 1964 1975 1990 19

2007 Funding, Millions 28.1 3.8 24 10.2 66.9 14.7 1.6 4.0 62.7 30 19 2.3 

% Extramural 89 90 80 75 85 63 75 90 93 90 63 100 

# Full-time M.D./Ph.D. 29 14 45 13 81 15 3 2.5 52 54 14 6 

-level staff

# Programmers 25 2 12 10 24 17 3.5 2 76 24 22 3 

Total Staff 269 118 130 78 500 106 12 31 467 250 90 31 1

Research Facilities

Survey Research •••••• ••• 

Clinical Center ••••• •••• 

Chart Abstraction ••••••••••••
12 The HMO Cancer Resea

Preferred Provider 0 0 0 36 50000000

Clinic Sites 30 1,234 14 34 70 17 10 17 159 27 103 21 

Hospitals 2 84 21 84 10 2 3 1 19 1 11 4 

Total enrollment, 540 210 805 620 295 462 286 225 3,260 487 3,190 221 

x 1,0002

1-year retention 80 82 793 77 84 83 87 85 87 82 85 85 

3-year retention 63 54 55 57 68 66 67 72 75 66 71 N/A 

5-year retention 51 41 — 44 56 56 54 63 66 57 61 N/A 

Age, Years, %

<=24 30 27 33 36 30 30 32 32 32 31 34 34 

25-44 24 26 31 29 26 27 34 28 28 27 27 29 

45-64 33 30 29 27 31 29 27 28 28 30 27 26 

65-74 784478467777

>=75 6 9 3 4 6 6 3 5 6 5 5 5 

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

Race, %

White 82 96 75 85 67 75 63 25 51 84 38 55 

African American 3 <1 16 6 28 6 33 <1 8 3 8 1 

Asian American 6 0 5 5 2 2 <1 63 17 5 10 1 

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

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

Other 35 <1 0 0 2 1 4 17 5 1 <1 0 

1 = Includes affiliated hospitals

2 = Total enrollment, all sites combined: 10,966,000 members

3 = 1-year retention is for Dec 2002 cohort

4 = Retention among cancer survivors only

5 = Includes persons reporting >1 race

NOTE: Information last updated in 2006
http://crn.cancer.gov 

summarizes data systems available

from each participating CRN site.

These data systems have been used

for research for decades for both

single and multi-site studies. The

create a more efficient and

standardized approach to data

aggregation. The CRN chose to

create a Virtual Data Warehouse

(VDW), consisting of databases

systems has made develop

VDW the CRN’s most for

challenge.

Key

P = Partial T = Text with search capability N/A = Information not available in a single comprehensive datafile 

GHC GHS HPHC HPRF HFHS KPCO KPG KPH KPNC KPNW KPSC LCF MC

Automated Medical 2005 1995 1969 2004 1988 1997 2006 2004 2005P 1997 2004 N/A 19

Record

Administrative Data 

Membership 1988 1999 1969 1990 1980 1992 1995 1958 1976 1982 1988 1996 19

Outside Claims 1979 1999 1990 1990 1991 1993 1995 1995 1992 1986 1991 1996 19

Patient Scheduling 1984 1997 N/A 1990 1988 1992 1995 1992 1987 1985 1993 N/A 19

Deaths 1972 N/A 1983 N/A 1990 1988 1995 1985 1970 1979 1988 N/A 199

Cost 1998 1999 1990 1990 1990 1997 1995 1995 1996 1998 1996 1999P 198

Automated Clinical Data

Outpatient Visits 1992 1996 1969P 1990 1988 1992 1995 1995 1995 1987 1993 1996 19

Hospitalizations 1979 1993 1990P 1990 1989 1991 1995 1988 1976 1965 1981 1996 19

Emergency Room 1992 1993 1990P 1990 1988 1994 1995 1988 1995 1985 1993 1996 19

Pharmacy 1977 1985 1988P 1990 1992 1993 1995 1992 1994 1986 1992 1996 19

Laboratory 1988 1995 1969P 1994 1995 1994 1995 1988 1994 1993 1991 2000P 19

Long-term Care 1992 N/A 1990P 1990 1995 1994 1995 1995 N/A 1986 1995 N/A N

Home Health Care 1992 N/A 1990P 1990 1995 1994 1995 1995 2002 1987 1995 N/A N

Radiology 1986 1994P 1969P, T 1990T 1988P 1992 1995 1991 1997 1989 1994 N/A 19

Pathology 1996 1987P 1969P, T 1990T 1988P 1994 1995 1995 1998 1970 N/A N/A 19

Cancer Registry 1974 1980 1997 N/A 1972 1987 2004 1973 1973 1960 1988 1999 19

Year of Availability for Key Data Resources
14 The HMO Cancer Resea

Emerging Partnerships with caBIGTM

The CRN is coordinating its informatics with NCI’s cancer Biomed

Informatics Grid (caBIGTM) to facilitate collaboration. One project i

identifying strategies for increasing enrollment in NCI clinical trials 

linking the CRN to the Cancer Text Information Extraction System

(caTIES), an open-source natural language processing system av

from the caBIG Web site. caTIES facilitates extraction, coding, an

querying attributes referenced in free-text pathology reports. A sta

caBIG-compliant version of caTIES is planned for the CRN’s VDW

aim of the caBIG collaboration is to use caBIG tools to improve th

VDW’s compatibility and interoperability with national standards. W

reasonable and feasible, the CRN will contribute candidate data e

for consideration in the caBIG Data Standards Repository.

The CRN also is an active contributor to the caBIG Population Sc

Special Interest Group and the cross-cutting Data Sharing and In

Capital Workspace. Both groups are working on strategies to fac

multi-site collaboration, data collection, and stewardship—topics 

well-aligned with the CRN’s extensive experience.

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

individuals and also data related to

quality or delivery of care and

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

counters, electronic me

and natural language pr

The CRN also operates 

NIH Certificate of Con

well as statutory provis

Agency for Healthcare 

Quality that further shie

research information co

patient or provider iden

from third party discove
http://crn.cancer.gov 

warehouse, a federated database that

is comprised of standardized

datasets stored behind separate

security firewalls at each

participating CRN site. The data

sets include variables with identical

names, formats, and specifications

(including definitions, labels, and

coding). 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—

facilitating storage, retrieval,

processing, and managing VDW

datasets; a set of access policies and

procedures governing use of VDW

resources; and documentation of all

elements of the VDW. 

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 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) and

Natural Language

Processing (NLP)

More CRN sites use EpicCare®

than any other EMR system. EMRs

allow researchers to manipulate and

standardize free-text clinical data

such as clinical assessment findings,

image interpretations, pathology

evaluations, hospital discharge

summaries, and consultant

evaluations. In addition to the

standard physician user-interface,

many of the EMRs also have a

patient interface, where patients can

view items in their medical record

enter information into a he

assessment survey or othe

instrument. This provides 

with opportunities for inno

interventions. Natural lang

processing (NLP) helps in

to identify the variety of s

clauses, words, symbols, a

abbreviations that represen

synonyms for a concept of 

interest. CRN informaticis

developed an NLP tool ca

MediClass® to collect sta

information about tobacco 

counseling in “Using Elec

Medical Records to Measu

Improve Adherence to Tob

Treatment Guidelines in P

Care.”
agreement grant, there is also active collaboration

between the CRN Principal Investigator’s Office and NCI

program staff. The CRN’s administrative structure includes

four cores, a Clinical Applications and Translation

Program, and research projects. 

The four cores include an Administrative Core, an

Evaluation Core, a Scientific and Data Resources Core,

and an Investigator Development Core. 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

> Pharmacovigilance

> Others

CRN SCIENTIFIC INTEREST 

GROUPS (SIGs)

16 The HMO Cancer Resea
http://crn.cancer.gov 

Cores

> Administrative Committees

> Evaluation 

> Investigator Development

> Scientific & Data Resources

Clinical

Applications &

Translation

Program

> Clinical Trials 

> Diffusion of Innovations 

Research Proje

> CRN Projects

>> Pilot Projects

> Affiliated Projects 

> Supplements

> Other Funded Work

COMMITTEE 

& 

STEERING

COMMITTEE

Principal

Investigator’s 

Office

NCI Pro

Staf

Academic

Liaison

Committee
18 The HMO Cancer Resea

Meyers Primary Care Institute,

Fallon Community Health Plan

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

Marshfield Clinic Research

Foundation, Marshfield Clinic

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; and clinical epidemiology of

cardiovascular disease, particularly

arrhythmias and conduction disorders

Geisinger Center for H

Research, Geisinger H

System

Robert D. Langer, M.D., 

Director, Outcomes Resea

Geisinger Center for Health 

Adjunct Professor of Epide

University of Pittsburgh Gra

of Public Health 

Research Interests: preven

diseases, with a focus on t

age, gender, and culture/et

affect the development and 

these conditions

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

CRN Principal Investigator

Senior Investigator, Group Health Center

for Health Studies

Director, MacColl Institute

Research Interests: studies of

interventions to reduce disability in

seniors and to enhance the care of

persons with chronic illness

Lawrence H. Kushi, Sc.D.

CRN Co-Principal Investigator

Associate Director for Etiology and

Prevention Research

Research Interests: role of diet and

nutrition in the etiology of coronary artery

disease and breast and other cancers

Mark C. Hornbrook, Ph.

CRN Co-Principal Investiga

Senior Investigator and Ch

Kaiser Permanente Northw

Health Research

Research Interests: health 

utilization analysis, econom

methods, patient classifica

health status measuremen

modeling, and health-base

systems
http://crn.cancer.gov 

information technology to improve

practice

Center for Health ResearchSoutheast, Kaiser Permanente

Georgia

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, and quality of chronic

disease care

Department of Ambulatory Care

and Prevention, Harvard Pilgrim

Health Care 

Suzanne W. Fletcher, M.D., M.Sc. 

Professor Emerita of Ambulatory Care

and Prevention, Harvard Medical School

and Harvard Pilgrim Health Care

Research Interests: prevention, especially

related to breast cancer screening, DCIS,

and quality of life issues

Department of Research, Henry

Ford Hospital and Health System

Christine Cole Johnson, M.P.H., Ph.D.

Senior Staff Scientist

Associate Chair for Research,

Department of Biostatistics and Research

Epidemiology 

Director, HFHS Josephine Ford Cancer

Center’s Epidemiology, Prevention, and

Control Program 

Director, HFHS Center for Allergy,

Asthma, and Immunology Research

Research Interests: cancer prevention

and the etiologies of allergy and asthma

Institute for Health Research,

Kaiser Permanente Colorado

Debra P. Ritzwoller, Ph.D.

Investigator, Health Care Economist,

Institute for Health Research, Kaiser

Permanente Colorado

Research Interests: costs and costeffectiveness of behavioral interventions,

the uninsured, disease management

interventions, vaccine effectiveness,

public health surveillance systems,

physician compensation, comorbidities,

cost estimation, and cost-effectiveness 

Rachel Novotny, M.S., Ph.D

Senior Investigator, Science D

Center for Health Research-H

Assistant Program Director fo

Bionutrition, The Center for He

Research

Research Interests: the impac

physical activity, and body siz

and disease; and how periods 

growth affect overall health

Department of Research 

Evaluation, Kaiser Perm

Southern California

Virginia P. Quinn, Ph.D.

Research Scientist

Department of Research and 

Kaiser Permanente Southern 

Research Interests: lifestyle an

behavior change, prevention, 

and adherence, adolescents a

depression, and quality of can

care
20 The HMO Cancer Resea

Site Principal Investigator and CRN

Principal Investigator

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

Senior Investigator, Group Health Center

for Health Studies

Director, MacColl Institute

wagner.e@ghc.org

Site Principal Investigator a

Co-Principal Investigator

Mark C. Hornbrook, Ph.

Senior Investigator and Ch

Kaiser Permanente Northw

Health Research

mark.c.hornbrook@kpchr.o

pg

Lawrence H. Kushi, Sc.D.

Associate Director for Etiology and

Prevention Research

Division of Research, Kaiser Permanente

Northern California

Adjunct Professor of Nutrition, 

Teachers College, Columbia University,

New York, NY

larry.kushi@kp.org

National Cancer Institute

Program Director

Martin L. Brown, Ph.D.

Chief, Health Services and Economics Branch

Applied Research Program

Division of Cancer Control and Population

Sciences

National Cancer Institute

mbrown@mail.nih.gov
http://crn.cancer.gov 

Terry S. Field, D.Sc.

Associate Director, Meyers Primary 

Care Institute

Associate Professor of Medicine,

University of Massachusetts Medical

School

tfield@meyersprimary.org

Marshfield Clinic Research

Foundation, Marshfield Clinic

Site Principal Investigator 

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

Marshfield Epidemiologic Study Area

Lead Scientist, Marshfield Clinic Research

Foundation

greenlee.robert@mcrf.mfldclin.edu

Lovelace Clinic Foundation,

Lovelace Health System

Site Principal Investigator

Margaret J. Gunter, Ph.D.

President and Executive Director,

Lovelace Clinic Foundation

maggie@lcfresearch.org

Geisinger Center for Health

Research, Geisinger Health

System

Site Principal Investigator

Robert D. Langer, M.D., M.P.H.

Director, Outcomes Research Institute,

Geisinger Center for Health Research

Adjunct Professor of Epidemiology,

University of Pittsburgh Graduate School

of Public Health 

rdlanger@geisinger.edu

Site Principal Investigator

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

douglas.roblin@kp.org

Department of Ambulatory Care

and Prevention, Harvard Pilgrim

Health Care 

Site Principal Investigator 

Suzanne W. Fletcher, M.D., M.Sc. 

Professor Emerita of Ambulatory Care

and Prevention 

Harvard Medical School and Harvard

Pilgrim Health Care

suzanne_fletcher@hms.harvard.edu

Department of Research, Henry

Ford Hospital and Health System

Site Principal Investigator 

Christine Cole Johnson, M.P.H., Ph.D.

Senior Staff Scientist

Associate Chair for Research,

Department of Biostatistics and Research

Epidemiology 

Director, HFHS Josephine Ford Cancer

Center’s Epidemiology, Prevention, and

Control Program 

Director, HFHS Center for Allergy,

Asthma, and Immunology Research

cjohnso1@hfhs.org

Debra P. Ritzwoller, Ph.D.

Investigator, Health Care Econ

Institute for Health Research, 

Permanente Colorado

debra.ritzwoller@kp.org

Center for Health Resea

Hawaii, Kaiser Permane

Hawaii

Site Principal Investigator

Rachel Novotny, M.S., Ph.D

Senior Investigator, Science D

Center for Health Research-H

Assistant Program Director fo

Bionutrition, The Center for He

Research

rachel.novotny@kp.org

Department of Research 

Evaluation, Kaiser Perm

Southern California

Site Principal Investigator

Virginia P. Quinn, Ph.D.

Research Scientist

Department of Research and 

Kaiser Permanente Southern 

virginia.p.quinn@kp.org

HealthPartners Researc

Foundation, HealthPartn

Site Principal Investigator

Cheri J. Rolnick, Ph.D., M.P

Associate Director of Researc

HealthPartners Research Fou

HealthPartners

cheri.j.rolnick@healthpartners.
22 The HMO Cancer Resea

Program Testing Early Cancer Treatment & Screening (PROTECTS) NCI CRN1 Project 1

HMOs Investigating Tobacco (HIT) NCI CRN1 Project 1

Detecting Early Tumors Enables Cancer Therapy (DETECT) NCI CRN1 Project 1

Evaluation of End-of-Life Care for Prostate Cancer in the CDC Task Order 2

Managed Care Environment

Pilot Study to Identify Organizational Barriers to HMO Participation NCI Administrative Supplement 2

in Clinical Trials

Design, Implementation & Analysis of a Clinician Survey (DETECT supplement) NCI Administrative Supplement 2

Lung/Colon Cancer Outcomes: The Cancer Research Network (CanCORS) NCI Cooperative Agreement 2

Patient-oriented Outcomes of Prophylactic Mastectomy NCI R01 Grant 2

Colon Cancer Survivors—Medications and Risk of Recurrence NCI R01 Grant 2

Investigating Medical Patient Records & Administrative Data NCI R01 Grant 2

in Case Identification and Treatment (IMPACT)

A Pilot Study of Disenrollment among HMO Patients with Cancer NCI Administrative Supplement 2

Enrolling Vietnamese and Chinese Women in Breast Cancer Treatment NCI Administrative Supplement 2

and Prevention Trials

The Impact of Endocrine Therapy on Survival in Men with Local or Regional NCI Administrative Supplement 2

Prostate Cancer—Feasibility Study

HRT Initiation & Cessation After WHI Results (HRT Diffusion) NCI Administrative Supplement 2

Evaluation of Hospice Referral and Palliative Care for Ovarian Cancer in CDC Task Order 2

the Managed Care Environment

Medication Use and Risk of Esophageal Adenocarcinoma NCI Contract 2

& Barrett’s Esophagus

Breast Cancer Treatment Effectiveness in Older Women (BOW) NCI R01 Grant 2

Clinical & Pathologic Predictors of Ductal Carcinoma in Situ NCI CRN2 Project 2

Making Effective Nutritional Choices (MENU) NCI CRN2 Project 2

Using Electronic Medical Records (EMRs) to Improve Adherence to NCI CRN2 Project 2

Tobacco Control Guidelines (HIT 2)

Michigan Center for Health Communications Research (three projects) NCI P50 Grant 2

Optimizing Breast Cancer Outcomes: BMI, Tumor Markers, and Training Grant 2

Quality of Care

Research Supplement for Underrepresented Minorities Program: NCI Administrative Supplement 2

Patterns of Preventive Services Utilization of Cancer Survivors

HIT 2 Supplement NCI Administrative Supplement 2

Infrastructure: HMO Cancer Research Network NCI CRN Infrastructure 2

Medications and Colorectal Cancer Risk AHRQ R03 2
http://crn.cancer.gov 

Outcomes Of Genetic Counseling for Heritable Breast/Ovarian Cancer: NCI Administrative Supplement 200

Feasibility of Identifying Cohort Through EMR

Development of a Method to Assess Obesity and Treatment via EMR NCI Administrative Supplement 200

Diffusion of Breast MRI Technology in Community Clinical Settings NCI Administrative Supplement 200

Virtual Data Warehouse (VDW) Enhancement NCI Administrative Supplement 200

4CQuality: Quality of Patient-centered Cancer Care, Communication, and NCI Contract 200

Coordination

Use of an Interactive Voice Response System, with Physician Feedback, to NCI CRN Pilot Funds 200

Reduce Cancer Symptoms: A Pilot Study

Informing an R01 Application: Interviewing Long-term Colorectal NCI CRN Pilot Funds 200

Cancer Survivors

New Markers: Clinical & Pathologic Predictors of Ductal Carcinoma in Situ NCI Administrative Supplement 200

Systems Failures Contributing to Chemotherapy Error: A Project of the AHRQ Contract 200

HMORN Center of Education in Research & Therapeutics

Descriptive Epidemiology and Clinical Course of Meyelodysplastic Syndromes AMGEN Contract 200

(MDS) in an HMO

caBIG Population Sciences Special Interest Group NCI caBIG Participant Contract 200

Is Stroke a Late Effect of Chemotherapy? NCI R01 Grant 200

Ovarian Cancer Treatment Diffusion Study NCI Administrative Supplement 200

Multiplex Genetic Susceptibility Testing—An Interdisciplinary Collaboration NHGRI Administrative Supplement 200

to CRN

Residential Segregation, Housing Status, and Prostate Cancer in Training Grant 200

African American and White Men

DEcIDE Distributed-data Network: Comparative Effectiveness and Safety of AHRQ Contract 200

Second-line Anti-hypertensive Agents

Impact of HIPAA Privacy Rule on Health Research IOM Contract 200

Economic Burden Pilot Study NCI CRN3 Project 200

Health Literacy and Cancer Prevention: Do People Understand NCI CRN3 Project 200

What They Hear?

Cancer Prevention Index Pilot Study NCI CRN3 Project 200

Medical Care Burden of Cancer: System and Data Issues NCI R01 Grant 200

Increasing Patient Participation in Clinical Trials NCI R01 Grant 200

Colorectal Cancer Disparities NIH Career Development Award 200

Infrastructure: Cancer Research Network Across Health Care Systems NCI CRN Infrastructure 200

High Deductible Health Plans & Receipt of Cancer Prevention Services ACS Research Scholar Grant 200

Intestinal Ostomies and Informal Caregiving for Colorectal Cancer Survivors NCI R21 Grant 200
24 The HMO Cancer Resea

Care: HMOs Investigating

Tobacco (HIT) 

This CRN 1 study (Dr. Victor J.

Stevens, KPNW, Principal

Investigator) examined tobacco

policies and delivery of cessation

services in nine non-profit HMOs

that collectively provide

comprehensive medical care to more

than eight million members. Three

annual surveys with health plan

managers showed that all of these

organizations had written tobacco

control guidelines that became more

comprehensive over the span of the

study. The project also surveyed a

random sample of 4,207 current

smokers who had attended a

primary care visit in the past year

(399 to 528 at each of nine health

plans). Of these smokers, 71 percent

reported receiving advice to quit, 56

percent were asked about their

willingness to quit, 49 percent were

provided some assistance in quitting

(mostly self-help material or

information about classes or

counseling), and 9 percent were

offered some kind of follow-up.

Smokers receiving assistance in

quitting reported higher satisfaction

with their care. In general, health

plans with the most comprehensive

policies also showed higher rates of

implementing tobacco treatment

programs in primary care. 

Late-stage Breast Cancer:

Detecting Early Tumors Eases

Cancer Therapy (DETECT)

This eight-site CRN 1 project (Dr.

Stephen Taplin, formerly GHC,

Principal Investigator) identified

1,347 women with late-stage breast

cancer and 833 with invasive

cervical cancer. The project

estimated the proportion of each

group attributable to potential

problems in care delivery, absence

of screening and detection, and

deficiencies in follow-up. The

project team created a model for

considering quality issues in cancer

care. They also profiled the

screening practices, policies, and

operational procedures in the eight

HMOs and surveyed clinician

attitudes about screening policies

and practices. For both breast and

cervical cancer, the absence of

screening accounted for most of the

late-stage cancers. The team also

identified the characteristics of

women among this insured

population who were not screened

or refused follow-up treatment.

Older women were over-represented

in both groups, and those refusing

treatment tended to have more

advanced cancer. Another analysis

sought—and did not find—missed

clinical opportunities for detection

in women with advanced disease

whose mammograms were normal.

A methodologic comparison of

patient self-report data with medical

congruence for receivin

The team also publishe

methods to optimize im

of physician surveys.

Effectiveness of Early 

and Prophylactic Mas

Women at Increased R

Breast Cancer: Progra

Early Cancer Treatme

Screening (PROTECTS

Project PROTECTS, a C

project (Dr. Suzanne Fl

HPHC, Principal Invest

evaluated the efficacy o

prophylactic mastectom

among women at high r

developing breast cance

contralateral prophylact

mastectomy (CPM) am

with unilateral cancer, i

subsequent breast cance

and mortality. The 269 

underwent BPM had a 

reduction in breast canc

approximately 2/3 expe

significant adverse effe

retrospective cohort stu

conducted in six CRN s

identified 53,200 wome

years at diagnosis who 

unilateral breast cancer 

1979–1999. Of these, 1

had CPM. Compared w

of 349 women without 

women reduced their ri

contralateral breast can

90 percent. After adjust

breast cancer characteri
http://crn.cancer.gov 

treatment, the hazard ratios for the

relationship of CPM to death from

breast cancer, other causes, and all

causes were 0.57, 0.78, and 0.60,

respectively. The project also

evaluated the efficacy of

mammography and clinical breast

exam in real-world settings. Among

their methodologic contributions,

this project team developed a

computerized approach to medical

record abstraction, which has been

used in other CRN projects, and

also examined the impact of

multiple Institutional Review Board

(IRB) reviews on the

implementation of the study.

Patient-oriented Outcomes of

Prophylactic Mastectomy

The Patient-oriented Outcomes of

Prophylactic Mastectomy study led

by Dr. Ann Geiger, formerly at

KPSC and now at Wake Forest

University, was funded as an R01 in

January 2002. Using the extant

prophylactic mastectomy efficacy

study cohort of nearly 800 women

at six CRN sites (GHC, HPHC,

HPRF, KPNC, KPNW, and KPSC),

the study gathered both quantitative

and qualitative data from women

who had undergone either

contralateral prophylactic

mastectomy (CPM) or bilateral

prophylactic mastectomy (BPM),

along with a comparison group of a

random sample of women with

breast cancer who had not

undergone the procedure. A mailed

survey ascertained: willingness to

recommend prophylactic

mastectomy; decision satisfaction;

breast cancer risk-related stress;

body image; and sexual activity. 

The majority of women undergoing

prophylactic mastectomy were

satisfied with their decision and

reported contentment with their

quality of life that was comparable

to similarly at-risk women who had

not had prophylactic mastectomy.

Investigators also examined

decision-making roles and what

women wished they had known

prior to the procedure. The study

contributed methods papers on the

validity of race prior to ethnicity

data in medical records, and the

impact of multiple IRB reviews on

study operations and response rates.

Collectively, these data provide a

rich picture of women’s medical and

emotional needs as they undertake

this profound decision. 

Pilot Study of Organizati

Barriers to Cancer Clinic

Participation by HMOs

This study, led by Dr. Car

(KPNC), used surveys and 

structured interviews to in

attitudinal and organizatio

barriers to clinical trial pa

A self-administered survey 

oncologists at 10 CRN site

fielded in 2001; 198 comp

questionnaires were receiv

response rate of 90 percen

team also conducted key i

interviews with health pla

oncology leaders at nine C

to explore extant strategie

barriers to plan member

participation in cancer tria

The survey results reveale

considerable enthusiasm f

trials, but also a critical ne

infrastructure to support tr

especially additional supp

and research nurses. In ad

need was expressed for be

organizational communica

consideration of the impac

design on internal health p

resources. This work led t

NCI R01 grant award for 

Somkin’s team to evaluate 

high-quality data for observational research and can fill critical gaps in our

knowledge, especially in situations where large-scale clinical trials are not lik

be mounted.

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

Getting the Answers? J Clin Oncol 2007; 25(21):2991-2.
26 The HMO Cancer Resea

The pilot study was conducted

through an administrative

supplement to assess turnover

among HMO enrollees with cancer

diagnoses—and how it may affect

longitudinal cancer research. The

Principal Investigator, Dr. Terry

Field (MPCI), and colleagues

studied the retention rates among

survivors of the 132,580 patients

diagnosed with cancer from January

1, 1993 through December 31, 1998

who were enrolled at five CRN

enrollees diagnosed with cancer

who remained enrolled and

available for evaluation suggests

that the CRN is well-suited for

studies of the quality of care for

cancer patients, survivorship, and

long-term outcomes. This study led

to the CRN Cancer Outcomes

Cohort 1993–1998 Study that has

published two manuscripts, both

focused on racial disparities in

cancer care and survival. 

(n=2,540), and the online

intervention was shown to be

effective. All three intervention arms

showed early and sustained increase

of more than two servings of F&V,

on average. The untailored Web

program arm was less effective than

either the tailored arm or tailored

plus email support arm. Across

arms, those participating online at a

higher rate had more gain in F&V

servings, the retention rate was high

(>80% at 12 months) and reported

satisfaction with the online program

was high. Further analyses will

explore the effect of participants’

demographic characteristics, family

history of cancer, and stage of

change on dietary behaviors at 3, 6,

and 12 months.

Clinical and Pathologi

for Recurrence after D

Carcinoma in situ

In this CRN 2 core proj

Dr. Laurel Habel (KPN

investigators at three CR

(KPSC, HPHC, and KP

studying clinical and pa

factors that could be us

accurately identify DCI

high and low risk of a r

From medical records, 

have identified DCIS pa

(n=3,700) diagnosed be

and 2001, treated with b

conserving surgery (BC

followed for recurrence

Standardized reviews o

slides from the initial tu

cases and controls have 

completed by collabora

CRN 2 Scientific Accomplishments

Making Effective Nutritional

Choices for Cancer Prevention

(MENU) 

This CRN 2 core study, led by Dr.

Christine Cole Johnson (HFHS),

developed and evaluated an

individually tailored, Web-based

program to promote daily fruit and

vegetable (F&V) consumption.

Focus groups and a preliminary

enrollment/retention study tested the

feasibility of a Web-based dietary

intervention program. The efficacy

of the intervention was tested in a

multi-site, randomized trial

involving five CRN HMOs. The

three strategies tested in the trial

were: untailored Web program,

tailored Web program, and tailored

Web program plus email support. A

diverse sample of adults enrolled

y g 

using administrative da

information was collect

surgery, adjuvant treatm

term surveillance, and r

and mortality outcomes

compared the effectiven

different treatment and 

patterns, and identified 

characteristics of provid

and patients associated 

treatment choices. Find

that increasing age is as

with lower probability o

recommended therapy, 

worse survival. 
http://crn.cancer.gov 

of recurrence after BCS for DCIS

have been declining as treatment

with adjuvant radiotherapy and

tamoxifen have increased; use of

adjuvant treatment does not appear

to differ markedly across

racial/ethnic groups; and

surveillance mammography after

BCS for DCIS declines over time

and becomes inadequate. This is the

largest and most comprehensive

study to date on prognostic factors

for DCIS, and will improve our

understanding of the natural history

of DCIS and help in the

development of individually tailored

treatment strategies for patients with

DCIS. This study also serves as a

model of a CRN project that

leverages the unique electronic and

biologic data available in the CRN

health plans.

Using Electronic Medical Records

to Measure and Improve

Adherence to Tobacco Treatment

Guidelines in Primary Care (HIT2)

Electronic medical records (EMRs)

offer an attractive method for

evaluating guideline implementation

and improving quality of care for

entire patient populations. This

CRN 2 study (HIT2), led by Dr.

Victor Stevens of Kaiser

Permanente Northwest, developed a

method for coding tobaccocessation activities (the “Five A’s”)

in four HMOs using EMRs. In

MediClass in assessing whether

clinicians adhered to the national

tobacco treatment guidelines (the

“Five A’s”) with patients. Specially

trained medical records abstractors

at each of the four participating

HMOs manually coded 500 records

according to whether or not each of

the five guidelines for smoking

cessation care were addressed

during routine outpatient visits. For

each patient’s record, they compared

the presence or absence of each of

the guidelines as assessed by each

human coder and by MediClass.

MediClass performed as well as the

human abstractors and was found to

be a practical method for assessing

adherence to the tobacco treatment

guidelines in primary care. 

Multicenter Study of Pancreatic

Cancer Etiology 

The Pancreatic Cancer Investigation:

Finding Causes (PACIFIC) study is

a large case-control study with

recruitment based in two CRN

HMOs (GHC and KPNC) with

infrastructure to support ultra-rapid

case identification as patients move

through diagnostic evaluation. Led

by Drs. Margaret Mandelson and

John Potter of GHC and the Fred

Hutchinson Cancer Research Center

(FHCRC), and by Dr. Stephen Van

Den Eeden of Kaiser Permanente

Northern California, this study’s

methods allow researchers to enroll

patients who represent the full

controls, this is one of the 

and most comprehensive

epidemiologic studies of p

cancer undertaken to date. 

Is Stroke a Late Effect o

Chemotherapy? 

This R01 grant, led by Dr

Geiger of Wake Forest Un

seeks to explore the hypot

chemotherapy may increa

of stroke for years after co

The study team will estim

relative risks of stroke due 

chemotherapy among a gr

over 30,000 ethnically div

patients diagnosed from 1

2003 with bladder, female 

colorectal, Hodgkin’s lym

adult leukemia, multiple m

non-Hodgkin’s lymphoma

ovarian cancers, adjusting 

gender, race/ethnicity, ana

cancer site, stage at diagno

of diagnosis, receipt of rad

therapy, and dispensed me

for hypertension, diabetes

coagulants, and tamoxifen 

breast cancer only). 
28 The HMO Cancer Resea

CRN 3 priorities emphasize further development of the research infrastructu

increasing collaboration with external researchers, research institutions, and 

outside the CRN member organizations; increasing support for junior investig

expanding research on the dissemination and impact of new cancer prevent

treatment modalities; and investigating strategies for increasing enrollment in 

trials. In addition to comprehensive infrastructure enhancements, a significan

proportion of CRN 3 funds in each year have been set aside to support pilot 

The goal of the pilot program is to enable investigators in the CRN and colla

institutions to produce information that will enhance innovative grant proposa

Principal Investigator: 

Kathleen Mazor, Ed.D. (Meyers

Primary Care Institute)

Participating sites: Meyers

Primary Care Institute, Group

Health, Kaiser Permanente

Hawaii, Kaiser Permanente

Georgia

This study proposes to develop a

test to assess comprehension of oral

(i.e., spoken) messages about cancer

prevention and screening, to

examine the relationship between

health literacy and cancer

prevention, and to test whether

changing oral messages can improve

comprehension. Findings will lay

the foundation for future research

into the prevalence of inadequate

oral health literacy; identification of

groups and individuals 

inadequate comprehens

identification of risk fac

causes of limited comp

and development and ev

interventions to improv

comprehension of orall

messages. The study tea

both quantitative and qu

methods to identify the 

affect comprehensibility 

messages about cancer 

and screening. The proj

develop recommendatio

modifying oral message

they are easily compreh

will test the impact of s

enhancements in a rand

experiment.

Health Literacy and Cancer Prevention: Do Peo

Understand What They Hear?
http://crn.cancer.gov 

undercount the full economic

burden of cancer care in the U.S.,

because of incomplete coverage of

outpatient prescribed medications

for aged Medicare beneficiaries. A

byproduct of this research will be

the development of a reusable

infrastructure that will enhance the

CRN VDW for other uses, including

efforts focused on the dissemination

of pharmacotherapy among cancer

patients. This pilot study

complements the R01 project,

Medical Burden of Cancer: System

and Data Issues.

Mark Hornbrook, Ph.D. (Kaiser

Permanente Northwest)

Participating sites: Group Health,

Henry Ford Hospital and Health

System, Kaiser Permanente

Colorado, Kaiser Permanente

Northwest

This two-year infrastructure pilot

study will use data from four sites 

to estimate the cancer-related

pharmacy costs among aged

Medicare HMO beneficiaries who

were omitted from SEER-Medicare

data due to the exclusion of

outpatient medication use/cost. The

investigative team will test the

Cancer Prevention Index: Using Electronic Records to

Improve Cancer Prevention

preliminary analyses on th

primary prevention measu

their relation to outcomes. 

study will inform the deve

of an R01 that will assess 

measures in multiple healt

to relate practice-level var

the scores of morbidity, m

and cost outcomes. A

complementary CPI study 

incorporates preventive pr

relevant to cardiovascular 

was recently funded as pa

newly initiated Cardiovasc

Research Network, sponso

the National Heart, Lung, 

Blood Institute.

variations to selected event rates

several years later, to evaluate the

association of clinician adherence to

guidelines to 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. The

study will explore how variations

across practices in intervals between

testing and percent of eligible

persons tested relate to these

outcomes, and will conduct

Principal Investigator: Tom Vogt,

M.D., M.P.H. (Kaiser Permanente

Hawaii)

Participating sites: Kaiser

Permanente Hawaii, Kaiser

Permanente Northwest

This two-year pilot study 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 retrospectively

the variation in CPI scores across

clinics and clinical practices, and

determine the association of these
30 The HMO Cancer Resea

In December of 2006, the National Heart, Lung, and Blood Ins

issued an RFA for a Cardiovascular Research Network (CVRN

goal of increasing scientific knowledge of cardiovascular disea

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

and diagnosis, treatment, and prognosis, in the context of com

based health care delivery, the environment in which most clin

preventive care is delivered. The RFA further stated that the re

should be designed to take advantage of existing integrated d

systems, and use complementary resources for collaborative a

relevant to the goal.

A cooperative agreement grant totaling $7.5 million was award

HMO-based CVRN lead by Dr. Alan S. Go, of the Kaiser Perm

Division of Research in Oakland, California. In addition to the K

Permanente Division of Research in Oakland, research collabo

span most of the CRN sites as well as other external organiza

Initial CVRN research projects include:

• A study of hypertension recognition, treatment, and control 

• A study of quality of care and outcomes of the blood thinne

for atrial fibrillation and blood clots

• A study of the use, outcomes, and costs of implantable card

defibrillators for primary prevention of sudden death in heart 

Most collaborating research organizations in the HMO Researc

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

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

opportunities to coordinate research activities of mutual interes

complementary research infrastructure and expertise, and wor

create creative synergy between the two networks. 

developmental pilot fund program 

to be funded through April 2012. 

The program invites the submission

of proposals for pilot activities that

are consistent with the CRN’s

scientific priorities and leverage

unique features of the CRN. The

expectation is that the funds invested

in this activity lead to a fundable

proposal. Pilot activities involve at

least one CRN site and have the

potential to lead to research projects

that involve two or more CRN sites.

All investigators from within the 

14 CRN sites are eligible to submit

proposals. The CRN also welcomes

new collaborations, including

investigators who are not employed

by a CRN site. There is a call for new

pilot proposals each year. 
A research network should nurture and develop new talent. The 

is currently extending its informal mentoring to include the syste

development of junior investigators, through a newly established 

Investigator Development Core. This Core has two components

on-one mentoring of 28 CRN Scholars (two groups of 14) over 

years of the grant cycle, and group sessions, including biweekly

conference calls and in-person meetings at annual meetings of 

An ultimate aim is to lead those investigators to develop succes

applications and author papers published in peer-reviewed jour

faculty leaders of the new CRN program for junior investigators 

Suzanne and Robert Fletcher. Both are active in CRN, Suzanne 

Principal Investigator of HPHC and Project Leader of the CRN 

PROTECTS project, and Robert as Co-Principal Investigator of 

component of the Cancer Care Outcomes Research and Surve

Consortium (CanCORS) project. The Fletchers have extensive e

in research investigator development. Other senior CRN investig

participate in the program to expose participants to leaders in c

research beyond those at their home institutions, and to increas

breadth and depth of expertise available to them.

http://crn.cancer.gov 

oppotunities to test

systems interventions on

important cancer

outcomes and cancer

health disparities. I have

had the opportunity to

work and partner with

investigators at various

levels of experience,

develop mentoring

relationships with

renowned investigators,

and build collaborative

relationships. The

combination of data

resources, systems to

support the development

of new investigators, and

the academic partnerships

has made it possible for

me to train and grow as

an investigator. 

Chyke Doubeni, M.D., M.P.H.

University of Massachusetts

Medical School, Meyers Primary

Care Institute 
32 The HMO Cancer Resea

KJ, Geiger AM. Diffusion of aromatase inhibitors for breast

cancer therapy between 1996 and 2003 in the Cancer

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403.

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

Organizational barriers to physician participation in cancer

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Breast Cancer Treatment Effectiveness in Older

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in older breast cancer patients. J Am Coll Surg 2008;206:66-

75.

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Quinn VP, Lash TL, Prout MN, Yood MU, Frost F

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Epub 2007 Dec 1.

Buist DSM, Ichikawa L, Prout MN, Ulcickas Yood 

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breast cancer therapy and adjuvant therapy are 

with obesity in older women with access to healt

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Clin Oncol 2007;25(21): 3001-6. Epub 2007 Jun 

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preventive health examination? Arch Intern Med

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(CARE)

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

differences in colon examination surveillance following a

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2005;(35):96-101.

Colorectal Cancer Pilot Study

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Clinical and Pathologic Predictors of Ductal

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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

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Detecting Early Tumors Enables Cancer Therapy

(DETECT)

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

C, Geiger AM, Ulcickas Yood M. Breast and cervical cancer

screening: clinicians’ views on health plan guidelines and

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2005;(35):46-54.

tests or symptoms suggestive of breast cancer. J N

Inst Monogr 2005;(35):33-8.

Mouchawar J, Taplin S, Ichikawa L, Barlow WE, Ge

Weinmann S, Gilbert J, Manos MM , Ulcickas Yood 

stage breast cancer among women with recent neg

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2005;(35):39-46.

Puleo E, Zapka JG, Goins KV, Yood MU, Mouchaw

M, Somkin C, Taplin S. Recommendations for care 

follow-up of abnormal cancer screening tests: accu

patient report. Eval Health Prof 2005;28(3):310-27.

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

J, Bischoff K, Yood MU, Gilbert J, Taplin SH. Cervic

women with comprehensive health care access: att

factors in the screening process. J Natl Cancer Inst

2005;97(9):675-83.

Taplin SH, Ichikawa L, Yood MU, Manos MM, Geige

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

Beverly RK, Casso D, Westbrook EO, Bischoff K, Z

Barlow WE. Reason for late-stage breast cancer: ab

screening or detection, or breakdown in follow-up? 

Cancer Inst 2004;96(20):1518-27.

Zapka JG, Puleo E, Taplin SH, Goins KV, Ulcickas Y

Mouchawar J, Somkin C, Manos MM. Processes o

cervical and breast cancer screening and follow-up—

importance of communication. Prev Med 2004;39(1

Mouchawar J, Valentine Goins K, Somkin C, Puleo 

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

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2003;5(6):444-50.
34 The HMO Cancer Resea

cancer screening services in health maintenance organizations.

Am J Manag Care 2003;9(11):745-55.

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. Cancer Epidemiol Biomarkers Prev

2003;12(1):4-13.

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):169-84.

Disenrollment among Cancer Patients in HMOs

Field TS, Cernieux J, Buist D, Geiger A, Lamerato L, Hart G,

Bachman D, Krajenta R, Greene S, Hornbrook MC, Ansell G,

Herrinton L, Reed G. Retention of enrollees following a cancer

diagnosis within health maintenance organizations in the

Cancer Research Network. J Natl Cancer Inst 2004;96(2):148-

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Evaluation of Hospice Referral and Palliative Care

for Ovarian Cancer in the Managed Care

Environment

Herrinton L, Hornbrook MC, Coughlin S, et al. Complications at

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

2007;34(3):237-43. Epub 2007 Jul 2.

Rolnick SJ, Jackson J, Nelson WW, Butani A, Herrinton LJ,

Hornbrook M, Neslund-Dudas C, Bachman DJ, Coughlin SS.

Pain management in the last six months of life among women

who died of ovarian cancer. J Pain Symptom Manage

2007;33(1):24-31.

Lambing A, Markey CA, Neslund-Dudas CM, Bricker LJ.

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

among seriously ill patients. Oncol Nurs Forum 2006;33(5):999-

1006.

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Genetics Scientific Interest Group

Mouchawar J, Laurion S, Ritzwoller DP, Ellis J, K

A, Hensley-Alford S. Assessing controversial dire

consumer advertising for hereditary breast cance

reactions from women and their physicians in a m

organization. Am J Manag Care 2005;11(10):601

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

Rahm A, Finucane ML, Meenan R, Axell L, Pollac

D. Impact of direct-to-consumer advertising for h

breast cancer testing on genetic services at a m

organization: a naturally-occurring experiment. G

2005;7(3):191-7.

HIT1 and HIT2

Hazlehurst B, Sittig DF, Stevens VJ, Smith KS, H

TM, Winickoff JP, Glasgow R, Palen TE, Rigotti N

language processing in the electronic medical re

assessing clinician adherence to tobacco treatm

Am J Prev Med 2005;29(5):434-9.

Hazlehurst B, Frost HR, Sittig DF, Stevens VJ. M

system for detecting and classifying encounter-b

events in any electronic medical record. J Am M

Assoc 2005;12(5):517-29.

Quinn VP, Stevens VJ, Hollis JF, Rigotti NA, Solb

N, Ritzwoller D, Smith KS, Hu W, Zapka J. Tobac

services and patient satisfaction in nine nonprofit 

Prev Med 2005;29(2):77-84.

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

KS, Zapka JG, France E, Vogt T, Gordon N, Fish

RG. Relationship between tobacco control polici

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Solberg LI, Quinn VP, Stevens VJ, Vogt TM, Rigotti NA, Zapka

JG, Ritzwoller DP, Smith KS. Tobacco control efforts in

managed care: what do the doctors think? Am J Manag Care

2004;10(3):193-8.

Quinn VP, Stevens VJ, Smith KS, Ritzwoller D, on behalf of the

HIT study investigators. Documentation of tobacco services in

the medical record: Promoting treatment and quality of care.

(Abstract). Am J Manag Care 2004;10:652.

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

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Winickoff JP, Glauber JH, Perrin JM, Boch B, Rigotti NA. The

process of improving tobacco dependence medication use in a

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approach. J Clin Outcomes Management 2003;10:535-539.

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

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Monroe M. Tobacco-control policies in 11 leading managed

care organizations: progress and challenges. Eff Clin Pract

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HRT Initiation and Cessation Following the

Women’s Health Initiative

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Connelly MT, Chan KA. Hormone therapy initiation after the

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Investigating Medical Patient Records and

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Treatment (IMPACT)

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Infrastructure

Greene SM and Geiger AM. A review finds that mul

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36 The HMO Cancer Resea

Wells K, Krajenta R, Lamerato L, Neslund Dudas C. Building a

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

research in integrated healthcare systems: the HMO Research

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Lung/Colon Cancer Outcomes: The Cancer

Research Network (CanCORS) 

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

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2006;14(8):837-48.

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

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

Potosky AL, Provenzale DT, Sandler RS, van Ryn M, Wallace

RB, Weeks JC, West DW. Understanding cancer treatment and

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Making Effective Nutritional Choices (MENU)

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MA, Fortman KK, Tolsma DD, Strecher VJ, Johnson CC. Effect

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of anti-inflammatory drugs and lower esophagea

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2007 Jul 23.

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Research (CHCR)

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

Strecher V. Interest in an online smoking cessatio

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

Northern California CanCORS 

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Variations in hospice use among cancer patients

Inst 2006;98(15):1053-9.

Patient-oriented Outcomes of Prophyla

Mastectomy (PM Outcomes)

Altschuler A, Nekhlyudov L, Rolnick SJ, Greene S

JG, West C, Herrinton LJ, Harris EL, Fletcher SW

KM, Geiger AM. Positive, negative and disparate

differing long-term psychosocial experiences of b

contralateral prophylactic mastectomy. The Brea

2008;14(1):25-32.
http://crn.cancer.gov 

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

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

Fletcher SW, Emmons KM. Quality of life after bilateral

prophylactic mastectomy. Ann Surg Oncol 2007;14(2):686-94.

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

Altschuler A, Rolnick SJ, Harris EL, Greene SM, Elmore JG,

Emmons KM, Fletcher SW. Contentment with quality of life

among breast cancer survivors with and without contralateral

prophylactic mastectomy. J Clin Oncol 2006;24(9):1350-6.

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):275-8.

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 Cancer Inst

Monogr 2005;(35):72-4.

Nekhlyudov L, Bower M, Herrinton LJ, Altschuler A, Greene

SM, Rolnick S, Elmore JG, Harris EL, Liu A, Emmons KM,

Fletcher SW, Geiger AM. Women’s decision-making roles

regarding contralateral prophylactic mastectomy. J Natl Cancer

Inst Monogr 2005;(35):55-60.

Program Testing Early Cancer Treatment and

Screening (PROTECTS)

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):332-7.

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

Cancer Inst 2005;97(14):1035-43.

with unilateral breast cancer: a cancer research netw

project. J Clin Oncol 2005;23(19):4275-86.

Geiger AM, Yu O, Herrinton LJ, Barlow WE, Harris E

S, Barton MB, Elmore JG, Fletcher SW. A populatio

study of bilateral prophylactic mastectomy efficacy 

elevated risk for breast cancer in community practic

Intern Med 2005;165(5):516-20.

Fenton JJ, Barton MB, Geiger AM, Herrinton LJ, Ro

Harris EL, Barlow WE, Reisch LM, Fletcher SW, Elm

Screening clinical breast examination: how often do

lethal breast cancer? J Natl Cancer Inst Monogr 20

71.

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

Herrinton LJ, Greene SM, Nekhlyudov L, Fletcher S

AM. Complications following bilateral prophylactic m

J Natl Cancer Inst Monogr 2005;(35):61-6.

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

KJ, Husson G, Harris EL, Geiger AM, Elmore JG, F

Comparing breast cancer case identification using H

computerized diagnostic data and SEER data. Am J 

Care 2004;10(4):257-62.

Geiger AM, Greene SM, Pardee RE 3rd, Hart G, He

Macedo AM, Rolnick S, Harris EL, Barton MB, Elmo

Fletcher SW. A computerized system to facilitate m

record abstraction in cancer research (United States

Causes Control 2003;14(5):469-76.

Reisch LM, Fosse JS, Beverly K, Yu O, Barlow WE, 

Rolnick S, Barton MB, Geiger AM, Herrinton LJ, Gr

Fletcher SW, Elmore JG. Training, quality assurance

assessment of medical record abstraction in a mult

Am J Epidemiol 2003;157(6):546-51.

Fletcher SW and Elmore JG. False-positive mammo

can the USA learn from Europe? Lancet 2005;365(9
38 The HMO Cancer Resea

improving breast cancer detection and diagnosis. A breast

cancer research foundation and institute of medicine

symposium. Washington, D.C.: The National Academies Press

2005:43-50.

Fletcher SW and Elmore JG. Clinical practice. Mammographic

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

80.

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

Christiansen CL, Fletcher SW. Screening mammograms by

community radiologists: variability in false-positive rates. J Natl

Cancer Inst 2002;94(18):1373-80.

Christiansen CL, Wang F, Barton MB, Kreuter W, Elmore JG,

Gelfand AE, Fletcher SW. Predicting the cumulative risk of

false-positive mammograms. J Natl Cancer Inst

2000;92(20):1657-66.

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):229-34.

Fletcher SW. Following up abnormal breast cancer screening

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

Pract 2000;13(2):152-4.

Fletcher SW. False-positive screening mammograms: good

news, but more to do. Ann Intern Med 1999;131(1):60-2.

Quality of Patient-centered Cancer Care (4CQuality)

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):934-42.

Racial Disparities

Doubeni CA, Field TS, Buist DS, Korner EJ, Bigelow C,

Lamerato L, Herrinton L, Quinn VP, Hart G, Hornbrook MC,

Gurwitz JH, Wagner EH. Racial differences in tumor stage and

survival for colorectal cancer in an insured population. Cancer

2007;109(3):612-20.

survival among breast cancer patients. J Natl Ca

Monogr 2005;(35):88-95.

Survey Measurement Expert Team

Ford ME, Hill DD, Nerenz D, Hornbrook M, Zapk

R, Greene S, Johnson CC. Categorizing race an

the HMO Cancer Research Network. Ethn Dis 20

40.

Field TS, Cadoret CA, Brown ML, Ford M, Green

Hornbrook MC, Meenan RT, White MJ, Zapka JM

physicians: do components of the “Total Design 

optimizing survey response rates apply to physic

Care 2002;40(7):596-605.

Survivorship Scientific Interest Group

Geiger A, Altschuler A, Buist D, Field T, Greene S

the NCI’s Cancer Research Network for survivors

Cancer (special supplement) 2008 Apr 21;Epub 

Other CRN-related Publications

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

medical records and prevention quality the preve

Am J Prev Med 2007;33(4):291-6.

Herrinton LJ, Liu L, Lafata JE, Allison JE, Andrad

EJ, Chan KA, Platt R, Hiatt D, O’Connor S. Estim

period prevalence of inflammatory bowel disease 

health plans using computerized diagnoses and 

pharmacy dispensings. Inflamm Bowel Dis 2007

Boudreau DM, Yu O, Miglioretti DL, Buist DS, He

Daling JR. Statin use and breast cancer risk in a 

population-based setting. Cancer Epidemiol Biom

2007;16(3):416-21.

Wallace P. Reshaping cancer learning thorugh th

information technology. Health Aff (Millwood) 200

w177.
http://crn.cancer.gov 

Boudreau DM, Buist DS, Rutter CM, Fishman PA, Beverly KR,

Taplin S. Impact of hormone therapy on false-positive recall

and costs among women undergoing screening

mammography. Med Care 2006;44(1):62-9.

Habel LA, Shak S, Jacobs MK, Capra A, Alexander C, Pho M,

Baker J, Walker M, Watson D, Hackett J, Blick NT, Greenberg

D, Fehrenbacher L, Langholz B, Quesenberry CP. A

population-based study of tumor gene expression and risk of

breast cancer death among lymph node-negative patients.

Breast Cancer Res 2006;8(3):R25.

Vogt TM, Feldstein AC, Aickin M, Hu W, Schneider J.

Assessing and improving quality with electronic medical

records. Final Report of the project to the Garfield Memorial

Fund 2005.

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):1765-72.

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, 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):1655-63.

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

cancer patients, age, race-ethnicity, gender and smoking

predict adverse comorbidity, which in turn predicts treatment

and survival. J Clin Epidemiol 2004;57(6):597-609.

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

Smoking and lung cancer survival: the role of comorbidity and

treatment. Chest 2004;125(1):27-37.

Editorials and Commentary

Kahn KL. Moving research from bench to bedside t

community: there is still more to do. J Clin Oncol

2008;26(4):523-526.

Norman GJ. Answering the “what works?” question 

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

Geiger AM, Prout MN, Silliman RA. Adjuvant radiatio

hormonal therapy prevent recurrences and second 

breast cancers in older women. Am J Hematol Onc

2007;6:400-05.

Keating NL, Herrinton LJ, Zaslavsky AM, Liu L, Aya

Response: re: variations in hospice use among can

J Natl Cancer Inst 2007;99(1):84. (Northern Californ

CanCORS.)

Mandelblatt J. To screen or not to screen older wom

breast cancer: a new twist on an old question or wi

invest in getting the answers? J Clin Oncol 2007;25

2.

Tuma R. Surveillance mammography extends overa

older breast cancer survivors. Oncology Times 2007

25.

Elmore JG and Fletcher SW. The risk of cancer risk 

“What is my risk of getting breast cancer”? J Natl C

2006;98(23):1673-5.

Mouchawar J, Ellis J, Ritzwoller D, Hensley-Alford S

Reply to letter from Marc Williams. Genet Med 2005
40 The HMO Cancer Resea

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BACK COVER 3

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NIH Publication No. 08-6448

Printed May 2008