CRN Research Themes

In 2008, staff from the National Institutes of Health and CRN research 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.

Data Resources and Infrastructure

CRN member organizations have electronic medical record systems, patient Web sites, and rich arrays of current and historical electronic data on enrollee populations. A major priority is the continued improvement of the CRN standardized data infrastructure, and the development and testing of research, surveillance, and medical practice innovations built upon electronic medical records, patient Web portals, computer-based physician order entry systems, and automated records of complete health service utilization.

Enhancing Cancer Communication & Decision-making

With its extensive data on patients and providers, a key CRN strength is the capacity to examine and optimize the quality of patient communication and decision making 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. One example is the CRN Cancer Communication Research Center.

Health Care Delivery, Quality, Costs, & Outcomes

Examining the influence of alternate 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 & 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.

Cancer Epidemiology, Prevention, & Health Promotion

The CRN provides large and diverse populations for conducting cross-sectional, 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 & 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.

Research Translation & Patterns of Screening, Treatment, & Care

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 and diffusion of new diagnostic and treatment modalities into practice, and the conduct of pharmaco-epidemiologic and pharmaco-genomic studies of the effectiveness of cancer drugs.

Building Capacity to Support Emerging Areas of Cancer Control Research

CRN investigators and health care organizations have tremendous potential to advance research activities to develop, enhance, and test health informatics, database, and biospecimen tools and resources to support research in areas such as cancer risk assessment and modeling; studies of behavioral, environmental, and genetic factors; and personalized health care approaches to preventive care, screening, diagnosis/prognosis, and treatment. In addition, the CRN aims to develop activities to increase the timeliness, efficiency, and effectiveness of recruitment to phase 2 and phase 3 prevention and treatment trials.

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Operationalizing the CRN Research Themes

During the month of September 2008, small teams of CRN staff and advisors developed work plans to operationalize the CRN research themes. Facilitators from each workgroup presented the work plans to the Steering and Academic Liaison Committees and NCI staff during the semi-annual September meeting in D.C. Five major action items emerged as they relate to the research themes:

Networking, making connections, and sharing knowledge

To increase awareness and use of the research themes, the workgroups suggested the CRN and all its committees and special interest groups look for opportunities to elucidate and promote each research theme through: new research proposals, publications, development of tools, orientation of new CRN staff, and a directory of researchers and research interests by site to encourage collaboration.

Study methods & design

To improve CRN science, the workgroups suggested that we emphasize the development and standardization of measures and methods, as well as conduct systematic reviews, evaluations, and efficacy and effectiveness studies related to the research themes..

Data & IT tools

To improve the CRN's data and IT tool set, the workgroups suggested that we expand variables, domains and VDW capabilities related to the themes, and conduct studies using the VDW and IT tools.

Biorepository

To develop a biorepository and conduct pharmacogenomic research, the workgroups suggested to assess the availability, quality and quantity of biospecimens, learning from others' experience, learning about policy issues on this topic.

Health plans & business concepts

The workgroups suggested working more closely with our health plan leadership to gain important input and to enhance infrastructure. They suggested looking at the availability of health plan data, conducting studies that are focused on health plan decisions and benefit design, and work with the health plan leadership to assure that important data such as lab and imaging results are in digital format.

The thematic workgroups suggested various research topics consistent with the CRN research themes. The study topics included assessing clinician-patient relationships, care teams, behavior and psychosocial issues, the care continuum and patients' care experience, patient decision making, health risk and communication, and studying the child and adolescent population.

To accomplish these actions, investigators and the Steering, Publications, New Proposals and Communications and Collaborations, VDW Operations Committees, and new and current Scientific Interest Groups will need to parse the work to activate the CRN's research themes.

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