Population-based health systems as a foundation for prostate cancer control research: The cancer research network

Abstract

The Cancer Research Network (CRN) has been a cooperative agreement between the National Cancer Institute (NCI) and nonprofit integrated health care delivery systems, with the participation of the Agency for HealthCare Research and Quality (AHRQ), all committed to conducting research in the public domain focusing on the entire cancer spectrum. Participating in the CRN is one way these health systems contribute to the evidence base for their cancer control programs. Capitated health care systems face strong incentives to develop and deliver cost-effective, affordable cancer prevention, screening, treatment, and survivorship care. The CRN represents a strategic platform for prostate cancer research, including clinical trials, epidemiology studies (including genetics, genomics, and pharmacogenetics), comparative effectiveness research, cost-effectiveness evaluations, and translational research. Their defined populations, sophisticated electronic medical records and other informatics systems, low rates of turnover among cancer patients, and representativeness of their local communities make the CRN well suited for conducting clinical trials and comparative effectiveness research on prostate cancer treatments, as well as behavioral trials on prostate cancer prevention, screening, communications, decision making, and survivorship care planning. Because prostate cancer is a leading cancer among males and advanced prostate cancer cases often receive very high-cost treatments, this disease is a high priority for health plans. Key clinical management challenges include: setting an appropriate investment in prostate cancer screening programs, discriminating slow-growing indolent tumors from aggressive tumors, assisting patients in making evidence-based choices among alternative treatment strategies, supporting survivors in coping with treatment effects (ED, UI, rectal bleeding, loss of cognitive function), and supporting patients with advanced and terminal disease. The rationale for facilitating innovative collaborations in prostate cancer research is finding better approaches to these challenges.