The HMO Cancer Research Network

The HMO Cancer Research Network, or CRN, is comprised of 14 health maintenance organizations throughout America which collaborate under the auspices of the National Cancer Institute, or NCI, to prevent and cure such major cancers as breast, colon and lung, as well as rare tumors.

Under its research arm, the CRN conducts investigations (through enrollees in the health maintenance organizations) to further understanding in the areas of prevention, early detection, treatment, long-term care, population surveillance, and the communication of research studies and novel cures.

Some current research programs include: early cancer treatment and screening; tobacco screening; early detection of tumors; end-of-life care for prostate cancer in managed care settings; lung and colon cancer outcomes; outcomes of prophylactic mastectomy (breast cancer surgery); using patient records in case collection and treatment; the value of endocrine therapy in prostate cancer; medications and the risk of esophageal cancers; medications and colorectal cancer risks; statins and site-specific cancers; and effective nutritional choices, to name just a few of the 65 trials underway.

The first protocol, early cancer treatment and screening, for example, evaluated the usefulness of bilateral prophylactic mastectomies (BPM, or surgical removal of one breast) among 269 women who had cancer in one breast and were additionally at high risk for developing cancer in the other breast (or additional cancers in the affected breast) based on their family history, lifestyle, age, race and genetic markers.

The 269 had a significant reduction in risk, but 66 percent also experienced significant adverse effects. Called PROTECT, this core project also identified a sampling of 1,074 women with breast cancer in only one breast who subsequently had a contralateral prophylactic mastectomy, or CPM, which involves surgical removal of both breasts. This, compared with a sampling of 349 women who did not, showed that the former group reduced their risk by 90 percent, clearly indicating that, for high-risk females, CPM provides less risk with greater benefits.

The project also evaluated the benefit of mammographies and clinical breast exams in "real-world" settings (i.e., hospitals, clinics and homes), to determine the best course for early identification of breast cancer.

Funding for this and other programs came primarily from the NCI and the U.S. Centers for Disease Control, or CDC, with the Institute of Medicine and the National Human Genome Research Institute also contributing to specific studies.

The Cancer Research Network operates its programs from a highly developed and fully implemented electronic medical record database which comprises hospital, clinic and patient websites, and includes current and historical data on its HMO population.

This wide-reaching dataset, which receives constant input, upgrades and improvements, enables CRN to surveil populations at risk, and also furthers the development of research protocols and medical practice innovations across the entire system.

In fact, this electronic record system is what enables CRN to evaluate and improve on patient care and patient communication. It also helps individual physicians within the HMO network to improve on cancer screening, diagnosis and treatment, and provides significant means for health professionals to improve cancer outcomes and extend cancer survival through the CRN's lead site, Group Health Cooperative, whose principal researcher, Ed Wagner (MD, MPH) has been with CRN since its inception.

The Cancer Research Network's commitment to improving cancer quality-of-care is backed and assisted by the U.S. Department of Health and Human Service's Agency for Healthcare Research and Quality, which assists organizations like CRN in improving the quality, safety, efficiency and effectiveness of American healthcare.

The Cancer Research Network, an official NCI affiliate, also examines the effect of alternative health care modalities, the effects of health insurance and cost sharing programs on healthcare options, and the psychosocial effects of cancer on patients and their families. It is also heavily vested in supporting emerging cancer control research venues, including biometrics, behavioral influences, genetic factors and environmental influences as they relate to the development of cancer.

As it currently stands, CRN provides care to almost 11 million patients through its 14 research centers across a web of HMO's nationwide, and all are integral to their communities in terms of longevity and service. This longstanding and committed presence enables CRN to deliver valuable cancer research and discoveries to a diverse population representative of the nation as a whole.

Sources of information on this page: American Society of Clinical Oncology, U.S. Agency for Healthcare Research and Quality, NCI Cancer Research Network,

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