Cancer Research Network
The Cancer Research Network (CRN) is an NCI-funded initiative to support and facilitate cancer research based in non-profit integrated health care delivery settings. The CRN welcomes collaborations that result in research projects that improve knowledge about cancer etiology, prevention, early detection, treatment and prognosis, and that decrease the burden of cancer across the cancer care spectrum. The integrated health care settings provide unique advantages for conducting population sciences research. Through the links below, find out more about the CRN, its activities, and how to develop collaborations with the CRN’s many investigators with expertise in conducting public-domain cancer research in these settings.
Supported by the National Cancer Institute since 1999, the CRN has catalyzed over 200 research projects across the spectrum of cancer care, from primary prevention and early detection to treatment and end-of-life care. Among its signature infrastructure accomplishments, the CRN developed and implemented the Virtual Data Warehouse (VDW), in which data from each health care system’s electronic health records and administrative databases are extracted and conformed to a common data model. With common formats across the participating institutions of the CRN, collaborative research projects are greatly facilitated.
CRN studies include those that rely solely on data from our health systems, and those that include enrollment of study participants with primary data and biospecimen collection. Most CRN institutions participate in oncology clinical trials, and many have participated in NIH research initiatives in cancer prevention, screening, and treatment. The CRN remains committed to fostering cancer research collaborations in our healthcare settings.
- PI: Lawrence H. Kushi, ScD of Kaiser Permanente Northern California
- Funding agency: National Cancer Institute
- Year funded: 1999
- Number of related studies funded, since inception: More than 75
Key Partners & Collaborators
The Cancer Research Network (CRN) facilitates cancer research in a consortium of non-profit health care systems. Supported by the National Cancer Institute since 1999, the CRN has catalyzed over 200 research projects across the spectrum of cancer care, from primary prevention and early detection to treatment and end-of-life care.
The Cancer Research Network remains successful only because of the continued commitment of our research investigators to collaborate. Thanks to everyone who has brought this network to where it is today, and to the future researchers who will keep the research collaborations going.
Partnering Health Plans | Research Centers
Fallon Community Health Plan | Meyers Primary Care Institute
Site PI: Kathleen Mazor
Group Health Cooperative | Group Health Research Institute
Site PI: Jessica Chubak
Health Alliance Plan | Henry Ford Hospital & Health System
Site PI: Christine Cole Johnson
Kaiser Permanente Colorado | Institute for Health Research
Site PI: Debra P. Ritzwoller
Kaiser Permanente Hawaii | Center for Health Research
Site PI: Stacey Honda
Kaiser Permanente Northern California | Division of Research
Site PI: Lawrence H. Kushi
Kaiser Permanente Northwest | Center for Health Research
Site PI: Mark C. Hornbrook
Kaiser Permanente Southern California | Department of Research & Evaluation
Site PI: Virginia P. Quinn
Security Health Plan | Marshfield Clinic Research Foundation
Site PI: Robert T. Greenlee
Affiliate Health Plans | Research Centers
- Baylor Scott & White Healthcare | Division of Research
- Geisinger Health System |Center for Health Research and Rural Advocacy
- Harvard Pilgrim Health Care |Department of Population Medicine, Harvard Med School
- HealthPartners | HealthPartners Institute for Education and Research
- Kaiser Permanente Georgia | Center for Outcomes Research and Evaluation
- Kaiser Permanente Mid-Atlantic States | Mid Atlantic Permanente Research Institute
- Harvard Medical School – Collaborating PI: Deborah Schrag
- Fred Hutchinson Cancer Research Center – Collaborating PI: Thomas Vaughan
- Roswell Park Cancer Institute – Collaborating PI: Christine B. Amrosone
- University of California, Davis – Collaborating PI: Diana L. Miglioretti
- VA Center for Implementation Practice and Research Support – Collaborating PI: Brian S. Mittman
Advantages of Conducting Research in our Settings
Network of Researchers
Our network is comprised of over 100 research scientists focused on diverse aspects of cancer, a history of collaboration within and beyond the CRN, and extensive multisite research experience. CRN investigators are familiar with their health systems and their structures, operations, leadership, and clinical activities.
Integrated Healthcare Delivery Systems
These learning health care systems are committed to quality improvement and translational research, providing opportunities for applying research findings directly to the care process. This real-world setting makes the results of CRN research broadly generalizable and applicable to health care improvement.
The CRN setting provides the potential for intervention studies at the patient, provider and system level, including multilevel interventions, cluster-randomized trials, and pragmatic clinical trials. For standard clinical trials, member loyalty and trust and automated rapid case identification facilitates patient recruitment, follow-up and retention.
Large, Diverse, Defined Member Populations
Member populations are representative of CRN site communities. Racial, ethnic, socioeconomic and age diversity enables studies of health inequities, including identifying disparities that persist within insured populations. With long-term retention of health plan members, the CRN is an ideal setting for longitudinal studies that benefit from information from clinical databases, including investigations of care over time, disease trajectories, and long-term outcomes.
Large, Diverse Provider Populations
Providers include specialists and subspecialists in primary care, oncology, surgery, radiology, and other areas. CRN researchers work with these providers to identify research questions and translate findings into practice. The large provider network also enables investigators to study providers’ knowledge, beliefs, and practices, and relationships among these domains and patient outcomes.
Our data includes comprehensive diagnosis, procedure, pathology, cancer registry, utilization and pharmacy data. EMRs enable identification of patients soon after diagnosis or other key events. Pathology and tumor databases enable identification of cancerous and precancerous tumors for linkage to patient outcomes. CRN investigators have harmonized informatics resources, including the VDW common data model and implementation of the PopMedNet™ distributed query tool to facilitate collaborations.
Cancer Therapy Look-up Tables
Chemotherapy, hormone therapy, and immunotherapy
These “look-up” tables were created by extracting codes from published research, NCI Web sites (e.g., Procedure Codes for SEER-Medicare Analyses), health plan formularies, and expert clinician opinion (e.g., medical oncologists, oncology clinical pharmacists). These tables contain over 8,000 NDC and 500 procedure cancer treatment-related codes. The tables are updated when new products or codes are identified. The codes are stratified by class of product (e.g., chemotherapy, hormone therapy, immunotherapy) and code type (e.g., ICD-9, HCPCS). Please see the data dictionary below for definitions of classes.
The lookup tables below were last updated on March 2018. Any newly assigned procedure codes, diagnosis codes, and NDC codes since that date are not included.
|Chemotherapy Drugs Table
|Chemotherapy Procedures Table
|Chemotherapy Lookup Documentation
|Chemotherapy Data Dictionary
Caveats: Probably not every code in existence is present. Some of the drugs listed might be used in non-cancer settings. The class product may not be correct for all codes. There are codes for infusion additives that are pharmaceuticals but not drugs per se (e.g., D5W).
The radiation therapy lookup tables contain lists of procedure and diagnosis codes that may be used to identify receipt of radiation therapy. We have included information about the general purpose of the code and the type of radiation therapy that applies to the code. Please see the data dictionary for information about each variable in the lookup tables.
The last update of the lookup tables was mid-2015 for procedures and April 2017 for diagnoses.
|Radiation Therapy Codes – Procedures
|Radiation Therapy Codes – Diagnosis
|Radiation Therapy Lookup Documentation
|Radiation Therapy Diagnosis Data Dictionary
Please reference the Cancer Research Network (U24 CA171524) if you will be using or producing any reports or publications from these look-up tables.
Prep to Research
Process for Requesting Data
** Now that the CRN is an unfunded consortium, site participation in data requests is voluntary and dependent upon programmer and investigator availability. **
The Prep-to-Research (PTR) Form should be reviewed, completed, and submitted by any investigator who wishes to obtain summary counts to help with a grant application. Please note that these data are provided only for preparatory to research purposes and should not be used without explicit permission from sites. They may contain proprietary information, therefore permission is needed from each contributing site to use that site’s numbers for any purpose including in a grant proposal, poster, or publication.
If this is your first time submitting a Prep-to-Research Form with the CRN, please review the Investigator Guide (PDF, 272 KB) before proceeding. The purpose of the Investigator Guide is to serve as an introduction for scientific investigators who wish to obtain and analyze CRN data.
Once you have reviewed the guide, you may download (use Adobe to view this file) and complete the Preparatory-to-Research Form (PDF, 155KB).
Summary of the Process:
- Requestor attaches the completed PTR Form in an email to: email@example.com.
- The CRN will review the request with respect to feasibility, priority, effort, and consistency with CRN objectives.
- Depending on the nature of the request submitted, the CRN may require that investigators not affiliated with the CRN identify a CRN investigator who is interested in collaborating on the project before completing the data request.
- CRN programmer works with the requestor to clarify request, if necessary, and share results when complete.
While data are collected and maintained independently by each CRN Site, a system of data standards and automated processes known as the Virtual Data Warehouse (VDW) has been established to facilitate consistent data analysis across the network.
The CRN uses a secure implementation of the open-source PopMedNetTM application to facilitate the distribution of SAS programs; the CRN implementation is referred to as CRNnet. CRNnet is the query tool that provides network infrastructure to conduct rapid QA, prep-to-research (PTR) analyses across multiple research institutions within the CRN. PopMedNet is used by several distributed networks include the FDA Sentinel, PCORnet, the Massachusetts Department of Public health surveillance network (MDPHnet), and the NIH Health Care Systems Research Collaboratory.
The CRN Cancer Counter is a data utility which generates frequencies and cross-tabulations of the number of primary tumors by selected individual and tumor characteristics extracted from the Tumor Registry files maintained by CRN health plans. Variables included in the Cancer Counter are as follows: a) SEER site recode of tumor site (computed from ICD-O primary site and histology data fields); b) Tumor Behavior; c) General Summary Stage; d) AJCC Stage; e) Age at Cancer Diagnosis; f) Year Cancer Diagnosed; g) Patient Race; h) Patient Gender; i) Patient Hispanic Ethnicity; j) Patient’s Vital Status (as of date of most recent update of the Tumor Registry); and, k) Health Plan (identities of individual health plans are masked). Patient aged 90 years and above are grouped together.
Users must have a valid business reason for viewing any Cancer Counter tabulations and must provide that reason when entering the Cancer Counter. To use the resultant counts in a research proposal, presentation, or paper, users must have the permission of the CRN Site Principal Investigator at each site included. The data on cancer counts are proprietary, and access to these data are limited to members of the CRN following the policies approved by the CRN Steering Committee and the HCSRN Governing Board. All CRN Cancer Counter data views are tracked by an electronic audit trail.
If you need access to the CRN cancer counter or have forgotten your username and/or password for this secure website, and for questions about the cancer counter content or use, please contact Joanna Bulkley, (firstname.lastname@example.org), Kaiser Permanente Center for Health Research.
As of Aug, 2017, the counter contains information on 1,632,787 tumors, spanning 1960-2015!
|Tumor Data through:
|Henry Ford Hospital & Health System (HFHS)
|Kaiser Permanente Colorado (KPCO), Institute for Health Research
|Kaiser Permanente Hawaii (KPHI), Center for Health Research
|Kaiser Permanente Northern California (KPNC), Division of Research
|Kaiser Permanente Northwest (KPNW), Center for Health Research
|Kaiser Permanente Washington (KPWA), Health Research Institute
|Marshfield Clinic Research Foundation (MCRF)
|Meyers Primary Care Institute / Fallon Community Health Plan (MPCI)
|HealthPartners Institute (HPIER)
|Kaiser Permanente Georgia (KPG), Center for Clinical and Outcomes Research
|Geisinger Health System (GHS), Center for Health Research
|Harvard Pilgrim Health Care Institute (HPHC), Dept of Population Medicine, Harvard Med School
|Essentia Institute of Rural Health (EIRH)
|Kaiser Permanente Southern California (KPSC), Dept of Research and Evaluation
The CRN welcomes opportunities to collaborate with colleagues across the CRN, the Health Care Systems Research Network, and other research institutions to address high priority areas of cancer research. Please use the links below to identify a potential collaborator, review our bibliography, or learn more about our institutions.
- The CRN does not fund research grants. It promotes discussions and collaborations that may result in applications for funding.
- The CRN focuses on population sciences research that is conducted in our integrated health care settings. The CRN does not conduct bench science.
Principles of Collaboration
The CRN has developed general principles to help both internal and external investigators navigate the process of collaborative research and to maximize the benefit of these collaborations for all parties.
- The CRN promotes research collaborations that result in scientific, public-domain, peer-reviewed manuscripts, with the long-term goal of decreasing the cancer burden. The CRN does not conduct proprietary research.
- CRN-based research projects benefit from involvement of CRN investigators from the outset, to ensure the development and formulation of research questions and study procedures that are feasible, meaningful, and consistent with the principle of respect for study participants.
- Studies for which the CRN is mainly a source of data, biospecimens, or study participants, and with minimal input from scientists at CRN research centers are discouraged. The CRN asks that potential collaborators identify a CRN scientist early in proposal development to work with the team.
- Research projects often benefit from involvement of health plan leaders who are involved in the delivery of care or operations oversight and management. CRN internal investigators are uniquely positioned to identify and facilitate the collaboration of health care system leaders who are not primarily researchers themselves.
- An outstanding and singular benefit of CRN research is its setting in integrated health care delivery systems, and access to their comprehensive clinical and administrative data. These have been extracted into VDW data tables to facilitate collaborative research across CRN Sites. Leveraging these data in a cost-efficient manner to investigate critical issues in cancer research is a main CRN focus. However, these are not public-domain data, and do not belong to CRN scientists or affiliated research groups. CRN investigators act as stewards of VDW and other health plan data, ensuring protection of patient privacy.
- Agreements for sharing data in research collaborations must be explicit and consider factors such as whether, under what circumstances, and how data will be shared. We employ strategies that protect patient and plan identity, while maximizing the utilization of data for current and future research, including the implementation of Data Use Agreements that define the scope of data sharing for a given research project.
- All research involving human subjects requires appropriate Institutional Review Board (IRB) review and approval before starting research activities. The CRN encourages the use of streamlined IRB procedures when appropriate. Although we uphold the principle that each CRN Site has the autonomy to determine whether its own IRB approval is needed for a research project (which is necessary for studies with active data collection from health plan members, and may be necessary for data-only studies), we have procedures to facilitate ceding IRB oversight to a lead CRN institution’s IRB. This includes use of a common IRB application for an initial request to cede that has been approved by all Kaiser Permanente and most other CRN institution IRBs.
- Collaborations facilitated by the CRN operate under an “opt-in” model, wherein no CRN Site participates without a willing and interested investigator at the site.
The CRN has compiled the published cancer research conducted at our sites over the past 20 years.
Click here to view more than 1500 peer-reviewed scientific research articles in our PubMed collection on MyNCBI. To search within this collection, click on “Advanced” once you get to PubMed and use the builder tool to add search terms.
List of select descriptive CRN papers:
- The Cancer Research Network: a platform for epidemiologic and health services research on cancer prevention, care, and outcomes in large, stable populations. Cancer Causes Control, 2016 Nov.
- The HMO Research Network Virtual Data Warehouse: A Public Data Model to Support Collaboration. EGEMS, 2014 March.
- Training in the Conduct of Population-Based Multi-Site and Multi-Disciplinary Studies: the Cancer Research Network’s Scholars Program. J Cancer Educ, 2017 Jun.
- Cancer research network: using integrated healthcare delivery systems as platforms for cancer survivorship research. J Cancer Surviv. 2013 Mar.
- Journal of the National Cancer Institute Monographs, special issue on Health Care Systems as Research Platforms: The Cancer Research Network.2005
|PROSPR: Optimizing Colonoscopy & FIT tests for Community Based Screening
|Contact PI – Doug Corley
|Screening can reduce colorectal cancer incidence and mortality in clinical trials. However, the real practice of screening in a community-based population differs from what can be achieved in trials. Optimizing screening strategies by characterizing potential failures of the screening process and developing screening strategies tailored to personal risk offer substantial potential for decreasing colorectal cancer deaths.
|Involved Sites: KP Northern California, KP Washington, University of Texas Southwestern
|Infrastructure for Pathways, A Prospective Study of Breast Cancer Survivorship
|Contact PI – Larry Kushi
|The Pathways Study is a prospective cohort study of 4,505 women diagnosed with invasive breast cancer in Kaiser Permanente Northern California (KPNC), with data on lifestyle and psychosocial factors, blood samples and extracted DNA, and linkage to KPNC medical records and neighborhood social and built environment databases. In this infrastructure grant, we are enhancing the Pathways Study resource by continuing to follow study participants and documenting outcomes; enhancing biospecimen resources with a tumor biobank and creation of tissue microarrays; and by adding new data from KPNC medical records, genome-wide assays, and neighborhood characteristics. These activities make the Pathways Study an outstanding and unique resource for research on breast cancer survivorship and prognosis. The Pathways Study welcomes collaborations with others interested in studies of breast cancer prognosis and outcomes.
Involved Sites: KP Northern California, Roswell Park Comprehensive Cancer Center, UCSF, Zero Breast Cancer.
Collaborative studies have been conducted or are ongoing with institutions such as: KP Washington, City of Hope Comprehensive Cancer Center, Columbia University, Georgetown University, Fred Hutchinson Cancer Research Center, and Memorial Sloan Kettering Cancer Center.
|Risk of Pediatric and Adolescent Cancer Associated with Medical Imaging
|Contact PI – Rebecca Smith Bindman
|The use of medical imaging that delivers ionizing radiation is high in the United States. The potential harmful effects of this imaging must be understood so they can be weighed against its diagnostic benefits, and this is especially critical for our vulnerable populations of children and pregnant women. The proposed study will comprehensively evaluate patterns of medical imaging, cumulative exposure to radiation, and subsequent risk of pediatric cancers in four integrated health care delivery systems comprising over 7 million enrolled patients enrolled from 1996-2017.
|Involved Sites: Geisinger Health System, HealthPartners, KP Northern California, KP Southern California, KP Northwest, KP Washington, Marshfield Clinic, University of Toronto, UCSF, and UC Davis.
|Obesity, Chemotherapy Dosing and Breast Cancer Outcomes
|Contact PI – Elizabeth Kantor
|Epidemiologic studies have linked obesity to poor breast cancer outcomes, and it has been suggested that obese women may experience poorer outcomes, in part, due to dose reductions of chemotherapy drugs; this is because most cytotoxic agents are dosed according to body size, and clinicians may scale back the high doses administered to obese women due to concern about inducing toxicity. Given persisting uncertainty about dosing obese women, in a study population of nearly 34,000 women with breast cancer who were diagnosed and treated in two integrated healthcare delivery systems, Kaiser Permanente Northern California and Group Health, we propose to: i) examine the relationship between body size and dose intensity, and will further examine how the factors contributing to dose reductions vary by body size, ii) evaluate whether chemotherapy dose reductions mediate the associations between obesity and adverse breast cancer outcomes, and iii) evaluate the association between body size and toxicity among women identified as receiving the full body-size determined dose of chemotherapy. Addressing these questions will provide the evidence needed to better inform clinicians treating the 102,000 obese women diagnosed with breast cancer each year in the United States.
|Involved Sites: Memorial Sloan Kettering Cancer Center, KP Northern California, KP Washington, Rutgers Cancer Institute of New Jersey
RESEARCH PROJECT PORTFOLIO
The CRN has facilitated hundreds of research collaborations: supporting the Scholar’s Program, funding pilot and developmental projects, connecting external collaborators, and more. Download a list of titles using the link below. Last updated: March 2018
[link to spreadsheet forthcoming]
Fourteen institutions have been considered CRN member sites since NCI funding began in 1999.
|NCI Funded Years
|Center for Clinical and Outcomes Research, Kaiser Permanente Georgia
|Center for Health Research, Kaiser Permanente Hawaii
|Center for Health Research, Kaiser Permanente Northwest
|Department of Population Medicine, Harvard Pilgrim Health Care Institute
|Department of Research, Henry Ford Hospital and Health System
|Department of Research and Evaluation, Kaiser Permanente Southern California
|Division of Research, Kaiser Permanente Northern California
|Geisinger Center for Health Research, Geisinger Health System
|HealthPartners Research Foundation, HealthPartners Institute
|Health Research Institute, Kaiser Permanente Washington (FKA Group Health Cooperative)
|Institute for Health Research, Kaiser Permanente Colorado
|LCF Research, Lovelace Health System
|Marshfield Clinic Research Institute, Marshfield Clinic
|Meyers Primary Care Institute, Fallon Community Health Plan
Ovarian cancer is a serious disease for which we see disparities in survival across racial/ethnic groups. We previously found that Black/African American women were 40% more likely to die from the disease even after accounting for factors that are known to be related to survival, such as stage of disease and treatment received, compared to White women. Hispanic women also have worse survival. Black and Hispanic women are also less likely to receive recommended treatments than White women. Very little is known about the factors that influence survival within different racial/ethnic groups, or the factors that drive survival differences across groups.
Our Study Goals
We will examine whether differences in neighborhood characteristics, patient and clinical factors including receipt of recommended treatments, and/or molecular features of the tumors, may account for these disparities. Ovarian cancer is understudied in diverse populations, and the proposed work is one of the largest to search for potentially modifiable factors that can reduce disparities in survival. This information is needed to improve outcomes for all women with ovarian cancer.
Given the many factors that can contribute to cancer health disparities, this study includes experts from different fields working together. The investigators responsible for conducting the study are:
Dr. Lawrence Kushi, Division of Research, Kaiser Permanente Northern California
Dr. Jennifer Anne Doherty, Huntsman Cancer Institute, University of Utah
Dr. Elisa Bandera, Rutgers Cancer Institute of New Jersey, Rutgers University
Dr. Scarlett Lin Gomez, University of California, San Francisco
Community Advisory Board Members
This study is funded by a grant from the National Cancer Institute. Read a blog from the NIH about it here. Our study includes understudied populations in ovarian cancer—such as Black/African American, Hispanic, and Asian women, as well as non-Hispanic White women.
Frequently Asked Questions
Who is included in the study?
All adult women diagnosed with ovarian cancer at Kaiser Permanente Northern California (KPNC) between 2000 and 2023, regardless of race/ethnicity or country of origin will be included in the study. If you were diagnosed and treated during those years at KPNC, you are probably part of the study. Below you can find more information about the study. If you have questions or do not want to be included in this study, please contact us at KP-ROCStudy@kp.org or 1-833-780-1811. Questions about your rights as a study participant, comments or complaints about the study may be presented to the Kaiser Permanente Northern California Institutional Review Board, 1800 Harrison Street, Oakland, CA 94612, or 1-866-241-0690.
What information or specimens will be used?
This study will be conducted using available patient records and surgical specimens from Kaiser Permanente Northern California; no patients will be contacted for additional information. The study will not have an adverse impact on participants’ medical care, and the medical records are kept separate from the study research database. The tumor tissue will be tested to understand the molecular features of the tumors, which may be associated with differences in survival. We will also look at neighborhood factors derived from area-level databases such as the census.
What are the risks involved from participating in the study?
All of the information that is gathered for this study will be kept strictly confidential with multiple data security and other protections in place. The only risk is that there is a very small chance that there could be a breach of confidentiality. However, there are many rigorous procedures in place to make sure that all personal identifying information will be removed from all data sets that are analyzed.
Why is this study important?
This study is important because it is the only study to date that can identify factors ranging from neighborhood characteristics, to clinical experiences, and tumor features, to understand why there are differences in survival across racial/ethnic groups. The findings from this study will be used to develop specific recommendations to reduce disparities in ovarian cancer survival. This study benefits society because it will provide recommendations that are important across racial/ethnic groups, which has not yet happened for ovarian cancer.
How to contact us?
Toll-free Phone: (1-833-780-1811)
For further information
Description of this study on the NIH RePORTER website: https://projectreporter.nih.gov/project_info_description.cfm?aid=9998465&icde=51675254
Description of research projects funded by the NCI to understand disparities in ovarian cancer outcomes: https://www.cancer.gov/news-events/cancer-currents-blog/2020/ovarian-cancer-racial-disparities-studies
Publications from our previous study
- Bandera EV, Lee VS, Rodriguez-Rodriguez L, Powell CB, Kushi LH. Impact of chemotherapy dosing and ovarian cancer survival according to body mass index. JAMA Oncology 2015; 1(6):737-45.
- Bandera EV, Lee V, Rodriguez-Rodriguez L, Powell B, Kushi LH. Racial/ethnic disparities in ovarian cancer treatment and survival. Clinical Cancer Research 2016 Dec 1;22(23):5909-5914.
- Bandera, EV, Lee V, Qin B, Rodriguez-Rodriguez L, Powell B, Kushi LH. Impact of body mass index on ovarian cancer survival varies by stage. Br J Cancer. 2017 Jul 11;117(2):282-289.
Facts About Ovarian Cancer
Ovarian Cancer Support and Advocacy Organizations