search Program, Division of Cancer Control and Population Sciences, NCI, personal communication, December 16, 1998):

  1. The development of an administrative infrastructure to support research collaboration, data quality, and integrity and to develop methods and organizational approaches to increase the participation of managed care patients in NCI-approved clinical trials. The infrastructure will include a data-coordinating center and expert teams to provide organized scientific input in the areas of biostatistics, health economics, survey measures, pharmacoepidemiology, genetics, clinical trials management, and survivorship.
  2. A study of the efficacy, reach, adherence to, and quality of delivery of smoking cessation programs in HMO practice settings.
  3. A study of late-stage breast and invasive cervical cancer cases to elucidate the patient, provider, and system factors that contribute to preventing advanced disease.
  4. A study of the effectiveness of the commonly used strategies of frequent mammography or prophylactic mastectomy, to prevent fatal breast cancer among women at increased risk for breast cancer.

Funding for this four-year extramural grant is approximately $4 million per year, with a total award of approximately $16 million.

The division has established an Outcomes Research Section to examine outcomes measures used in clinical trials and to monitor the national burden of cancer. The section will support research in the areas of measurement of quality of life, cost, and quality of care. Aspects of clinical trial organization and financing will also be addressed (e.g., integrating trials into routine care) (Martin Brown, Head, Health Services and Economics Section, Applied Research Branch, Cancer Surveillance Research Program, Division of Cancer Control and Population Sciences, NCI, personal communication, December 16, 1998).

Office of Cancer Survivorship. In 1996, NCI established the Office of Cancer Survivorship to develop and support a research agenda that explores the long-and short-term physical and psychological effects of cancer and its treatment. The office has provided $4 million to supplement existing cooperative agreements, grants, and contracts. An additional $700,000 was committed by the Susan Komen Foundation. Investigator-initiated research will be funded with an additional $3 million per year for five years. Most of the research funded to date has focused on treatment complications (e.g., effects of cancer treatment on gonadal function and reproductive health) and quality-of-life issues (e.g., quality of life for adult survivors of childhood leukemia), but a few awards have addressed health services research issues (e.g., medical care costs of cancer). Box 7.3 shows prioritized areas of research for the Office of Cancer Survivorship.

Health services research supported by the NCI is shown for breast cancer in Box 7.4, other cancer sites in Box 7.5, and other general research (i.e., not cancer-site specific) in Box 7.6.

Several other NIH institutes have supported extramural health services research (Table 7.1).

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