Working with Researchers and Policy Makers
The CISNET infrastructure serves as a tool to inform evidence-based policy decisions, cancer control planning, and research priority-setting. CISNET has collaborated with the following organizations:
U.S. Preventive Services Task Force (USPSTF)
CISNET models have served as a resource for USPSTF evidence review panels as they issued or revised screening recommendations for breast, colorectal, and lung cancers.
Centers for Medicare and Medicaid Services (CMS)
CISNET microsimulation models have been used for technology assessments as part of National Coverage Determinations to evaluate the cost-effectiveness of immunochemical fecal occult blood tests, DNA stool testing, and CT colonography in colorectal cancer screening compared to screening methods currently covered.
Centers for Disease Control and Prevention (CDC)
The CDC's Division of Cancer Prevention and Control works with CISNET colorectal cancer investigators to project potential shifts in costs to Medicare, Medicaid, and private payers for programs that would increase colorectal cancer screening rates among the U.S. population ages 50 to 64. This group has also assessed the colonoscopy capacity required to initiate a colorectal cancer screening program in lower-income U.S. populations. Another project with the CISNET breast cancer group modeled the potential costs and benefits of utilizing digital mammography as part of the National Breast and Cervical Cancer Early Detection Program. Finally, a set of projects were developed to assist state and local cancer control planners customize screening recommendations for their local situation.
The American College of Radiology Imaging Network (ACRIN)
The National CT Colonography Trial (ACRIN 6664) was conducted to clinically validate widespread use of CT colonography in an asymptomatic screening population for the detection of colorectal neoplasia. The clinical performance of the CT colonography (CTC) examination was prospectively compared in a blinded fashion to colonoscopy. CISNET has collaborated with ACRIN to study the cost-effectiveness of CTC based on these trial results.
Healthy People Cancer Working Groups
CISNET provided support for the development of the Healthy People 2010 mid-course review. Analyses were conducted in breast, lung, and colorectal cancers, linking "upstream" objectives (i.e., risk factors and screening rates) to the "downstream" objective (i.e., mortality).
Institute for Clinical and Economic Review (ICER)
ICER produces rigorous independent assessments of new medical interventions to support value-based insurance benefit designs, coverage and reimbursement policy, and patient-clinician decision support tools. As part of an assessment of CT colonography for primary colorectal cancer screening, ICER commissioned a cost-effectiveness analysis using one of the colorectal cancer CISNET models.
District of Columbia Health Department
In an effort to reduce racial disparities associated with breast cancer in the District of Columbia, a CISNET model has been utilized to evaluate local breast cancer surveillance data to determine the efficacy of proposed interventions. In collaboration with local policy planners and public health officials, this information will aid in the development of public health priorities to improve breast cancer outcomes.
State of Kentucky
The Pacific Institute of Research and Evaluation CISNET model (SimSmoke) was developed to monitor changes in smoking behavior and to evaluate the efficacy of tobacco-control policies with the ultimate goal of reducing morbidity and mortality associated with smoking. Developers of the SimSmoke model worked closely with Kentucky in-state partners, and disseminated the model as a tool to aid in the mitigation of smoking through improved public policies and increased tobacco control legislation.
Integrative Cancer Biology Program (ICBP)
The ICBP was a consortium of investigators sponsored by NCI's Division of Cancer Biology focused on the development and implementation of cancer models at the cellular and molecular levels. There were two pilot projects in breast and lung cancers jointly sponsored by CISNET and ICBP aimed at bridging models of cancer biology at the molecular/cellular level and models of cancer outcomes at the population level. A joint workshop brought together the CISNET and ICBP communities. One key product of the workshop was a funding opportunity announcement entitled Bridging the Gap Between Cancer Mechanism and Population Science (U01; PAR-13-081). A newer funding announcement which is broader in scope, entitled Emerging Questions in Cancer Systems Biology (U01; PAR-16-131), encourages applications that bridge a mechanistic systems biology model at one scale and a population-level model at the other.
Early Detection Research Network (EDRN)
The EDRN is an initiative sponsored by NCI's Division of Cancer Prevention that joins dozens of institutions to form a collaboration to accelerate the translation of biomarker information into applicable clinical practices in addition to evaluating new cancer screening procedures for early cancer detection and determining cancer risk. Collaborative work had been conducted to determine how CISNET models could be used to help prioritize developments that have the most promise when scaled up to the population level.
Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial Group
The CISNET colorectal group has collaborated with PLCO investigators to analyze the detection of advanced adenomas and colorectal cancers at the time of flexible sigmoidoscopy, performed 3 years after an initial negative flexible sigmoidoscopy. These findings will provide an understanding of missed and rapidly growing lesions, which impacts the appropriate interval for rescreening. The CISNET prostate cancer group has collaborated with PLCO investigators to evaluate how criteria for prostate biopsy have changed over time in the U.S. population. The prostate group is collaborating with the PLCO Cancer Screening Trial Group and European Randomized Study of Screening for Prostate Cancer (ERSPC) investigators to utilize modeling; the goal is to determine whether these two major prostate-specific antigen (PSA) screening trials, conducted under very different conditions, could be utilized to estimate a measure of PSA screening’s impact on prostate cancer mortality that is consistent with both trials.
International Collaborations to Evaluate Colorectal Cancer Screening Programs
The CISNET colorectal cancer groups have informed health policy planners in Canada, Ireland, The Netherlands, and Hong Kong by projecting health and economic outcomes for alternative colorectal cancer screening initiatives for these populations.
American Cancer Society (ACS)
Investigators in the CISNET colorectal group collaborated with the American Cancer Society to study the contributions of risk factors, screening, and survival differences to racial and state disparities in colorectal cancer rates.