Table 1.

Illustrative simulation models addressing multilevel challenges in cancer care research^*

Multilevel challenge in cancer care research	Illustrative simulation model(s)	Objective	Intervention levels/scales under study	Potential for multilevel/multiscale adaptation
Effective cancer control requires interventions at multiple ecological levels	SimSmoke	To inform tobacco-control policy decision making in the United States and internationally	National and state policies Community provider reimbursement Patient education	Addresses >2 ecological levels Needs to adapt to include cellular and genetic levels (eg, genotypes for nicotine addiction)
New technologies	CISNET Colorectal Cancer Screening	To assess the effectiveness and cost-effectiveness of screening for colorectal cancer with a variety of screening tests	Patient adherence to screening Cellular growth of adenomas	Extend to examine smaller scales, such as genetic basis of adenoma risk and growth Extend to encompass other ecological levels affecting patient adherence to screening at the provider, practice, or policy level
For each cancer site, disease is heterogeneous	Goldie et al. Cervical Cancer Screening Strategies	To examine alternative cervical cancer prevention strategies in the context of HIV	Patient adherence to screening and HIV treatment regimens Cellular processes of HPV infection	Extend to include other ecological levels, including state policies on HIV prevention, community effects on individual sexual behavior, practice-level availability of HIV medicines
Disparities in cancer mortality	CISNET Breast Cancer Disparities	To ascertain how much of the black–white mortality gap in breast cancer is attributable to mutable factors	Patient adherence to screening Biomarkers of cancer natural history (ER/HER2)	Extend to include federal or state policies that affect access to screening or emerging therapies

^*CISNET = Cancer Intervention Surveillance Network; ER = estrogen receptor; HPV = human papillomavirus.