Table 1.
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.