Cancer

Research overview

Kaiser Permanente Washington Health Research Institute (KPWHRI) was the first organization to develop and implement an evidence-based breast cancer screening program. This novel initiative used a computer-based registry before electronic health records (EHRs) existed. It included nurse team care and embodied what became the Chronic Care Model. The program led to a rich portfolio of studies including on breast, colorectal, blood, cervical, lung, ovarian, and other cancer types. “Decades later,” says Karen Wernli, PhD, KPWHRI associate investigator, “Kaiser Permanente Washington is just as committed to developing and evaluating innovations in cancer care.”

• improving cancer prevention by identifying risk factors and ways to reduce risk, for example through smoking cessation;
• evaluating appropriate use of genetic testing among people at high risk for specific cancers;
• developing and testing interventions to improve screening uptake and quality of care, for example in colorectal cancer;
• working to decrease disparities in cancer screening and outcomes;
• identifying the best screening and diagnostic tests and screening intervals; and
• comparing cost-effectiveness of cancer screening and care strategies.

• understanding patterns of cancer treatment to promote equitable and patient-centered care;
• improving treatment outcomes by identifying effective therapies and increasing the continuity of care;
• identifying factors that affect patients’ risk of recurrence;
• supporting long-term care of cancer survivors;
• exploring ways to increase cost transparency for care of multiple cancer types;
• encouraging thoughtful communication between patients and caregivers and providers about cancer, palliative care, and end-of-life options; and
• understanding patients’ health and social needs during screening, treatment, survivorship, and end of life.

The core of KPWHRI cancer research lies in its participation in many collaborative networks and programs. “Collaboration increases the power of Kaiser Permanente studies and helps us learn from different populations and health care settings,” says senior investigator Jessica Chubak, PhD. Examples of these networks include:

• a pragmatic trial offering women cervical cancer screening through home tests;
• work to improve shared decision-making to inform individuals about the harms and benefits of lung screening with low-dose computed tomography (CT) to decrease deaths from lung cancer;
• research on second breast events and second cancers associated with breast cancer in studies in collaboration with the National Cancer Institute on radiation therapy, breast density, and tumor biology;
• the Radiation-Induced Cancers (RIC) study to evaluate imaging trends in children and during pregnancy with ionizing radiation methods such as CT and associations with risk of leukemia and other cancers;
• studies on medications that cancer patients might take for diabetes, hypertension, and other conditions that may be associated with increased and decreased risks of second cancer or cancer recurrence; and
• research on ways to increase effective colorectal cancer screening, including advocacy for and outreach to underserved communities. 

Affiliate researchers

Wylie Burke, MD, PhD
University of Washington (UW) Department of Medical History and Ethics

Joann G. Elmore, MD, MPH
Harborview Medical Center; UW Department of Epidemiology

Larry Kessler, ScD
UW Department of Health Services

Constance D. Lehman, MD, PhD
Seattle Cancer Care Alliance; UW Department of Radiology

Kathy Leppig, MD
Kaiser Foundation Health Plan of Washington; UW Department of Pathology

Peggy L. Porter, MD
Fred Hutchinson Cancer Research Center (FHCRC); UW Department of Pathology

Emily White, PhD
FHCRC; UW Department of Epidemiology

Rachel Winer, PhD, MPH
Fred Hutchinson/UW Cancer Consortium; UW Department of Epidemiology