“We're continuing our longstanding program of research along the cancer care continuum from prevention and screening to survivorship and end of life. Our goal remains gathering sound evidence and using it to improve patient care.”

Diana Buist, PhD, MPH,
Kaiser Permanente Washington Health Research Institute Senior Investigator and Director of Research and Strategic Partnerships

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.”

Our work in prevention and screening includes:
  • 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.
KPWHRI studies also span treatment and survivorship, such as:
  • 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:

Breast Cancer Surveillance Consortium (BCSC)
The BCSC identifies strategies that detect breast cancer early, minimize harms, and reach diverse communities. Results help policymakers and health systems improve breast cancer screening and outcomes. The Kaiser Permanente Washington Breast Imaging Registry contributes to this national effort and the BCSC Statistical Coordinating Center resides at KPWHRI.
 
Population-based Research to Optimize the Screening Process (PROSPR)
The PROSPR national consortium conducts research to improve screening for cervical, colon, and lung cancer. PROSPR results will help optimize and tailor screening.
 
Kaiser Permanente Research Bank (KPRB) Cancer Cohort
The KPRB Cancer Cohort is a national resource for understanding genetic, lifestyle, and environmental factors that contribute to cancer etiology and survival. EHR data, stored tissue specimens, detailed treatment data, and ability to follow patients for recurrence and mortality are accelerating progress toward improved cancer care.
 
Selected KPWHRI cancer research projects 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. 

Recent publications on Cancer

Calip GS, Yu O, Boudreau DM, Shao H, Oratz R, Richardson SB, Gold HT. Diabetes and differences in detection of incident invasive breast cancer. Cancer Causes Control. 2019;30(5):435-441. doi: 10.1007/s10552-019-01166-2. Epub 2019 Apr 4. PubMed

Boudreau DM, Chen L, Yu O, Bowles EJA, Chubak J. Risk of second breast cancer events with chronic opioid use in breast cancer survivors. Pharmacoepidemiol Drug Saf. 2019 Apr 3. doi: 10.1002/pds.4779. [Epub ahead of print]. PubMed

Brooks GA, Uno H, Aiello Bowles EJ, Menter AR, O'Keeffe-Rosetti M, Tosteson ANA, Ritzwoller DP, Schrag D. Hospitalization risk during chemotherapy for advanced cancer: development and validation of risk stratification models using real-world data. JCO Clin Cancer Inform. 2019;(3):1-10. doi: 10.1200/CCI.18.00147. PubMed

Miglioretti DL, Abraham L, Lee CI, Buist DSM, Herschorn SD, Sprague BL, Henderson LM, Tosteson ANA, Kerlikowske K. Digital breast tomosynthesis: radiologist learning curve. Radiology. 2019;291(1):34-42. doi: 10.1148/radiol.2019182305. Epub 2019 Feb 26. PubMed

Haas CB, Phipps AI, Hajat A, Chubak J, Wernli KJ. Time to fecal immunochemical test completion for colorectal cancer screening. Am J Manag Care. 2019 Apr;25(4):174-180. PubMed

Researchers in Cancer

Diana S. Buist, PhD, MPH

Director of Research and Strategic Partnerships; Senior Investigator
206-287-2931
Diana.S.Buist@kp.org

Curriculum vitae (CV)

Diana L. Miglioretti, PhD

Senior Investigator, KPWHRI; Dean’s Professor of Biostatistics, University of California, Davis
206-287-4266
dmiglioretti@ucdavis.edu

Curriculum vitae (CV)

Edward H. Wagner, MD, MPH

Director (Emeritus, Retired), MacColl Center for Health Care Innovation
206-287-2877
Brian.T.Austin@kp.org

Curriculum vitae (CV)

Beverly B. Green, MD, MPH

Senior Investigator
206-287-2997
Bev.B.Green@kp.org

Curriculum vitae (CV)

Karen Wernli, PhD

Associate Investigator
206-287-2934
Karen.J.Wernli@kp.org

Curriculum vitae (CV)

Erin J. Bowles, MPH

Research Associate
206-287-2708
Erin.A.Bowles@kp.org

Curriculum vitae (CV)

Denise M. Boudreau, PhD

Senior Investigator
206-287-2067
Denise.M.Boudreau@kp.org

Curriculum vitae (CV)

Jennifer B. McClure, PhD

Director of Research, Faculty, & Development; Senior Investigator
206-287-2737
Jennifer.B.Mcclure@kp.org

Curriculum vitae (CV)

Jessica Chubak, PhD, MBHL

Senior Investigator
206-287-2556
Jessica.Chubak@kp.org

Curriculum vitae (CV)

Andrea J. Cook, PhD

Senior Investigator
206-287-4257
Andrea.J.Cook@kp.org

Curriculum vitae (CV)

Nora Henrikson, PhD, MPH

Assistant Investigator
206-287-4675
Nora.B.Henrikson@kp.org

Curriculum vitae (CV)

Aruna Kamineni, PhD, MPH

Assistant Investigator
206-287-2922
Aruna.S.Kamineni@kp.org

Curriculum vitae (CV)

Ellen O'Meara, PhD

Research Associate
206-287-2938
Ellen.S.O'Meara@kp.org

Curriculum vitae (CV)

Melissa L. Anderson, MS

Senior Biostatistician
206-287-2647
Melissa.L.Anderson@kp.org

Curriculum vitae (CV)

Laura E. Ichikawa, MPH

Senior Biostatistician
206-287-2395
Laura.E.Ichikawa@kp.org

Curriculum vitae (CV)

Onchee Yu, MS

Senior Biostatistician
206-287-2389
Onchee.Yu@kp.org

Curriculum vitae (CV)

Eric Johnson, MS

Biostatistician
206-287-2105
Eric.Johnson@kp.org

Curriculum vitae (CV)

Rod L. Walker, MS

Biostatistician
206-287-2895
Rod.L.Walker@kp.org

Curriculum vitae (CV)

Weiwei Zhu, MS

Biostatistician III
206-442-5215
Weiwei.Zhu@kp.org

Curriculum vitae (CV)

Robert D. Wellman, MS

Biostatistician
206-287-2557
Robert.D.Wellman@kp.org

Curriculum vitae (CV)

Gaia Pocobelli, PhD

Research Associate
206-287-2914
Gaia.S.Pocobelli@kp.org

Curriculum vitae (CV)

Marlaine Gray, PhD

Assistant Investigator
206-287-2620
Marlaine.S.Figueroagray@kp.org

Curriculum vitae (CV)

David S. Carrell, PhD

Assistant Investigator
206-287-2705
David.S.Carrell@kp.org

Curriculum vitae (CV)

Rebecca Y. Coley, PhD

Assistant Investigator
206-287-2071
Rebecca.Y.Coley@kp.org

Curriculum vitae (CV)

Predrag Klasnja, PhD

Associate Investigator, KPWHRI; Assistant Professor of Information, University of Michigan School of Information
206-442-5207
Predrag.V.Klasnja@kp.org

Curriculum vitae (CV)

Lu Chen, PhD, MPH

Assistant Investigator
206-287-2024
Lu.Chen@kp.org

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