Cancer

Research overview

Cancer is complex and can be a devastating diagnosis for individuals and their families. Our researchers work to improve cancer control on many levels, from prevention and screening through treatment and survivorship.

Kaiser Permanente Washington Health Research Institute (KPWHRI) has been studying how to provide life-saving breast cancer screening since 1986. In a novel initiative, researchers used a computer-based registry and collaborations with organizations across the U.S. before electronic health records existed and multi-site studies were common. The program led to a rich portfolio of studies on breast, colorectal, blood, cervical, lung, and thyroid cancers.

“Decades later, Kaiser Permanente Washington is just as committed to developing and evaluating innovations in cancer care,” says Karen Wernli, PhD, KPWHRI associate investigator.

Our work in prevention and screening includes:

• Developing and testing interventions to improve screening uptake and quality of care in breast, colorectal, lung, and cervical cancers
• Working to decrease disparities in cancer screening and outcomes
• Identifying the best screening and diagnostic tests and screening intervals
• Increasing screening uptake in individuals who are overdue for routine screening
• Comparing cost-effectiveness of cancer screening and care strategies
• 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 as well as testing novel strategies for reaching relatives who may also be candidates for genetic testing

KPWHRI studies also span treatment and survivorship, such as:

• Improving surveillance strategies for individuals who have a previous cancer diagnosis 
• Understanding patterns of cancer treatment to promote equitable and patient-centered care and understanding the downstream harms and benefits of cancer treatment
• Improving treatment outcomes by identifying effective therapies and increasing the continuity of care
• Identifying factors that affect risk of cancer recurrence
• Supporting long-term care of cancer survivors, including survivors of adolescent and young adult cancers
• Developing and testing ways to prevent and reduce cancer-related financial hardship
• Encouraging thoughtful communication between patients, caregivers, and providers about cancer, palliative care, and end-of-life options
• 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 surveillance 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 cancers. PROSPR results will help optimize and tailor screening for different subgroups of the population.

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. Electronic health record data, stored tissue specimens, detailed treatment data, and the 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 by providing the option to complete 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 through studies focused on radiation therapy, breast density, and tumor biology in collaboration with the National Cancer Institute and Kaiser Permanente Colorado and Northwest
• 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 linked to higher or lower risks of second cancers or cancer recurrence
• Research on ways to increase effective colorectal cancer screening, including advocacy for and outreach to underserved communities
• Work to synthesize evidence on cancer screening and preventive counseling topics through partnership with the Kaiser Permanente Evidence-based Practice Center
• A large suite of studies on improving the health and health care of survivors of adolescent and young adult cancers

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