November 14, 2016

Research leads to smarter medicine for cancer survivors

Decades ago, when people heard the word “cancer,” it sounded like a death sentence. Today, that’s not the case. Early detection, diagnosis and treatment have improved. Not only do people survive, they thrive in staggering numbers, and for a very, very long time.

The Kaiser Permanente Southern California Department of Research & Evaluation — one of seven regional research centers within the Kaiser Permanente program — advances cancer prevention and treatment, but also aims to improve life after cancer.

“Attention needs to focus on how we help patients with cancer in the medium and long term,” said Senior Director of Research Steven J. Jacobsen, MD, PhD, “because there is a medium and long term now.”

In 2015, Kaiser Permanente Southern California conducted important research to improve the lives of cancer survivors in many areas including:

  • Mental health: Researchers explored concerns about taking antidepressants at the same time as medications designed to prevent breast cancer recurrence.
  • Preventive care: Researchers looked at whether men with prostate cancer were receiving appropriate preventive care.
  • Understudied populations: Researchers assessed the risk of cardiovascular disease among adolescent and young adult cancer survivors.

Kaiser Permanente is uniquely positioned to weigh the risks and benefits of different cancer treatments in the long term for a broad cross-section of society, said Joanne Schottinger, MD, the clinical lead for cancer for Kaiser Permanente’s Care Management Institute.

“We have a large, ethnically diverse population,” she said, “and most of the patients stay with us for many, many years. So we can answer questions in ways many other health systems can’t.”

Breast cancer and antidepressant medications

One breast cancer study made a big difference for some of patients because it dispelled a concern that antidepressants could lessen the effectiveness of certain anti-cancer medications, said Lara Durna, MD, an oncologist with the Kaiser Permanente South Bay Medical Center. Led by research scientist Reina Haque, PhD, MPH, the study showed no statistical increase in breast cancer recurrence for women who take tamoxifen with an antidepressant, compared to those who take tamoxifen alone.

“It was very reassuring for patients that they could remain stable on their antidepressants and fight their breast cancer,” Dr. Durna said.

Preventive screenings and prostate cancer

Two separate studies explored whether Kaiser Permanente Southern California members with prostate cancer were getting the appropriate screenings for other conditions. The studies found “overall we are doing a good job getting preventive services to them,” said adjunct investigator, Lauren Wallner, PhD, MPH. The work also helped researchers gain a new understanding.

“It seems like the diagnosis of cancer may be an opportunity to discuss screening and managing these other conditions,” Wallner said. “We have an opportunity to address them at a time when the men are motivated for change.”

Cardiovascular disease and young adult cancer survivors

In another study, Robert M. Cooper, MD, the physician director of the cancer program at the Kaiser Permanente Los Angeles Medical Center, and research scientist Chun Chao, PhD, MS, teamed up to look at the impact of cancer and cancer treatment on adolescents and young adults. The work was possible only because of Kaiser Permanente Southern California’s large, relatively stable membership of teens and young adults.

The study showed that adolescent and young adult cancer survivors had twice the risk for developing cardiovascular disease than those without cancer. Also, those who developed cardiovascular disease had 10 times the risk of dying than those who didn’t.

“Now that we have done this work and shown what the issue is, we are actively sharing it with the community at large and determining ways to educate our clinicians and create a system that helps them systematically prevent cardiovascular disease in our cancer survivors,” Dr. Cooper said.

These studies and more are detailed in the Department of Research & Evaluation 2015 Annual Report.