OAKLAND, Calif. May 7, 2014 — Radiation treatment can help reduce the recurrence of Merkel cell carcinoma, a rare and aggressive skin cancer, while chemotherapy does not appear to have any impact on recurrence or survival, according to a Kaiser Permanente study published online in the current issue of JAMA Dermatology.
The study presents one of the largest single-institution datasets on Merkel cell carcinoma, which occurs in about 1,500 people in the United States annually. Most such cancers occur on the sun-exposed skin of white males and are first diagnosed at age 75, on average. Using the Kaiser Permanente Northern California Cancer Registry, the researchers found that out of 218 cases of Kaiser Permanente patients who had Merkel cell carcinoma, those who had radiation treatment had a 70 percent lower risk of disease recurrence while chemotherapy did not appear to have any impact on recurrence or survival.
"We used our database to show what characteristics impact recurrence and survival in this very rare cancer," said the study's lead author Maryam M. Asgari, MD, MPH, of the Kaiser Permanente Division of Research. "The electronic records allowed us to identify patients with Merkel cell carcinoma, see how they were diagnosed and treated, and then follow them over time to see how their care affected their outcomes."
Using an electronic health record system, Kaiser Permanente HealthConnect®, allowed the researchers to evaluate the relationships between cancer recurrence and survival with demographic information (age, sex, race, immunosuppression) and tumor characteristics (extent, size and location), as well as cancer work-ups (pathologic lymph node evaluation, imaging) and treatments (surgery, radiation and chemotherapy).
The study results also showed that immunosuppression and more advanced tumors were associated with worse survival rates related to Merkel cell carcinoma, and that pathological evaluation of the patient's lymph nodes also had a significant impact on outcomes.
Asgari noted that the success of different work-up and treatment protocols has been difficult to compare for rare cancers. "This research should help dermatologists and oncologists in caring for their patients with Merkel cell carcinomas," she said.
Kaiser Permanente can conduct transformational health research in part because it has the largest private patient-centered electronic health system in the world. The organization's electronic health record system, Kaiser Permanente HealthConnect®, securely connects 9.1 million patients to more than 16,000 physicians in almost 600 medical offices and 37 hospitals. It also connects Kaiser Permanente's research scientists to one of the most extensive collections of longitudinal medical data available, facilitating studies and important medical discoveries that shape the future of health and care delivery for patients and the medical community.
In addition to Asgari, co-authors of the study were Monica M. Sokil, BS, and E. Margaret Warton, MPH, Kaiser Permanente Division of Research, Oakland, Calif.; and Jayasri Iyer, MD, Kelly G. Paulson, MD, PhD, and Paul Nghiem, MD, PhD, Fred Hutchinson Cancer Research Center, Seattle.
The study was funded by the National Cancer Institute, Michael Piepkorn Endowment and UC MCC Patient Gift Fund.
About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR's 550-plus staff is working on more than 250 epidemiological and health services research projects. For more information, visit http://www.dor.kaiser.org or follow us @KPDOR.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 9.1 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to kp.org/share.
Journal
JAMA Dermatology