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November 28, 2005

Major study of pancreatic cancer features quick case identification

Seattle—Group Health Center for Health Studies and Kaiser Permanente Northern California recently began enrolling volunteers in one of the nation’s largest and most comprehensive studies of pancreatic cancer.

Unique in its ability to rapidly identify cases following diagnosis, the PACFIC ("Pancreatic Cancer Investigation: Finding Causes") study will help scientists better understand environmental and genetic factors that may cause cancer of the pancreas. This, in turn, could lead to better screening and prevention of the disease, which strikes 29,000 American annually, is the fifth leading cause of cancer death in the United States, and has a five-year survival rate of less than 5 percent. The study is funded by a five-year $6 million grant from the National Cancer Institute.

Working with colleagues from the Fred Hutchinson Cancer Research Center (FHCRC) and the University of Washington (UW), scientists from Group Health and Kaiser will use their organizations’ computerized clinical information systems to identify 745 cases soon after diagnosis and collect information via interviews and blood specimens. Data from these cases will then be compared to information from 1,041 other study participants who do not have pancreatic cancer. The scientists plan to include extra numbers of African Americans in the control group to help determine why this racial group has higher rates of pancreatic cancer than the general public.

"The risk factors for pancreatic cancer are not well known, in part because cases of pancreatic cancer are very difficult to identify quickly enough to enroll in research studies," explains Meg Mandelson, PhD, an associate investigator at Group Health’s Center for Health Studies, associate member of the FHCRC, and a co-principal investigator of the study. "By the time a patient has developed signs and symptoms of pancreatic cancer, the disease is usually already fairly advanced." About half of all patients with pancreatic cancer die within six months of diagnosis.

Located deep in the abdomen behind the stomach and other organs, the pancreas gland is a difficult to reach surgically, so there is no single path to diagnose pancreatic cancer. Unlike diseases such as colon cancer, which is nearly always detected from a surgical biopsy, pancreatic cancer may be diagnosed using a combination of imaging (x-ray), blood tests, and surgical biopsies. Historically, this complexity has made it difficult for researchers to identify and reach patients in time to collect data needed for comprehensive evaluation. But new computerized clinical information systems at Group Health and Kaiser are changing this. The researchers in this study conduct daily surveillance of test results in all three areas (radiology, lab, and biopsies) to track nearly all patients with pancreatic cancer in the system soon after diagnosis.

"Group Health and Kaiser Northern California are two of just a handful of research institutions nationwide that have the capacity to do this ‘ultra-rapid case identification’ the study requires," says Mandelson. Once identified, the patient’s physician can give the researchers permission to contact the patient to arrange a 45-minute interview regarding their medical history, family history, medication use, diet, and other environmental factors, and to collect a blood specimen for study.

The researchers are establishing a specimen repository at UW’s Institute for Public Health Genetics and FHCRC to store blood collected in the study so that it can be used over time in studies of the molecular characteristics of pancreatic cancer.

"The study would not be possible without the support and commitment of many people at Group Health and Kaiser—especially their clinical teams in oncology and gastroenterology," Mandelson says.

"We believe that combining data from the study specimen repository with information from patient interviews will allow us to take major steps toward understanding and preventing pancreatic cancer," she adds.

Other investigators on the study team include:

• Co-Principal Investigator John D. Potter, MD, PHD, of FHCRC
• Melissa Austin, PhD, of UW’s Department of Epidemiology
• Teri Brentnall, MD, of UW’s Division of Gastroenterology
• Stephen J. Rulyak, MD, MPH, of UW’s Division of Gastroenterology;
• Alan Kristal, PhD, of FHCRC
• Stephen K. Van Den Eeden, PhD, of FHCRC
• Lawrence H. Kushi, ScD, of Kaiser Permanente Northern California’s Division of Research
• Carolyn Rutter, PhD, of Group Health Center for Health Studies

About Group Health Center for Health Studies

Group Health is a consumer-governed, nonprofit health care system that coordinates care and coverage. Based in Seattle, Group Health and Group Health Options, Inc. serve nearly 550,000 members in Washington and Idaho. Group Health Center for Health Studies conducts research related to prevention, diagnosis, and treatment of major health problems. Group Health Center for Health Studies is funded primarily through government and private research grants.

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