Based on a Kaiser Permanente study published online in JAMA Dermatology, radiation treatment could help lead to a decrease in the recurrence of Merkel cell carcinoma, a rare and aggressive skin cancer, while chemotherapy appears to have no lasting impact or effect on the disease's recurrence or patient survival.
Kaiser Permanente can carry out transformational health research in part due to it having the largest private patient-centered electronic health system in the world. The institution's electronic health record system, Kaiser Permanente HealthConnect®, safely connects 9.1 million patients to more than 16,000 physicians in almost 600 medical offices and 37 hospitals. It also links Kaiser Permanente's research scientists to one of the most wide-ranging collections of longitudinal medical data available, smoothing the progress of studies and important medical discoveries that shape the future of health and care delivery for patients and the medical community.
The study showcases one of the biggest single-institution datasets on Merkel cell carcinoma, which is contracted in approximately 1,500 people in the United States year round. Most such cancers come about on the sun-exposed skin of Caucasian males and are usually first diagnosed at age 75. Using the Kaiser Permanente Northern California Cancer Registry, the researchers discovered 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 whereas those treated with 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. 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," said the study's lead author Maryam M. Asgari, MD, MPH, of the Kaiser Permanente Division of Research.
Using an electronic health record system, Kaiser Permanente HealthConnect®, authorized the researchers to assess the relationships between cancer recurrence and survival with demographic information (age, sex, race, immunosuppression) and tumor porperties (extent, size and location), in addition to cancer work-ups (pathologic lymph node evaluation, imaging) and treatments (surgery, radiation and chemotherapy).
The study results also revealed that immunosuppression and more advanced tumors were linked with worse survival rates related to Merkel cell carcinoma, and that pathological assessment of the patient's lymph nodes also had a considerable influence on results.
Asgari commented that the success of different work-up and treatment procedures has been hard to compare for rare cancers. "This research should help dermatologists and oncologists in caring for their patients with Merkel cell carcinomas," she said.