Clinical Areas of Research
Early lung cancer detection and lung cancer screening
A landmark randomized trial published in 2011 identified a reduction in mortality from lung cancer with screening using low dose computed tomography. While the benefit of lung cancer screening has been widely established, much research is needed to determine effective implementation and equitable access.
On a national scale, our research goal has been to determine whether populations eligible for lung cancer screening and at a high risk for lung cancer have access to facilities offering lung cancer screening. Much of our research, however, focuses on lung cancer screening within our Pacific Northwest Healthcare Network, where we are aiming to determine the barriers to implementation of lung cancer screening programs, the quality of existing lung cancer screening programs and the outcomes of lung cancer screening performed in our community setting.
We have an interest in identifying and addressing the disparities that exist in minority populations accessing lung cancer screening. We are embarking on a project funded by a $100,000 grant awarded by the Lung Ambition Alliance to identify, quantify and understand current issues in access to lung cancer screening services in Washington State American Indian and Alaska Native populations.
A common, and often recurrent, complication of advanced neoplastic disease is a malignant pleural effusion. This complication imparts a significant burden, not only on the patient’s quality of life and independence, but on their caregivers and the healthcare system as well.
An area of our research focus is the management of malignant pleural effusions, and in particular, the utilization of tunneled pleural catheters. A primary project in progress is assessment of the risk of infection related to tunneled pleural catheters in patients on antineoplastic therapy with an immunocompromised state, as well as the temporal implementation and utilization of these catheters.
We also have an interest in pleural-based infections. When drainage of a complicated pleural space infection fails, there exist two competing management strategies: surgery or dual-agent fibrinolytic therapy.
Our first endeavor was to answer the question of which management strategy may be superior and to determine which factors may be predictive of treatment failure and treatment crossover via a large retrospective review of patients within our Healthcare Network. In addition, we are currently running a randomized controlled trial to determine the feasibility of a management algorithm of pleural-based infections as a pilot study in anticipation of a multicenter randomized controlled trial. There is also, concurrently, a qualitative research study to measure and evaluate the quality of life of patients undergoing each management strategy.
Palliative care in advanced malignant disease
Early referral of patients with stage IV non-small cell lung cancer to outpatient palliative care has been shown to increase survival, improve quality of life and reduce unnecessary use of healthcare resources. Thus, the American Society of Clinical Oncology has recommended an automatic referral to outpatient palliative care for eligible patients, and the National Quality Forum has endorsed metrics to measure quality and aggressiveness of end-of-life care.
Our interest in the utilization of palliative care and the subsequent end-of-life resource utilization in this patient population has a two-tiered approach: the high level multistate, community-based hospital network view and the granular hospital system view.