Skip to main content

Advertisement

Log in

The Pathways Study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California

  • Original Paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Objective

With 2.3 million breast cancer survivors in the US today, identification of modifiable factors associated with breast cancer recurrence and survival is increasingly important. Only recently new studies have been designed to examine the impact of lifestyle factors on prognosis, including Pathways, a prospective study of women with breast cancer in Kaiser Permanente Northern California (KPNC).

Methods

Pathways aims to examine the effect on recurrence and survival of (1) lifestyle factors such as diet, physical activity, quality of life, and use of alternative therapies and (2) molecular factors such as genetic polymorphisms involved in metabolism of chemotherapeutic agents. Eligibility includes any woman diagnosed with invasive breast cancer within KPNC, no previous diagnosis of other invasive cancer, age 21 years or older, and ability to speak English, Spanish, Cantonese, or Mandarin. Newly diagnosed patients are identified daily from electronic pathology records and are enrolled within two months of diagnosis. An extensive baseline interview is conducted, blood and saliva samples are collected, and body measurements are taken. Women are followed for lifestyle updates, treatment, and outcomes by self-report and query of KPNC databases.

Results

Recruitment began in 9 January, 2006, and as of 16 January, 2008, 1,539 women have been enrolled along with collection of 1,323 blood samples (86%) and 1,398 saliva samples (91%).

Conclusions

The Pathways Study will become a rich resource to examine behavioral and molecular factors and breast cancer prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. http://www.cancer.org, American Cancer Society. 2006

  2. Ambrosone CB, Rebbeck TR, Morgan GJ et al (2006) New developments in the epidemiology of cancer prognosis: traditional and molecular predictors of treatment response and survival. Cancer Epidemiol Biomarkers Prev 15(11):2042–2046. doi:10.1158/1055-9965.EPI-06-0827

    Article  PubMed  Google Scholar 

  3. Kushi LH, Kwan ML, Lee MM, Ambrosone CB (2007) Lifestyle factors and survival in women with breast cancer. J Nutr 137(1 Suppl):236S–242S

    PubMed  CAS  Google Scholar 

  4. Rock CL, Demark-Wahnefried W (2002) Can lifestyle modification increase survival in women diagnosed with breast cancer? J Nutr 132(11 Suppl):3504S–3507S

    PubMed  CAS  Google Scholar 

  5. Rock CL, Demark-Wahnefried W (2002) Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. J Clin Oncol 20(15):3302–3316. doi:10.1200/JCO.2002.03.008

    Article  PubMed  Google Scholar 

  6. World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, Washington, DC

  7. Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241. doi:10.1056/NEJMoa022152

    Article  PubMed  Google Scholar 

  8. Fisher B, Jeong JH, Bryant J et al (2004) Treatment of lymph-node-negative, oestrogen-receptor-positive breast cancer: long-term findings from National Surgical Adjuvant Breast and Bowel Project randomised clinical trials. Lancet 364(9437):858–568. doi:10.1016/S0140-6736(04)16981-X

    Article  PubMed  CAS  Google Scholar 

  9. Carlson RW, Brown E, Burstein HJ et al (2006) NCCN Task Force Report: adjuvant therapy for breast cancer. J Natl Compr Canc Netw 4(Suppl 1):S1–S26

    Google Scholar 

  10. Buyse M, Loi S, van’t Veer L et al (2006) Validation and clinical utility of a 70-gene prognostic signature for women with node-negative breast cancer. J Natl Cancer Inst 98(17):1183–1192

    Article  PubMed  CAS  Google Scholar 

  11. Paik S, Shak S, Tang G et al (2004) A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med 351(27):2817–2826. doi:10.1056/NEJMoa041588

    Article  PubMed  CAS  Google Scholar 

  12. Doyle C, Kushi LH, Byers T et al (2006) Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin 56(6):323–353

    PubMed  Google Scholar 

  13. Centers for Disease Control and Prevention NCfHS (1999–2000) National Health and Nutrition Examination Survey. NHANES 1999–2000 Public Data Release File Documentation, Available at: http://www.cdc.gov/nchs/data/nhanes/gendoc.pdf

  14. Centers for Disease Control and Prevention NCfHS (2000–2001) National Health and Nutrition Examination Survey. NHANES 2001–2002 Public Data General Release File Documentation. Available at: http://www.cdc.gov/nchs/data/nhanes/nhanes_01_02/general_data_release_doc.pdf

  15. U.S. Department of Agriculture ARS (2006) USDA food and nutrient database for dietary studies 2.0

  16. Schakel SF, Buzzard IM, Gebhardt SE (1997) Procedures for estimating nutrient values for food composition databases. J Food Composition Anal. 10:102–114. doi:10.1006/jfca.1997.0527

    Article  CAS  Google Scholar 

  17. Schakel SF, Sievert YA, Buzzard IM (1988) Sources of data for developing and maintaining a nutrient database. J Am Diet Assoc 88(10):1268–71

    PubMed  CAS  Google Scholar 

  18. Bair YA, Gold EB, Greendale GA et al (2002) Ethnic differences in use of complementary and alternative medicine at midlife: longitudinal results from SWAN participants. Am J Public Health 92(11):1832–1840

    Article  PubMed  Google Scholar 

  19. Lee MM, Lin SS, Wrensch MR, Adler SR, Eisenberg D (2000) Alternative therapies used by women with breast cancer in four ethnic populations. J Natl Cancer Inst 92(1):42–47. doi:10.1093/jnci/92.1.42

    Article  PubMed  CAS  Google Scholar 

  20. Pierce JP, Faerber S, Wright FA et al (2002) A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women’s Healthy Eating and Living (WHEL) Study. Control Clin Trials 23(6):728–756. doi:10.1016/S0197-2456(02)00241-6

    Article  PubMed  Google Scholar 

  21. Gammon MD, Neugut AI, Santella RM et al (2002) The Long Island Breast Cancer Study Project: description of a multi-institutional collaboration to identify environmental risk factors for breast cancer. Breast Cancer Res Treat 74(3):235–254. Medline doi:10.1023/A:1016387020854

    Article  PubMed  CAS  Google Scholar 

  22. Caan B, Sternfeld B, Gunderson E, Coates A, Quesenberry C, Slattery ML (2005) Life After Cancer Epidemiology (LACE) Study: a cohort of early stage breast cancer survivors (United States). Cancer Causes Control 16(5):545–556. doi:10.1007/s10552-004-8340-3

    Article  PubMed  Google Scholar 

  23. Staten LK, Taren DL, Howell WH et al (2001) Validation of the Arizona activity frequency questionnaire using doubly labeled water. Med Sci Sports Exerc 33(11):1959–1967. doi:10.1097/00005768-200111000-00024

    Article  PubMed  CAS  Google Scholar 

  24. Brady MJ, Cella DF, Mo F et al (1997) Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol 15(3):974–986

    PubMed  CAS  Google Scholar 

  25. Cella D, Peterman A, Hudgens S, Webster K, Socinski MA (2003) Measuring the side effects of taxane therapy in oncology: the functional assesment of cancer therapy-taxane (FACT-taxane). Cancer 98(4):822–831. doi:10.1002/cncr.11578

    Article  PubMed  CAS  Google Scholar 

  26. Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401. doi:10.1177/014662167700100306

    Article  Google Scholar 

  27. Scheier MF, Carver CS (1985) Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol 4(3):219–247. doi:10.1037/0278-6133.4.3.219

    Article  PubMed  CAS  Google Scholar 

  28. Neighbors HW, Jackson JS, Bowman PJ, Gurin G (1983) Stress, coping, and Black mental health: preliminary findings from a national study. Prev Hum Serv 2(3):5–29

    PubMed  CAS  Google Scholar 

  29. Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM (2005) Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med 61(7):1576–1596. doi:10.1016/j.socscimed.2005.03.006

    Article  PubMed  Google Scholar 

  30. Chew LD, Bradley KA, Boyko EJ (2004) Brief questions to identify patients with inadequate health literacy. Fam Med 36(8):588–594

    PubMed  Google Scholar 

  31. Stewart AL, Napoles-Springer AM, Gregorich SE, Santoyo-Olsson J (2007) Interpersonal processes of care survey: patient-reported measures for diverse groups. Health Serv Res 42(3 Pt 1):1235–1256. doi:10.1111/j.1475-6773.2006.00637.x

    Article  PubMed  Google Scholar 

  32. Llewellyn-Thomas HA, McGreal MJ, Thiel EC, Fine S, Erlichman C (1991) Patients’ willingness to enter clinical trials: measuring the association with perceived benefit and preference for decision participation. Soc Sci Med 32(1):35–42. doi:10.1016/0277-9536(91)90124-U

    Article  PubMed  CAS  Google Scholar 

  33. O’Malley AS, Sheppard VB, Schwartz M, Mandelblatt J (2004) The role of trust in use of preventive services among low-income African-American women. Prev Med 38(6):777–785. doi:10.1016/j.ypmed.2004.01.018

    Article  PubMed  Google Scholar 

  34. Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32(6):705–714. doi:10.1016/0277-9536(91)90150-B

    Article  PubMed  CAS  Google Scholar 

  35. Oehrli MD, Quesenberry CP, Leyden W (2006) Annual report on trends, incidence, and outcomes. 2006, Kaiser Permanente, Northern California Cancer Registry

  36. Irwin ML, McTiernan A, Bernstein L et al (2004) Physical activity levels among breast cancer survivors. Med Sci Sports Exerc 36(9):1484–1491

    PubMed  Google Scholar 

  37. Lu W, Cui Y, Zheng Y et al (2007) Impact of newly diagnosed breast cancer on quality of life among Chinese women. Breast Cancer Res Treat 102(2):201–210. doi:10.1007/s10549-006-9318-5

    Article  PubMed  Google Scholar 

  38. Jacobson JS, Workman SB, Kronenberg F (2000) Research on complementary/alternative medicine for patients with breast cancer: a review of the biomedical literature. J Clin Oncol 18(3):668–683

    PubMed  CAS  Google Scholar 

  39. Bloechl-Daum B, Deuson RR, Mavros P, Hansen M, Herrstedt J (2006) Delayed nausea and vomiting continue to reduce patients’ quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol 24(27):4472–4478. doi:10.1200/JCO.2006.05.6382

    Article  PubMed  CAS  Google Scholar 

  40. Macquart-Moulin G, Viens P, Bouscary ML et al (1997) Discordance between physicians’ estimations and breast cancer patients’ self-assessment of side-effects of chemotherapy: an issue for quality of care. Br J Cancer 76(12):1640–1645

    PubMed  CAS  Google Scholar 

  41. Miller M, Kearney N (2004) Chemotherapy-related nausea and vomiting–past reflections, present practice and future management. Eur J Cancer Care (Engl) 13(1):71–81. doi:10.1111/j.1365-2354.2004.00446.x

    Article  CAS  Google Scholar 

  42. McWayne J, Heiney SP (2005) Psychologic and social sequelae of secondary lymphedema. Cancer 104(3):457–466. doi:10.1002/cncr.21195

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all Pathways Study office and field staff, and most importantly, the participants. The Pathways Study is supported by the National Cancer Institute (R01 CA105274). The ancillary studies are supported by the U.S. Department of Defense (BC043120), American Cancer Society (RSG-06-209-01-LR), and National Cancer Institute (R01 CA124924). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the funding agencies.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marilyn L. Kwan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kwan, M.L., Ambrosone, C.B., Lee, M.M. et al. The Pathways Study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California. Cancer Causes Control 19, 1065–1076 (2008). https://doi.org/10.1007/s10552-008-9170-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-008-9170-5

Keywords

Navigation