Hutchinson Institute for Cancer Outcomes Research

Studies

HICOR

The following are studies being conducted by HICOR faculty and collaborators.

Center for Comparative Effectiveness Research in Cancer Genomics

Principal Investigator: Scott Ramsey, M.D., Ph.D.
Funding Source:  National Institutes of Health

CANCERGEN logo

The Center for Comparative Effectiveness Research in Cancer Genomics (CANCERGEN) is a multidisciplinary collaborative consortium that includes the Fred Hutchinson Cancer Research Center, University of Washington, the Center for Medical Technology Policy (CMTP), and SWOG (a clinical trials Cooperative Group funded by the National Cancer Institute). The overall objective of CANCERGEN is to generate high-quality evidence regarding the clinical utility and economic impact of promising genomic technology applications versus standard care in oncology. An essential feature of this project is the role of an External Stakeholder Advisory Group (ESAG), created to inform the prioritization and design of comparative effectiveness studies for future conduct within SWOG. CANCERGEN provides a model for establishing and refining stakeholder engagement practices for CER research in complex organizational settings.  Through the CANCERGEN collaboration, SWOG has implemented a comparative effectiveness trial in breast cancer evaluating the use of gene expression profiling to guide chemotherapy treatment decisions.

A Study of Cancer Diagnosis as a Risk Factor for Personal Bankruptcy

Principal Investigator: Scott Ramsey, M.D., Ph.D.
Funding Source: National Cancer Institute

Bankruptcy may represent a unique and heretofore unstudied potential source of health disparity.  In this study, we formed a novel partnership with the Federal Bankruptcy Court and the National Cancer Institute’s SEER cancer registry to link bankruptcy records for cancer patients and a matched control population without cancer.  Our findings indicate that  that cancer patients experience excess rates of bankruptcy compared to persons without cancer, results that have potentially important implications for those researching the causes of cancer disparity, and for policymakers seeking to mitigate the economic as well as clinical burden of persons with cancer.

Cost-Effectiveness Analysis Alongside Clinical Trials

A Multi-Center, Phase III, Randomized Trial of Reduced Intensity Conditioning (RIC) and Transplantation of Double Unrelated Umbilical Cord Blood (dUCB) versus HLA-Haploidentical Related Bone Marrow (haplo-BM) for Patients with Hematologic Malignancies

Principal Investigator: Scott Ramsey, M.D., Ph.D.
Funding Source: NIH Heart, Lung and Blood Institute

The BMT CTN 1101 parent trial is a Phase III, randomized, open label, multicenter, prospective, comparative trial of double unrelated umbilical cord blood (dUCB) versus HLA-Haploidentical related bone marrow (haplo-BM) transplantation after reduced intensity conditioning (RIC) in patients with hematologic malignancies. This clinical trial is being led by Dr. Paul O’Donnell at Seattle Cancer Care Alliance. In conjunction with this clinical trial, Dr. Scott Ramsey is spearheading a parallel cost-effectiveness analysis substudy to determine the incremental cost per quality adjusted life years (QALYs), of double unrelated umbilical cord blood (dUCB) versus HLA-Haploidentical related bone marrow (haplo-BM). The purpose of this ancillary cost-effectiveness analysis substudy is to compare patient outcomes to determine which transplantation source improves quality-adjusted survival and whether the more effective transplant type also provides a cost savings to the health care payer. BMT CTN 1101 is one of the first trials to study the total cost of transplantation by collecting out-of-pocket costs from patients and caregivers. The results of this cost-effectiveness substudy will have the potential to fundamentally change treatment decision-making for patients by maximizing health outcomes for patients and helping patients and health insurers to manage high transplantation costs.

Technology Development Collaboration

Principal Investigator: Scott Ramsey, M.D., Ph.D.
Funding Source: GE Healthcare via Center for Sustainable Health

This collaboration between GE Healthcare, Arizona State University’s Center for Sustainable Health, and Fred Hutchinson Cancer Research Center uses multi-stakeholder engagement, and early cycle health economic evaluation to identify, prioritize and evaluate the diagnostic technologies early in the research and development process.  The aim of this collaborative project is use a systems-based, stakeholder-guided approach to develop cost-effective, evidence-based diagnostics that improve human health and are well-positioned for clinical implementation.

Advancing Innovative Comparative Effectiveness in Cancer Diagnostics (ADVICE)

Principal Investigators: Larry Kessler, Sc.D.; Scott Ramsey, M.D., Ph.D.; Sean Sullivan, Ph.D.; Diana Buist, Ph.D.

Funding Source: National Cancer Institute

ADVancing Innovative Comparative Effectiveness research-cancer diagnostics (ADVICE) is a collaboration between researchers at Fred Hutchinson Cancer Research Center (FHCRC), Group Health Research Institute (GHRI), the University of Washington (UW), and the Veterans Administration (VA) of Puget Sound.    

The ADVICE project, performed with active involvement of local stakeholders, developed a data infrastructure for comparative effectiveness research studies that linked private and public insurance claims data with the SEER Cancer Registry.   Initial analyses focused on MRI, PET/PET-CT and CT compared to mammography for women with local, regional and advanced stage breast cancer as well as the use of PET/PET-CT for staging of newly diagnosed NSCLC patients. The resulting dataset consists of more than 85% of patients in the public and private insurance market (excluding the self-insured) in Western Washington.  The size and inclusiveness of this database allows for results to be generalized to other regions and nationally.  

Impact of Bevacizumab Use on Overall Survival in Metastatic Colorectal Cancer Patients Treated in the Community

Principal Investigator: Veena Shankaran, M.D., M.S.
Funding Source: Genentech, Inc.

This research initiative aims to understand the impact of bevacizumab use in overall survival for patients diagnosed with metastatic colorectal cancer using SEER-Medicare claims data. In collaboration with Genentech, Inc., this retrospective database study is led by Dr. Shankaran, gastrointestinal oncologist at Seattle Cancer Care Alliance and clinical investigator at the Fred Hutchinson Cancer Research Center.  Bevacizumab is a monoclonal antibody drug marketed by Genentech, Inc. that has become an essential component of colorectal cancer therapy in the last several years.  Although the use of bevacizumab in combination with chemotherapy for the first-line treatment of metastatic colorectal cancer (mCRC) has been shown to improve overall survival in large clinical trials, the impact of bevacizumab on patient survival in community practices in the United States is not known. 

Outcomes and Costs of Low-Dose Computed Tomography for Early Detection of Lung Cancer: A Pilot Study

Principal Investigator: Bernardo Goulart, M.D., M.S.
Funding Source: The Gregory Fund for Early Cancer Detection Research

To address the uncertainties associated with low-dose CT (LDCT) screening for lung cancer, Dr. Goulart and collaborators at the Hutchinson Institute for Cancer Outcomes Research (HICOR) have developed a pilot registry of patients undergoing LDCT screening at the Seattle Cancer Care Alliance (SCCA). This single center pilot study conducts chart reviews and patient surveys using the EQ-5-D and SF-12 quality of life questionnaires to collect prospective data on LDCT test performance (true and false positive rates), health-related quality of life at baseline, 3, and 6 months after screening, healthcare resource utilization, medical complications, adherence to guidelines for patient selection, and smoking cessation rates. This pilot project has been critical for establishing the research infrastructure for data collection in a single academic medical center and will generate insightful preliminary data about the characteristics of the initial patients screened in practice and the clinical and economic outcomes of LDCT screening after the release of the NLST results.

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