Researchers will use PCORnet® resources to explore whether cancer screening practices change after weight loss surgery

Posted on September 13, 2023November 14, 2023 by Jodi Snare

According to the U.S. Centers for Disease Control and Prevention, 40 percent of all cancers diagnosed in the U.S. since 2014 were associated with overweight and obesity. Can weight loss associated with bariatric surgery reduce the risk of some cancers? Maybe, according to a recent meta-analysis of several key studies, which found that people with obesity who had bariatric surgery had a substantially lower risk of developing five types of solid tumors. But it remains unclear if the factors driving the risk reductions might be physical, behavioral, or both.

Now, a new study funded by the National Cancer Institute (NCI) will use PCORnet resources to understand if one of those factors is a change in adherence to recommended preventative cancer screenings after bariatric surgery. We know, for example, that women with obesity are less likely to undergo regular screenings, like pap smears and mammograms. Investigators for the new PCORnet® Study will determine if undergoing bariatric surgery influences such trends.

“People living with obesity are at higher risk for many types of cancer, and yet they tend to have lower rates of cancer screening than other individuals. As a result, when cancer occurs, it may be detected later, which can contribute to worse outcomes,” said Kathleen McTigue, principal investigator for the PaTH Clinical Research Network, one of six PCORnet^® Network Partners contributing to the NCI study. “This study will help us better understand the impact of bariatric surgery on preventive screening practices.”

McTigue believes the challenges that people who are living with severe obesity face regarding cancer screening could be reduced following bariatric surgery. For example, in the process of preparing for surgery, patients may become more familiar with the healthcare system and aware of the need for screening. Likewise, weight loss may lesson concerns related to body image and modesty.

Building on earlier PCORnet-leveraged work

NCI’s interest in PCORnet as a resource to fuel its research stemmed from the successful PCORnet^® Bariatric Study, which launched in 2016 as a retrospective, observational comparative effectiveness study designed to capture accurate estimates of 1-, 3-, and 5-year benefits and risk of bariatric surgery. Using PCORnet resources, the study team collaborated with 41 sites across the U.S. to glean insights related to more than 46,000 patients. Its results continue to provide important reference information for patients and providers about real-world bariatric surgery outcomes.

“NCI approached us through the PCORnet^® Front Door to see if we could leverage the patient and data partnerships established with the original bariatric study to bring new insights around cancer screenings to light,” said McTigue. “It has been wonderful to see the Network recognized for its capacity to support research at scale and surface new answers around cancer and obesity, two important topics that impact millions of Americans.”

The project will find answers by looking at de-identified electronic health record (EHR) information accessible across six sites participating in PCORnet. As with all PCORnet^® Studies, the NCI study will embed patient input throughout the project lifecycle, with bariatric surgery recipient Neely Williams serving on the study leadership team and sitting on its Stakeholder Engagement Committee.

“I am thrilled to be a part of this important research, which will bring more clarity to the relationship between bariatric surgery and cancer—a question that is certainly of great interest to bariatric surgery recipients like me,” said Williams. “The participation of myself and others on NCI’s Stakeholder Engagement Committee for this study will help ensure the lived experience of patients is considered in the development and execution of this research.”

Looking to the future

McTigue hopes that this initial study is only the beginning. This work may ultimately lead to a larger NCI project exploring other connections between weight loss and cancer via PCORnet. Such work would link EHR data with tumor registry data, building from the PCORnet^® NET-PRO Study, which is currently comparing the effects of different treatment approaches on neuroendocrine tumors.

“We are excited by the potential for PCORnet to serve as a powerful resource for conducting large-scale cancer research,” said McTigue. “Cancer is consistently a leading cause of death in the US, and over 40% of US adults live with obesity. We need to learn all we can as quickly as possible—and thankfully, PCORnet offers the infrastructure to make it happen.”

Comparing the Benefits and Harms of Three Types of Weight Loss Surgery — The PCORnet® Bariatric Study

Posted on May 1, 2023March 5, 2024 by Jodi Snare

Study Updated 03/05/2024

Study Website: The PCORnet Bariatric Study (PBS)
ClinicalTrials.gov#: NCT02741674
Study Design: Retrospective Observational
PCORnet Infrastructure: Collaboration, CDM, Engagement
Principal Investigator: David Arterburn
Site Name: Kaiser Permanente Washington Health Research Institute
PCORnet® Network Partner: Legacy PCORnet Partner
Funder: Patient-Centered Outcomes Research Institute (PCORI); (Project webpage)
Funding Date: 2015
Study Duration: 2016 – 2018
Participating Clinical Research Networks: ADVANCE, GPC, INSIGHT, OneFlorida+, PaTH, PEDSnet, REACHnet, STAR
Therapeutic Area: Gastroenterology
Condition: Bariatrics, Body Weight, Diabetes, Gastric Bypass, Obesity
Population: up to 79 Years (Child, Adult, Older Adult)
Status: Completed

Research Question(s):
We don’t know much about the long-term effectiveness of bariatric interventions. Can we use PCORnet to compare compare weight loss and safety among three popular bariatric procedures?

Primary Publication(s):
Comparative effectiveness of bariatric procedures among adolescents: the PCORnet bariatric study
Inge TH, Coley RY., Bazzano LA,. et al. Comparative effectiveness of bariatric procedures among adolescents: the PCORnet bariatric study. SOARD, 2018, 14(9):1374-1386.

Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass: The National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study
McTigue KM, Wellman R, Nauman E, et al. PCORnet Bariatric Study Collaborative. Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass: The National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study. JAMA Surg. 2020;155(5):e200087. doi: 10.1001/jamasurg.2020.0087. Epub 2020 May 20. PMID: 32129809; PMCID: PMC7057171.

PCORnet is Delivering Important COVID-19 Answers

Posted on February 11, 2021November 14, 2023 by Jodi Snare

With access to coordinated heath data from more than 70 million people across the United States, PCORnet®, the National Patient-Centered Clinical Research Network, is a key resource in the fight against COVID-19. To maximize its utility, the Patient-Centered Outcomes Research Institute (PCORI) offered enhancement funding for nine existing PCORnet-enabled research studies. The idea behind these enhancement awards is to leverage existing infrastructure from PCORI-funded research to more efficiently expand understanding of COVID-19 and address this public health crisis.

One of many lessons learned from the COVID-19 pandemic is that good public health decisions in times of crisis require fast analysis of diverse patient data. While many healthcare organizations across the U.S. have the capacity to use their electronic health records (EHRs) and claims data as tools for horizon-scanning and disease surveillance, few offer the infrastructure to support the large-scale integration needed in the pandemic. The coordinated, interoperable infrastructure of PCORnet supports that needed speed and efficiency.

Following are a few snapshots of how PCORI-funded enhancement awards are supporting the use of PCORnet to combat the pandemic:

The Identifying and Predicting Patients with Preventable High Utilization project initially set out to use PCORnet to better understand and support people who frequently visit health care systems. With a COVID-19 enhancement award from PCORI, the research team will use the project’s existing infrastructure to develop prediction models to plan for resource needs and improve outcomes for patients hospitalized with COVID-19.
Variation in Case Management Programs and Their Effectiveness in Managing High-Risk Patients for Medicare ACOs, a project using PCORnet resources to improve case management programs in health systems, is expanding its scope to understand how the pandemic-driven shift to telehealth is affecting care and health outcomes for older patients with multiple chronic health problems.
Comparing Ways for Patients and Clinics to Improve Blood Pressure Control seeks to monitor how well clinics and patients are controlling blood pressure. With its enhancement award, it will use the same PCORnet-enabled cohort of patients to examine how taking different types of blood pressure medicines affects patients’ risk for contracting COVID-19 and severity of infection.
As patients with type 2 diabetes may have a higher risk of severe COVID-19 infections, the project team for Comparing Medicines for Treating Type 2 Diabetes among Patients with Chronic Kidney Disease is using its established data resources enabled by PCORnet to look at whether people with type 2 diabetes have a higher risk of COVID-19-related hospital stays. The team is also comparing rates of COVID-19 hospital stays for people who take different diabetes medicines.
Improving Methods for Extracting Data from Clinicians’ Notes in Electronic Health Records is working to create better methods for obtaining data from PCORnet-accessible EHR notes using natural language processing, or NLP. With NLP, computer programs interpret written language and make it easier to sort and study. With its enhancement award, the project team will use that same NLP technology to examine unstructured clinician notes for COVID-19 patients in an effort to glean new insights that may not be captured in a structured EHR record.
Understanding How Health Policy Affects Weight Loss Counseling and Diabetes Care set out to use PCORnet data resources to understand how the Affordable Care Act’s policy for insurance companies to pay for obesity screening and counseling affects the health of people with, or at risk for, diabetes. Now, it has expanded its scope to better understand outcomes related to the transition to virtual visits for patients with, or at high risk of, diabetes before, during, and after COVID-19.
An established PCORnet-enabled study was working to answer the question: Does Paying Doctors to Virtually Provide Chronic Care Management Improve Health for People with Diabetes Who Have Medicare Coverage? PCORI’s enhancement award is now allowing the team to also look at COVID-19 outcomes for people with type 2 diabetes who have at least one additional chronic disease and are covered by Medicare.
The scope of the Comparing Two Ways to Promote Healthy Weight Gain and Prevent Obesity in Early Childhood project expanded with a COVID-19 enhancement award. Now, the team is also using PCORnet to look at the impact of COVID-19 on families in the study who are participating in the Greenlight and Greenlight Plus programs, two interventions to support parents with low health literacy.

For more information about PCORI’s enhancement awards for COVID-19 research, check out the PCORI funding website.

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