Outcomes Research
The goal of the Division of Outcomes Research is to better understand the after-effects (physical, emotional, and social) of cancer and its treatment. These after-effects may include things such as fatigue, worry, sadness, problems with the heart and lungs, learning difficulties, problems with memory, and second cancers. Gaining a better understanding of these after-effects will help to identify people who are at high risk for having these types complications after cancer treatment, and ways to reduce that risk.
Key research studies include the following:
Saro Armenian, D.O., M.P.H.

Reducing Congestive Heart Failure Risk in Survivors of Childhood Cancer

Congestive heart failure is a condition that occurs when the heart muscle has been weakened and can’t pump blood as well as it should. Many people who were treated for cancer as children received a type of chemotherapy called anthracyclines; those survivors are at a much higher risk of congestive heart failure.  Saro Armenian , D.O., M.P.H., is leading a clinical research study into whether a low dose of the drug carvedilol can reduce the risk of congestive heart failure in childhood cancer survivors who received chemotherapy with anthracyclines.
Disparities in Care Among Adolescents and Young Adults
Some adolescents and young adults (AYAs) with cancer have better outcomes than others, and young minority patients often fare poorly.  Julie Wolfson , M.D, M.S.H.S., is looking into the causes of disparities (differences) in care, to see whether patients’ race or ethnic background or where they have received care affected their survival, while taking into account their disease, how far they traveled for their cancer care, as well as their income, educational level, and other social factors. Wolfson is also comparing the experiences of people diagnosed with sickle cell anemia but not undergoing bone marrow transplants with those of patients who are being treated with such transplants. 

Adherence to Medication and Relapse Risk

A team led by  Smita Bhatia , M.D., M.P.H., the Ruth Ziegler Chair in Population Sciences, is studying programs designed to help pediatric cancer patients diagnosed with acute lymphoblastic leukemia, or ALL, take their home medications as prescribed in order to help prevent relapse. One current study includes an electronic pill-monitoring system, Medication Event Monitoring System, or MEMS, which documents how well patients follow a medication schedule prescribed by their doctors. In this program, all patients receive multimedia patient education, and some patients also receive text-message reminders, Web-based medication scheduling, and printed schedules.

HPV Vaccine in Cancer Survivors

Cancer treatments can place survivors at higher risk for getting illnesses related to the Human Papillomavirus (HPV), the most common sexually transmitted infection in the United States. HPV infection can lead to genital warts and certain cancers, including cervical cancer in women, and cancers of the reproductive system, mouth, and throat in both women and men. In healthy young people, the HPV vaccine has been found to be safe and effective in preventing infection with four of the most common strains of HPV, including the two strains most commonly associated with cancer.  Wendy Landier , Ph.D., R.N., N.P, is leading a study to find out if the vaccine induces similar levels of protective antibodies against HPV in young cancer survivors.

Low-Dow Tamifoxen in Lowering Breast Cancer Risk for Survivors

City of Hope researcher Melanie Palomares, M.D., M.S., is conducting studies to identify simple interventions like diet, exercise or well-tolerated medications that may help people avoid getting cancer. This includes the prevention of second cancers in cancer survivors. One clinical trial is investigating the use of low-dose tamifoxen to prevent breast cancer among women who have been treated with chest radiation therapy for other cancers.

Key Adverse Events Studies

The use of hematopoietic stem cell transplant (HCT) to treat various medical conditions has improved over the last 20 years. There are now over 100,000 long-term survivors who have received HCT and the number is growing. Most of these survivors are doing well, but some may develop problems after receiving their transplant.  Smita Bhatia , M.D., M.P.H., the Ruth Ziegler Chair in Population Sciences, is leading a study looking into how certain complications, such as diabetes, heart conditions, lung conditions, stroke, bone problems, hormonal imbalances, and second cancers develop, and to see if certain lifestyle factors, treatments, or genes (factors that pass inherited traits from parent to child) are related to an increased risk of getting such complications. Read more about the Key Adverse Events after Hematopoietic Cell Transplantation study
Bhatia is also leading a study to identify patients who are more likely to develop after-effects following treatment for childhood cancer. These after-effects include cardiac dysfunction (a damaged heart that is unable to circulate blood efficiently), avascular necrosis (poor blood supply to an area of the bone that causes permanent bone damage), stroke (blood flow to the brain is interrupted), or a second cancer. Certain people may be at a higher risk for developing these after-effects because of genetic (inherited) factors, treatment given to them for their first cancer, a combination of genetics and treatment, or a cause not understood at this time. About 6,900 patients will likely take part in the study Key Adverse Events After Childhood Cancer.  In people treated for childhood cancers and in those who received HCT, if we understand who is at higher risk of developing complications, then those patients can be checked more closely (such as by having blood tests and other evaluations more often than is done for people at lower risk) in order to prevent the complication from happening, or to find it early, when it is most easily treated.
BMT Study
Donors, recipients and friends and family join City of Hope staff at a BMT reunion. A collaborative research effort between City of Hope and University of Minnesota examines detailed information regarding the long-term health of those treated with BMT.

Blood or Marrow Transplant (BMT) is used to treat many life-threatening illnesses. More than 70% of those who survive the first two years after BMT become long-term survivors. The  BMT Long-term Follow-up Study , a collaborative research effort between City of Hope and University of Minnesota, examines detailed information regarding the long-term health of those treated with BMT. The researchers first assembled a group of 2500 patients who had undergone BMT between 1974 and 1998. Findings from this study helped the researchers to understand the physical and psychological health of people who had received BMT. The  original BMT Long-term Follow-up Study is now including more patients (transplanted up to 2010) and continuing for a longer time period (adding longer follow-up of the original patients in the study) to form the  Expanded BMT Long-term Follow-up Study . This study will continue to look at the health and well-being of individuals undergoing BMT, extend the length of follow-up after transplant, and, by collecting blood or saliva samples, pinpoint genetic (inherited) factors that will allow us to identify people at high risk for developing after-effects of cancer treatment and to individualize their preventive care to help ease the burden of cancer and its after-effects.
The goal of the Expanded Blood or Marrow Transplant Long-term Follow-up Study is to:
  • Understand the long-term health issue faced by patients undergoing BMT
  • Describe the burden of cancer and its after-effects in people who have had a BMT compared to their brothers or sisters of similar age who have not had cancer
  • Describe lifestyle factors, such as use of tobacco and heavy drinking, that can increase the risk of health problems, and  describe how BMT survivors use health care compared to their brothers or sisters of a similar age who have not had cancer
  • Describe the risks of developing long-term after-effects in people undergoing BMT
  • Create a bank of genetic (DNA) specimens for future study to help identify people at highest risk for developing long-term complications of cancer tretment, and how best to treat these conditions

An important part of the Division of Outcomes Research is the  Center for Cancer Survivorship , a clinical long-term follow-up program designed to create a bridge between cancer treatment and community medical care.

The growing number of cancer survivors (estimated at almost 14 million adults in the U.S. alone), need individualized survivorship-focused care.  Development of Survivorship Care Plans is an important part of this care. These care plans are designed to empower cancer survivors, and to encourage health-promoting behavior. City of Hope’s Center for Cancer Survivorship creates plans that address the chronic effects of cancer and its therapy (such as pain, fatigue, premature menopause, worry, and sadness) and provide recommendations for monitoring so that problems can be caught early. That way problems that may develop, such as thinning of the bones (osteoporosis), heart disease and second cancers, can be identified and treated earlier, when treatments are often most effective.
The overall goal of the Center for Cancer Survivorship is to provide specialized long-term follow-up care for cancer survivors, and, in the process, to carry out much-needed research in cancer survivorship. The Center for Cancer Survivorship fulfills these goals by providing individualized, comprehensive follow-up care for cancer survivors in a clinical research setting.  The center continually strives to improve the overall quality of life for cancer survivors.