Engaging Primary Care Providers in Cancer Survivorship Care
On any given weekend, Erin Hahn, Ph.D., M.P.H., might be found tending native plants like sage, salvia, and mallow in her garden, with her husband and three rescue dogs nearby. During the week, this penchant for cultivating spills into her work as a researcher at the Kaiser Permanente Southern California Department of Research and Evaluation to improve care for cancer survivors.
Erin studies cancer care delivery with a focus on cancer survivorship, a phase that people enter after receiving a cancer diagnosis and a research area that she believes needs nurturing. “Cancer care is uniquely complex. Cancer survivorship,” she noted, “is a distinct phase of care and needs to be attended to.”
There are concerns that the current oncology workforce may be insufficient to care for the rapidly growing population of survivors, with more than 18 million cancer survivors living in the United States today. This population is only expected to grow as innovations in treatment allow cancer patients to live longer past diagnosis. Erin points to cancer surveillance and primary prevention procedures—such as mammograms, colonoscopies, vaccines, lipid profile testing, and cardiovascular risk management—as underused tools in the care of cancer survivors.
First independent R01: A Cancer Moonshot award
In 2019, Erin applied for her first NCI R01 grant and received it in 2020. The R01 grant is considered the “gold standard” for independent investigators working to answer specific research questions. Erin’s grant was funded through the Cancer Moonshot℠ on the topic of optimizing and managing cancer survivor care. “When I saw that topic, it was right up my alley,” she said. “I knew I had to apply.”
Through her grant, she is studying novel models of care for cancer survivors in a large health system. Health system–based research provides evidence that, when applied, can make care more affordable, effective, equitable, accessible, patient-centered, and safer. Erin hopes her research will answer the question: Will primary care cancer survivorship clinics, staffed by primary care physicians trained in cancer survivorship care (such as cancer surveillance and managing late effects of treatment), help optimize care for cancer survivors?
For the study, Erin is leveraging the relationship that the Department of Research and Evaluation in Southern California has with the Kaiser Permanente health system. In Southern California, Kaiser Permanente provides care to 7 million members. This gives Erin unique access to several thousand early-stage breast and colorectal cancer survivors across the Kaiser Permanente Southern California system. Having access to such a large group of patients is a boon for Erin’s research, and ultimately, she hopes to learn if the primary care survivorship clinics are effective and can be scaled up nationally across large health systems like Kaiser Permanente, which has about 12.7 million members in the United States.
Prior to receiving the R01, Erin focused on several areas of implementation science that helped coalesce her approach to research on cancer survivorship care in a large health care system. While working on her master of public health degree, she was strongly influenced by a mentor who taught her that research influences policy, and that health care research can be an effective way to get evidence into practice. Erin went on to receive an NCI predoctoral (R25) award, followed by a Kaiser Permanente postdoctoral fellowship in delivery system science with a focus on cancer care.
Collaborating on cancer care and prevention
Shortly after receiving her first R01, Erin applied for and received two more NCI awards. As with her first grant, she brings her health systems perspective to these projects. For her second NCI award, Erin is collaborating with four other principal investigators on a program project grant (P01) surveying the care given to adolescent and young adult cancer survivors with the intent to learn about their care experience and where interventions to improve care delivery are needed.
Her third NCI award is an R01 grant on which she is a co-principal investigator. This research compares several strategies across 60 Kaiser Permanente pediatric practices to help increase uptake of the human papillomavirus (HPV) vaccine, which can prevent cervical and several other HPV-related cancers, among youths ages 9 to 12.
Erin’s efforts to improve health care for cancer survivors and advance cancer prevention are central to NCI’s goal of improving the experience of people living with and after cancer and the institute’s mission to advance scientific knowledge to help all people live longer, healthier lives.
“Health system–based research is critical,” Erin said. “Figuring out how to do research within such systems in a way that positively affects our patients’ lives is really important. The kind of work I do, the kind of strategies I use, the tools I develop,” she reflected, “they are very purposefully designed for dissemination. For cancer care, there are a lot of points where we can intervene and improve.”