Radiation treatment can help reduce the recurrence of Merkel cell carcinoma, a rare and aggressive skin cancer, while chemotherapy does not appear to have any impact on recurrence or survival, according to a Kaiser Permanente study published online in the current issue of JAMA Dermatology.
The study presents one of the largest single-institution datasets on Merkel cell carcinoma, which occurs in about 1,500 people in the United States annually. Most such cancers occur on the sun-exposed skin of white males and are first diagnosed at age 75, on average. Using the Kaiser Permanente Northern California Cancer Registry, the researchers found that out of 218 cases of Kaiser Permanente patients who had Merkel cell carcinoma, those who had radiation treatment had a 70 percent lower risk of disease recurrence while chemotherapy did not appear to have any impact on recurrence or survival.
“We used our database to show what characteristics affect recurrence and survival in this very rare cancer,” said the study’s lead author Maryam M. Asgari, MD, MPH, of the Kaiser Permanente Division of Research. “The electronic records allowed us to identify patients with Merkel cell carcinoma, see how they were diagnosed and treated, and then follow them over time to see how their care affected their outcomes.”
Using an electronic health record system, Kaiser Permanente HealthConnect®, allowed the researchers to evaluate the relationships between cancer recurrence and survival with demographic information (age, sex, race, immunosuppression) and tumor characteristics (extent, size and location), as well as cancer work-ups (pathologic lymph node evaluation, imaging) and treatments (surgery, radiation and chemotherapy).
The study results also showed that immunosuppression and more advanced tumors were associated with worse survival rates related to Merkel cell carcinoma, and that pathological evaluation of the patient’s lymph nodes also had a significant impact on outcomes.
Asgari noted that the success of different work-up and treatment protocols has been difficult to compare for rare cancers. “This research should help dermatologists and oncologists in caring for their patients with Merkel cell carcinomas,” she said.
Kaiser Permanente can conduct transformational health research in part because it has the largest private patient-centered electronic health system in the world. The organization’s electronic health record system, Kaiser Permanente HealthConnect®, securely connects 9.1 million patients to more than 16,000 physicians in almost 600 medical offices and 37 hospitals. It also connects Kaiser Permanente’s research scientists to one of the most extensive collections of longitudinal medical data available, facilitating studies and important medical discoveries that shape the future of health and care delivery for patients and the medical community.
In addition to Asgari, co-authors of the study were Monica M. Sokil, BS, and E. Margaret Warton, MPH, Kaiser Permanente Division of Research, Oakland, Calif.; and Jayasri Iyer, MD, Kelly G. Paulson, MD, PhD, and Paul Nghiem, MD, PhD, Fred Hutchinson Cancer Research Center, Seattle.
The study was funded by the National Cancer Institute, Michael Piepkorn Endowment and UC MCC Patient Gift Fund.