Prescription Opioid Management in Chronic Pain Patients
Chronic pain affects approximately 100 million people in the United States, many of whom use a prescription opioid. "As medication dosages increase, they run risks of adverse events, including falls, overdoses, and problems with misuse," said Cynthia Campbell, PhD, MPH, research scientist with the Division of Research. "They also may have a difficult time talking with their doctors about their pain and medication."
The goal of this three-year, $1.9 million study, funded by the Patient Centered Outcomes Research Institute, is to improve patients' confidence about managing their care, increase skills to take care of their health, and improve communication with their doctors about pain and pain medication.
The study will examine how an intervention of four group sessions — designed to empower chronic pain sufferers — can help them take charge of their pain and overall health care, communicate with their doctors, make changes in pain medication use, and improve their overall quality of life.
Buprenorphine and Substance Abuse Services
Prescription opioid dependence affects 1.9 million people in the United States, with a 400 percent increase in treatment admissions in recent years, and more than 15,500 fatal overdoses a year.
Buprenorphine/naloxone (BUP/NX) is an effective treatment for prescription opioid dependence, with longer adherence to the medication leading to a lower risk of opioid relapse. Yet adherence can be low, and behavioral services remain a critical part of treatment. There is little evidence on what level of behavioral services can support BUP/NX adherence and improve outcomes, particularly for complex patients with medical and psychiatric comorbidities who present to specialty treatment.
This four-year, $1.6 million study, funded by the National Institutes of Health, addresses these important issues by focusing on complex patients with psychiatric and medical comorbidities in specialty care. It adapts a care model previously only tested in primary care, with a 12-month follow-up, an examination of health care and societal costs, and a combination of patient self-report and electronic medical record data.
"This study will yield critically important findings on how best to treat complex prescription opioid dependent patients, a growing patient population, with an integrative behavioral services and medication treatment model in substance abuse treatment," Campbell said.
Bladder Cancer and Vegetable Consumption
In July 2014, the National Cancer Institute granted $4.9 million for a new prospective cohort study of more than 1,800 bladder cancer cases to investigate the role of cruciferous vegetable consumption on disease outcomes and improve the efficacy of current treatments.
"Identifying dietary changes to prevent or delay the recurrence and progression of bladder cancer is of great clinical and public health importance, especially since population-based studies of bladder cancer have been limited," said Marilyn L. Kwan, PhD, a principal investigator of the Bladder Cancer Epidemiology, Wellness and Lifestyle Study (Be-Well), with Lawrence H. Kushi, ScD, and Li Tang, PhD, of Roswell Park Cancer Institute.
The study will focus on non-muscle invasive bladder cancer, which represents the majority of diagnosed cases. Bladder cancer is one of the top 10 cancers diagnosed in the United States and is one of the most expensive to treat due to its extraordinarily high rate of recurrence.
The study will incorporate genetic profiles of study participants, questionnaires, and banked biospecimens to examine associations between lifestyle, clinical care, genetic variability, and bladder cancer prognosis, survival, and quality of life.
Enrollment is now underway and will continue in Kaiser Permanente's Northern California and Southern California regions over four years, with planned follow-up for at least two years.
Determinants of Midlife and Longitudinal Change in Cognitive Function
The landmark CARDIA study has followed more than 5,000 men and women, white and African American, since 1985. Study participants were assessed every 2 to 3 years until 1995, then every 5 years through 2010 — providing a wealth of data on how blood pressure, cholesterol and weight, and lifestyle factors such as exercise and smoking affect heart health.
In 2010, year 25 of the study, cognitive testing was added to the measures and assessment. In 2015, this ancillary study will look at the cardiovascular risk factors observed in the participants' young adulthood and their cognitive function at mid-life, including 5-year changes since 2010. In addition, researchers will use genome-wide association study to identify novel, common and rare genetic variants, particularly on pathways of cardiovascular disease associated with cognitive function and decline.
"It makes sense that decreased blood supply to the brain, due to fatty deposits and calcification of blood vessels, can affect both brain structure and cognitive function," says Dr. Sidney. "We'll be getting a baseline for understanding cognitive decline from the now middle-aged CARDIA participants all the way into older age."
Researchers will also seek to determine if there are racial or ethnic differences in the association between risk factors and cognitive function and, if so, whether they are moderated by disparities in socioeconomic status, education and literacy.