Questions that this study hopes to address include:
Should women with breast cancer eat a particular diet? - How much and what type of exercise is best?
- Are there particular dietary supplements or herbal remedies that are recommended?
- What role, if any, do friendships and social networks play in survivorship?
By collecting and analyzing data about a woman’s genetic background, tumor characteristics and lifestyle choices immediately after diagnosis, the study hopes to provide more objective information to help guide women as they make decisions following a breast cancer diagnosis. Pathways will also be studying various genetic factors and their role in treatment and survival. It will also look at whether certain molecular changes in the tumor may be markers for prognosis.
Eligibility
Pathways is open to women 21 years and older with a first diagnosis of invasive breast cancer who are members of Kaiser Permanente of Northern California. To participate, women must be recently diagnosed with breast cancer and not have previously been diagnosed with invasive cancer. Women who participate in the study do not need to make any changes in their lifestyle or treatment.
Participation
Participation in the study involves a four hour in-person interview shortly after diagnosis, a blood draw, and a saliva sample. The interview will be followed with questionnaires that will be mailed about 6 months after diagnosis, and periodically thereafter. Participants will also be required to fill out a 3-day food diary on a periodic basis.
Ancillary Studies
Two ancillary studies have been funded that build on the main Pathways Study. Women who are enrolled in Pathways have an opportunity to participate in these studies if they fulfill the eligibility criteria.
Racial Disparities in the Initiation and Intensity of Adjuvant Therapy for Breast Cancer. This study will collect information to better understand the use of breast cancer treatment and any differences in treatment and survival amongst women of different racial and ethnic backgrounds. This study is funded by the U.S. Department of Defense and is part of a Breast Cancer Center of Excellence that is based at Columbia University.
Natural History and Cost Analysis of Lymphedema Secondary to Breast Cancer. This study will describe the natural history of lymphedema after breast cancer surgery, examine medical and behavioral risk factors of lymphedema, and estimate costs of treating lymphedema within Kaiser Permanente of Northern California. This study is funded by the American Cancer Society and is coordinated at the Division of Research.
Physiology of Aging
This study will look at complex decision making with regard to considering chemotherapy for all women with invasive breast cancer, in particular with a focus on older women. Age, other health issues and clinical judgment fail to predict which older women will tolerate chemotherapy. This ancillary study will enroll all women 65 years and older from the Pathways Study to fill gaps in knowledge about chemotherapy in older women from interview and computerized records. An index of "physiological age", defined as capacity to respond to stressors such as chemotherapy, will be developed and validated. Results will then be used to enhance a widely used web-based clinical decision tool. The coordinating site for this study is Lombardi Cancer Center at Georgetown University in Washington, D.C. Funding is provided by the National Cancer Institute.
Our Research Team
Principal Investigator |
| Lawrence H. Kushi, ScD |
Co-Investigators |
| Christine Ambrosone, PhD |
| Janice Barlow, BSN, NP |
| Bette Caan, DrPH |
| Harley Goldberg, DO |
| Susan Kutner, MD |
| Marilyn Kwan, PhD |
| Marion Lee, PhD |
| Fern Orenstein |
| Balaram Puligandla, MD |
| Charles Quesenberry, PhD |
| Carol Somkin, PhD |
| Barbara Sternfeld, PhD |
| John Wiencke, PhD |
Research Team |
Field Interviewers |
| Garrett Chin |
Judy Jensen |
| Jeanne Darbinian, MS, MPH |
Sara Lee |
| Isaac Joshua Ergas, MPH |
Cathleen Mayers |
| Rosa Hippler, MA |
Elinette Nicolas-Hearn |
| Janise Kim, MSW, MPH |
Mariana Pereyra |
| Valerie Lee, MS |
Virginia Pozo-Castrillo |
| Julie Munneke |
Veronica Rincon |
| Mariana Pereyra |
Claudia Samayoa |
| Ling Shen, PhD |
Wendy Sun |
| Frances Sato |
Katherine Szaky |
| Jun Song, MS |
Janet Thiessen |
| Emily Tam |
Sandra Wolter |
| Allegra Timperi |
|
Collaborating Institutions
This study is conducted by researchers at the Kaiser Permanente Division of Research (Oakland, CA); Kaiser Permanente of Northern California; University of California at San Francisco; Georgetown University (Washington, DC); Roswell Park Cancer Institute (Buffalo, NY); the Cancer Prevention Institute of California (Fremont, CA); and Zero Breast Cancer (San Rafael, CA).
This study is made possible thanks to funding from the National Cancer Institute.
BREAST CANCER - Organizations
Breast Cancer Action
Seeks to inspire and compel changes necessary to end the breast cancer epidemic
Web site »
The Breast Cancer Fund
Identifies and advocates for elimination of environmental and other preventable causes of breast cancer
Web site »
Zero Breast Cancer
Mission is to find the causes of breast cancer through community participation in the research process
Web site »
Y-ME National Breast Cancer Organization
Provides a 24 hour hotline, access to publications, multimedia resource library and book reviews for breast cancer
Web site »
ALTERNATIVE AND COMPLEMENTARY MEDICINE
AlternativeDr.com
Provides consumers and providers information about the practice of alternative healthcare, as well as access to products, services, and news on emerging issues
Web site »
Alternative Health News Online
Provides a collection of alternative medicine websites
Web site »
Bastyr University
Provides online resources for alternative therapy treatments
Web site »
Commonweal (Cancer Help Program)
A health and environmental research institute providing programs assisting patients in making informed choices about mainstream and contemporary cancer therapies
Web site »
Consumer Lab
Evaluates quality of over the counter supplements
Web site »
HealthWorld Online
Provides a virtual health village where you can access information, products, and services to help create your wellness-based lifestyle
Web site »
Moss Reports
Provides information on the topic of complementary and alternative cancer treatments.
Web site »
National Center for Complementary and Alternative Medicine
Dedicated to exploring complementary and alternative healing practices in the context of rigorous science, alternative medicine researchers, and disseminating information to the public and professionals
Web site »
University of Texas MD Anderson
Website provides educational resources for complementary and alternative therapies
Web site »
CANCER RELATED WEBSITES
American Cancer Society
Provides information on support, medication, treatment and services.
Web site »
American Society of Clinical Oncology
Good source of clinical cancer information. Also helps in locating an oncologist.
Web site »
Association of Cancer Online Resources
Provides a large collection of cancer-related Internet mailing lists
Web site »
Cancer Care, Inc.
Provides free professional help to people with all cancers through counseling, education, information and referral and direct financial assistance.
Web site »
Cancer Facts
Interactive website that provides users with educational materials tailored to their own medical situation. Services include online support groups and peer matching for patients.
Web site »
Cancer Index
Internet resource of over 1000 links to cancer family of websites, including resources for rare cancers
Web site »
Cancer Information from the National Cancer Institute (CancerNet and PDQ)
Contains information on screening, detection and treatment of cancers and clinical trials.
Web site »
CURE - Cancer Updates
Cancer Updates' Research and Education is a quarterly magazine that combines the science and humanity of cancer for those who have to deal with it on a daily basis
Web site »
Macmillan Cancer Support
UK's leading cancer information service. Very comprehensive.
Web site »
Publications
Change in Physical Activity During Active Treatment in a Prospective Study of Breast Cancer Survivors
Kwan ML, Sternfeld B, Ergas IJ, Timperi AW, Roh JK, Quesenberry CP, Kushi LH.
Breast Cancer Research and Treatment, September 28, 2011
PubMed abstract »
Associations of physical activity with quality of life and functional ability in breast cancer patients during active adjuvant treatment: The Pathways Study
Mandelblatt JS, Luta G, Kwan ML, Makgoeng SB, Ergas IJ, Roh JM, Sternfeld B, Adams-Campbell LL, Kushi LH.
Breast Cancer Research and Treatment, 2011 Sep;129(2):521-9.
PubMed abstract »
Risk factors of lymphedema in a prospective breast cancer survivorship study: The Pathways Study
Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P, Kutner SE, Kushi LH. Archives of Surgery, 2010;145(11):1055-1063
PubMed abstract »
Publisher full text of article »
Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer
Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, Kwan M, Gomez SL, Neugut AI.
Breast Cancer Research and Treatment, 2011 Apr;126(2):529-37.
PubMed abstract »
A Practical Method for Collecting Food Records in a Prospective Cohort Study of Breast Cancer Survivors
Kwan ML, Kushi LH, Song J, Timperi AW, Boynton AM, Johnson KM, Standley J, Kristal AR.
American Journal of Epidemiology, 2010 Dec 1;172(11):1315-23.
PubMed abstract »
Publisher full text of article »
Breast cancer DNA methylation profiles are associated with tumor size and alcohol and folate intake
Christensen BC, Kelsey KT, Zheng S, Houseman EA, Marsit CJ, Wrensch MR, Wiemels JL, Nelson HH, Karagas MR, Kushi LH, Kwan ML, Wiencke JK.
PLoS Genetics, 2010;6(7):e1001043.
PubMed abstract »
Quality of life among women recently diagnosed with invasive breast cancer: the Pathways Study
Kwan ML, Ergas IJ, Somkin CP, Quesenberry, Jr. CP, Neugut AI, Hershman DL, Mandelblatt J, Pelayo MP, Timperi AW, Miles SQ, Kushi LH.
Breast Cancer Research and Treatment 2010;123(2):507.
PubMed abstract »
PubMedCentral full text of article »
Early discontinuation and non-adherence to adjuvant hormonal therapy in a cohort of 8769 early stage breast cancer patients
Hershman D, Kushi L, Shao T, et al:
J Clin Oncol, June 28, 2010
PubMed abstract »
Publisher full text of article »
Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors
Kwan ML, Kushi LH, Weltzien E, Maring B, Kutner SE, Fulton RS, Lee MM, Ambrosone CB, Caan BJ.
Breast Cancer Res. 2009 May 22;11(3):R31. [Epub ahead of print]
PubMed abstract »
Publisher full text of article »
Complementary and alternative therapy use before and after breast cancer diagnosis: the Pathways Study
Greenlee H, Kwan ML, Ergas IJ, Sherman KJ, Krathwohl SE, Bonnell C, Lee MM, Kushi LH.
Breast Cancer Res Treat. 2009 Jan 31. [Epub ahead of print]
PubMed abstract »
PubMedCentral full text of article »
The Pathways Study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California
Kwan ML, Ambrosone CB, Lee MM, Barlow J, Krathwohl SE, Ergas IJ, Ashley CH, Bittner JR, Darbinian J, Stronach K, Caan BJ, Davis W, Kutner SE, Quesenberry CP, Somkin CP, Sternfeld B, Wiencke JK, Zheng S, Kushi LH.
Cancer Causes Control. 2008 May 14. [Epub ahead of print]
PubMed abstract »
SpringerLink full text of article »
Lifestyle factors and survival in women with breast cancer
Kushi LH, Kwan ML, Lee MM, Ambrosone CB.
J Nutr. 2007 Jan;137(1 Suppl):236S-242S.
PubMed abstract »
Publisher full text of article »
Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices
Doyle C, Kushi LH, Byers T, Courneya KS, Demark-Wahnefried W, Grant B, McTiernan A, Rock CL, Thompson C, Gansler T, Andrews KS
The 2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee; American Cancer Society
CA Cancer J Clin. 2006 Nov-Dec;56(6):323-53. Review
PubMed abstract »
Publisher full text of article »
New developments in the epidemiology of cancer prognosis: traditional and molecular predictors of treatment response and survival
Ambrosone CB, Rebbeck TR, Morgan GJ, Albain KS, Calle EE, Evans WE, Hayes DF, Kushi LH, McLeod HL, Rowland JH, Ulrich CM.
Cancer Epidemiol Biomarkers Prev. 2006 Nov;15(11):2042-6.
PubMed abstract »
Publisher full text of article »
American Cancer Society Guidelines on Nutrition and Physical Activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity
Kushi LH, Byers T, Doyle C, Bandera EV, McCullough M, McTiernan A, Gansler T, Andrews KS, Thun MJ
American Cancer Society 2006 Nutrition and Physical Activity Guidelines Advisory Committee
CA Cancer J Clin. 2006 Sep-Oct;56(5):254-81; quiz 313-4.
Erratum in: CA Cancer J Clin. 2007 Jan-Feb;57(1):66. NcTiernan, Anne [added]. Summary for patients in: CA Cancer J Clin. 2006 Sep-Oct;56(5):310-2.
PubMed abstract »
Publisher full text of article »
TPMG Forum – November/December 2006
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