Kaiser Permanente research scientist uses expertise in epidemiology and nutrition to improve cancer survivorship
By Sue Rochman
As an undergraduate student at Brown University in Providence, Rhode Island, Elizabeth Cespedes Feliciano, ScD, SM, volunteered as a medical interpreter for Spanish-speaking adults. This glimpse into patients’ lives allowed her to see firsthand how obesity and its underlying social causes contribute to health disparities and the burden of diabetes, heart disease, and cancer in Latinx communities.
The work spurred her to apply to the Harvard School of Public Health, where she first pursued a master’s degree in social and behavioral sciences and then earned a doctoral degree in epidemiology and nutrition. In 2015, a postdoctoral position at the Kaiser Permanente Division of Research with Bette Caan, DrPH brought her to Oakland, where she shifted her research focus from cancer risk to cancer survivorship. Today, as a research scientist with multiple funding awards, including large grants from the National Institutes of Health, she is leading research studies designed to improve outcomes for cancer patients and enhance their survivorship.
We spoke with Cespedes Feliciano about her interest in cancer survivorship research, her love of grant writing, and her advice for others embarking on a career as a research scientist.
How does body composition tie into cancer survivorship?
As someone trained in obesity research, I see the utility of body-mass index (BMI) because it’s an easy metric of body size; it tells you how big the envelope is. There is no question that looking at BMI can help at a population level to track trends. But at an individual level, we know there is huge variation in what’s inside the envelope, and that’s where body composition comes in. It tells you the amount and distribution of muscle, fat, and bone.
The work we’ve done here at the Division of Research has changed the conversation.
Thirteen cancers have a confirmed relationship with obesity, so for a long time those of us studying non-metastatic cancers were worried primarily about fat and assumed muscle was more relevant in advanced cancers. But the work we’ve done here at the Division of Research has changed the conversation. There is now wide acknowledgement that muscle and fat tissue have differing relationships to cancer survival and that both are important for the health and longevity of cancer survivors. And it’s not just older patients for whom body composition is a concern. Cancer and its treatments are associated with biological aging, of which loss of muscle is a hallmark, so this is relevant for younger patients as well.
Has this research changed the way Kaiser Permanente provides care?
This work is timely as Kaiser and other health systems try to better serve the needs of an aging population. Kaiser is implementing frailty assessments to help guide surgical planning. This can help patients know what to expect and help providers make sure patients get the right support so that they can better meet the patient’s goals. With our new grant from the National Institutes of Health, we are evaluating new ways to assess frailty, which includes looking at how we might use imaging data that shows body composition to tailor treatment to the patient’s needs.
Why is Kaiser Permanente a great place to do cancer survivorship research?
Kaiser is a remarkable setting for this type of research because of the availability of medical records and biospecimens. We can follow patients through their treatment and see their outcomes. For our team, 2020 was an amazing year: I’m now leading 3 large-scale National Institutes of Health-funded projects. This shows we are not the only ones who recognize that this is a great setting to do research that will make an impact on patient care.
What advice do you have for young investigators?
First and foremost, you have to know your field in order to know what is innovative and what new knowledge will make an impact on patient care or scientific understanding. Then you need to formulate a specific question and design a robust study to answer it. You also need to be deeply passionate and excited about your research and be able to transfer that excitement and passion to your reviewers. Unless you have someone reviewing your grant who says, “Yes, we must do this research to advance the field!” you are not going to get the funding.
I love grant writing, because it is aspirational, and you are trying to identify the critical gap in our knowledge that holds us back from improving human health. When you start to do the study, you address that critical gap, but you also realize all the limitations and pitfalls and you enter the troubleshooting phase, so that part is the most important but is not as dreamy.
What do you like to do in your free time?
Well, one of things that I do a lot is play in the backyard with my one-year-old son. Before the pandemic, my spouse and I loved traveling. We do a lot of mountain biking and I can’t wait to put my son on a mountain bike.