Eleanor Brown

All Publications

• "Quite Devastating, Traumatic, and Lonely": Understanding the Mental Health Experiences of Hispanic/Latino Rectal Cancer Patients and Their Caregivers. Cancer medicine Cosby, Z. N., Howland, J. P., Brown, E., Carpenter, L. K., Davis-Lopez, K. M., Kim, M. Y., Castañeda, P., Gonzalez, M., Hernandez, M. T., Duron, Y., Rodriguez, G. M., Zaky, S. S., Morris, A. M., Dawes, A. J. 2025; 14 (18): e71253

  Abstract

  Psychological distress increases after a cancer diagnosis. However, patients who identify as Hispanic/Latino are less likely than their White counterparts to receive mental health care after being diagnosed, placing them at risk of poor psychological adjustment. The parent research objective aimed to characterize the treatment experiences of rectal cancer patients who identify as Hispanic/Latino. This qualitative secondary analysis specifically explored patients' emotional and psychological experiences.We partnered with local community health workers to recruit rectal cancer patients who identified as Hispanic/Latino and their caregivers from California's Bay Area and Central Valley. Semi-structured interviews (n = 21) were conducted in either Spanish or English based on patient preference. Initial themes were identified using reflexive analysis. Experiences of distress were found in nearly all interviews, motivating this qualitative secondary analysis using directed content analysis.We identified three main themes: (1) emotional reactions to the initial diagnosis, (2) perspectives and emotions experienced throughout treatment, and (3) coping strategies and advice for others. Participants reported shock and incongruence with their diagnosis. The treatment journey caused feelings of embarrassment and frustration from difficulties such as racial profiling and insurance. Patients coped through faith and support from trusted individuals.Rectal cancer patients who identify as Hispanic/Latino endure emotional distress at multiple stages of their cancer journey, including from sources that are unique to this population. Culturally and linguistically tailored interventions are needed to help mitigate this psychological burden and to provide active, coordinated support throughout the treatment phase in order to better prepare patients for survivorship.

  View details for DOI 10.1002/cam4.71253

  View details for PubMedID 40956000

  View details for PubMedCentralID PMC12439271

• "Interpreters don't tell you everything": experiences with medical interpretation among Latino cancer patients and caregivers with limited English proficiency. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Brown, E., Kim, M. Y., Cosby, Z. N., Howland, J. P., Carpenter, L., Castañeda, P., Gonzalez, M., Hernandez, M. T., Davis-Lopez, K. M., Duron, Y., Rodriguez, G. M., Zaky, S. S., Morris, A. M., Dawes, A. J. 2025; 33 (7): 595

  Abstract

  Language is an underrecognized social driver of health that disproportionately affects Hispanic/Latino (H/L) patients and can negatively impact comprehension and engagement with medical care. Professional interpretation services can help overcome language barriers in the clinic or hospital setting; however, interpreters are not universally available and, even when they are, the quality of communication can be limited. In this secondary analysis of a qualitative study which examined the barriers and facilitators H/L patients and their caregivers experience when navigating rectal cancer care, we sought to explore how Spanish-speaking rectal cancer patients and their caregivers communicated with oncology providers and the ways in which professional interpretation may have facilitated or detracted from their care experiences.We conducted a community-partnered qualitative study to explore H/L patients with rectal cancer and their caregivers' experiences with medical interpretation during their oncologic care. We developed an interview guide based on the Ecological Model of Health Behavior and iteratively refined it with input from our Community Advisory Board. Data analysis utilized grounded theory and reflexive thematic analysis to identify core themes.Over a 6-month period, we conducted 21 semi-structured interviews. Three major themes related to language arose from our review of coded transcripts: (1) interpreters' use of medical jargon; (2) dialect discordance between patient and hospital interpreter; and (3) lack of trust in the interpretation process.Our sample of H/L rectal cancer patients and their caregivers reported barriers due to overuse of medical jargon and dialectic differences, both of which eroded trust in the interpretation process. Beyond simply hiring more interpreters, hospitals would benefit from re-envisioning the patient-interpreter relationship as a means of improving communication and fostering trust in the healthcare system.

  View details for DOI 10.1007/s00520-025-09657-6

  View details for PubMedID 40533581

  View details for PubMedCentralID 10574305

• Phase II trial of organ preservation program using short-course radiation and FOLFOXIRI for rectal cancer (SHORT-FOX): Two-Year primary outcome analysis. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology Klebaner, D., Brown, E., Fisher, G. A., Shelton, A., Johnson, T. P., Shaheen, S., Chen, C., Heestand, G., Holden, T., Bien, J., King, D. A., Dawes, A. J., Morris, A. M., Kirilcuk, N., Kin, C., Gahagan, J., Sheth, V., Ghanouni, P., Richter, S., Vitzthum, L., Rahimy, E., Chang, D. T., Pollom, E. L. 2025; 207: 110884

  Abstract

  As patients with rectal cancer with clinical complete response (cCR) after neoadjuvant therapy may be safely spared Total Mesorectal Excision (TME), strategies to maximize cCR are needed.We conducted a single-arm phase II study to determine whether dose-escalated short-course radiotherapy (25 Gy/5 fractions + 5 Gy/1 fraction boost) followed by eight cycles of FOLFOXIRI increased cCR rates among adult patients with > T2N0M0 or low T2N0 rectal cancer.Between 2020 and 2023, we enrolled 37 patients, of whom 27 (73 %) had at least one high-risk feature (cT4, extramural vascular invasion [EMVI], N2, threatened circumferential resection margin, positive lateral node). At primary endpoint assessment, nine (24 %) patients had cCR on both endoscopy and MRI, and pursued organ preservation (OP). Fourteen (38 %) patients had cCR only on endoscopy, nine of whom pursued OP. Of the 18 patients who pursued OP, nine had local regrowth at two years from radiotherapy start, with two-year TME-free survival of 26 %. Baseline factors significantly associated with not achieving OP included age < 50 years and T4 disease. At mid-treatment restaging, patients who achieved OP were significantly less likely to have persistent node positivity, EMVI, and endoscopically visible tumor. Grade 3+ adverse events at least possibly attributed to chemotherapy and radiotherapy occured in 51% and 43% of patients, respectively.Short-course radiotherapy with a boost followed by FOLFIXIRI results in OP in one-quarter of patients with high-risk rectal cancer, with poorer response among younger patients and T4 disease. Mid-treatment response may help guide timely decision-making regarding treatment.

  View details for DOI 10.1016/j.radonc.2025.110884

  View details for PubMedID 40209856

• Single- versus multi-fraction spine stereotactic radiosurgery (ALL-STAR) for patients with spinal metastases: a randomized phase III trial protocol. BMC cancer Pratapneni, A., Klebaner, D., Soltys, S. G., Rahimy, E., Gibbs, I. C., Chang, S. D., Li, G., Hayden Gephart, M., Veeravagu, A., Szalkowski, G. A., Gu, X., Wang, L., Chuang, C., Liu, L., Jackson, S., Lu, R., Skerchak, J. A., Huang, K. Z., Wong, S., Brown, E., Pollom, E. L. 2025; 25 (1): 323

  Abstract

  For patients with spine metastases, stereotactic radiosurgery (SRS) provides excellent local control and pain response. Despite increasing use of this treatment modality, there is no consensus on the optimal dose and fractionation of spine SRS for efficacy and toxicity. We have initiated a single-center phase III randomized trial that compares two dose regimens with similar biological equivalent dose (BED) to determine the isolated effect of SRS fractionation on local control.Patients with one to three cervical, thoracic, or lumbar spine metastases spanning no more than two contiguous vertebral levels in need of radiation will be eligible for enrollment. Patients will be assigned 1:1 to receive either 22 Gy in 1 fraction or 28 Gy in 2 fractions. Biased coin randomization will be used to randomly assign patients while balancing the following stratifying variables between the two treatment arms at baseline: gastrointestinal histology (yes/no), paraspinal tissue extension (yes/no), epidural compression (low-/high-grade), and number of sites treated (one to three). The primary endpoint is one-year local control, defined per Spine Response Assessment in Neuro-Oncology (SPINO) criteria. The secondary endpoints include patient-reported health-related quality of life (HRQOL), pain associated with the treated site, vertebral compression fracture (VCF), and two-year local control. Patients will be followed for these outcomes at one to two weeks, one month, three months, and six months after treatment, and every six months thereafter until 24 months after treatment. While on the study, patients will receive routine co-interventions as clinically indicated.The studies published thus far comparing the single- and multi-fraction SRS are lacking long-term local control outcomes and are limited by selection bias as well as single-fraction arms with higher BED, which is correlated with improved local control. Our study will isolate the effect of fractionation by comparing one-year local control in patients treated with single- and multi-fraction SRS with equivalent BED. We anticipate that the results of this, as well as secondary endpoints such as pain response, adverse effects, and quality of life will provide much-needed guidance regarding optimal dose and fractionation for both maximizing local control and minimizing toxicity.NCT#06173401. Approved by Stanford Scientific Review Committee (study ID: BRN0060) on 9/12/2023 and Stanford Institutional Review Board (study ID: IRB-72248) on 11/14/2023.

  View details for DOI 10.1186/s12885-025-13655-6

  View details for PubMedID 39984889

  View details for PubMedCentralID PMC11846292

• La lengua materna: Understanding language challenges experienced by Latino patients and caregivers in rectal cancer care Brown, E., Howland, J. P., Kim, M. Y., Carpenter, L. K., Castaneda, P., Gonzalez, M., Hernandez, M. T., Cosby, Z. N., Davis-Lopez, K. M., Duron, Y., Rodriguez, G. M., Zaky, S. S., Morris, A. M., Dawes, A. J. AMER ASSOC CANCER RESEARCH. 2024

  View details for DOI 10.1158/1538-7755.DISP24-B077

  View details for Web of Science ID 001319480800242

• "Quite devastating, traumatic and lonely": The mental health experiences of Hispanic/Latino rectal cancer patients Cosby, Z. N., Brown, E., Howland, J. P., Carpenter, L. K., Kim, M., Davis-Lopez, K. M., Castaneda, P., Gonzalez, M., Hernandez, M. T., Duron, Y., Rodriguez, G. M., Zaky, S. S., Morris, A. M., Dawes, A. J. AMER ASSOC CANCER RESEARCH. 2024

  View details for DOI 10.1158/1538-7755.DISP24-B155

  View details for Web of Science ID 001319480800320

• Caring for the Caregivers: Characteristics and challenges faced by caregivers of Latino Californians with rectal cancer Kim, M., Howland, J. P., Brown, E., Carpenter, L. K., Castaneda, P., Gonzalez, M., Hernandez, M. T., Cosby, Z. N., Davis-Lopez, K. M., Duron, Y., Rodriguez, G. M., Zaky, S. S., Morris, A. M., Dawes, A. J. AMER ASSOC CANCER RESEARCH. 2024

  View details for DOI 10.1158/1538-7755.DISP24-B081

  View details for Web of Science ID 001319480800246

• Advancing Clinical Trial Equity through Integration of Telehealth and Decentralized Treatment. JNCI cancer spectrum Brown, E., Albert Fisher, G., Shelton, A., Chang, D. T., Pollom, E. 2024

  Abstract

  Innovative strategies to increase clinical trial accessibility and equity are needed. We conducted a retrospective review of a phase II investigator-initiated trial to determine whether the modification of clinical trial design to decentralize study treatment can improve trial accessibility among underrepresented groups. Sociodemographic characteristics including area deprivation indices as well as study site travel distance, time, and costs were compared between those enrolled participants who received chemotherapy locally and those who did not. Participants who received chemotherapy locally lived significantly farther from the study site (median 95.90 vs 25.20 miles, p = .004), faced a greater time burden traveling to the study site (median 115.00 vs 34.00 minutes, p = .002), and had higher travel-related costs for a single trip to the study site (median 62.81 vs 16.51 dollars, p = .004). This study highlights opportunities for alleviating financial and time toxicities associated with clinical trial participation, promoting equity in clinical research.

  View details for DOI 10.1093/jncics/pkae050

  View details for PubMedID 38902952

• A Technology-Informed Approach to Clinical Trial Equity. International journal of radiation oncology, biology, physics Brown, E., Jr, G. A., Shelton, A., Johnson, T., Chen, C., Shaheen, S., Holden, T. L., Dao, V. A., Bien, J. Y., King, D., Vitzthum, L., Kirilcuk, N., Morris, A., Kin, C., Dawes, A., Sheth, V., Chang, D. T., Pollom, E. 2023; 117 (2S): e8

  Abstract

  PURPOSE/OBJECTIVE(S): Despite efforts to increase participation of diverse communities in clinical trials, ethnic/racial minorities remain underrepresented. One such determinant may be lack of access to a comprehensive cancer center that conducts clinical research. Historically, our institution has had low accrual from rural regions further away from our cancer center, with Hispanic or Latino (HL) patients (pts) being especially underrepresented in our clinical research. In this study, we explored the impact of a clinical trial that allowed pts to receive chemotherapy (chemo) with their local oncologist. We hypothesize that allowing pts to receive chemo locally will lead to higher rates of enrollment from populations under-represented in clinical trials.MATERIALS/METHODS: We conducted a study for pts with rectal cancer to undergo short-course radiation followed by 4 months of chemo with the option to pursue watch and wait if pts achieve a clinical complete response. Radiation was administered at our institution while pts could receive standard-of-care chemo closer to home with their local oncologist. For pts who received chemo locally, the research coordinator and co-investigators held video visits with the pts prior to each chemo infusion to review adverse events (AE), labs, and chemo dosing. We compared demographic data of pts on this trial with that of pts enrolled across all adult therapeutic oncologic clinical trials over the same time period at our institution. Distance to our institution was calculated based on pts' primary residence zip code. Protocol compliance with AE reporting for pts who received chemo locally was assessed by chart review.RESULTS: Between May 2020 and January 2023, 24/35 enrolled pts completed both radiation and chemo on trial. 13/24 pts (54%) received chemo locally. Of the 24 pts, 16 were White (67%), 7 Asian (29%), 1 Native Hawaiian/ Pacific Islander (4%). Of all enrolled patients, 4 were HL (16.7%), compared to our institutional average of 16.5%. All enrolled HL pts received their chemo locally. The average distance traveled by non-HL pts from their home to our institution was 87.7 miles (range 5.1 - 308). In contrast, HL pts traveled an average of 147.8 miles (range 110 - 249), 68% further than their non-HL counterparts. There was 100% compliance with AE reporting among those pts who received their chemo locally.CONCLUSION: Although the percentage of HL participation in our study was consistent with our institutional average, all HL pts enrolled on the trial received treatment locally and lived substantially further from our institution than non-HL. By allowing pts to receive this part of treatment locally, we provided pts who live further away an opportunity to engage in clinical research without the associated financial and time toxicities related with traveling for treatment. By decentralizing clinical trials and leveraging telemedicine, we can promote the participation of under-represented groups in clinical trials.

  View details for DOI 10.1016/j.ijrobp.2023.06.664

  View details for PubMedID 37786184

• Individualized Stereotactic Ablative Radiotherapy for Lung Tumors: The iSABR Phase 2 Nonrandomized Controlled Trial. JAMA oncology Gensheimer, M. F., Gee, H., Shirato, H., Taguchi, H., Snyder, J. M., Chin, A. L., Vitzthum, L. K., Maxim, P. G., Wakelee, H. A., Neal, J., Das, M., Chang, D. T., Kidd, E., Hancock, S. L., Shultz, D. B., Horst, K. C., Le, Q. T., Wong, S., Brown, E., Nguyen, N., Liang, R., Loo, B. W., Diehn, M. 2023

  Abstract

  Stereotactic ablative radiotherapy (SABR) is used for treating lung tumors but can cause toxic effects, including life-threatening damage to central structures. Retrospective data suggested that small tumors up to 10 cm3 in volume can be well controlled with a biologically effective dose less than 100 Gy.To assess whether individualizing lung SABR dose and fractionation by tumor size, location, and histological characteristics may be associated with local tumor control.This nonrandomized controlled trial (the iSABR trial, so named for individualized SABR) was a phase 2 multicenter trial enrolling participants from November 15, 2011, to December 5, 2018, at academic medical centers in the US and Japan. Data were analyzed from December 9, 2020, to May 10, 2023. Patients were enrolled in 3 groups according to cancer type: initial diagnosis of non-small cell lung cancer (NSCLC) with an American Joint Committee on Cancer 7th edition T1-3N0M0 tumor (group 1), a T1-3N0M0 new primary NSCLC with a history of prior NSCLC or multiple NSCLCs (group 2), or lung metastases from NSCLC or another solid tumor (group 3).Up to 4 tumors were treated with once-daily SABR. The dose ranged from 25 Gy in 1 fraction for peripheral tumors with a volume of 0 to 10 cm3 to 60 Gy in 8 fractions for central tumors with a volume greater than 30 cm3.Per-group freedom from local recurrence (same-lobe recurrence) at 1 year, with censoring at time of distant recurrence, death, or loss to follow-up.In total, 217 unique patients (median [IQR] age, 72 [64-80] years; 129 [59%] male; 150 [69%] current or former smokers) were enrolled (some multiple times). There were 240 treatment courses: 79 in group 1, 82 in group 2, and 79 in group 3. A total of 285 tumors (211 [74%] peripheral and 74 [26%] central) were treated. The most common dose was 25 Gy in 1 fraction (158 tumors). The median (range) follow-up period was 33 (2-109) months, and the median overall survival was 59 (95% CI, 49-82) months. Freedom from local recurrence at 1 year was 97% (90% CI, 91%-99%) for group 1, 94% (90% CI, 87%-97%) for group 2, and 96% (90% CI, 89%-98%) for group 3. Freedom from local recurrence at 5 years ranged from 83% to 93% in the 3 groups. The proportion of patients with grade 3 to 5 toxic effects was low, at 5% (including a single patient [1%] with grade 5 toxic effects).The results of this nonrandomized controlled trial suggest that individualized SABR (iSABR) used to treat lung tumors may allow minimization of treatment dose and is associated with excellent local control. Individualized dosing should be considered for use in future trials.ClinicalTrials.gov Identifier: NCT01463423.

  View details for DOI 10.1001/jamaoncol.2023.3495

  View details for PubMedID 37707820

• Effect of Radiation Schedule on Transportation-Related Carbon Emissions: A Case Study in Rectal Cancer. Advances in radiation oncology Frick, M. A., Baniel, C. C., Qu, V., Hui, C., Brown, E., Chang, D. T., Pollom, E. L. 2023; 8 (5): 101253

  Abstract

  The health care sector is a major contributor of worldwide greenhouse gas (GHG) emissions. Indirect emissions, including those associated with transportation, make up 82% of the US health care sector's environmental footprint. Radiation therapy (RT) treatment regimens present an opportunity for environmental health care-based stewardship owing to the high incidence of cancer diagnosis, significant utilization of RT, and myriad treatment days required for curative regimens. Because the use of short-course RT (SCRT) in the treatment of rectal cancer has demonstrated noninferior clinical outcomes compared with conventional, long-course RT (LCRT), we investigate the environmental and health equity-related outcomes.Patients treated with curative, preoperative RT for newly diagnosed rectal cancer at our institution between 2004 and 2022 and living in-state were included. Travel distance was estimated using patients' reported home address. Associated GHG emissions were calculated and reported in carbon dioxide equivalents (CO2e).Of 334 patients included, the total distance traveled for the treatment course was significantly greater in patients treated with LCRT versus SCRT (median, 1417 vs 319 miles; P < .001). Total CO2e emissions for those undergoing LCRT (n = 261) and SCRT (n = 73) were 665.3 kg CO2e and 149.9 kg CO2e, respectively, per treatment course (P < .001), with a net difference of 515.4 kg CO2e. Relatively, this suggests that LCRT is associated with 4.5 times greater GHG emissions from patient transportation.Using treatment of rectal cancer as proof-of-principle, we advocate for the inclusion of environmental considerations in the creation of climate-resilient oncologic RT practices, especially in the context of equivocal clinical outcomes between RT fractionation schedules.

  View details for DOI 10.1016/j.adro.2023.101253

  View details for PubMedID 37250284

  View details for PubMedCentralID PMC10209481

• Personalized Accelerated ChEmoRadiation (PACER) for Lung Cancer: Protocol for a Bayesian Optimal Phase I/II Trial Clin Lung Cancer Hui, C., Brown, E., Das, M., Wakalee, H., Neal, J., Ramchandran, K., Myall, N., Pham, D., Xing, L., Yang, Y., Kovalchuk, N., Yuan, Y., Xiang, M., Chin, A., Diehn, M., Loo, B. W., Vitzthum, L. K. 2023
• Phase II trial of organ preservation program using short-course radiation and folfoxiri for rectal cancer (SHORT-FOX) Pollom, E. L., Shelton, A., Fisher, G. A., Bien, J., King, D., Johnson, T., Chen, C., Shaheen, S., Chong, C., Vitzthum, L., Kirilcuk, N., Morris, A. M., Kin, C., Dawes, A., Sheth, V., Sundaram, V., Brown, E., Chang, D. LIPPINCOTT WILLIAMS & WILKINS. 2022

  View details for DOI 10.1200/JCO.2022.40.4_suppl.TPS218

  View details for Web of Science ID 000770995900213

• A Phase II Trial of Individualized Stereotactic Ablative Radiotherapy for Lung Tumors (iSABR). International journal of radiation oncology, biology, physics Gensheimer, M. F., Gee, H. E., Von Eyben, R., Shirato, H., Taguchi, H., Wong, S., Brown, E., Nguyen, N., Liang, R., Maxim, P. G., Wakelee, H. A., Neal, J. W., Das, M., Loo, B. W., Diehn, M. 2021; 111 (3S): S89-S90

  Abstract

  PURPOSE/OBJECTIVE(S): Stereotactic ablative radiotherapy (SABR) is an effective treatment for lung tumors, but can result in toxicity such as chest wall pain and life-threatening damage to central lung structures. We hypothesized that while larger tumors require higher dose, small tumors up to 10cc in volume can be controlled with biologically effective dose < 100Gy. In this phase II single-arm trial, we tested the hypothesis that individualizing lung SABR dose and fractionation to tumor size, location, and histology would result in excellent local control with acceptable toxicity. The trial was conducted at two centers in the United States and Japan (NCT# redacted for blinded review).MATERIALS/METHODS: Patients in three groups were enrolled: initial diagnosis of non-small cell lung cancer (NSCLC), AJCC 7th edition stage T1-3 N0 M0 (group 1); new primary NSCLC with history of NSCLC, or multiple synchronously diagnosed NSCLCs (group 2); and lung metastases from NSCLC or another primary site (group 3). Up to four tumors could be treated with once-daily SABR. There were six dose/fractionation schedules used, depending on gross tumor volume (≤10cc, 10-30cc, > 30cc) and location (peripheral vs. central). Larger tumors received higher dose and central tumors generally received lower dose per fraction. Dose ranged from 25Gy in one fraction for 0-10cc peripheral tumors to 60Gy in 8 fractions for > 30cc central tumors. Colorectal cancer metastases were treated to higher dose, at least 50Gy in 4 fractions. The primary endpoint was per-group cumulative incidence of local recurrence at 1 year (recurrence of treated tumor within same lobe), with distant recurrence and death as competing risks. Treated tumor recurrence (recurrence with epicenter within 1cm of PTV) and toxicity were also analyzed.RESULTS: A total of 217 patients were enrolled from 2011-2018 (some patients were enrolled multiple times). Median age was 72, 59% were male, and 69% were current/former smokers. There were 240 treatment courses and 285 tumors treated (range 1-3 tumors per course). 211 tumors were peripheral and 74 were central. Tumor size distribution was: ≤10cc, 74%; 10-30cc, 19%; > 30cc, 7%. The most common dose was 25Gy in one fraction (158 tumors). Median follow-up was 30 months (range 2-95). Median overall survival was 57 months. Local recurrence data are currently being updated and will be presented at the meeting. The rate of grade 2 or higher pneumonitis was 16/217 (7%) and grade 3 or higher pneumonitis was 3/217 (1%). The rate of grade 2 or higher chest wall pain was 13/217 (6%). One patient had a grade 5 adverse event, developing pulmonary hemorrhage that was possibly related to radiotherapy, 17 months after treatment of a large central NSCLC.CONCLUSION: Individualized SABR to lung cancers resulted in excellent local control and favorable toxicity profile.

  View details for DOI 10.1016/j.ijrobp.2021.07.212

  View details for PubMedID 34700657