Douglas W. Blayney, MD is a Professor of Medicine (Oncology) Stanford, former Medical Director of Stanford Cancer Center, and specializes in the treatment of breast cancer. He has a special interest in the quality and value of cancer care. Dr. Blayney is a past president of the American Society of Clinical Oncology (ASCO), a founder of the ASCO Quality Symposium, and co-author of the ASCO value framework descriptions. He received the inagural Ellen Stovall Award for Leadership in Patient Centered Care from the National Coalition for Cancer Survivorship in 2016. He was previously a Professor of Internal Medicine and Medical Director of the Comprehensive Cancer Center at the University of Michigan, and prior to that practiced and led Wilshire Oncology Medical Group, Inc. a physician owned multidisciplinary oncology practice in southern California. He has expertise on clinical trial development, use of oncology drugs in clinical practice, reimbursement and marketing strategies and information technology use.

Dr. Blayney's research interests include breast cancer, febrile neutropenia mitigation, the use of electronic technology to enhance medical practice, and he has over 70 scientific publications. He has served on the Food and Drug Administration's Oncologic Drugs Advisory Committee, and is Founding Editor-in-Chief and Editor-in-Chief Emeritus of ASCO's Journal of Oncology Practice. He has a degree in electrical engineering from Stanford, is a graduate of the University of California, San Diego School of Medicine, and received post graduate training at UCSD and at the National Cancer Institute in Bethesda, Maryland.

He is married, and has three grown daughters, one of whom is also a physician.

Clinical Focus

  • Cancer > Breast Cancer
  • Medical Oncology
  • Cancer Survivorship

Academic Appointments

Administrative Appointments

  • President, Wilshire Oncology Medical Group, Inc. (1996 - 2003)
  • Medical Director, University of Michigan Comprehensive Cancer Center (2003 - 2010)
  • Medical Director, Stanford Cancer Center (2010 - 2015)
  • Medical Director for Quality and Outreach, Stanford Cancer Institute (2015 - Present)

Honors & Awards

  • The Ellen Stovall Award for Leadership in Patient-Centered Care, National Coalition for Cancer Survivorship (October 13, 2016)
  • President, American Society of Clinical Oncology (2009-10)
  • Best Doctors in America, . (2007 - current)
  • Fellow, American Society of Clinical Oncology (2007)
  • Fellow, American College of Physicians (1991)

Professional Education

  • Residency:University of California San Diego School of Medicine Registrar (1980) CA
  • Medical Education:UC San Diego Office of the Registrar (1977) CA
  • Fellowship:National Cancer Institute - Center Cancer Research (1983) MD
  • Board Certification: Medical Oncology, American Board of Internal Medicine (1983)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (1980)
  • Fellowship, Medicine Branch, National Cancer Institute, Bethesda, Maryland (1983)
  • Fellowship, Environmental Epidemiology Branch, National Cancer Institute, Bethesda, Maryland (1983)
  • Resident, University of California Hospitals, San Diego (1980)
  • M.D., University of California, San Diego (1977)
  • B.S.E.E., Stanford University (1972)

Current Research and Scholarly Interests

During my tenure as Medical Director of the Stanford Cancer Institute (2010-15)

The Patient Experience, as measured by the Press-Ganey question “Likelihood to Recommend the Institution” for care, increased from the ninth percentile to consistently above the 90 percentile.

I co-led a task force that developed a strategic plan for the clinical operations of SCI, which was incorporated into a larger plan to transform cancer care at Stanford and nationwide. This plan resulted in a large gift, a substantial portion of which is allocated to Transform Cancer Care at Stanford and the nation (“the Transformation”).

Growth, as measured by new patient visits, increased by eleven percent year over year starting in fiscal year 2012, the year in which we set a goal to grow by fifty percent by 2017.

Stanford’s Cancer Program has increased its ranking to number 10 in the nation for 2014 in the US News and World Report’s (USNWR) latest ranking of cancer programs. Stanford ranked 14th in 2011. Cancer is the highest ranked Stanford Program in the USNWR system.

Clinical Trials

  • A Study of Atezolizumab and Paclitaxel Versus Placebo and Paclitaxel in Participants With Previously Untreated Locally Advanced or Metastatic Triple Negative Breast Cancer (TNBC) Recruiting

    This Phase 3, multicenter, randomized, double-blind, placebo controlled study is designed to evaluate the efficacy and safety of atezolizumab (MPDL3280A, an anti-programmed death-ligand 1 [PD-L1] antibody) administered in combination with paclitaxel compared with placebo in combination with paclitaxel in participants with previously untreated, inoperable locally advanced or metastatic, centrally confirmed TNBC. Participants will be randomized in a 2:1 ratio to receive atezolizumab or placebo plus paclitaxel until disease progression or unacceptable toxicity or end of study, whichever occurs first (maximum up to approximately 45 months).

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  • Brief Behavioral Intervention for Insomnia During Chemotherapy Recruiting

    PRIMARY OBJECTIVE(S): The purpose of this study is to test the efficacy of brief behavioral therapy versus control condition that accounts for time and attention (nutrition education) in the treatment of insomnia in humans. SECONDARY OBJECTIVE(S): To assess the impact of different biomarkers on sleep disruption and other patient reported outcomes

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  • A Study Evaluating Talazoparib (BMN 673), a PARP Inhibitor, in Advanced and/or Metastatic Breast Cancer Patients With BRCA Mutation (EMBRACA Study) Not Recruiting

    The purpose of this open-label, 2:1 randomized phase III trial is to compare the safety and efficacy of talazoparib (also known as BMN 673) versus protocol-specific physician's choice in patients who have locally advanced and/or metastatic breast cancer with germline BRCA mutations.

    Stanford is currently not accepting patients for this trial. For more information, please contact Cancer Clinical Trials Office (CCTO), 650-498-7061.

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  • A Study of Abemaciclib (LY2835219) Combined With Fulvestrant in Women With Hormone Receptor Positive HER2 Negative Breast Cancer Not Recruiting

    The main purpose of this study is to compare progression-free survival for women with hormone receptor positive (HR+), human epidermal growth factor receptor (HER2) negative advanced breast cancer receiving either abemaciclib+fulvestrant or fulvestrant alone. Participants will be randomized to abemaciclib or placebo in a 2:1 ratio. The study will last about 9 months for each participant.

    Stanford is currently not accepting patients for this trial. For more information, please contact Annabel Castaneda, 650-498-7977.

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  • A Study of Palbociclib in Addition to Standard Endocrine Treatment in Hormone Receptor Positive Her2 Normal Patients With Residual Disease After Neoadjuvant Chemotherapy and Surgery Not Recruiting

    The PENELOPEB study is designed to demonstrate that in the background of standard anti-hormonal therapy palbociclib provides superior invasive disease-free survival (iDFS) compared to placebo in pre- and postmenopausal women with HR-positive/HER2-normal early breast cancer at high risk of relapse after showing less than pathological complete response to neoadjuvant taxane- containing chemotherapy. Considering the high risk of recurrence in patients after neoadjuvant chemotherapy and a high CPS-EG score, palbociclib appears to be an attractive option with a favourable safety profile for these patients.

    Stanford is currently not accepting patients for this trial. For more information, please contact Amy Isaacson, 650-723-0501.

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  • A Study of Trastuzumab Emtansine (Kadcyla) Plus Pertuzumab (Perjeta) Following Anthracyclines in Comparison With Trastuzumab (Herceptin) Plus Pertuzumab and a Taxane Following Anthracyclines as Adjuvant Therapy in Participants With Operable HER2-Positive Primary Breast Cancer Not Recruiting

    This two-arm, randomized, open-label, multicenter study will evaluate the efficacy and safety of trastuzumab emtansine in combination with pertuzumab versus trastuzumab in combination with pertuzumab and a taxane as adjuvant therapy in participants with human epidermal growth (HER) factor 2 (HER2)-positive primary invasive breast cancer. Following surgery and anthracycline-based chemotherapy, participants will receive either trastuzumab emtansine at a dose of 3.6 milligrams per kilogram (mg/kg) and pertuzumab at a dose of 420 milligrams (mg) intravenously (IV) every 3 weeks (q3w) or trastuzumab at a dose of 6 mg/kg and pertuzumab at a dose of 420 mg IV q3w in combination with a taxane.

    Stanford is currently not accepting patients for this trial. For more information, please contact Annabel Castaneda, 650-498-7977.

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  • Chemotherapy With or Without Trastuzumab After Surgery in Treating Women With Invasive Breast Cancer Not Recruiting

    This randomized phase III clinical trial studies chemotherapy with or without trastuzumab after surgery to see how well they work in treating women with invasive breast cancer. Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving more than one drug (combination chemotherapy) and giving chemotherapy after surgery may kill more tumor cells. Monoclonal antibodies, such as trastuzumab, can block cancer growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. It is not yet known whether combination chemotherapy is more effective with trastuzumab in treating breast cancer.

    Stanford is currently not accepting patients for this trial. For more information, please contact Amy Isaacson, 650-723-0501.

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  • Docetaxel, Carboplatin, Trastuzumab, and Pertuzumab With or Without Estrogen Deprivation in Treating Patients With Hormone Receptor-Positive, HER2-Positive Operable or Locally Advanced Breast Cancer Not Recruiting

    This randomized phase III trial studies docetaxel, carboplatin, trastuzumab, and pertuzumab with estrogen deprivation to see how they work compared to docetaxel, carboplatin, trastuzumab, and pertuzumab without estrogen deprivation in treating patients with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-positive breast cancer that is operable or has spread from where it started to nearby tissue or lymph nodes (locally advanced). Drugs used in chemotherapy, such as docetaxel, carboplatin, trastuzumab, and pertuzumab, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving more than one drug (combination chemotherapy) may kill more tumor cells. Estrogen can cause the growth of breast cancer cells. Hormone therapy using goserelin acetate and aromatase inhibition therapy may fight breast cancer by blocking the use of estrogen by the tumor cells. Radiation therapy uses high energy x rays to kill tumor cells. Giving combination chemotherapy and radiation therapy with or without hormone therapy may be an effective treatment for hormone receptor-positive, HER2-positive, operable or locally advanced breast cancer.

    Stanford is currently not accepting patients for this trial. For more information, please contact Amy Isaacson, 650-723-0501.

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  • Olaparib as Adjuvant Treatment in Patients With Germline BRCA Mutated High Risk HER2 Negative Primary Breast Cancer Not Recruiting

    Olaparib treatment in patients with germline BRCA1/2 mutations and high risk HER2 negative primary breast cancer who have completed definitive local treatment and neoadjuvant or adjuvant chemotherapy

    Stanford is currently not accepting patients for this trial. For more information, please contact Amy Isaacson, 650-723-0501.

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2018-19 Courses

All Publications

  • Efficacy of Medicaid for Patients With Cancer in California JAMA ONCOLOGY Blayney, D. W. 2018; 4 (3): 323–25

    View details for DOI 10.1001/jamaoncol.2017.4356

    View details for Web of Science ID 000426995100011

    View details for PubMedID 29192302

  • Critical Lessons From High-Value Oncology Practices JAMA ONCOLOGY Blayney, D. W., Simon, M. K., Podtschaske, B., Ramsey, S., Shyu, M., Lindquist, C., Milstein, A. 2018; 4 (2): 164–71


    Cancer care is expensive. Cancer care provided by practice organizations varies in total spending incurred by patients and payers during treatment episodes and in quality of care, and this unnecessary variation contributes to the high cost.To use the variation in total spending and quality of care to assess oncology practice attributes distinguishing "high value" that may be tested and adopted by others to produce similar results."Positive deviance" was used in this exploratory mixed-methods (quantitative and qualitative) analysis of interview results. To quantify value, oncology practices located near the US Pacific Northwest and Midwest with low mean insurer-allowed spending were identified. Among those, practices with high quality were selected. A team then conducted site visits to interview practice personnel from June 2, 2015, through October 3, 2015, and to probe for attributes of high-value care. A qualitative analysis of their interview results was performed, and a panel of experienced oncologists was convened to review attributes occurring uniquely or frequently in low-spending practices for their contribution to value improvement and ease of implementation. Four positive deviant (ie, low-spending) oncology practices and 3 oncology practices that ranked near the middle of the spending distribution were studied.Thematic saturation in a qualitative analysis of high-value care attributes.From the 7 oncology practices studied, 13 attributes within the following 5 themes emerged: treatment planning and goal setting, services supporting the patient journey, technical support and physical layout, care team organization and function, and external context. Five attributes (ie, conservative use of imaging, early discussion of treatment limitations and consequences, single point of contact, maximal use of registered nurses for interventions, and a multicomponent health care system) most sharply distinguished the high-value practice sites. The expert oncologist panel judged 3 attributes (ie, early and normalized palliative care, ambulatory rapid response, and early discussion of treatment limitations and consequences) to carry the highest immediate potential for lowering spending without compromising the quality of care.Oncology practice attributes warranting further testing were identified that may lower total spending for high-quality oncology care.

    View details for DOI 10.1001/jamaoncol.2017.3803

    View details for Web of Science ID 000424778600007

    View details for PubMedID 29145584

    View details for PubMedCentralID PMC5838576

  • Updating the American Society of Clinical Oncology Value Framework: Revisions and Reflections in Response to Comments Received. Journal of clinical oncology Schnipper, L. E., Davidson, N. E., Wollins, D. S., Blayney, D. W., Dicker, A. P., Ganz, P. A., Hoverman, J. R., Langdon, R., Lyman, G. H., Meropol, N. J., Mulvey, T., Newcomer, L., Peppercorn, J., Polite, B., Raghavan, D., Rossi, G., Saltz, L., Schrag, D., Smith, T. J., Yu, P. P., Hudis, C. A., Vose, J. M., Schilsky, R. L. 2016; 34 (24): 2925-2934

    View details for DOI 10.1200/JCO.2016.68.2518

    View details for PubMedID 27247218

  • American Society of Clinical Oncology Statement: A Conceptual Framework to Assess the Value of Cancer Treatment Options. Journal of clinical oncology Schnipper, L. E., Davidson, N. E., Wollins, D. S., Tyne, C., Blayney, D. W., Blum, D., Dicker, A. P., Ganz, P. A., Hoverman, J. R., Langdon, R., Lyman, G. H., Meropol, N. J., Mulvey, T., Newcomer, L., Peppercorn, J., Polite, B., Raghavan, D., Rossi, G., Saltz, L., Schrag, D., Smith, T. J., Yu, P. P., Hudis, C. A., Schilsky, R. L., American Society of Clinical Oncology 2015; 33 (23): 2563-2577

    View details for DOI 10.1200/JCO.2015.61.6706

    View details for PubMedID 26101248

  • Do Wise Choices Translate Into Cost Savings and Improved Outcomes? Journal of oncology practice / American Society of Clinical Oncology Blayney, D. W. 2015; 11 (4): 344-345

    View details for DOI 10.1200/JOP.2015.004937

    View details for PubMedID 26060226

  • Transforming data from information to quality improvement: a panel discussion with electronic health record vendors. Journal of oncology practice / American Society of Clinical Oncology Blayney, D. W. 2015; 11 (3): 174-175

    View details for DOI 10.1200/JOP.2015.004267

    View details for PubMedID 25829523

  • Development and Future of the American Society of Clinical Oncology's Quality Oncology Practice Initiative JOURNAL OF CLINICAL ONCOLOGY Blayney, D. W., McNiff, K., Eisenberg, P. D., Gilmore, T., Jacobsen, P. B., Jacobson, J. O., Kadlubek, P. J., Neuss, M. N., Simone, J. 2014; 32 (35): 3907-U174

    View details for DOI 10.1200/JCO.2014.56.8899

    View details for Web of Science ID 000345905100002

    View details for PubMedID 25225418

  • Breast cancer treatment across health care systems: linking electronic medical records and state registry data to enable outcomes research. Cancer Kurian, A. W., Mitani, A., Desai, M., Yu, P. P., Seto, T., Weber, S. C., Olson, C., Kenkare, P., Gomez, S. L., de Bruin, M. A., Horst, K., Belkora, J., May, S. G., Frosch, D. L., Blayney, D. W., Luft, H. S., Das, A. K. 2014; 120 (1): 103-111


    Understanding of cancer outcomes is limited by data fragmentation. In the current study, the authors analyzed the information yielded by integrating breast cancer data from 3 sources: electronic medical records (EMRs) from 2 health care systems and the state registry.Diagnostic test and treatment data were extracted from the EMRs of all patients with breast cancer treated between 2000 and 2010 in 2 independent California institutions: a community-based practice (Palo Alto Medical Foundation; "Community") and an academic medical center (Stanford University; "University"). The authors incorporated records from the population-based California Cancer Registry and then linked EMR-California Cancer Registry data sets of Community and University patients.The authors initially identified 8210 University patients and 5770 Community patients; linked data sets revealed a 16% patient overlap, yielding 12,109 unique patients. The percentage of all Community patients, but not University patients, treated at both institutions increased with worsening cancer prognostic factors. Before linking the data sets, Community patients appeared to receive less intervention than University patients (mastectomy: 37.6% vs 43.2%; chemotherapy: 35% vs 41.7%; magnetic resonance imaging: 10% vs 29.3%; and genetic testing: 2.5% vs 9.2%). Linked Community and University data sets revealed that patients treated at both institutions received substantially more interventions (mastectomy: 55.8%; chemotherapy: 47.2%; magnetic resonance imaging: 38.9%; and genetic testing: 10.9% [P < .001 for each 3-way institutional comparison]).Data linkage identified 16% of patients who were treated in 2 health care systems and who, despite comparable prognostic factors, received far more intensive treatment than others. By integrating complementary data from EMRs and population-based registries, a more comprehensive understanding of breast cancer care and factors that drive treatment use was obtained.

    View details for DOI 10.1002/cncr.28395

    View details for PubMedID 24101577

  • American society of clinical oncology 2013 top five list in oncology. Journal of clinical oncology Schnipper, L. E., Lyman, G. H., Blayney, D. W., Hoverman, J. R., Raghavan, D., Wollins, D. S., Schilsky, R. L. 2013; 31 (34): 4362-4370

    View details for DOI 10.1200/JCO.2013.53.3943

    View details for PubMedID 24170249

  • ASCO's Quality Care Symposium (November 1-2, 2013) Abstracts JOURNAL OF CLINICAL ONCOLOGY Kuznetsov, J. L., Bailey, K., Bombach, P. K., Carmichael, S., Chen, X., Herberg, M. L., Owen, T., Wilson, J., Blayney, D. W. 2013; 31 (31)
  • Computerized prescriber order entry implementation in a physician assistant-managed hematology and oncology inpatient service: effects on workflow and task switching. Journal of oncology practice / American Society of Clinical Oncology Hanauer, D. A., Zheng, K., Commiskey, E. L., Duck, M. G., Choi, S. W., Blayney, D. W. 2013; 9 (4): e103-14


    Little is known about the impact of computerized prescriber order entry (CPOE) systems on inpatient hematology/oncology services. The objective of this study was to quantify the impact of an inpatient CPOE implementation on workflow, with an emphasis on ordering and direct patient care time.We conducted a direct-observation time-and-motion study of the provider team of a hematology/oncology inpatient service both before and after CPOE implementation, characterizing workflow into 60 distinct activity categories. The provider team comprised physician assistants supervised by attending physicians. Results were adjusted to account for variations in the census. We also conducted an analysis of computer logs to assess CPOE system usage.Study participants were observed for 228.0 hours over 53 observation sessions. There was little change in the proportion of census-adjusted time spent on ordering (10.2% before v 11.4% after) and on direct patient care (50.7% before v 47.8% after). Workflow fragmentation decreased, with providers spending an average of 131.2 seconds on a continuous task before implementation and 218.3 seconds after (P < .01). An eight-fold decrease in the number of pages was observed during the course of the study.CPOE implementation did not negatively affect time available for direct patient care. Workflow fragmentation decreased, which is likely beneficial.

    View details for DOI 10.1200/JOP.2012.000655

    View details for PubMedID 23942926

  • Measuring the Improving Quality of Outpatient Care in Medical Oncology Practices in the United States JOURNAL OF CLINICAL ONCOLOGY Neuss, M. N., Malin, J. L., Chan, S., Kadlubek, P. J., Adams, J. L., Jacobson, J. O., Blayney, D. W., Simone, J. V. 2013; 31 (11): 1471-1477


    The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) has provided a method for measuring process-based practice quality since 2006. We sought to determine whether QOPI scores showed improvement in measured quality over time and, if change was demonstrated, which factors in either the measures or participants were associated with improvement.The analysis included 156 practice groups from a larger group of 308 that submitted data from 2006 to 2010. One hundred fifty-two otherwise eligible practices were excluded, most commonly for insufficient data submission. A linear regression model that controlled for varied initial performance was used to estimate the effect of participation over time and evaluate participant and measure characteristics of improvement.Participants completed a mean of 5.06 (standard deviation, 1.94) rounds of data collection. Adjusted mean quality scores improved from 0.71 (95% CI, 0.42 to 0.91) to 0.85 (95% CI, 0.60 to 0.95). Overall odds ratio of improvement over time was 1.09 (P < .001). The greatest improvement was seen in measures that assessed newly introduced clinical information, in which the mean scores improved from 0.05 (95% CI, 0.01 to 0.17) to 0.69 (95% CI, 0.33 to 0.91; P < .001). Many measures showed no change over time.Many US oncologists have participated in QOPI over the past 6 years. Participation over time was highly correlated with improvement in measured performance. Greater and faster improvement was seen in measures concerning newly introduced clinical information. Some measures showed no change despite opportunity for improvement.

    View details for DOI 10.1200/JCO.2012.43.3300

    View details for Web of Science ID 000317174400022

    View details for PubMedID 23478057

  • Tumor Boards (Team Huddles) Aren't Enough to Reach the Goal JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE Blayney, D. W. 2013; 105 (2): 82-84

    View details for DOI 10.1093/jnci/djs523

    View details for Web of Science ID 000314865100005

    View details for PubMedID 23274389

  • Adoption of Gene Expression Profile Testing and Association With Use of Chemotherapy Among Women With Breast Cancer JOURNAL OF CLINICAL ONCOLOGY Hassett, M. J., Silver, S. M., Hughes, M. E., Blayney, D. W., Edge, S. B., Herman, J. G., Hudis, C. A., Marcom, P. K., Pettinga, J. E., Share, D., Theriault, R., Wong, Y., Vandergrift, J. L., Niland, J. C., Weeks, J. C. 2012; 30 (18): 2218-2226


    Gene expression profile (GEP) testing is a relatively new technology that offers the potential of personalized medicine to patients, yet little is known about its adoption into routine practice. One of the first commercially available GEP tests, a 21-gene profile, was developed to estimate the benefit of adjuvant chemotherapy for hormone receptor-positive breast cancer (HR-positive BC).By using a prospective registry data set outlining the routine care provided to women diagnosed from 2006 to 2008 with HR-positive BC at 17 comprehensive and community-based cancer centers, we assessed GEP test adoption and the association between testing and chemotherapy use.Of 7,375 women, 20.4% had GEP testing and 50.2% received chemotherapy. Over time, testing increased (14.7% in 2006 to 27.5% in 2008; P < .01) and use of chemotherapy decreased (53.9% in 2006 to 47.0% in 2008; P < .01). Characteristics independently associated with lower odds of testing included African American versus white race (odds ratio [OR], 0.70; 95% CI, 0.54 to 0.92) and high school or less versus more than high school education (OR, 0.63; 95% CI, 0.52 to 0.76). Overall, testing was associated with lower odds of chemotherapy use (OR, 0.70; 95% CI, 0.62 to 0.80). Stratified analyses demonstrated that for small, node-negative cancers, testing was associated with higher odds of chemotherapy use (OR, 11.13; 95% CI, 5.39 to 22.99), whereas for node-positive and large node-negative cancers, testing was associated with lower odds of chemotherapy use (OR, 0.11; 95% CI, 0.07 to 0.17).There has been a progressive increase in use of this GEP test and an associated shift in the characteristics of and overall reduction in the proportion of women with HR-positive BC receiving adjuvant chemotherapy.

    View details for DOI 10.1200/JCO.2011.38.5740

    View details for Web of Science ID 000305413200014

    View details for PubMedID 22585699

  • American Society of Clinical Oncology Identifies Five Key Opportunities to Improve Care and Reduce Costs: The Top Five List for Oncology JOURNAL OF CLINICAL ONCOLOGY Schnipper, L. E., Smith, T. J., Raghavan, D., Blayney, D. W., Ganz, P. A., Mulvey, T. M., Wollins, D. S. 2012; 30 (14): 1715-1724

    View details for DOI 10.1200/JCO.2012.42.8375

    View details for Web of Science ID 000303914800027

    View details for PubMedID 22493340

  • Michigan Oncology Practices Showed Varying Adherence Rates To Practice Guidelines, But Quality Interventions Improved Care HEALTH AFFAIRS Blayney, D. W., Severson, J., Martin, C. J., Kadlubek, P., Ruane, T., Harrison, K. 2012; 31 (4): 718-728


    Despite improvements in care for patients with cancer, and in their survival rates, it is not clear that best practices are uniformly delivered to patients. We measured the quality of outpatient cancer care, using validated quality measures, in a consortium of thirty-six outpatient oncology practices in Michigan. We discovered that throughout the measurement period, for breast and colorectal cancer care, there was a more than 85 percent rate of adherence to quality care processes. For end-of-life care processes, the adherence rate was 73 percent, and for symptom and toxicity management care processes, adherence was 56 percent. In particular, we found variations in care around the fundamental oncologic task of management of cancer pain. To address quality gaps, we developed interventions to improve adherence to treatment guidelines, improve pain management, and incorporate palliative care into oncology practice. We concluded that statewide consortia that assume much of the cost burden of quality improvement activities can bring together oncology providers and payers to measure quality and design interventions to improve care.

    View details for DOI 10.1377/hlthaff.2011.1295

    View details for Web of Science ID 000302777400009

    View details for PubMedID 22492888

  • Enhancing Quality Through Innovation: American Society of Clinical Oncology Presidential Address 2010 JOURNAL OF CLINICAL ONCOLOGY Blayney, D. W. 2010; 28 (28): 4283-4288

    View details for DOI 10.1200/JCO.2010.31.1696

    View details for Web of Science ID 000282272700024

    View details for PubMedID 20697071

  • Oncologists' Views on Using Value to Guide Cancer Treatment Decisions VALUE IN HEALTH Gidwani-Marszowski, R., Nevedal, A. L., Blayney, D. W., Patel, M., Kelly, P., Timko, C., Ramchandran, K., Murrell, S. S., Asch, S. M. 2018; 21 (8): 931–37


    Cancer costs have increased substantially in the past decades, prompting specialty societies to urge oncologists to consider value in clinical decision making. Despite oncologists' crucial role in guiding cancer care, current literature is sparse with respect to the oncologists' views on value. Here, we evaluated oncologists perceptions of the use and measurement of value in cancer care.We conducted in-depth, open-ended interviews with 31 US oncologists practicing nationwide in various environments. Oncologists discussed the definition, measurement, and implementation of value. Transcripts were analyzed using matrix and thematic analysis.Oncologists' definitions of value varied greatly. Some described versions of the standard health economic definition of value, that is, cost relative to health outcomes. Many others did not include cost in their definition of value. Oncologists considered patient goals and quality of life as important components of value that they perceived were missing from current value measurement. Oncologists prioritized a patient-centric view of value over societal or other perspectives. Oncologists were inclined to consider the value of a treatment only if they perceived treatment would pose a financial burden to patients. Oncologists had differing opinions regarding who should be responsible for determining whether care is low value but generally felt this should remain within the purview of the oncology community.Oncologists agreed that cost was an important issue, but disagreed about whether cost was involved in value as well as the role of value in guiding treatment. Better clarity and alignment on the definition of and appropriate way to measure value is critical to the success of efforts to improve value in cancer care.

    View details for DOI 10.1016/j.jval.2018.01.005

    View details for Web of Science ID 000441071700005

    View details for PubMedID 30098670

  • Architecture and Implementation of a Clinical Research Data Warehouse for Prostate Cancer. EGEMS (Washington, DC) Seneviratne, M. G., Seto, T., Blayney, D. W., Brooks, J. D., Hernandez-Boussard, T. 2018; 6 (1): 13


    Background: Electronic health record (EHR) based research in oncology can be limited by missing data and a lack of structured data elements. Clinical research data warehouses for specific cancer types can enable the creation of more robust research cohorts.Methods: We linked data from the Stanford University EHR with the Stanford Cancer Institute Research Database (SCIRDB) and the California Cancer Registry (CCR) to create a research data warehouse for prostate cancer. The database was supplemented with information from clinical trials, natural language processing of clinical notes and surveys on patient-reported outcomes.Results: 11,898 unique prostate cancer patients were identified in the Stanford EHR, of which 3,936 were matched to the Stanford cancer registry and 6153 in the CCR. 7158 patients with EHR data and at least one of SCIRDB and CCR data were initially included in the warehouse.Conclusions: A disease-specific clinical research data warehouse combining multiple data sources can facilitate secondary data use and enhance observational research in oncology.

    View details for DOI 10.5334/egems.234

    View details for PubMedID 30094285

  • Myeloid Growth Factors, Version 2.2017 Clinical Practice Guidelines in Oncology JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Crawford, J., Becker, P., Armitage, J. O., Blayney, D. W., Chavez, J., Curtin, P., Dinner, S., Fynan, T., Gojo, I., Griffiths, E. A., Hough, S., Kloth, D. D., Kuter, D. J., Lyman, G. H., Mably, M., Mukherjee, S., Patel, S., Perez, L. E., Poust, A., Rampal, R., Roy, V., Rugo, H. S., Saad, A. A., Schwartzberg, L. S., Shayani, S., Talbott, M., Vadhan-Raj, S., Vasu, S., Wadleigh, M., Westervelt, P., Burns, J. L., Pluchino, L. 2017; 15 (12): 1520-+
  • Predicting Long-Term Cognitive Outcome Following Breast Cancer with Pre-Treatment Resting State fMRI and Random Forest Machine Learning FRONTIERS IN HUMAN NEUROSCIENCE Kesler, S. R., Rao, A., Blayney, D. W., Oakley-Girvan, I. A., Karuturi, M., Palesh, O. 2017; 11: 555


    We aimed to determine if resting state functional magnetic resonance imaging (fMRI) acquired at pre-treatment baseline could accurately predict breast cancer-related cognitive impairment at long-term follow-up. We evaluated 31 patients with breast cancer (age 34-65) prior to any treatment, post-chemotherapy and 1 year later. Cognitive testing scores were normalized based on data obtained from 43 healthy female controls and then used to categorize patients as impaired or not based on longitudinal changes. We measured clustering coefficient, a measure of local connectivity, by applying graph theory to baseline resting state fMRI and entered these metrics along with relevant patient-related and medical variables into random forest classification. Incidence of cognitive impairment at 1 year follow-up was 55% and was predicted by classification algorithms with up to 100% accuracy (p < 0.0001). The neuroimaging-based model was significantly more accurate than a model involving patient-related and medical variables (p = 0.005). Hub regions belonging to several distinct functional networks were the most important predictors of cognitive outcome. Characteristics of these hubs indicated potential spread of brain injury from default mode to other networks over time. These findings suggest that resting state fMRI is a promising tool for predicting future cognitive impairment associated with breast cancer. This information could inform treatment decision making by identifying patients at highest risk for long-term cognitive impairment.

    View details for DOI 10.3389/fnhum.2017.00555

    View details for Web of Science ID 000415176500001

    View details for PubMedID 29187817

    View details for PubMedCentralID PMC5694825

  • Redesigning Cancer Care Delivery: Views From Patients and Caregivers. Journal of oncology practice Patel, M. I., Periyakoil, V. S., Blayney, D. W., Moore, D., Nevedal, A., Asch, S., Milstein, A., Coker, T. R. 2017; 13 (4): e291-e302


    Cancer is a leading cause of death in the United States. Although treatments have improved, patients and caregivers continue to report significant gaps in their care. The objective of this study was to examine the views of patients and caregivers on their experiences with current cancer care delivery and identify key strategies to improve the delivery of care.Semistructured interviews were conducted with 75 patients and 45 caregivers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis.Participants reported multiple gaps in care delivery, including barriers in health communication with health care providers, lack of elucidation of care goals, lack of care coordination, and challenges in accessing care. Participants identified that greater use of nonphysician providers and alternative formats, such as telephone-based care and home and community-based care, would narrow these gaps.Understanding patients' and caregivers' experiences with gaps in cancer care delivery can inform cancer care delivery redesign efforts and lead to targeted interventions that result in patient-centered and family-oriented care.

    View details for DOI 10.1200/JOP.2016.017327

    View details for PubMedID 28399387

  • The Appropriate Provision of Primary versus Specialist Palliative Care to Cancer Patients: Oncologists' Perspectives JOURNAL OF PALLIATIVE MEDICINE Gidwani, R., Nevedal, A., Patel, M., Blayney, D. W., Timko, C., Ramchandran, K., Kelly, P. A., Asch, S. M. 2017; 20 (4): 395-403


    Many cancer patients do not receive recommended palliative care (PC). Oncologists' perspectives about PC have not been adequately described qualitatively and may explain some of the gaps in the delivery of PC.To characterize U.S. oncologists' perceptions of: primary and specialist PC; experiences interacting with PC specialists; and the optimal interface of PC and oncology in providing PC.In-depth interviews with practicing oncologists.Oncologists working in: the general community, academic medical centers (AMC), and Veterans Health Administration.Semistructured telephone interviews with 31 oncologists analyzed using matrix and thematic approaches.Seven major themes emerged: PC was perceived as appropriate throughout the disease trajectory but due to resource constraints was largely provided at end of life; oncologists had three schools of thought on primary versus specialist PC; there was an under-availability of outpatient PC; poor communication about prognosis and care plans created tension between providers; PC was perceived as a "team of outsiders"; PC had too narrow a focus of care; and AMC-based PC evidence did not generalize to community practices. Oncologists noted three ways to improve the interface between oncologists and PC providers: a clear division of responsibility, in-person collaboration, and sharing of nonphysician palliative team members.Oncologists in our sample were supportive of PC, but they reported obstacles related to care coordination and inpatient PC. Inpatient PC posed some unique challenges with respect to conflicting prognoses and care practices that would be mitigated through the increased availability and use of outpatient PC.

    View details for DOI 10.1089/jpm.2016.0399

    View details for Web of Science ID 000398452000016

  • Disrupted brain network functional dynamics and hyper-correlation of structural and functional connectome topology in patients with breast cancer prior to treatment BRAIN AND BEHAVIOR Kesler, S. R., Adams, M., Packer, M., Rao, V., Henneghan, A. M., Blayney, D. W., Palesh, O. 2017; 7 (3)


    Several previous studies have demonstrated that cancer chemotherapy is associated with brain injury and cognitive dysfunction. However, evidence suggests that cancer pathogenesis alone may play a role, even in non-CNS cancers.Using a multimodal neuroimaging approach, we measured structural and functional connectome topology as well as functional network dynamics in newly diagnosed patients with breast cancer. Our study involved a novel, pretreatment assessment that occurred prior to the initiation of any cancer therapies, including surgery with anesthesia. We enrolled 74 patients with breast cancer age 29-65 and 50 frequency-matched healthy female controls who underwent anatomic and resting-state functional MRI as well as cognitive testing.Compared to controls, patients with breast cancer demonstrated significantly lower functional network dynamics (p = .046) and cognitive functioning (p < .02, corrected). The breast cancer group also showed subtle alterations in structural local clustering and functional local clustering (p < .05, uncorrected) as well as significantly increased correlation between structural global clustering and functional global clustering compared to controls (p = .03). This hyper-correlation between structural and functional topologies was significantly associated with cognitive dysfunction (p = .005).Our findings could not be accounted for by psychological distress and suggest that non-CNS cancer may directly and/or indirectly affect the brain via mechanisms such as tumor-induced neurogenesis, inflammation, and/or vascular changes, for example. Our results also have broader implications concerning the importance of the balance between structural and functional connectome properties as a potential biomarker of general neurologic deficit.

    View details for DOI 10.1002/brb3.643

    View details for Web of Science ID 000397564200014

    View details for PubMedID 28293478

  • Implementing a Method for Evaluating Patient-Reported Outcomes Associated With Oral Oncolytic Therapy. Journal of oncology practice Mackler, E., Petersen, L., Severson, J., Blayney, D. W., Benitez, L. L., Early, C. R., Hough, S., Griggs, J. J. 2017: JOP2016018390-?


    The paradigm shift in health care toward value-based reimbursement has brought emphasis to providing better quality of care to patients with chronic diseases, including patients with cancer. In accordance with providing better quality of care to patients, there has been a growing interest in evaluating quality of life through patient-reported outcomes (PROs). The revised Edmonton Symptom Assessment Scale (ESAS-r) is a tool that can be used to assess PROs and has been validated for use in patients with cancer. This initiative sought to use this standard assessment tool to acquire PROs concerning symptom burden from patients prescribed oral oncolytics.Eight oncology practices in the state of Michigan used a modified ESAS-r to evaluate symptom burden of patients prescribed oral oncolytics before each outpatient visit. Thirteen symptoms were categorized as mild (0 to 3), moderate (4 to 6), or severe (7 to 10).A total of 1,235 modified ESAS-r surveys were collected and analyzed; 82.5% of symptoms were categorized as mild, 11.9% of symptoms were categorized as moderate, and 5.6% of symptoms were categorized as severe.PROs can be evaluated through the use of a standardized tool, such as the ESAS-r, in oncology patients receiving oral oncolytic therapy. Implementing such a tool in both community and academic practices is feasible and may facilitate improvements in the quality of care.

    View details for DOI 10.1200/JOP.2016.018390

    View details for PubMedID 28195813

  • Mining Electronic Health Records to Extract Patient-Centered Outcomes Following Prostate Cancer Treatment. AMIA ... Annual Symposium proceedings. AMIA Symposium Hernandez-Boussard, T., Kourdis, P. D., Seto, T., Ferrari, M., Blayney, D. W., Rubin, D., Brooks, J. D. 2017; 2017: 876–82


    The clinical, granular data in electronic health record (EHR) systems provide opportunities to improve patient care using informatics retrieval methods. However, it is well known that many methodological obstacles exist in accessing data within EHRs. In particular, clinical notes routinely stored in EHR are composed from narrative, highly unstructured and heterogeneous biomedical text. This inherent complexity hinders the ability to perform automated large-scale medical knowledge extraction tasks without the use of computational linguistics methods. The aim of this work was to develop and validate a Natural Language Processing (NLP) pipeline to detect important patient-centered outcomes (PCOs) as interpreted and documented by clinicians in their dictated notes for male patients receiving treatment for localized prostate cancer at an academic medical center.

    View details for PubMedID 29854154

  • Subtype-Dependent Relationship Between Young Age at Diagnosis and Breast Cancer Survival. Journal of clinical oncology Partridge, A. H., Hughes, M. E., Warner, E. T., Ottesen, R. A., Wong, Y., Edge, S. B., Theriault, R. L., Blayney, D. W., Niland, J. C., Winer, E. P., Weeks, J. C., Tamimi, R. M. 2016; 34 (27): 3308-3314


    Young women are at increased risk for developing more aggressive subtypes of breast cancer. Although previous studies have shown a higher risk of breast cancer recurrence and death among young women with early-stage breast cancer, they have not adequately addressed the role of tumor subtype in outcomes.We examined data from women with newly diagnosed stage I to III breast cancer presenting to one of eight National Comprehensive Cancer Network centers between January 2000 and December 2007. Multivariable Cox proportional hazards models were used to assess the relationship between age and breast cancer-specific survival.A total of 17,575 women with stage I to III breast cancer were eligible for analysis, among whom 1,916 were ≤ 40 years of age at diagnosis. Median follow-up time was 6.4 years. In a multivariable Cox proportional hazards model controlling for sociodemographic, disease, and treatment characteristics, women ≤ 40 years of age at diagnosis had greater breast cancer mortality (hazard ratio [HR], 1.4; 95% CI, 1.2 to 1.7). In stratified analyses, age ≤ 40 years was associated with statistically significant increases in risk of breast cancer death among women with luminal A (HR, 2.1; 95% CI, 1.4 to 3.2) and luminal B (HR 1.4; 95% CI, 1.1 to 1.9) tumors, with borderline significance among women with triple-negative tumors (HR, 1.4; 95% CI, 1.0 to 1.8) but not among those with human epidermal growth factor receptor 2 subtypes (HR, 1.2; 95% CI, 0.8 to 1.9). In an additional model controlling for detection method, young age was associated with significantly increased risk of breast cancer death only among women with luminal A tumors.The effect of age on survival of women with early breast cancer seems to vary by breast cancer subtype. Young age seems to be particularly prognostic in women with luminal breast cancers.

    View details for DOI 10.1200/JCO.2015.65.8013

    View details for PubMedID 27480155

  • Neurotoxic Effects of Anthracycline- vs Nonanthracycline-Based Chemotherapy on Cognition in Breast Cancer Survivors. JAMA oncology Kesler, S. R., Blayney, D. W. 2016; 2 (2): 185-192


    Chemotherapy exposure is a known risk factor for cancer-related cognitive impairments. Anthracycline-based regimens are commonly used chemotherapies that have been shown to be associated with cognitive impairment and brain changes in clinical studies.To directly compare the effects of anthracycline and nonanthracycline regimens on cognitive status and functional brain connectivity.In this observational study, we retrospectively examined cognitive and resting state functional magnetic resonance imaging data acquired from 62 primary breast cancer survivors (mean [SD] age, 54.7 [8.5] years) who were more than 2 years off-therapy, on average. Twenty of these women received anthracycline-based chemotherapy as part of their primary treatment, 19 received nonanthracycline regimens, and 23 did not receive any chemotherapy. Participants were enrolled at a single academic institution (Stanford University) from 2008 to 2014, and the study analyses were performed at this time.Cognitive status was measured using standardized neuropsychological tests, and functional brain connectivity was evaluated using resting state functional magnetic resonance imaging with a focus on the brain's default mode network.The anthracycline group demonstrated significantly lower verbal memory performance including immediate recall (F = 3.73; P = .03) and delayed recall (F = 11.11; P < .001) as well as lower left precuneus connectivity (F = 7.48; P = .001) compared with the other 2 groups. Patient-reported outcomes related to cognitive dysfunction (F = 7.27; P = .002) and psychological distress (F = 5.64; P = .006) were similarly elevated in both chemotherapy groups compared with the non-chemotherapy-treated controls.These results suggest that anthracyclines may have greater negative effects than nonanthracycline regimens on particular cognitive domains and brain network connections. Both anthracycline and nonanthracycline regimens may have nonspecific effects on other cognitive domains as well as certain patient reported outcomes. Further research is needed to identify potential methods for protecting the brain against the effects of various chemotherapeutic agents.

    View details for DOI 10.1001/jamaoncol.2015.4333

    View details for PubMedID 26633037

  • American Society of Clinical Oncology Statement: A Conceptual Framework to Assess the Value of Cancer Treatment Options. Journal of clinical oncology Schnipper, L. E., Davidson, N. E., Wollins, D. S., Tyne, C., Blayney, D. W., Blum, D., Dicker, A. P., Ganz, P. A., Hoverman, J. R., Langdon, R., Lyman, G. H., Meropol, N. J., Mulvey, T., Newcomer, L., Peppercorn, J., Polite, B., Raghavan, D., Rossi, G., Saltz, L., Schrag, D., Smith, T. J., Yu, P. P., Hudis, C. A., Schilsky, R. L. 2015; 33 (23): 2563-2577

    View details for DOI 10.1200/JCO.2015.61.6706

    View details for PubMedID 26101248

  • Brain network alterations and vulnerability to simulated neurodegeneration in breast cancer NEUROBIOLOGY OF AGING Kesler, S. R., Watson, C. L., Blayney, D. W. 2015; 36 (8): 2429-2442


    Breast cancer and its treatments are associated with mild cognitive impairment and brain changes that could indicate an altered or accelerated brain aging process. We applied diffusion tensor imaging and graph theory to measure white matter organization and connectivity in 34 breast cancer survivors compared with 36 matched healthy female controls. We also investigated how brain networks (connectomes) in each group responded to simulated neurodegeneration based on network attack analysis. Compared with controls, the breast cancer group demonstrated significantly lower fractional anisotropy, altered small-world connectome properties, lower brain network tolerance to systematic region (node), and connection (edge) attacks and significant cognitive impairment. Lower tolerance to network attack was associated with cognitive impairment in the breast cancer group. These findings provide further evidence of diffuse white matter pathology after breast cancer and extend the literature in this area with unique data demonstrating increased vulnerability of the post-breast cancer brain network to future neurodegenerative processes.

    View details for DOI 10.1016/j.neurobiolaging.2015.04.015

    View details for Web of Science ID 000355771100010

    View details for PubMedID 26004016

  • Racial and Ethnic Differences in Breast Cancer Survival: Mediating Effect of Tumor Characteristics and Sociodemographic and Treatment Factors. Journal of clinical oncology Warner, E. T., Tamimi, R. M., Hughes, M. E., Ottesen, R. A., Wong, Y., Edge, S. B., Theriault, R. L., Blayney, D. W., Niland, J. C., Winer, E. P., Weeks, J. C., Partridge, A. H. 2015; 33 (20): 2254-2261


    To evaluate the relationship between race/ethnicity and breast cancer-specific survival according to subtype and explore mediating factors.Participants were women presenting with stage I to III breast cancer between January 2000 and December 2007 at National Comprehensive Cancer Network centers with survival follow-up through December 2009. Cox proportional hazards regression was used to compare breast cancer-specific survival among Asians (n = 533), Hispanics (n = 1,122), and blacks (n = 1,345) with that among whites (n = 14,268), overall and stratified by subtype (luminal A like, luminal B like, human epidermal growth factor receptor 2 type, and triple negative). Model estimates were used to derive mediation proportion and 95% CI for selected risk factors.In multivariable adjusted models, overall, blacks had 21% higher risk of breast cancer-specific death (hazard ratio [HR], 1.21; 95% CI, 1.00 to 1.45). For estrogen receptor-positive tumors, black and white survival differences were greatest within 2 years of diagnosis (years 0 to 2: HR, 2.65; 95% CI, 1.34 to 5.24; year 2 to end of follow-up: HR, 1.50; 95% CI, 1.12 to 2.00). Blacks were 76% and 56% more likely to die as a result of luminal A-like and luminal B-like tumors, respectively. No disparities were observed for triple-negative or human epidermal growth factor receptor 2-type tumors. Asians and Hispanics were less likely to die as a result of breast cancer compared with whites (Asians: HR, 0.56; 95% CI, 0.37 to 0.85; Hispanics: HR, 0.74; 95% CI, 0.58 to 0.95). For blacks, tumor characteristics and stage at diagnosis were significant disparity mediators. Body mass index was an important mediator for blacks and Asians.Racial disparities in breast cancer survival vary by tumor subtype. Interventions are needed to reduce disparities, particularly in the first 2 years after diagnosis among black women with estrogen receptor-positive tumors.

    View details for DOI 10.1200/JCO.2014.57.1349

    View details for PubMedID 25964252

  • Racial and Ethnic Differences in Breast Cancer Survival: Mediating Effect of Tumor Characteristics and Sociodemographic and Treatment Factors. Journal of clinical oncology Warner, E. T., Tamimi, R. M., Hughes, M. E., Ottesen, R. A., Wong, Y., Edge, S. B., Theriault, R. L., Blayney, D. W., Niland, J. C., Winer, E. P., Weeks, J. C., Partridge, A. H. 2015; 33 (20): 2254-2261

    View details for DOI 10.1200/JCO.2014.57.1349

    View details for PubMedID 25964252

  • Leveraging state cancer registries to measure and improve the quality of cancer care: a potential strategy for California and beyond. Journal of the National Cancer Institute Hiatt, R. A., Tai, C. G., Blayney, D. W., Deapen, D., Hogarth, M., Kizer, K. W., Lipscomb, J., Malin, J., Phillips, S. K., Santa, J., Schrag, D. 2015; 107 (5)


    Despite recent increased attention to healthcare performance and the burden of disease from cancer, measures of quality of cancer care are not readily available. In 2013, the California HealthCare Foundation convened an expert workgroup to explore the potential for leveraging data in the California Cancer Registry (CCR), one of the world's largest population-based cancer registries, for measuring and improving the quality of cancer care. The workgroup assessed current registry operations, the value to be gained by linking CCR data with health insurance claims or encounter data and clinical data contained in health system electronic health records, and potential barriers to these linkages. The workgroup concluded that: 1) The CCR mandate should be expanded to include use of its data for quality of cancer care measurement and public reporting; and 2) a system should be developed to support linkage of registry data with both claims data and provider electronic health record data.

    View details for DOI 10.1093/jnci/djv047

    View details for PubMedID 25766400

  • American society of clinical oncology third quality care symposium. Journal of oncology practice / American Society of Clinical Oncology Earle, C. C., Jacobson, J. O., Blayney, D. W. 2015; 11 (3): 167-?

    View details for DOI 10.1200/JOP.2015.004119

    View details for PubMedID 25804987

  • Detecting unplanned care from clinician notes in electronic health records. Journal of oncology practice / American Society of Clinical Oncology Tamang, S., Patel, M. I., Blayney, D. W., Kuznetsov, J., Finlayson, S. G., Vetteth, Y., Shah, N. 2015; 11 (3): e313-9


    Reduction in unplanned episodes of care, such as emergency department visits and unplanned hospitalizations, are important quality outcome measures. However, many events are only documented in free-text clinician notes and are labor intensive to detect by manual medical record review.We studied 308,096 free-text machine-readable documents linked to individual entries in our electronic health records, representing care for patients with breast, GI, or thoracic cancer, whose treatment was initiated at one academic medical center, Stanford Health Care (SHC). Using a clinical text-mining tool, we detected unplanned episodes documented in clinician notes (for non-SHC visits) or in coded encounter data for SHC-delivered care and the most frequent symptoms documented in emergency department (ED) notes.Combined reporting increased the identification of patients with one or more unplanned care visits by 32% (15% using coded data; 20% using all the data) among patients with 3 months of follow-up and by 21% (23% using coded data; 28% using all the data) among those with 1 year of follow-up. Based on the textual analysis of SHC ED notes, pain (75%), followed by nausea (54%), vomiting (47%), infection (36%), fever (28%), and anemia (27%), were the most frequent symptoms mentioned. Pain, nausea, and vomiting co-occur in 35% of all ED encounter notes.The text-mining methods we describe can be applied to automatically review free-text clinician notes to detect unplanned episodes of care mentioned in these notes. These methods have broad application for quality improvement efforts in which events of interest occur outside of a network that allows for patient data sharing.

    View details for DOI 10.1200/JOP.2014.002741

    View details for PubMedID 25980019

    View details for PubMedCentralID PMC4438112

  • Administration of oral chemotherapy: results from three rounds of the quality oncology practice initiative. Journal of oncology practice / American Society of Clinical Oncology Zerillo, J. A., Pham, T. H., Kadlubek, P., Severson, J. A., Mackler, E., Jacobson, J. O., Blayney, D. W. 2015; 11 (2): e255-62


    Although use of oral chemotherapy is becoming more prevalent, little is known about the quality of care that patients receive when these agents are prescribed. Moreover, few practice-level systems are in place to ensure safe management of oral chemotherapy in the vulnerable population of patients with cancer.We analyzed results from 155 practices that were voluntarily participating in the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) program on 17 test measures of oral chemotherapy administration and management in at least one of three collection periods: spring or fall of 2012, or spring of 2013. The 17 test measures cover three domains: treatment plan documentation, patient education, and adherence/toxicity monitoring. We defined composite scores for each of the three domains. We analyzed the composite scores by secular trend and tested the difference in composite scores for the three domains. Additionally, we tested change in scores over time among practices that participated at least twice.The majority of data was provided by QOPI-certified practices. Overall, mean practice composite scores ranged from 66% to 68% for treatment plan documentation, 51% to 57% for patient education, and 75% to 81% for adherence/toxicity monitoring. Composite scores for practices that participated more than once did not improve significantly.The collection of oral chemotherapy test measure data is feasible. Composite scores for treatment plan documentation and patient education were not only lower, but had greater variability compared with adherence/toxicity monitoring. Improvement opportunities exist for patients who are prescribed oral chemotherapy.

    View details for DOI 10.1200/JOP.2014.001842

    View details for PubMedID 25784581

  • Are Patients With Thoracic Malignancies at Risk for Uncontrolled Symptoms? Journal of oncology practice / American Society of Clinical Oncology Patel, M. I., Williams, D. C., Wohlforth, C., Fisher, G., Wakelee, H. A., Blayney, D. W. 2015; 11 (1): e98-e102


    Patients with cancer often develop symptoms and contact their oncologists and care teams after normal clinic operating hours. Better understanding of these after-hours telephone calls can inform efforts to improve cancer care and to reduce health care spending. We sought to evaluate after-hours calls at Stanford Cancer Institute (SCI) Thoracic Oncology Clinic.We retrospectively analyzed content of telephone call notes made to SCI during weekends and from 5 pm to 8 am on weekdays. Chief complaint, caller and patient demographics, patient diagnosis, advice given, and disposition were analyzed. χ(2) tests were used to analyze differences in proportions.There were a total of 263 after-hours telephone calls during the 6 months of the study. After exclusions, there were 241 telephone calls for analysis. The majority of calls occurred between 5 pm to 11 pm (n = 175 [73%]; P < .001), followed by daytime calls on weekends (n = 157 [65%]; P < .001). Common symptoms were cough (28%) and dyspnea (27%). Of the calls, 62% (150 patients) resulted in emergency department (ED) referral, and 77% of patients (115 of 150) evaluated in the ED were admitted to the hospital.Most after-hours telephone calls from patients with lung cancer are related to symptoms. Many patients were referred to the ED and subsequently required hospitalization. Analysis of call content and prior events leading to after-hours calls may predict hospital admissions in this group of patients and can inform development of proactive interventions to improve quality of care and patient-centered outcomes.

    View details for DOI 10.1200/JOP.2014.001502

    View details for PubMedID 25271246

  • Reply to L.k. Griffeth et Al and j.e. Battley et Al. Journal of clinical oncology Schnipper, L. E., Schilsky, R. L., Hoverman, J. R., Raghavan, D., Lyman, G. H., Wollins, D. S., Blayney, D. W. 2014; 32 (25): 2812-2813

    View details for DOI 10.1200/JCO.2014.55.2349

    View details for PubMedID 25024078

  • Transforming cancer care: are transdisciplinary approaches using design-thinking, engineering, and business methodologies needed to improve value in cancer care delivery? Journal of oncology practice / American Society of Clinical Oncology Patel, M. I., Moore, D., Blayney, D. W., Milstein, A. 2014; 10 (2): e51-4

    View details for DOI 10.1200/JOP.2013.000928

    View details for PubMedID 24371302

  • Breast Cancer Treatment Across Health Care Systems CANCER Kurian, A. W., Mitani, A., Desai, M., Yu, P. P., Seto, T., Weber, S. C., Olson, C., Kenkare, P., Gomez, S. L., de Bruin, M. A., Horst, K., Belkora, J., May, S. G., Frosch, D. L., Blayney, D. W., Luft, H. S., Das, A. K. 2014; 120 (1): 103-111

    View details for DOI 10.1002/cncr.28395

    View details for Web of Science ID 000328443000017

  • Patients with systemic lupus erythematosus and haematological malignancy at a tertiary care centre: timing, histopathology and therapy. Lupus science & medicine Knight, J. S., Blayney, D. W., Somers, E. C. 2014; 1 (1)


    Patients with systemic lupus erythematosus (SLE) are at higher risk of haematological malignancies (HMs) than the general population. Most reports have focused on HM diagnosed after SLE, and have excluded concurrent and preceding diagnoses. Information on response to therapy is also limited.We identified 13 296 cases of HM and 10 539 potential patients with SLE at our centre; 45 patients were confirmed to have HM and SLE. Our retrospective case series was based on these 45 patients.Of the 45 patients, 64% were diagnosed with HM ≥1 year after diagnosis with SLE, and 36% with HM before or concurrent with SLE. Of the 29 patients with HM after SLE, 13 had diffuse large B cell lymphoma (DLBCL), 6 indolent lymphoma, 4 leukaemia, 3 Hodgkin's disease, and 1 each Burkitt's lymphoma, T cell lymphoma and multiple myeloma. Eleven patients with DLBCL were treated with cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone (CHOP) or rituximab-CHOP; hydroxydaunorubicin, oncovin and prednisone; only four achieved durable remission. Of the 16 patients diagnosed with HM before or concurrent with SLE, 9 were diagnosed with HM more than 2 years before SLE and tended to be in remission prior to SLE diagnosis. Seven patients were diagnosed with HM and SLE concurrently; in terms of their HM, six achieved remission or stable disease.In summary, DLBCL was the most common type of lymphoma in patients diagnosed with HM after SLE; these patients presented with advanced-stage disease and had poor outcomes. In contrast, patients diagnosed with HM before or concurrent with SLE had early stage disease and typically achieved remission.

    View details for DOI 10.1136/lupus-2014-000051

    View details for PubMedID 25452880

  • Myeloid Growth Factors JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Crawford, J., Armitage, J., Balducci, L., Becker, P. S., Blayney, D. W., Cataland, S. R., Heaney, M. L., Hudock, S., Kloth, D. D., Kuter, D. J., Lyman, G. H., McMahon, B., Rugo, H. S., Saad, A. A., Schwartzberg, L. S., Shayani, S., Steensma, D. P., Talbott, M., Vadhan-Raj, S., Westervelt, P., Westmoreland, M., Dwyer, M., Ho, M. 2013; 11 (10): 1266-1290


    Febrile neutropenia, a common side effect of myelosuppressive chemotherapy in patients with cancer, can result in prolonged hospitalization and broad-spectrum antibiotic use, often prompting treatment delays or dose reductions of drug regimens. Prophylactic use of myeloid growth factors (mainly the colony-stimulating factors filgrastim and pegfilgrastim) in patients of heightened risk can reduce the severity and duration of febrile neutropenia. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Myeloid Growth Factors provide recommendations on the use of these agents mainly in the oncology setting based on clinical evidence and expert consensus. This version includes revisions surrounding the issue of timing of pegfilgrastim administration. It also includes new sections on tbo-filgrastim, a recently approved agent that is biologically similar to filgrastim, and the role of myeloid growth factors in the hematopoietic cell transplant setting.

    View details for Web of Science ID 000325929600010

    View details for PubMedID 24142827

  • Measuring and improving quality of care in an academic medical center. Journal of oncology practice / American Society of Clinical Oncology Blayney, D. W. 2013; 9 (3): 138-141


    The Donabedian definition of quality—structure, process, and outcome—provides a useful framework. A relentless focus on measuring process adherence and outcome is critical. Systemic improvements usually require teams to plan and to implement them. The lean or Toyota production system for process improvement is one useful method of organizing work, although different approaches are often necessary at the physician, practice unit, and statewide level. Challenges include scalability of the change (ie, rolling them out across the institution or system), tailoring the information technology tools, and building systems for sustainability.

    View details for DOI 10.1200/JOP.2013.000991

    View details for PubMedID 23942492

  • Time to diagnosis and breast cancer stage by race/ethnicity BREAST CANCER RESEARCH AND TREATMENT Warner, E. T., Tamimi, R. M., Hughes, M. E., Ottesen, R. A., Wong, Y., Edge, S. B., Theriault, R. L., Blayney, D. W., Niland, J. C., Winer, E. P., Weeks, J. C., Partridge, A. H. 2012; 136 (3): 813-821


    We examined differences in time to diagnosis by race/ethnicity, the relationship between time to diagnosis and stage, and the extent to which it explains differences in stage at diagnosis across racial/ethnic groups. Our analytic sample includes 21,427 non-Hispanic White (White), Hispanic, non-Hispanic Black (Black) and non-Hispanic Asian/Pacific Islander (Asian) women diagnosed with stage I to IV breast cancer between January 1, 2000 and December 31, 2007 at one of eight National Comprehensive Cancer Network centers. We measured time from initial abnormal mammogram or symptom to breast cancer diagnosis. Stage was classified using AJCC criteria. Initial sign of breast cancer modified the association between race/ethnicity and time to diagnosis. Among symptomatic women, median time to diagnosis ranged from 36 days among Whites to 53.6 for Blacks. Among women with abnormal mammograms, median time to diagnosis ranged from 21 days among Whites to 29 for Blacks. Blacks had the highest proportion (26 %) of Stage III or IV tumors. After accounting for time to diagnosis, the observed increased risk of stage III/IV breast cancer was reduced from 40 to 28 % among Hispanics and from 113 to 100 % among Blacks, but estimates remained statistically significant. We were unable to fully account for the higher proportion of late-stage tumors among Blacks. Blacks and Hispanics experienced longer time to diagnosis than Whites, and Blacks were more likely to be diagnosed with late-stage tumors. Longer time to diagnosis did not fully explain differences in stage between racial/ethnicity groups.

    View details for DOI 10.1007/s10549-012-2304-1

    View details for Web of Science ID 000312071000019

    View details for PubMedID 23099438

  • Clinicopathologic Features, Patterns of Recurrence, and Survival Among Women With Triple-Negative Breast Cancer in the National Comprehensive Cancer Network CANCER Lin, N. U., Vanderplas, A., Hughes, M. E., Theriault, R. L., Edge, S. B., Wong, Y., Blayney, D. W., Niland, J. C., Winer, E. P., Weeks, J. C. 2012; 118 (22): 5463-5472


    The objective of this study was to describe clinicopathologic features, patterns of recurrence, and survival according to breast cancer subtype with a focus on triple-negative tumors.In total, 15,204 women were evaluated who presented to National Comprehensive Cancer Network centers with stage I through III breast cancer between January 2000 and December 2006. Tumors were classified as positive for estrogen receptor (ER) and/or progesterone receptor (PR) (hormone receptor [HR]-positive) and negative for human epidermal growth factor receptor 2 (HER2); positive for HER2 and any ER or PR status (HER2-positive); or negative for ER, PR, and HER2 (triple-negative).Subtype distribution was triple-negative in 17% of women (n = 2569), HER2-positive in 17% of women (n = 2602), and HR-positive/HER2-negative in 66% of women (n = 10,033). The triple-negative subtype was more frequent in African Americans compared with Caucasians (adjusted odds ratio, 1.98; P < .0001). Premenopausal women, but not postmenopausal women, with high body mass index had an increased likelihood of having the triple-negative subtype (P = .02). Women with triple-negative cancers were less likely to present on the basis of an abnormal screening mammogram (29% vs 48%; P < .0001) and were more likely to present with higher tumor classification, but they were less likely to have lymph node involvement. Relative to HR-positive/HER2-negative tumors, triple-negative tumors were associated with a greater risk of brain or lung metastases; and women with triple-negative tumors had worse breast cancer-specific and overall survival, even after adjusting for age, disease stage, race, tumor grade, and receipt of adjuvant chemotherapy (overall survival: adjusted hazard ratio, 2.72; 95% confidence interval, 2.39-3.10; P < .0001). The difference in the risk of death by subtype was most dramatic within the first 2 years after diagnosis (overall survival for 0-2 years: OR, 6.10; 95% confidence interval, 4.81-7.74).Triple-negative tumors were associated with unique risk factors and worse outcomes compared with HR-positive/HER2-negative tumors.

    View details for DOI 10.1002/cncr.27581

    View details for Web of Science ID 000310483800002

    View details for PubMedID 22544643

  • The anemia impact measure (AIM): development and content validation of a patient-reported outcome measure of anemia symptoms and symptom impacts in cancer patients receiving chemotherapy QUALITY OF LIFE RESEARCH Kleinman, L., Benjamin, K., Viswanathan, H., Mattera, M. S., Bosserman, L., Blayney, D. W., Revicki, D. A. 2012; 21 (7): 1255-1266


    To develop a patient-reported outcome instrument for measuring anemia symptoms and their impact in patients with chemotherapy-induced anemia (CIA).Qualitative research was conducted using six focus groups and 24 interviews with 46 CIA patients, eight interviews in patients receiving chemotherapy with no CIA history and two interviews in patients successfully treated for CIA. Atlas.ti 5.0 was used to organize key concepts. Cognitive interviews with 16 CIA patients and assessment of relevance of each item to CIA by 10 clinicians were also conducted to evaluate content validity.Most CIA patients were white (76%) and female (83%), and the average age was 60 years. The most common cancer types were breast cancer (54%) and lung cancer (17%). Tiredness was the most prevalent symptom and rated as the most important by 83% of CIA patients; weakness, shortness of breath, lightheadedness, and dizziness were ranked next in importance. The final anemia impact measure (AIM) contains: (1) daily CIA symptom diary (9 items), and (2) impact of CIA-related tiredness (29 items covering daily living activities, social activities, cognitive function, and emotions). Cognitive interviews found that the AIM was relevant and easy to understand.The AIM assesses important patient-perceived CIA symptoms and their impact and was developed using extensive patient qualitative data.

    View details for DOI 10.1007/s11136-011-0034-1

    View details for Web of Science ID 000314910300016

    View details for PubMedID 21987032

  • The Effect of Age on Delay in Diagnosis and Stage of Breast Cancer ONCOLOGIST Partridge, A. H., Hughes, M. E., Ottesen, R. A., Wong, Y., Edge, S. B., Theriault, R. L., Blayney, D. W., Niland, J. C., Winer, E. P., Weeks, J. C., Tamimi, R. M. 2012; 17 (6): 775-782


    Young women with breast cancer are more likely to present with more advanced disease and are more likely to die as a result of breast cancer than their older counterparts. We sought to examine the relationship among young age (≤40 years), the likelihood of a delay in diagnosis, and stage.We examined data from women with newly diagnosed stage I-IV breast cancer presenting to one of eight National Comprehensive Cancer Network centers in January 2000 to December 2007. Delay in diagnosis was defined as time from initial sign or symptom to breast cancer diagnosis >60 days.Among 21,818 women with breast cancer eligible for analysis, 2,445 were aged ≤40 years at diagnosis. Young women were not more likely to have a delay in diagnosis >60 days (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.98-1.19) after adjustment for type of initial sign or symptom. Young women were only modestly more likely to present with higher stage disease after a similar adjustment (OR, 1.18; 95% CI, 1.07-1.31). Women presenting with symptomatic disease, more common in younger women, were more likely to have a delay in diagnosis (OR, 3.31; 95% CI, 3.08-3.56) and higher stage (OR, 4.31; 95% CI 4.05-4.58).Young age is not an independent predictor of delay in diagnosis of breast cancer and only modestly is associated with higher stage disease. Presenting with symptoms of breast cancer predicts delay and higher stage at diagnosis.

    View details for DOI 10.1634/theoncologist.2011-0469

    View details for Web of Science ID 000306147200009

    View details for PubMedID 22554997

  • Comparative outcome of initial therapy for younger patients with mantle cell lymphoma: an analysis from the NCCN NHL Database BLOOD LaCasce, A. S., Vandergrift, J. L., Rodriguez, M. A., Abel, G. A., Crosby, A. L., Czuczman, M. S., Nademanee, A. P., Blayney, D. W., Gordon, L. I., Millenson, M., Vanderplas, A., Lepisto, E. M., Zelenetz, A. D., Niland, J., Friedberg, J. W. 2012; 119 (9): 2093-2099


    Few randomized trials have compared therapies in mantle cell lymphoma (MCL), and the role of aggressive induction is unclear. The National Comprehensive Cancer Network (NCCN) Non-Hodgkin Lymphoma (NHL) Database, a prospective cohort study collecting clinical, treatment, and outcome data at 7 NCCN centers, provides a unique opportunity to compare the effectiveness of initial therapies in MCL. Patients younger than 65 diagnosed between 2000 and 2008 were included if they received RHCVAD (rituximab fractionated cyclophosphamide, vincristine, adriamycin, and dexamethasone), RCHOP+HDT/ASCR (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone + high-dose therapy/autologous stem cell rescue), RHCVAD+HDT/ASCR, or RCHOP. Clinical parameters were similar for patients treated with RHCVAD (n = 83, 50%), RCHOP+HDT/ASCR (n = 34, 20%), RCHOP (n = 29, 17%), or RHCVAD+HDT/ASCR (n = 21, 13%). Overall, 70 (42%) of the 167 patients progressed and 25 (15%) expired with a median follow-up of 33 months. There was no difference in progression-free survival (PFS) between aggressive regimens (P > .57), which all demonstrated superior PFS compared with RCHOP (P < .004). There was no difference in overall survival (OS) between the RHCVAD and RCHOP+HDT/ASCR (P = .98). RCHOP was inferior to RHCVAD and RCHOP+HDT/ASCR, which had similar PFS and OS. Despite aggressive regimens, the median PFS was 3 to 4 years. Future trials should focus on novel agents rather than comparing current approaches.

    View details for DOI 10.1182/blood-2011-07-369629

    View details for Web of Science ID 000300949500019

    View details for PubMedID 22234679

  • The impact of obesity on receipt of adjuvant chemotherapy for breast cancer in the National Comprehensive Cancer Network (NCCN) centers BREAST CANCER RESEARCH AND TREATMENT Brewster, A. M., Etzel, C., Zhou, R., Wong, Y., Edge, S., Blayney, D. W., Wilson, J., Hudis, C., Ottesen, R., Hughes, M. E., Weeks, J. C., Theriault, R. L. 2011; 130 (3): 897-904


    Disparities in the receipt of adjuvant chemotherapy for early stage breast cancer is an important factor influencing mortality. We investigated whether greater body mass index (BMI) decreases receipt of adjuvant chemotherapy among women with operable breast cancer. In the NCCN breast cancer outcomes database, we identified women aged ≤ 70 with newly diagnosed stage I, II, or III breast cancer between 1997 and 2007, for whom use of adjuvant chemotherapy was classified as either standard-of-care or discretionary based on their clinical characteristics. Body mass index was assessed in categories (<18.5 kg/m(2) [underweight], 18.5 to <25 kg/m(2) [normal], 25 to <30 kg/m(2) [overweight], 30-39 kg/m(2) [obese], ≥ 40 kg/m(2) [extreme obese]). Multivariable logistic regression analysis was used to examine the association between BMI and receipt of chemotherapy in each classification group. 9,527 women were eligible for the study; 40% normal weight or less; 31% overweight; 24% obese; and 5% extremely obese. In multivariable analysis, there was no significant association between BMI and receipt of chemotherapy in either classification group. Among women for whom chemotherapy would be considered standard-of-care, older age (P < 0.001), comorbidity (P < 0.001), and non-Hispanic black ethnicity (P = 0.002) were associated with a lower likelihood of receipt of chemotherapy; however, the effect of ethnicity was not modified by obesity. Among women treated for operable breast cancer in the NCCN centers, BMI had no impact on receipt of adjuvant chemotherapy and did not modify the lower likelihood of chemotherapy among non-Hispanic black patients. Further investigation is needed into other factors that contribute to patient disparities in the receipt of chemotherapy in major academic centers.

    View details for DOI 10.1007/s10549-011-1516-0

    View details for Web of Science ID 000297225600018

    View details for PubMedID 21809116

  • Commentary: six years of trends in oncology practice data. Journal of oncology practice / American Society of Clinical Oncology Blayney, D. W. 2011; 7 (5): 291-293

    View details for DOI 10.1200/JOP.2011.000412

    View details for PubMedID 22211123

  • Myeloid Growth Factors JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Crawford, J., Allen, J., Armitage, J., Blayney, D. W., Cataland, S. R., Heaney, M. L., Htoy, S., Hudock, S., Kloth, D. D., Kuter, D. J., Lyman, G. H., McMahon, B., Steensma, D. P., Vadhan-Raj, S., Westervelt, P., Westmoreland, M. 2011; 9 (8): 914-?

    View details for Web of Science ID 000293583500007

    View details for PubMedID 21900221

  • Institutional Variation in the Surgical Treatment of Breast Cancer A Study of the NCCN ANNALS OF SURGERY Greenberg, C. C., Lipsitz, S. R., Hughes, M. E., Edge, S. B., Theriault, R., Wilson, J. L., Carter, W. B., Blayney, D. W., Niland, J., Weeks, J. C. 2011; 254 (2): 339-345


    To investigate the relationship between supply of subspecialty care and type of procedure preferentially performed for early stage breast cancer.Three surgical options exist for early stage breast cancer: (1) breast conserving surgery (BCS), (2) mastectomy with reconstruction (RECON), and (3) mastectomy alone. Current guidelines recommend that surgical treatment decisions should be based on patient preference if a patient is eligible for all 3. However, studies demonstrate persistent variation in the use of BCS and RECON.Patients undergoing an operation for DCIS or stage I or II breast cancer at NCCN institutions between 2000 and 2006 were identified. Institutional procedure rates were determined. Spearman correlations measured the association between procedure types. Patient-level logistic regression models investigated predictors of procedure type and association with institutional supply of subspecialty care.Among 10,607 patients, 19% had mastectomy alone, 60% BCS, and 21% RECON. The institutional rate of BCS and RECON were strongly correlated (r = -0.80, P = 0.02). Institution was more important than all patient factors except age in predicting receipt of RECON or BCS. RECON was more likely for patients treated at an institution with a greater supply of reconstructive surgeons or where patients live further from radiation facilities. RECON was less likely at institutions with longer waiting times for surgery with reconstruction.Even within the NCCN, a consortium of multidisciplinary cancer centers, the use of BCS and mastectomy with reconstruction substantially varies by institution and correlates with the supply of subspecialty care.

    View details for DOI 10.1097/SLA.0b013e3182263bb0

    View details for Web of Science ID 000292908700023

    View details for PubMedID 21725233

  • Continued Use of Trastuzumab Beyond Disease Progression in the National Comprehensive Cancer Network: Should We Practice Ahead of the Evidence? ONCOLOGIST Wong, Y., Ottesen, R. A., Hughes, M. E., Niland, J. C., Theriault, R., Edge, S. B., Blayney, D., Weeks, J. C. 2011; 16 (5): 559-565


    The role of continued trastuzumab after progression in women with human epidermal growth factor receptor (HER)-2+ metastatic breast cancer is controversial. Controlled clinical trials that establish a benefit from continued trastuzumab have been difficult to complete.In the National Comprehensive Cancer Center Network (NCCN) Breast Cancer Outcomes Database, we identified women treated with trastuzumab for metastatic or relapsed HER-2+ breast cancer at eight NCCN centers who subsequently progressed. Patients were eligible for this analysis if they initiated treatment at an NCCN institution between July 1997 and December 2004, received trastuzumab-containing treatment, and progressed while on therapy. We calculated the proportion of patients who received trastuzumab after progression, and in a multivariate analysis assessed the association of patient and provider characteristics with continued trastuzumab therapy.Our final cohort consisted of 218 women who experienced disease progression while on trastuzumab-containing therapy. Of these, 168 (77%) continued trastuzumab. Of these, 36 patients (17%) received therapy as part of a clinical trial. The only factors significantly associated with continuation of trastuzumab beyond progression were the presence of bone metastases and more recent year of development of progressive disease.Prior to the availability of any high-quality evidence supporting this practice, over three quarters of patients treated with trastuzumab for HER-2+ metastatic breast cancer at eight NCCN centers continued therapy beyond progression. Further work is needed to understand how physicians adopt new treatments when there is ambiguity surrounding their benefit.

    View details for DOI 10.1634/theoncologist.2010-0360

    View details for Web of Science ID 000290661900005

    View details for PubMedID 21450786

  • Expansion of cancer care and control in countries of low and middle income: a call to action LANCET Farmer, P., Frenk, J., Knaul, F. M., Shulman, L. N., Alleyne, G., Armstrong, L., Atun, R., Blayney, D., Chen, L., Feachem, R., Gospodarowicz, M., Gralow, J., Gupta, S., Langer, A., Lob-Levyt, J., Neal, C., Mbewu, A., Mired, D., Piot, P., Reddy, K. S., Sachs, J. D., Sarhan, M., Seffrin, J. R. 2010; 376 (9747): 1186-1193


    Substantial inequalities exist in cancer survival rates across countries. In addition to prevention of new cancers by reduction of risk factors, strategies are needed to close the gap between developed and developing countries in cancer survival and the effects of the disease on human suffering. We challenge the public health community's assumption that cancers will remain untreated in poor countries, and note the analogy to similarly unfounded arguments from more than a decade ago against provision of HIV treatment. In resource-constrained countries without specialised services, experience has shown that much can be done to prevent and treat cancer by deployment of primary and secondary caregivers, use of off-patent drugs, and application of regional and global mechanisms for financing and procurement. Furthermore, several middle-income countries have included cancer treatment in national health insurance coverage with a focus on people living in poverty. These strategies can reduce costs, increase access to health services, and strengthen health systems to meet the challenge of cancer and other diseases. In 2009, we formed the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, which is composed of leaders from the global health and cancer care communities, and is dedicated to proposal, implementation, and evaluation of strategies to advance this agenda.

    View details for DOI 10.1016/S0140-6736(10)61152-X

    View details for Web of Science ID 000282915700035

    View details for PubMedID 20709386

  • Challenges to National Cancer Institute-Supported Cooperative Group Clinical Trial Participation: An ASCO Survey of Cooperative Group Sites. Journal of oncology practice / American Society of Clinical Oncology Baer, A. R., Kelly, C. A., Bruinooge, S. S., Runowicz, C. D., Blayney, D. W. 2010; 6 (3): 114-117


    Anecdotal information regarding clinical research sites limiting participation in NCI-funded cooperative group studies prompted ASCO to collect data on and investigate the reasons behind this trend.

    View details for DOI 10.1200/JOP.200028

    View details for PubMedID 20808551

  • Partnering with payers for success: quality oncology practice initiative, blue cross blue shield of michigan, and the michigan oncology quality consortium. Journal of oncology practice / American Society of Clinical Oncology Blayney, D. W., Stella, P. J., Ruane, T., Martin, J., Lavasseur, B., Leyden, T., Malloy, M. 2009; 5 (6): 281-284


    More than 16% of the total sites participating nationally in the QOPI survey are in Michigan. A significant component of the growth in QOPI participation in Michigan can be attributed to the involvement and quality improvement efforts of Blue Cross Blue Shield of Michigan.

    View details for DOI 10.1200/JOP.091043

    View details for PubMedID 21479071

  • Lymphoma After Solid Organ Transplantation: Risk, Response to Therapy, and Survival at a Transplantation Center 49th Annual Meeting of the American-Society-of-Hematology Knight, J. S., Tsodikov, A., Cibrik, D. M., Ross, C. W., Kaminski, M. S., Blayney, D. W. AMER SOC CLINICAL ONCOLOGY. 2009: 3354–62


    We studied the incidence, risk factors, treatment, and outcomes of post-transplantation lymphoproliferative disorder (PTLD) that occurred at the University of Michigan since 1964.We identified 7,040 patients who received solid organ transplantation (SOT) and post-transplantation immunosuppressive therapy. Seventy-eight patients developed PTLD.Diffuse large B-cell lymphoma (n = 43), polymorphic PTLD (n = 10), Hodgkin's lymphoma (n = 7), Burkitts lymphoma (n = 6), plasmacytoma (n = 5), and mucosa-associated lymphoid tissue lymphoma (n = 3) were all over-represented in the SOT population compared with a population sample from the Surveillance, Epidemiology, and End Results (SEER) database; follicular lymphoma (n = 0) was underrepresented. Negative pretransplantation Epstein-Barr virus (EBV) serology was a risk factor for PTLD. Available histologic analysis of tumor tissue showed that 75% were CD20 positive and that 62% were EBV positive; EBV-positive tumors occurred sooner after SOT than EBV-negative tumors (mean, 29 v 66 months). Extralymphatic disease (79%), poor performance status (68%), elevated lactate dehydrogenase (LDH; 71%), and advanced stage (68%) disease were all common at the time of lymphoma diagnosis. Two thirds of patients had a complete response when treated with cyclophosphamide, doxorubicin, vincristine, and prednisone-like chemotherapy (either with or without rituximab). Median overall survival in all patients with PTLD was 8.23 years (95% CI, 2.28 to 30.0 years).EBV-naïve patients who receive a donor organ from an EBV-infected donor are in the highest-risk situation for PTLD development. Most of these lymphomas are CD20 positive. Follicular lymphoma is unusual. With treatment, survival of patients with PTLD was indistinguishable from that of the SEER population sample.

    View details for DOI 10.1200/JCO.2008.20.0857

    View details for Web of Science ID 000267821400016

    View details for PubMedID 19451438

  • Chemotherapy Use for Hormone Receptor-Positive, Lymph Node-Negative Breast Cancer Breast Cancer Symposium of the American-Society-of-Clinical-Oncology Hassett, M. J., Hughes, M. E., Niland, J. C., Edge, S. B., Theriault, R. L., Wong, Y., Wilson, J., Carter, W. B., Blayney, D. W., Weeks, J. C. AMER SOC CLINICAL ONCOLOGY. 2008: 5553–60


    To describe the frequency of chemotherapy use for hormone receptor (HR)-positive, lymph node (LN)-negative breast cancer from 1997 to 2004 at eight National Comprehensive Cancer Network institutions, to explore whether chemotherapy use varied over time and between institutions, and to identify factors associated with the decision to forego chemotherapy.Among women younger than age 70 years with HR-positive, LN-negative breast cancer measuring more than 1 cm, we analyzed the frequency of chemotherapy use on a yearly basis. A multivariable logistic regression model assessed the relationship between receipt of chemotherapy and year of diagnosis, institution, tumor features, and patient characteristics. Interaction terms were added to the model, and stratified analyses were conducted to further explore the determinants of chemotherapy use.Fifty-five percent of 3,190 women received chemotherapy. Chemotherapy use was less common for patients with 1.1- to 2-cm tumors than for patients tumors greater 2 cm (47% v 87%, respectively; P < .01) and for women age 60 to 69 years versus women younger than age 50 years (24% v 76%, respectively; P < .01). On multivariable analysis, predictors independently associated with receiving chemotherapy included larger tumor size, higher grade, human epidermal growth factor receptor 2 overexpression, younger age, and institution (P < .01 for all). Institutions exhibited dramatically different rates of chemotherapy use (from 46% to 65%) and patterns of change in chemotherapy use over time (from a 79% relative increase to a 22% relative decrease).Although institutions seemed to agree that not all women with HR-positive, LN-negative breast cancer need chemotherapy, there did not seem to be consensus regarding which women should get chemotherapy. Only prospective randomized controlled trials will conclusively establish which subtypes of HR-positive, LN-negative breast cancer benefit from chemotherapy.

    View details for DOI 10.1200/JCO.2008.17.9705

    View details for Web of Science ID 000261199700012

    View details for PubMedID 18955448

  • The registry case finding engine: An automated tool to identify cancer cases from unstructured, free-text pathology reports and clinical notes. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Hanauer, D. A., Miela, G., Chinnaiyan, A. M., Chang, A. E., Blayney, D. W. 2007; 205 (5): 690-697


    The American College of Surgeons mandates the maintenance of a cancer registry for hospitals seeking accreditation. At the University of Michigan Health System, more than 90% of all registry patients are identified by manual review, a method common to many institutions. We hypothesized that an automated computer system could accurately perform this time- and labor-intensive task. We created a tool to automatically scan free-text medical documents for terms relevant to cancer.We developed custom-made lists containing approximately 2,500 terms and phrases and 800 SNOMED codes. Text is processed by the Case Finding Engine (CaFE), and relevant terms are highlighted for review by a registrar and used to populate the registry database. We tested our system by comparing results from the CaFE to those by trained registrars who read through 2,200 pathology reports and marked relevant cases for the registry. The clinical documentation (eg, electronic chart notes) of an additional 476 patients was also reviewed by registrars and compared with the automated process by the CaFE.For pathology reports, the sensitivity for automated case identification was 100%, but specificity was 85.0%. For clinical documentation, sensitivity was 100% and specificity was 73.7%. Types of errors made by the CaFE were categorized to direct additional improvements. Use of the CaFE has resulted in a considerable increase in the number of cases added to the registry each month.The system has been well accepted by our registrars. CaFE can improve the accuracy and efficiency of tumor registry personnel and helps ensure that cancer cases are not overlooked.

    View details for DOI 10.1016/j.jamcollsurg.2007.05.014

    View details for Web of Science ID 000250649800009

    View details for PubMedID 17964445

  • Defining Quality: QOPI Is a Start. Journal of oncology practice / American Society of Clinical Oncology Blayney, D. W. 2006; 2 (5): 203-?

    View details for PubMedID 20859337

  • Dose-intense chemotherapy every 2 weeks with dose-intense cyclophosphamide, doxorubicin, vincristine, and prednisone may improve survival in intermediate- and high-grade lymphoma: A phase II study of the Southwest Oncology Group (SWOG 9349) JOURNAL OF CLINICAL ONCOLOGY Blayney, D. W., LeBlanc, M. L., Grogan, T., GAYNOR, E. R., Chapman, R. A., Spiridonidis, C. H., Taylor, S. A., Bearman, S. I., MILLER, T. P., Fisher, R. I. 2003; 21 (13): 2466-2473


    To test the hypothesis that therapy of intermediate- and high-grade (excluding Burkitt lymphoblastic) lymphoma with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) could be safely dose-intensified with routine filgrastim support.Eligible patients were those who were previously untreated and who had either bulky stage II, or stage III or IV lymphoma with working formulation histology D, E, F, G, H, or J; performance status < or = 2; and acceptable end organ function. No upper age limit was specified. Therapy was dose-intensified CHOP (CHOP-DI) with filgrastim support. Each course was repeated every 14 days for six planned courses.Eighty-eight eligible patients were treated with CHOP-DI and had a median follow-up of 5.1 years on this phase II study, designated Southwest Oncology Group (SWOG) 9349. The progression-free survival was 51% at 2 years and 41% at 5 years. The overall survival was 60% at 5 years. Three fatal treatment-related events occurred. One patient with myelodysplastic syndrome was reported.Treatment with CHOP-DI can be safely administered in the cooperative group setting and results in improved survival. Estimated overall survival at 5 years was 14% better than that of patients treated with standard-dose CHOP in an earlier SWOG study, although progression-free survival of 60% at 2 years-the prespecified end point-was not achieved. CHOP-DI, given every 2 weeks at escalated doses, is a strategy that should be tested in a future randomized clinical trial in lymphoma.

    View details for DOI 10.1200/JCO.2003.06.137

    View details for Web of Science ID 000183818800005

    View details for PubMedID 12829664



    Acute nonlymphocytic leukemia is a recognized complication of combined chemotherapy and radiation treatment of patients with Hodgkin's disease. Previous studies have suggested that the risk of leukemia in these patients increases with time after treatment. We analyzed the occurrence of second neoplasms among 192 patients with Hodgkin's disease who were followed for a median of over 15 years. We originally planned to identify prospectively the morphologic changes in bone marrow that precede the development of acute leukemia. All 63 patients consenting to bone marrow aspiration had normal marrow morphology, and no case of acute leukemia occurred more than 11 years after treatment. Actuarial analysis revealed that the peak onset of leukemia-related complications was between three and nine years after first treatment. We conclude that there appears to be a period of increased risk in patients treated with chemotherapy and radiation, after which the risk of secondary leukemia decreases. Patients surviving for more than 11 years after treatment appear to be at no increased risk of acute leukemia.

    View details for Web of Science ID A1987G405500003

    View details for PubMedID 3821809



    The human T-cell leukemia-lymphoma virus (HTLV) is a recently described RNA tumor virus associated with human T-cell malignant neoplasms. In two geographic areas, Japan and the Caribbean basin, clusters of adult T-cell leukemia-lymphoma are "sentinel diseases" and have suggested an underlying prevalence of HTLV infection in both family members of the index cases and in the population. Four cases of lymphoma from the United States are described as illustrative of the sentinel disease. Serological studies of families and of a small population sample suggest that HTLV infection is endemic in certain parts of the southeastern United States at rates similar to those seen in Caribbean blacks but at a lower rate than that observed in southwestern Japan.

    View details for Web of Science ID A1983RD90600015

    View details for PubMedID 6308290

  • THE HUMAN T-CELL LEUKEMIA LYMPHOMA VIRUS, LYMPHOMA, LYTIC BONE-LESIONS, AND HYPERCALCEMIA ANNALS OF INTERNAL MEDICINE Blayney, D. W., Jaffe, E. S., Fisher, R. I., Schechter, G. P., Cossman, J., ROBERTGUROFF, M., Kalyanaraman, V. S., Blattner, W. A., Gallo, R. C. 1983; 98 (2): 144-151


    The human T-cell lymphoma (HTL) virus is a type C RNA tumor virus isolated from patients with malignancies of mature T cells. We report three patients with peripheral T-cell lymphoma, hypercalcemia, and antibodies to HTL virus. One patient presented with idiopathic hypercalcemia of 6 months' duration, two with striking lytic bone lesions, and two with circulating malignant lymphocytes. Malignant cells from all patients had surface markers characteristic of thymic-derived lymphocytes (T cells), and all patients had natural serum antibodies to disrupted HTL virus and to one or both viral structural proteins p19 and p24. Patients with adult peripheral T-cell lymphomas, particularly those that present with hypercalcemia and lytic bone lesions, may have antibodies to the type C RNA human tumor virus, HTL virus.

    View details for Web of Science ID A1983QB56900004

    View details for PubMedID 6600592

  • THE HUMAN T-CELL LEUKEMIA LYMPHOMA VIRUS ASSOCIATED WITH AMERICAN ADULT T-CELL LEUKEMIA LYMPHOMA BLOOD Blayney, D. W., Jaffe, E. S., Blattner, W. A., Cossman, J., ROBERTGUROFF, M., Longo, D. L., Bunn, P. A., Gallo, R. C. 1983; 62 (2): 401-405


    The human T-cell leukemia/lymphoma virus (HTLV) is a novel type-C retrovirus isolated from patients with T-lymphoproliferative malignancies. Thirteen cases of HTLV-associated malignancy from US centers were studied in detail. Ten of these cases share common clinical features and define a typical virus-associated adult T-cell leukemia/lymphoma (ATL). All ten patients presented with Ann Arbor stage IV lymphoma because of skin involvement, bone marrow involvement, or lymphomatous leptomeningitis. Lymphadenopathy occurred in 7 of 10 patients at presentation, and the malignant cells were cytologically pleomorphic. Leukemia occurred in 60% of the patients at presentation. Hypercalcemia was found initially in two-thirds of the patients, with lytic bone lesions or positive bone scans in 7 of 10. Complete remission occurred in 40%, but all have relapsed. These cases closely resemble those virus-positive cases of adult T-cell leukemia/lymphoma (ATL) reported from Japan and the Caribbean. Three additional virus-positive patients had atypical presentations and diagnoses (acute lymphocytic leukemia, Sézary's syndrome, leukemic reticuloendotheliosis), usually with less aggressive clinical courses and atypical demographic and laboratory features. Presence of HTLV serum antibodies in cases of ATL (with hypercalcemia and circulating malignant cells) appears to define a distinct clinicopathologic entity that may occur in geographic clusters.

    View details for Web of Science ID A1983RC87400025

    View details for PubMedID 6223675



    Human T-cell leukemia virus (HTLV) is a human type-C RNA tumor virus (retrovirus) previously identified in and isolated from several patients with T-cell leukemias or lymphomas. The known virus isolates from the United States and Japan are closely related and are found in adults with an acute malignancy of mature T cells. A related retrovirus has been found in a patient (Mo) with a somewhat different disease (a T-cell variant of relatively benign hairy cell leukemia). Serum from Mo contains antibodies to the major internal core protein (p24) of HTLV. A T-cell line established from the spleen of Mo expresses HTLV antigens. However, HTLV from Mo is significantly different from all previous HTLV isolates in immunological cross-reactivity tests of p24. The usual prototype HTLV isolate is represented as HTLV-I, and the HTLV from Mo is represented as HTLV-II. Individual members of each subgroup may then be identified by subscript initials of the patient [for example, HTLV-I(CR), HTLV-I(MB), and HTLV-II(Mo)].

    View details for Web of Science ID A1982PM84400028

    View details for PubMedID 6981847