- Medical Oncology
- Breast Cancer
- Cancer Survivorship
Editor-in-Chief Cancer.Net, American Society of Clinical Oncology (2015 - Present)
Director Cancer Survivorship Program, Stanford (2016 - Present)
Medical Education:Dartmouth Geisel School of Medicine Office of the Registrar (1982) NH
Board Certification: Medical Oncology, American Board of Internal Medicine (1997)
Fellowship:Dana Farber Cancer Institute Hematology Oncology Fellowship (1989) MA
Board Certification: Internal Medicine, American Board of Internal Medicine (1985)
Residency:Beth Israel Deaconess Medical Center (1985) MA
Patient reported outcomes for cancer patients receiving immunotherapy: opportunities for palliative care - A Systematic Review.
Journal of pain and symptom management
CONTEXT: Immune checkpoint inhibitors (ICIs) are increasingly used to treat a variety of cancers, but comparatively little is known about patient-reported outcomes (PROs) and health-related quality of life (HRQoL) among patients receiving these novel therapies.OBJECTIVES: We performed a systematic review to examine PROs and HRQoL among cancer patients receiving ICIs as compared to other anticancer therapies.METHODS: We systematically searched PubMed, CINAHL, Embase, Web of Science, and Scopus, using search terms representing ICIs, PROs and HRQoL on August 10, 2018. Eligible articles were required to involve cancer patients treated with ICIs and to report PROs and/or HRQoL data.RESULTS: We screened 1,453 references and included 15 publications representing 15 randomized controlled trials in our analysis. Studies included several cancer types (melanoma, lung cancer, genitourinary cancer, and head/neck cancer), utilized four different ICIs (nivolumab, pembrolizumab, atezolizumab, and ipilimumab), and compared ICIs to a wide range of therapies (chemotherapy, targeted therapies, other immunotherapy strategies, and placebo). Studies utilized a total of seven different PROs to measure HRQOL, most commonly the European Organisation for the Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30) (n = 12, 80%). PRO data were reported in a variety of formats and at a variety of time points throughout treatment which made direct comparison challenging. Some trials (n=11, 73%) reported PROs on specific symptoms. In general, patients receiving ICIs had similar to improved HRQoL and experiences when compared to other therapies.CONCLUSION: Despite the broad clinical trials experience of ICI therapies across cancer types, relatively few randomized studies reported patient PROs and HRQoL data. Available data suggest that ICIs are well-tolerated in terms of HRQoL compared to other anticancer therapies although the conclusions are limited by the heterogeneity of trial designs and outcomes. Currently used instruments may fail to capture important symptomatology unique to ICIs, underscoring a need for PROs designed specifically for ICIs.
View details for DOI 10.1016/j.jpainsymman.2019.03.015
View details for PubMedID 30905677
Identifying Distinct Trajectories of Change in Young Breast Cancer Survivors' Sexual Functioning.
OBJECTIVES: To identify and characterize distinct trajectories of change in young women's sexual functioning over five years following breast cancer diagnosis.METHODS: Group-based trajectory modeling was applied to the sexual functioning of 896 women diagnosed with stage I-IV breast cancer at age ≤40 years. The Cancer Rehabilitation Evaluation System was used to evaluate women's symptoms of sexual dysfunction annually for five years.RESULTS: Five distinct trajectories of sexual functioning were identified: one asymptomatic, one minimally symptomatic, two moderately symptomatic, and one severely symptomatic trajectory. 12% of women were asymptomatic throughout follow-up. The plurality of women experienced stable mild symptoms (42%). Amongst those with moderate symptoms, some experienced improvement over time (22%) while others experienced deterioration (13%). 11% experienced stable severe symptoms that did not remit over time. Independent predictors of experiencing a symptomatic rather than asymptomatic trajectory (p<0.05, two-sided) included diagnosis with stage 2 versus 1 disease, ER+ disease treated with oophorectomy or ovarian suppression, being partnered, having anxiety, poorer body image, and greater musculoskeletal pain.CONCLUSIONS: We identified distinct trajectories that describe the reported sexual symptoms in this cohort of young breast cancer survivors. The majority of women reported various degrees of sexual dysfunction that remained stable over the study period. There is, however, potential for improvement of moderate and severe symptoms of sexual dysfunction in early survivorship.
View details for DOI 10.1002/pon.5047
View details for PubMedID 30817075
Online Communities as Sources of Peer Support for People Living With Cancer: A Commentary.
Journal of oncology practice
Online communities are virtual spaces dedicated to hosting conversations between individuals with a common interest. Information can be shared and obtained incrementally, as users can periodically post both questions and responses to other users' questions. Although online communities have been used frequently by patients for a myriad of health issues, much remains to be learned about these resources. In this commentary, we explore the emerging role of online communities as forums for information exchange and sources of support for patients with cancer and caregivers. We discuss selected examples of online communities launched by research institutions, advocacy groups, philanthropic organizations, start-ups, and novel enterprises featuring collaborations between industry, health care professionals, and advocates. We explore the risks and benefits of online communities as perceived by oncology clinicians and provide practical recommendations for improving communication between clinicians and patients about the use of online resources.
View details for DOI 10.1200/JOP.18.00261
View details for PubMedID 30335558
- MODERN CHEMOTHERAPY USE AMONG YOUNG WOMEN WITH EARLYSTAGE ER+/HER2-BREAST CANCER CHURCHILL LIVINGSTONE. 2018: S18
Anxiety and Depression in Young Women With Metastatic Breast Cancer: A Cross-Sectional Study
2018; 59 (3): 251–58
Young adults with cancer experience disruptions in their normal developmental trajectories and commonly experience psychologic distress related to their diagnoses. Young women with metastatic breast cancer (MBC) are at particular risk of adverse mental health outcomes.We sought to determine the prevalence of and factors associated with anxiety and depression symptoms in young women with newly diagnosed de novo MBC.A total of 54 women with newly diagnosed de novo MBC were identified from an ongoing, prospective, multicenter cohort of women diagnosed with breast cancer at age <40. Depression and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Items assessing socio-demographics, physical symptom burden, social support, and disease and treatment history, with complementary medical record review, were used to assess variables potentially associated with anxiety and depression symptoms.Mean HADS Depression score was 4.4 (standard deviation = 3.7) and mean HADS Anxiety score was 7.9 (standard deviation = 5.0). Eleven (20%) women scored ≥8 on the HADS Depression subscale, the suggested threshold for depression/anxiety screening, and 24 (44%) women scored ≥8 on the HADS Anxiety subscale. In a multivariable model of anxiety, higher physical symptom scores (odds ratio = 4.41, p = 0.005) was significantly associated with higher anxiety scores. None of the other variables improved the model fit.In this study, a considerable proportion of young women with newly diagnosed MBC experienced anxiety symptoms, although depression was less common. Future strategies focused on distress reduction in young MBC patients should focus on physical symptom management as well as anxiety identification and management.
View details for Web of Science ID 000432519500005
View details for PubMedID 29525523
View details for PubMedCentralID PMC5935568
- The Power of Trust. JAMA oncology 2018
Management of side effects during and post-treatment in breast cancer survivors
2018; 24 (2): 167–75
Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are commonly experienced symptoms that share psychological and physical manifestations. One or more of these symptoms will affect nearly all patients at some point during their course of treatment or survivorship. These side effects are burdensome and reduce patients' quality of life well beyond their cancer diagnosis and associated care treatments. Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are likely to have multiple etiologies that make it difficult to identify the most effective method to manage them. In this review, we summarized the information on cancer-related fatigue, insomnia, and cancer-related cognitive impairment incidence and prevalence among breast cancer patients and survivors as well as recent research findings on pharmaceutical, psychological, and exercise interventions that have shown effectiveness in the treatment of these side effects. Our review revealed that most current pharmaceutical interventions tend to ameliorate symptoms only temporarily without addressing the underlying causes. Exercise and behavioral interventions are consistently more effective at managing chronic symptoms and possibly address an underlying etiology. Future research is needed to investigate effective interventions that can be delivered directly in clinic to a large portion of patients and survivors.
View details for DOI 10.1111/tbj.12862
View details for Web of Science ID 000426750700011
View details for PubMedID 28845551
Bridging gaps in breast cancer care: A pilot forum for mental health professionals
AMER ASSOC CANCER RESEARCH. 2018
View details for Web of Science ID 000425489402012
Fertility interest, management and outcomes in young BRCA plus breast cancer survivors
AMER ASSOC CANCER RESEARCH. 2018
View details for Web of Science ID 000425489402194
Fertility concerns and their impact on hormonal therapy decisions in young breast cancer survivors
AMER ASSOC CANCER RESEARCH. 2018
View details for Web of Science ID 000425489401105
- Amani's Silence. oncologist 2017
For Our Patients, for Ourselves: The Value of Personal Reflection in Oncology.
American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Meeting
2017; 37: 765-770
Caring for patients with cancer is a great privilege as well as an emotionally and intellectually challenging task. Stress and burnout are prevalent among oncology clinicians, with serious repercussions for the care of patients. Professional societies must provide guidance for trainees and practicing physicians to mitigate the negative consequences of stress on their personal lives and medical practice. Reflection, reading, and writing about personal experiences provide outlets for fortifying personal reserves and promoting resilience to allow us to recognize the joy and meaning of our work and to forge connections with our peers. Herein, we present some of our own reflections on how and why one might take time to write, and about the power of the written word in oncology and medicine.
View details for DOI 10.14694/EDBK_175520
View details for PubMedID 28561701