Clinical Focus

  • Medical Oncology
  • Breast Cancer
  • Cancer Survivorship

Academic Appointments

Administrative Appointments

  • Editor-in-Chief Cancer.Net, American Society of Clinical Oncology (2015 - Present)
  • Director Cancer Survivorship Program, Stanford (2016 - Present)

Professional Education

  • Medical Education: Dartmouth Geisel School of Medicine Office of the Registrar (1982) NH
  • Board Certification: American Board of Internal Medicine, Medical Oncology (1997)
  • Fellowship: Dana Farber Cancer Institute Hematology Oncology Fellowship (1989) MA
  • Board Certification: American Board of Internal Medicine, Internal Medicine (1985)
  • Residency: Beth Israel Deaconess Medical Center (1985) MA

Community and International Work

  • IDEA, global


    Building Capacity for Cancer Care

    Partnering Organization(s)

    ASCO (American Society of Clinical Oncology)

    Populations Served

    Low and Medium Resource Countries



    Ongoing Project


    Opportunities for Student Involvement


Research Interests

  • Lifelong Learning
  • Literacy and Language
  • Professional Development

Clinical Trials

  • Leveraging Mindsets to Improve Health and Wellbeing in Patients With Cancer Not Recruiting

    Primary Objectives: Mindsets have been rigorously studied in the domains of development, education, and more recently, in health and disease. However, there are no large-scale longitudinal studies of the mindsets held by cancer patients and how they may affect treatment outcomes, physical health, and psychological well-being. This randomized, single-blind, treatment-as-usual (TAU) control study aims to assess (1) mindsets at four time points spanning from the point of diagnosis to six weeks post-treatment to patients who are newly diagnosed with cancer and undergoing treatment with curative intent, and (2) the impact of a brief but targeted mindset intervention to help instill more useful mindsets about the nature of cancer and the role of the body on patient reported measures of physical and psychological health. This study aims to add to the existing literature on psychosocial interventions for cancer patients and survivors while addressing the substantial time and cost limitations of traditional interventions. It also contributes to the body of research indicating that mindsets play an important role in both health and wellbeing. Secondary Objectives: This study has two secondary objectives. First, we aim to determine the impact of patient mindsets on measures of treatment (treatment efficacy and treatment related adverse events) and psychosocial health (stress, coping, mood, emotions). Second, we aim to understand the relationship between patient mindsets and biomarkers of immune and inflammatory processes in patients undergoing cancer treatment

    Stanford is currently not accepting patients for this trial. For more information, please contact Alia J Crum, PhD, 650-725-2418.

    View full details

All Publications

  • Risk of primary urological and genital cancers following incident breast cancer: a Danish population-based cohort study. Breast cancer research and treatment Sundboll, J., Farkas, D. K., Adelborg, K., Schapira, L., Tamang, S., Norgaard, M., Cullen, M. R., Cronin-Fenton, D., Sorensen, H. T. 2020


    PURPOSE: The prevalence of breast cancer survivors has increased due to dissemination of population-based mammographic screening and improved treatments. Recent changes in anti-hormonal therapies for breast cancer may have modified the risks of subsequent urological and genital cancers. We examine the risk of subsequent primary urological and genital cancers in patients with incident breast cancer compared with risks in the general population.METHODS: Using population-based Danish medical registries, we identified a cohort of women with primary breast cancer (1990-2017). We followed them from one year after their breast cancer diagnosis until any subsequent urological or genital cancer diagnosis. We computed incidence rates and standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) as the observed number of cancers relative to the expected number based on national incidence rates (by sex, age, and calendar year).RESULTS: Among 84,972 patients with breast cancer (median age 61years), we observed 623 urological cancers and 1397 genital cancers during a median follow-up of 7.4years. The incidence rate per 100,000 person-years was stable during follow-up (83 for urological cancers and 176 for genital cancers). The SIR was increased for ovarian cancer (1.37, 95% CI 1.23-1.52) and uterine cancer (1.37, 95% CI 1.25-1.50), but only during the pre-aromatase inhibitor era (before 2007). Moreover, the SIR of kidney cancer was increased (1.52, 95% CI 1.15-1.97), but only during 2007-2017. The SIR for urinary bladder cancer was marginally increased (1.15, 95% CI 1.04-1.28) with no temporal effects. No associations were observed for cervical cancer.CONCLUSION: Breast cancer survivors had higher risks of uterine and ovarian cancer than expected, but only before 2007, and of kidney cancer, but only after 2007. The risk of urinary bladder cancer was moderately increased without temporal effects, and we observed no association with cervical cancer.

    View details for DOI 10.1007/s10549-020-05879-w

    View details for PubMedID 32845432

  • ASCO Voices 2020. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Rayson, D., Bufill, J. A., Close, J., Cyusa, A., Oettel, K., Okolo, O., Parikh, A., Schapira, L. 2020: JCO2001584

    View details for DOI 10.1200/JCO.20.01584

    View details for PubMedID 32772763

  • Utilization of COVID-19 treatments and clinical outcomes among patients with cancer: A COVID-19 and Cancer Consortium (CCC19) cohort study. Cancer discovery Rivera, D. R., Peters, S., Panagiotou, O. A., Shah, D. P., Kuderer, N. M., Hsu, C., Rubinstein, S. M., Lee, B. J., Choueiri, T. K., de Lima Lopes, G., Grivas, P., Painter, C. A., Rini, B. I., Thompson, M. A., Arcobello, J., Bakouny, Z., Doroshow, D. B., Egan, P. C., Farmakiotis, D., Fecher, L. A., Friese, C. R., Galsky, M. D., Goel, S., Gupta, S., Halfdanarson, T. R., Halmos, B., Hawley, J. E., Khaki, A. R., Lemmon, C. A., Mishra, S., Olszewski, A. J., Pennell, N. A., Puc, M. M., Revankar, S. G., Schapira, L., Schmidt, A., Schwartz, G. K., Shah, S. A., Wu, J. T., Xie, Z., Yeh, A. C., Zhu, H., Shyr, Y., Lyman, G. H., Warner, J. L. 2020


    Among 2,186 US adults with invasive cancer and laboratory-confirmed SARS-CoV-2 infection, we examined the association of COVID-19 treatments with 30-day all-cause mortality, and factors associated with treatment. Logistic regression with multiple adjustments (e.g., comorbidities, cancer status, baseline COVID-19 severity) was performed. Hydroxychloroquine with any other drug was associated with increased mortality versus treatment with any COVID-19 treatment other than hydroxychloroquine or untreated controls; this association was not present with hydroxychloroquine alone. Remdesivir had numerically reduced mortality versus untreated controls that did not reach statistical significance. Baseline COVID-19 severity was strongly associated with receipt of any treatment. Black patients were approximately half as likely to receive remdesivir as white patients. While observational studies can be limited by potential unmeasured confounding, our findings add to the emerging understanding of patterns of care for patients with cancer and COVID-19 and support evaluation of emerging treatments through prospective controlled trials inclusive of this population.

    View details for DOI 10.1158/2159-8290.CD-20-0941

    View details for PubMedID 32699031

  • Uncertainty upon uncertainty: supportive Care for Cancer and COVID-19. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Young, A. M., Ashbury, F. D., Schapira, L., Scotte, F., Ripamonti, C. I., Olver, I. N. 2020

    View details for DOI 10.1007/s00520-020-05604-9

    View details for PubMedID 32613372

  • The Effects of Tai Chi and Qigong on Immune Responses: A Systematic Review and Meta-Analysis. Medicines (Basel, Switzerland) Oh, B., Bae, K., Lamoury, G., Eade, T., Boyle, F., Corless, B., Clarke, S., Yeung, A., Rosenthal, D., Schapira, L., Back, M. 2020; 7 (7)


    Background: Effective preventative health interventions are essential to maintain well-being among healthcare professionals and the public, especially during times of health crises. Several studies have suggested that Tai Chi and Qigong (TQ) have positive impacts on the immune system and its response to inflammation. The aim of this review is to evaluate the current evidence of the effects of TQ on these parameters. Methods: Electronic searches were conducted on databases (Medline, PubMed, Embase and ScienceDirect). Searches were performed using the following keywords: "Tai Chi or Qigong" and "immune system, immune function, immunity, Immun*, inflammation and cytokines". Studies published as full-text randomized controlled trials (RCTs) in English were included. Estimates of change in the levels of immune cells and inflammatory biomarkers were pooled using a random-effects meta-analysis where randomised comparisons were available for TQ versus active controls and TQ versus non-active controls. Results: Nineteen RCTs were selected for review with a total of 1686 participants and a range of 32 to 252 participants within the studies. Overall, a random-effects meta-analysis found that, compared with control conditions, TQ has a significant small effect of increasing the levels of immune cells (SMD, 0.28; 95% CI, 0.13 to 0.43, p = 0.00), I2 = 45%, but not a significant effect on reducing the levels of inflammation (SMD, -0.15; 95% CI, -0.39 to 0.09, p = 0.21), I2 = 85%, as measured by the systemic inflammation biomarker C-reactive protein (CRP) and cell mediated biomarker cytokines. This difference in results is due to the bidirectional regulation of cytokines. An overall risk of bias assessment found three RCTs with a low risk of bias, six RCTs with some concerns of bias, and ten RCTs with a high risk of bias. Conclusions: Current evidence indicates that practising TQ has a physiologic impact on immune system functioning and inflammatory responses. Rigorous studies are needed to guide clinical guidelines and harness the power of TQ to promote health and wellbeing.

    View details for DOI 10.3390/medicines7070039

    View details for PubMedID 32629903

  • Management of cancer and health after the clinic visit: A call to action for self-management in cancer care. Journal of the National Cancer Institute Howell, D., Mayer, D. K., Fielding, R., Eicher, M., Verdonck-de Leeuw, I. M., Johansen, C., Soto-Perez-de-Celis, E., Foster, C., Chan, R., Alfano, C. M., Hudson, S. V., Jefford, M., Lam, W. W., Loerzel, V., Pravettoni, G., Rammant, E., Schapira, L., Stein, K. D., Kocswara, B., Global Partners for Self-Management in Cancer 2020


    Individuals with cancer and their families assume responsibility for management of cancer as an acute and chronic disease. Yet, cancer lags other chronic diseases in its provision of proactive self-management support (SMS) in routine 'everyday' care leaving this population vulnerable to worse health status, long-term disability and poorer survival. Enabling cancer patients to manage the medical, emotional consequences, and lifestyle/work changes due to cancer and treatment is essential to optimizing health and recovery across the continuum of cancer. In this paper, the Global Partners on Self-Management in Cancer (GPS) puts forth six priority areas for action. Action 1: Prepare patients/survivors for active involvement in care. Action 2: Shift the care culture to support patients as partners in co-creating health and embed self-management support in everyday health care provider practices and in care pathways. Action 3: Prepare the workforce in the knowledge and skills necessary to enable patients in effective self-management and reach consensus on core curricula. Action 4: Establish and reach consensus on a patient reported outcome system for measuring the effects of self-management support and performance accountability. Action 5: Advance the evidence and stimulate research on self-management and self-management support in cancer populations. Action 6: Expand reach and access to self-management support programs across care sectors and tailored to diversity of need, and stimulation of research to advance knowledge. It's time for a revolution to better integrate self-management support as part of high quality, person-centered support and precision medicine in cancer care to optimize health outcomes, accelerate recovery and possibly improve survival.

    View details for DOI 10.1093/jnci/djaa083

    View details for PubMedID 32525530

  • Posttraumatic Stress in Breast Cancer Survivors Diagnosed at a Young Age. Psycho-oncology Vazquez, D., Rosenberg, S., Gelber, S., Ruddy, K. J., Morgan, E., Recklitis, C., Come, S., Schapira, L., Partridge, A. H. 2020


    OBJECTIVE: Young breast cancer patients experience greater psychosocial distress compared with older patients, which raises concern for their risk of posttraumatic stress disorder (PTSD). We sought to characterize the prevalence of clinically significant symptoms of PTSD and associated factors among breast cancer survivors diagnosed at a young age.METHODS: The Young Women's Breast Cancer Study, an ongoing prospective cohort study, enrolled 1302 women diagnosed with breast cancer at age≤40 between 2006 and 2016. Participants complete serial surveys, and we obtained additional information from medical record review. Socio-demographics, anxiety and depression, social support, and psychiatric co-morbidities and medications were assessed at study baseline (median, 5months post-diagnosis). We defined a participant as having clinically significant posttraumatic stress symptoms (PTSS) by scoring ≥50 on the PTSD Checklist-Specific Version, administered on the 30-month survey.RESULTS: Among 700 women with stage 1-3 disease, the prevalence of PTSS was 6.3% (95%CI = 4.5-8.1). In multivariable analyses, PTSS was significantly associated with anxiety (OR 12.43, 95%CI = 5.81-26.59, P <0.0001) and stage 2 vs 1 disease (OR 2.26, 95%CI = 1.04-4.93, P =0.04). PTSS was inversely associated with having a college degree (OR 0.29, 95%CI = 0.13-0.62, P =0.002) and greater social support (OR 0.44, 95%CI = 0.21-0.94, P =0.03).CONCLUSION: We found similar rates of cancer-related PTSS in breast cancer survivors diagnosed at a young age compared with the general breast cancer population despite their well-documented increased risk of overall distress. Nevertheless, factors associated with posttraumatic stress should be considered at diagnosis and in survivorship to identify young patients who may benefit from psychosocial resources.

    View details for DOI 10.1002/pon.5438

    View details for PubMedID 32515073

  • Risk of primary gastrointestinal cancers following incident non-metastatic breast cancer: a Danish population-based cohort study. BMJ open gastroenterology Adelborg, K., Farkas, D. K., Sundboll, J., Schapira, L., Tamang, S., Cullen, M. R., Cronin-Fenton, D., Sorensen, H. T. 2020; 7 (1)


    OBJECTIVE: We examined the risk of primary gastrointestinal cancers in women with breast cancer and compared this risk with that of the general population.DESIGN: Using population-based Danish registries, we conducted a cohort study of women with incident non-metastatic breast cancer (1990-2017). We computed cumulative cancer incidences and standardised incidence ratios (SIRs).RESULTS: Among 84972 patients with breast cancer, we observed 2340 gastrointestinal cancers. After 20 years of follow-up, the cumulative incidence of gastrointestinal cancers was 4%, driven mainly by colon cancers. Only risk of stomach cancer was continually increased beyond 1year following breast cancer. The SIR for colon cancer was neutral during 2-5 years of follow-up and approximately 1.2-fold increased thereafter. For cancer of the oesophagus, the SIR was increased only during 6-10 years. There was a weak association with pancreas cancer beyond 10 years. Between 1990-2006 and 2007-2017, the 1-10 years SIR estimate decreased and reached unity for upper gastrointestinal cancers (oesophagus, stomach, and small intestine). For lower gastrointestinal cancers (colon, rectum, and anal canal), the SIR estimate was increased only after 2007. No temporal effects were observed for the remaining gastrointestinal cancers. Treatment effects were negligible.CONCLUSION: Breast cancer survivors were at increased risk of oesophagus and stomach cancer, but only before 2007. The risk of colon cancer was increased, but only after 2007.

    View details for DOI 10.1136/bmjgast-2020-000413

    View details for PubMedID 32611556

  • Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet (London, England) Kuderer, N. M., Choueiri, T. K., Shah, D. P., Shyr, Y., Rubinstein, S. M., Rivera, D. R., Shete, S., Hsu, C. Y., Desai, A., de Lima Lopes, G., Grivas, P., Painter, C. A., Peters, S., Thompson, M. A., Bakouny, Z., Batist, G., Bekaii-Saab, T., Bilen, M. A., Bouganim, N., Larroya, M. B., Castellano, D., Del Prete, S. A., Doroshow, D. B., Egan, P. C., Elkrief, A., Farmakiotis, D., Flora, D., Galsky, M. D., Glover, M. J., Griffiths, E. A., Gulati, A. P., Gupta, S., Hafez, N., Halfdanarson, T. R., Hawley, J. E., Hsu, E., Kasi, A., Khaki, A. R., Lemmon, C. A., Lewis, C., Logan, B., Masters, T., McKay, R. R., Mesa, R. A., Morgans, A. K., Mulcahy, M. F., Panagiotou, O. A., Peddi, P., Pennell, N. A., Reynolds, K., Rosen, L. R., Rosovsky, R., Salazar, M., Schmidt, A., Shah, S. A., Shaya, J. A., Steinharter, J., Stockerl-Goldstein, K. E., Subbiah, S., Vinh, D. C., Wehbe, F. H., Weissmann, L. B., Wu, J. T., Wulff-Burchfield, E., Xie, Z., Yeh, A., Yu, P. P., Zhou, A. Y., Zubiri, L., Mishra, S., Lyman, G. H., Rini, B. I., Warner, J. L. 2020


    Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness.In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with, NCT04354701, and is ongoing.Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57-76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1·84, 95% CI 1·53-2·21), male sex (1·63, 1·07-2·48), smoking status (former smoker vs never smoked: 1·60, 1·03-2·47), number of comorbidities (two vs none: 4·50, 1·33-15·28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 vs 0 or 1: 3·89, 2·11-7·18), active cancer (progressing vs remission: 5·20, 2·77-9·77), and receipt of azithromycin plus hydroxychloroquine (vs treatment with neither: 2·93, 1·79-4·79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0·24, 0·07-0·84) or the US-Midwest (0·50, 0·28-0·90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality.Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments.American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.

    View details for DOI 10.1016/S0140-6736(20)31187-9

    View details for PubMedID 32473681

  • Do qualitative interviews cause distress in adolescents and young adults asked to discuss fears of cancer recurrence? Psycho-oncology Heathcote, L. C., Loecher, N., Spunt, S. L., Simon, P., Tutelman, P. R., Wakefield, C. E., Ach, E., Schapira, L. 2020


    This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/pon.5544

    View details for PubMedID 32909342

  • Contemporary management of breast cancer during pregnancy and subsequent lactation in a multicenter cohort of young women with breast cancer. The breast journal Lee, G. E., Rosenberg, S. M., Mayer, E. L., Borges, V., Meyer, M. E., Schapira, L., Come, S. E., Partridge, A. H. 2019


    The incidence of breast cancer diagnosed during pregnancy is increasing. We sought to characterize patient, treatment, pregnancy and lactation factors among young women with newly diagnosed breast cancer during pregnancy in a prospective cohort study. We identified all women who were pregnant when diagnosed with invasive breast cancer among those enrolled in the Young Women's Breast Cancer Study (NCT01468246), and collected details on pregnancy, birth and lactation from surveys, and treatment information medical record review. Of 1302 enrolled participants, 976 women with invasive breast cancer completed full baseline surveys, among whom 39 (4.0%) patients reported being pregnant at diagnosis. Median age at diagnosis was 34years (range: 25-40), with stage distribution: I, 28%; II, 44%; III, 23%; and IV, 5%. 74% of patients (29/39) had grade 3 tumors, 59% (23/39) ER-positive, and 31% (12/39) HER2-positive disease. 23 (59%) had surgery during pregnancy, 4 (17%) during the first trimester. Among the women who had surgery during pregnancy, 61% (14/23) underwent lumpectomy, 35% (8/23) unilateral, and 4% (1/23) bilateral mastectomy. All patients who had chemotherapy (51%, 20/39) received it in second and third trimesters, and had ACx4. There were 31 live births, 2 spontaneous, and 5 therapeutic abortions. Among live births, 16 (41%) were before 37weeks of gestation. Three women reported breastfeeding. Within 6months after delivery, comprehensive staging in 13 patients showed upstaging in four patients. In a contemporary cohort of young women with breast cancer, pregnancy at diagnosis is relatively uncommon. Treatment during pregnancy can generally be consistent with standard surgical and chemotherapy approaches, with attention to timing of therapies. Longer-term outcomes including effects of some timing issues including delayed use of anti-HER2 therapy on patient outcomes warrant further research.

    View details for DOI 10.1111/tbj.13431

    View details for PubMedID 31318125

  • Patient-Reported Outcomes for Cancer Patients Receiving Checkpoint Inhibitors: Opportunities for Palliative Care-A Systematic Review JOURNAL OF PAIN AND SYMPTOM MANAGEMENT Hall, E. T., Singhal, S., Dickerson, J., Gabster, B., Wong, H., Aslakson, R. A., Schapira, L., Ast, K., Carroll, T., Dzeng, E., Harrison, K. L., Kaye, E. C., LeBlanc, T. W., Lo, S. S., McKenna, K., Nageswaran, S., Powers, J., Rotella, J., Ullrich, C., Vickey, T., AAHPM Res Comm Writing Grp 2019; 58 (1): 137-+
  • Nonadherent behaviors among young women on adjuvant endocrine therapy for breast cancer. Cancer Wassermann, J., Gelber, S. I., Rosenberg, S. M., Ruddy, K. J., Tamimi, R. M., Schapira, L., Borges, V. F., Come, S. E., Meyer, M. E., Partridge, A. H. 2019


    BACKGROUND: Young age is a known factor associated with suboptimal adherence to endocrine therapy (ET) for adjuvant breast cancer (BC) treatment. This study was aimed at assessing nonadherent behaviors and associated factors among young women with early-stage hormone receptor-positive BC.METHODS: As part of a multicenter, prospective cohort of women with a diagnosis of BC at or under the age of 40years, participants were surveyed 30months after their diagnosis about adherent behaviors. Among those who reported taking ET, adherence was measured with a 3-item Likert-type scale: Do you ever forget to take your ET? If you feel worse when you take your ET, do you stop taking it? Did you take your ET exactly as directed by your doctor over the last 3months? Women reporting at least 1 nonadherent behavior were classified as nonadherers. Variables with a P value<.20 were included in a multivariable logistic model.RESULTS: Among 384 women, 194 (51%) were classified as nonadherers. Univariate factors that retained significance in the multivariable model included educational level (odds ratio [OR], 0.50 for high vs low; P=.04), level of social support according to the Medical Outcome Study Social Support Survey (OR, 0.98 per 1 point; P=.01), and confidence with the decision regarding ET measured on a 0 to 10 numerical scale (OR, 0.63 for high vs low; P=.04).CONCLUSIONS: Findings from this study could help to identify young patients at higher risk for nonadherence. Interventions adapted to the level of education and aimed at reinforcing support and patients' confidence in their decision to take ET could improve adherence and associated outcomes in this population.

    View details for DOI 10.1002/cncr.32192

    View details for PubMedID 31120571

  • Body weight changes in young breast cancer survivors and associated predictors. Sella, T., Tan-Wasielewski, Z., Rosenberg, S. M., Poorvu, P., Ruddy, K., Gelber, S. I., Tamimi, R. M., Schapira, L., Come, S. E., Peppercorn, J. M., Borges, V. F., Partridge, A. H., Ligibel, J. A. AMER SOC CLINICAL ONCOLOGY. 2019
  • Differences among Asian/Asian American, and Caucasian breast and gynecologic cancer patient reported survivorship needs, symptoms, and illness mindsets (N=220). Schapira, L., Hofmeister, E., Kurian, A. W., Zion, S., Shen, H., Torres, T., Berek, J. S., Palesh, O. AMER SOC CLINICAL ONCOLOGY. 2019
  • "If you don't ask, you won't know": Do patient reported outcome (PRO) instruments capture the symptom experience of patients treated with immune checkpoint inhibitors (ICIs)? Gabster, B., Hall, E., Singhal, S., Dickerson, J., Schapira, L. AMER SOC CLINICAL ONCOLOGY. 2019
  • The impact of blinding on patient-reported outcomes (PROs) in randomized controlled trials of immune checkpoint inhibitors versus traditional chemotherapies. Dickerson, J., Hall, E., Singhal, S., Gabster, B., Schapira, L. AMER SOC CLINICAL ONCOLOGY. 2019
  • Variations in patient-reported outcome (PRO) collection and reporting in novel FDA approved anticancer therapies. Singhal, S., Hall, E., Gabster, B., Dickerson, J., Schapira, L. AMER SOC CLINICAL ONCOLOGY. 2019
  • Diagnostic and treatment delays in young women with breast cancer. Poorvu, P. D., Zheng, Y., Sella, T., Rosenberg, S. M., Ruddy, K., Gelber, S. I., Tamimi, R. M., Peppercorn, J. M., Schapira, L., Borges, V. F., Come, S. E., Warner, E., Partridge, A. H. AMER SOC CLINICAL ONCOLOGY. 2019
  • Does the innovative 4R Care Delivery Model improve timing and sequencing of guideline recommended breast cancer care in safety net and non-safety net centers? Weldon, C. B., Trosman, J., Makower, D. F., Rapkin, B. D., Bozier, M., Knightly, E., Schaeffer, C. M., Hoskins, K., Gallagher, C., Lo, S. S., Grace-Louthen, C., Throckmorton, A., Vanderwalde, L., Krueger, E. A., Van Horn, J., Schapira, L., Santa-Maria, C., Ravelo, A., Benson, A., Gradishar, W. AMER SOC CLINICAL ONCOLOGY. 2019
  • Does the innovative 4R Cancer Care Delivery Model improve patient self-management in safety net and non-safety net centers? Trosman, J., Weldon, C. B., Makower, D. F., Rapkin, B. D., Bozier, M., Knightly, E., Schaeffer, C. M., Hoskins, K., Gallagher, C., Lo, S. S., Grace-Louthen, C., Throckmorton, A., Vanderwalde, L., Krueger, E. A., Van Horn, J., Schapira, L., Santa-Maria, C., Ravelo, A., Benson, A., Gradishar, W. AMER SOC CLINICAL ONCOLOGY. 2019
  • Genomics of HER2+breast cancer in young women before and after exposure to chemotherapy (chemo) plus trastuzumab (H). Waks, A., Jain, E., Collins, L. C., Rosenberg, S. M., Ruddy, K., Tamimi, R. M., Schapira, L., Come, S. E., Peppercorn, J. M., Borges, V. F., Warner, E., Snow, C., Partridge, A. H., Wagle, N. AMER SOC CLINICAL ONCOLOGY. 2019
  • Identifying distinct trajectories of change in young breast cancer survivors' sexual functioning PSYCHO-ONCOLOGY von Hippel, C., Rosenberg, S. M., Austin, S., Sprunck-Harrild, K., Ruddy, K. J., Schapira, L., Come, S., Borges, V. F., Partridge, A. H. 2019; 28 (5): 1033–40

    View details for DOI 10.1002/pon.5047

    View details for Web of Science ID 000467279600012

  • Patient reported outcomes for cancer patients receiving immunotherapy: opportunities for palliative care - A Systematic Review. Journal of pain and symptom management Hall, E. T., Singhal, S., Dickerson, J., Gabster, B., Wong, H., Aslakson, R. A., Schapira, L. 2019


    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 PubMedID 30905677

  • Identifying Distinct Trajectories of Change in Young Breast Cancer Survivors' Sexual Functioning. Psycho-oncology von Hippel, C., Rosenberg, S. M., Austin, S. B., Sprunck-Harrild, K., Ruddy, K. J., Schapira, L., Come, S., Borges, V. F., Partridge, A. H. 2019


    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 PubMedID 30817075

  • Family-building decision aid and planning tool for young adult women after cancer treatment: protocol for preliminary testing of a web-based decision support intervention in a single-arm pilot study. BMJ open Benedict, C., Ford, J. S., Schapira, L., Simon, P., Spiegel, D., Diefenbach, M. 2019; 9 (12): e033630


    Many young adult female (YA-F) cancer survivors who received gonadotoxic therapy will experience fertility problems. After cancer, having a child will often require assisted reproductive technology (ART), surrogacy or adoption. However, there are significant informational, psychosocial, financial and logistical barriers to pursuing these options. Survivors report high rates of decision uncertainty and distress related to family-building decisions. The aim of this study is to pilot test a web-based decision aid and planning tool for family-building after cancer.The pilot study will use a single-arm trial design to test the feasibility and acceptability (aim 1) and obtain effect size estimates of the decision support intervention (aim 2). The target sample size is 100. Participants will include YA-F survivors (aged 18-45 years) who are post-treatment and have not completed desired family-building. A longitudinal prepost design will be conducted. Participants will complete three psychosocial assessment surveys over a 3-month time period to track decisional conflict (primary outcome) and cognitive, emotional, and behavioural functioning (secondary outcomes). After completing the baseline survey (T1; pre-intervention), participants will have access to the decision aid website. Postintervention surveys will be administered at 1-month (T2) and 3-month (T3) follow-up time points. Feasibility and acceptability metrics will be analysed. Pairwise t-tests will test mean scores of outcome variables from T1 to T2. Effect size estimates (Cohen's d) will be calculated. Google analytics will evaluate user engagement with the website over the study period. Baseline and follow-up data will examine measures of feasibility, acceptability and intervention effect size.This will be the first test of a supportive intervention to guide YA-F cancer survivors in family-building decisions and early planning. Study findings will inform intervention development. Future directions will include a randomised controlled trial to test intervention efficacy over a longer time period.NCT04059237; Pre-results.

    View details for DOI 10.1136/bmjopen-2019-033630

    View details for PubMedID 31888941

  • Prognostic Impact of the 21-Gene Recurrence Score Assay Among Young Women With Node-Negative and Node-Positive ER-Positive/HER2-Negative Breast Cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Poorvu, P. D., Gelber, S. I., Rosenberg, S. M., Ruddy, K. J., Tamimi, R. M., Collins, L. C., Peppercorn, J., Schapira, L., Borges, V. F., Come, S. E., Warner, E., Jakubowski, D. M., Russell, C., Winer, E. P., Partridge, A. H. 2019: JCO1901959


    The 21-gene recurrence score (RS) assay is prognostic among women with early-stage estrogen receptor-positive (ER+) and human epidermal growth factor receptor 2-negative (HER2-) breast cancer and is used to inform recommendations for chemotherapy. Women ≤ 40 years of age represent a minority of patients studied using gene expression profiles.The Young Women's Breast Cancer Study is a prospective cohort of women diagnosed with breast cancer at age ≤ 40 years and enrolled patients between 2006 and 2016 (N = 1,302). We identified patients with stage I-III ER+/HER2- breast cancer. The RS assay was performed on banked specimens for patients who had not been tested clinically. Distant recurrence-free survival (DRFS) was assessed by TAILORx and traditional RS risk groups among patients with axillary node-negative (N0) and limited node-positive (N1) breast cancer.Among eligible women (N = 577), 189 (33%) had undergone RS testing, and 320 (56%) had banked specimens sufficient for testing. Median follow-up was 6.0 years. Median age at diagnosis was 37.2 years; 300 of 509 patients (59%) had N0 breast cancer, of whom 195 (65%) had an RS of 11-25 and fewer than half (86 of 195; 44%) received chemotherapy. Six-year DRFS rates were 94.4% and 92.3% (RS < 11), 96.9% and 85.2% (RS 11-25), and 85.1% and 71.3% (RS ≥ 26) among women with N0 and N1 disease, respectively.The RS assay is prognostic among young women with node-negative and limited node-positive breast cancer, representing a valuable tool for risk stratification. Disease outcomes with a median follow-up of 6 years among young women with N0 disease and an RS of 0-25, a minority of whom received chemotherapy, and node-positive disease with an RS < 11 were very good, whereas those with N0 disease and an RS ≥ 26 or N1 disease with an RS ≥ 11 experienced substantial risk of early distant recurrence.

    View details for DOI 10.1200/JCO.19.01959

    View details for PubMedID 31809240

  • Targeting Mindsets, Not Just Tumors Trends in Cancer Zion, S. R., Schapira, L., Crum, A. J. 2019
  • Employment trends in young women following a breast cancer diagnosis. Breast cancer research and treatment Rosenberg, S. M., Vaz-Luis, I., Gong, J., Rajagopal, P. S., Ruddy, K. J., Tamimi, R. M., Schapira, L., Come, S., Borges, V., de Moor, J. S., Partridge, A. H. 2019


    Little is known about how a breast cancer diagnosis and treatment affects job-related outcomes in young women with breast cancer, who are an integral part of the workforce. We sought to describe employment trends among young breast cancer survivors.911 women with non-metastatic breast cancer were surveyed about employment-related outcomes 1 year post-diagnosis. Participants were enrolled in the Young Women's Breast Cancer Study an ongoing, multi-center cohort of women diagnosed with breast cancer at age ≤ 40.Among 911 women, median age at diagnosis was 36 years (range 17-40). Most women (80%, n = 729) were employed 1 year post-diagnosis. Among the 7% (n = 62) employed before diagnosis but who reported unemployment at 1 year, approximately half reported they were unemployed for health reasons. Among employed women, 7% said treatment affected their ability to perform their job. Women with stage-three disease (vs. stage 1 disease, odds ratio (OR): 3.73, 95% CI 1.39-9.97) and those who reported having money to pay bills after cutting back or difficulty paying bills at baseline (vs. having enough money for special things, OR 2.70, 95% CI 1.32-5.52) at baseline were more likely to have transitioned out of the workforce.Our results suggest an impact of disease burden and socioeconomic status on employment in young breast cancer survivors. There is a need to ensure young survivors who leave the workforce following diagnosis are sufficiently supported given the potential adverse psychosocial and financial impacts of unemployment on survivors, their families, communities, and society.

    View details for DOI 10.1007/s10549-019-05293-x

    View details for PubMedID 31147983

  • Evaluation of significant genome-wide association studies risk - SNPs in young breast cancer patients. PloS one Rath, M., Li, Q., Li, H., Lindstrom, S., Miron, A., Miron, P., Dowton, A. E., Meyer, M. E., Larson, B. G., Pomerantz, M., Seo, J., Collins, L. C., Vardeh, H., Brachtel, E., Come, S. E., Borges, V., Schapira, L., Tamimi, R. M., Partridge, A. H., Freedman, M., Ruddy, K. J. 2019; 14 (5): e0216997


    PURPOSE: Genome-wide-association studies (GWAS) have identified numerous single nucleotide polymorphisms (SNPs) that are associated with an increased risk of breast cancer. Most of these studies were conducted primarily in postmenopausal breast cancer patients. Therefore, we set out to assess whether or not these breast cancer variants are also associated with an elevated risk of breast cancer in young premenopausal patients.METHODS: In 451 women of European ancestry who had prospectively enrolled in a longitudinal cohort study for women diagnosed with breast cancer at or under age 40, we genotyped 44 SNPs that were previously associated with breast cancer risk. A control group was comprised of 1142 postmenopausal healthy women from the Nurses' Health Study (NHS). We assessed if the frequencies of the adequately genotyped SNPs differed significantly (p≤0.05) between the cohort of young breast cancer patients and postmenopausal controls, and then we corrected for multiple testing.RESULTS: Genotyping of the controls or cases was inadequate for comparisons between the groups for seven of the 44 SNPs. 9 of the remaining 37 were associated with breast cancer risk in young women with a p-value <0.05: rs10510102, rs1219648, rs13387042, rs1876206, rs2936870, rs2981579, rs3734805, rs3803662 and rs4973768. The directions of these associations were consistent with those in postmenopausal women. However, after correction for multiple testing (Benjamini Hochberg) none of the results remained statistically significant.CONCLUSION: After correction for multiple testing, none of the alleles for postmenopausal breast cancer were clearly associated with risk of premenopausal breast cancer in this relatively small study.

    View details for DOI 10.1371/journal.pone.0216997

    View details for PubMedID 31125336

  • Online Communities as Sources of Peer Support for People Living With Cancer: A Commentary. Journal of oncology practice Gupta, T., Schapira, L. 2018: JOP1800261


    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 PubMedID 30335558

  • MODERN CHEMOTHERAPY USE AMONG YOUNG WOMEN WITH EARLYSTAGE ER+/HER2-BREAST CANCER Poorvu, P., Gelber, S., Rosenberg, S., Ruddy, K., Tamimi, R., Peppercorn, J., Schapira, L., Borges, V., Come, S., Collins, L., Warner, E., Partridge, A. CHURCHILL LIVINGSTONE. 2018: S18
  • Anxiety and Depression in Young Women With Metastatic Breast Cancer: A Cross-Sectional Study PSYCHOSOMATICS Park, E. M., Gelber, S., Rosenberg, S. M., Seah, D. E., Schapira, L., Come, S. E., Partridge, A. H. 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 PubMedID 29525523

    View details for PubMedCentralID PMC5935568

  • The Power of Trust. JAMA oncology Mou, E., Schapira, L., Kunz, P. 2018

    View details for PubMedID 29710067

  • Management of side effects during and post-treatment in breast cancer survivors BREAST JOURNAL Palesh, O., Scheiber, C., Kesler, S., Mustian, K., Koopman, C., Schapira, L. 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 PubMedID 28845551

  • Bridging gaps in breast cancer care: A pilot forum for mental health professionals Yang, R., Rabinowitz, B., Frank, M., Schapira, L., Wapnir, I. AMER ASSOC CANCER RESEARCH. 2018
  • Amani's Silence. oncologist Baider, L., Schapira, L. 2017

    View details for DOI 10.1634/theoncologist.2017-0207

    View details for PubMedID 28592623

  • 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 Schapira, L., Meisel, J. L., Srivastava, R. 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