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Improving Outcomes for Breast Cancer Survivors

May 28, 2013

Comparative Effectiveness Research Professorship (CERP) in Breast Cancer Supports Research and Mentoring

In 2010, Patricia A. Ganz, MD, of the University of California, Los Angeles (UCLA), received the first Comparative Effectiveness Research Professorship (CERP) in Breast Cancer award from the Conquer Cancer Foundation of the American Society of Clinical Oncology. The five-year, $500,000 grant provides funding to outstanding researchers who have made, and are continuing to make, significant contributions that have changed the direction of breast cancer research, and who will provide mentorship to junior researchers. The 2010 CERP is supported by The Breast Cancer Research Foundation®.

Dr. Ganz received the grant for her research project, “Improving Outcomes for Breast Cancer Survivors: Measuring the Comparative Effectiveness of Survivorship Care Programs within the UCLA–LIVESTRONG Survivorship Center for Excellence.”

ASCO Connection recently spoke with Dr. Ganz on the status of her project and the importance of mentoring junior researchers.

  Dr. Patricia A. Ganz (left), and Erin Hahn (right).

AC: What projects are currently underway with your Conquer Cancer Foundation-supported research, “Improving Outcomes for Breast Cancer Survivors: Measuring the Comparative Effectiveness of Survivorship Care Programs within the UCLA-LIVESTRONG Survivorship Center of Excellence”?

Dr. Ganz: One of the main projects is funding an individual who is working on her PhD in health policy and management. She has published a few papers—one of the major papers looks at how patients are followed up after their breast cancer treatment at UCLA. She was able to investigate how often women with early-stage breast cancer had tumor markers, imaging tests, and mammograms done. The paper, which was just submitted for publication, shows that women are often receiving unnecessary tests and not getting mammograms when they should. There was a great deal of variability among individual physicians’ pattern of delivery. This is an area where education and feedback about performance would be useful.

I’m also mentoring a surgeon at one of our UCLA-affiliated county hospitals. She is working on a project to increase knowledge and awareness of primary care providers caring for breast cancer survivors. The clinics at the county hospitals are quite full; continuing to follow survivors in that setting is not the best use of resources, and issues such as diabetes and high blood pressure are largely overlooked. This will be a pilot demonstration project to see if they can transition this care to the primary care providers.

We’re just beginning a project with a radiation oncologist faculty member. She recognized that as the primary breast radiation oncologist, she is the “last stop” after patients finish their treatment. When she sees patients two weeks after the conclusion of radiation therapy, they are all asking her: “What should I do next? Where do I go and who do I see for follow-up?” This is a perfect time to do the transition and survivorship care planning visit. We’re going to start a small pilot randomized trial in which half of the patients will get assessment and planning at that two-week visit versus six months later when they come in for a follow-up appointment. We’ll be collecting detailed information on symptoms and quality of life.

AC: Is there a special niche that grants like the CERP fill, with its strong mentoring component?

Dr. Ganz: Mentoring is a large part of my role at the cancer center, so I would probably be doing it anyway, but having that flexible funding allows me to take up new things. To have to wait two or three years to begin a project you or your mentee is excited about because you’re looking for funding can be painful. As a senior investigator, I’ve been able to creatively finance a lot of different things, but it takes a lot of time and effort to find that money, especially in the current financial climate. The support from the Conquer Cancer Foundation is a real gift.

AC: What other projects are keeping you busy?

Dr. Ganz:
Over the past 10 years, I’ve been really focused on cognitive problems after breast cancer treatment. We had a large National Cancer Institute–funded R01 study that just ended, in which we followed about 190 women from their post-treatment (after primary chemotherapy and radiation) and before starting endocrine therapy, because I was interested in the role of endocrine therapy on cognitive difficulties—if it made chemotherapy-associated complaints worse. We were able to show that about 25% of patients in post-treatment had memory or executive-function problems. There’s been a lot of debate in the literature about how when a patient says she’s not doing well and neuropsychologic tests are performed, they may not show that the patient is very impaired. The problem is that these complaints are often subtle, and the tests are really designed to pick up major trauma, stroke, or psychiatric illness. In this study, we were able to show a relationship between self-report and neuropsychologic tests.

"The support 
from the
Conquer Cancer 
is a real gift." 

- Dr. Ganz

We also looked at blood samples in the same patients and found that there’s a genetic susceptibility to fatigue and cognitive complaints, associated with genetic variant SNPs in the promoter regions of IL1, IL6, and TNF-alpha. These are the genes that control inflammation associated with cancer treatment. We’ve had a long-term set of studies looking at fatigue and inflammation, so we think that the cancer treatment actually stimulates the persistence of inflammation in a certain subset of people who may be more vulnerable due to a genetic predisposition.

We’ve been able to maintain follow-up in these women and are now calling them back, four years later, to do neuropsychologic tests, blood work, EEGs, and positron emission tomography scans to understand the biology of these symptoms.

The other half of my life is on the policy side. I’m chairing an Institute of Medicine committee that will release a report in the next six months focused on the quality of cancer care and the challenges of an aging population. We’re going to be facing epidemic numbers of cancer cases and must consider how the health system will handle them.

Please make a gift to the Conquer Cancer Foundation to help support the Medical Student Rotation for Underrepresented Populations (MSR) and other Foundation programs like it that encourage young people interested in medicine to enter and stay in the field of oncology.


Mark Allen O'Rourke, MD

May, 29 2013 11:23 PM

Excellent work to improve care of cancer survivors for guideline-based surveillance, coordination with primary care, and symptoms such as cognitive change.  

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