From the Duke Cancer Institute archives. Content may be out of date.
It’s something that has happened to all of us; you arrive on time for your 10:30 a.m. doctor’s appointment and wait an hour, only to have the doctor spend 15 minutes with you. Doctors are busy people.
Thomas LeBlanc, MD is no different, but early in his career as a medical student, he took special notice of this problem: doctors do not have much time to listen to the patient, and they focus too much on the medical aspects and not enough on the person.
“I saw that we often fail to attend to patients’ lived experiences of illness, so I decided to make that a priority in my research and in my practice—to amplify the patient voice in cancer care,” says LeBlanc, who treats patients with blood cancers at Duke Cancer Center Institute (DCI).
CHEYENNE CORBETT, PhD, LMFT, is collaborating to expand a tool that makes it easy for patients to report symptoms and psychosocial concerns.
LeBlanc, an associate professor of medicine, is excited about patient-reported outcomes (PROs), a set of tools that allow patients to self-report their own experiences via a survey or even an app. PROs give doctors and researchers measurements of the patient’s quality of life, mobility, emotional state, social well-being, and daily symptoms.
In recent years, PROs are playing an increasing role in cancer research and care. They help physicians get information directly from their patients about what they are going through and how they are feeling—information that blood work or a physical exam can’t reveal. LeBlanc and colleague Amy Abernethy, MD, adjunct professor of medicine, recently reviewed the state of the science of PROs in cancer care, in an article publishedin the journal Nature Reviews Clinical Oncology.
As one way of measuring patient quality of life, the Duke Cancer Patient Support Program uses the National Comprehensive Cancer Network (NCCN) distress thermometer, a paper survey that allows cancer patients to inform their doctors about family, emotional, spiritual, physical, and practical concerns. Nurses and patient navigators at Duke Cancer Institute gather the data and refer patients to the services that can help them.
LeBlanc is currently working with Cheyenne Corbett, PhD, LMFT, director of the Duke Cancer Patient Support Program, and with DCI leadership on expanding the NCCN distress thermometer initiative to also include symptom screening, which will assess for common symptoms like pain, weight loss, nausea, fatigue, and physical functioning.
They plan to digitize the paper survey using the Duke patient portal (Duke MyChart), so that patients can fill it out electronically before they visit the clinic or in the waiting room.
They hope to roll out a pilot program later in 2018.
“Having patients complete the distress thermometer electronically will improve clinicians’ workflow, save time for our nurses in clinic, and help us provide better care to patients,” LeBlanc says.
Corbett adds, “The distress screening tool helps us introduce to patients that we are concerned about how they are coping through their cancer experience and ensure that we continue to ask, so we can help identify challenges early. Digitizing this process will help people access information and services quickly, understand all that is available to them and how it can help, and see the impact of the care through their reported outcomes.”
It is likely that you or someone you care about is affected by cancer; one in two men and one in three women will be diagnosed with cancer in their lifetimes. In this issue of Breakthroughs, you will see just a few of the faces of people who are bravely taking on cancer with the help of Duke Cancer Institute. We were one of the first centers in the country to treat the whole person, not just their cancer, and we continue to break new ground in support services for our patients and their families. Our Supportive Care and Survivorship Center partnered with Duke University Communications to bring you the Many Faces of Cancer photo essay featured on the cover.In this issue you’ll also read about the dedicated team that helps thousands of people at Duke and beyond reduce their dependence on tobacco, all the while contributing to the science that lies behind the newest treatments.And you will find an inspiring story of hope about a mother and physician who is benefiting from a new combination treatment for people with bladder cancer and other urothelial cancers. Our physician-scientists played a role in taking this treatment to trial. This is just one example of how DCI is rewriting the narrative for patients who previously had few options.None of this progress would be possible without you. The dedication of our donors and friends motivates us to continue pushing forward to discover, develop, and deliver tomorrow’s cancer care…today. Thank you for all that you do.Michael B. Kastan, MD, PhDExecutive Director, Duke Cancer InstituteWilliam and Jane Shingleton Professor, Pharmacology and Cancer BiologyProfessor of Pediatrics
TALIA ARON, MD, WASN’T ALARMED AT FIRST WHEN SHE STARTED TO FEEL SOME NASTY LOWER BACK PAIN. Last September, the medical director at a telehealth company had been traveling to professional conferences for days, sitting on airplanes and in hard-backed chairs.But instead of getting better when she returned home to Greensboro, North Carolina, the pain got worse. “Looking back at a picture of me [at a conference] in Nashville, I was kind of a grey color,” Aron said.By the time she saw her OB-GYN, the pain was so bad that her physician sent her straight to the emergency department in Greensboro.Doctors at first thought that Aron had a kidney stone or infection. Then she was diagnosed with kidney cancer.When she sought a second opinion at Duke, she received what would turn out to be the correct diagnosis: a urothelial cancer that had already clawed its way into her kidney. Urothelial cancers include all cancers that grow out of cells that line the bladder and the ureters (tubes that drain urine from the kidneys to the bladder).Historically, people with advanced urothelial cancer live, on average, for sixteen months, with only 10% surviving five years or more on standard-of-care therapy.But doctors at Duke had a new treatment in mind for Aron that offered her much better odds. The only problem was, the combination therapy, developed by a medical oncologist at Duke Cancer Institute, was approved at that time only for a select population of patients. She would need help from friends and physicians at Duke and beyond to get the best treatment for her.
It is likely that you or someone you care about is affected by cancer; one in two men and one in three women will be diagnosed with cancer in their lifetimes. In this issue of Breakthroughs, you will see just a few of the faces of people who are bravely taking on cancer with the help of Duke Cancer Institute. We were one of the first centers in the country to treat the whole person, not just their cancer, and we continue to break new ground in support services for our patients and their families. Our Supportive Care and Survivorship Center partnered with Duke University Communications to bring you the Many Faces of Cancer photo essay featured on the cover.In this issue you’ll also read about the dedicated team that helps thousands of people at Duke and beyond reduce their dependence on tobacco, all the while contributing to the science that lies behind the newest treatments.And you will find an inspiring story of hope about a mother and physician who is benefiting from a new combination treatment for people with bladder cancer and other urothelial cancers. Our physician-scientists played a role in taking this treatment to trial. This is just one example of how DCI is rewriting the narrative for patients who previously had few options.None of this progress would be possible without you. The dedication of our donors and friends motivates us to continue pushing forward to discover, develop, and deliver tomorrow’s cancer care…today. Thank you for all that you do.Michael B. Kastan, MD, PhDExecutive Director, Duke Cancer InstituteWilliam and Jane Shingleton Professor, Pharmacology and Cancer BiologyProfessor of Pediatrics
TALIA ARON, MD, WASN’T ALARMED AT FIRST WHEN SHE STARTED TO FEEL SOME NASTY LOWER BACK PAIN. Last September, the medical director at a telehealth company had been traveling to professional conferences for days, sitting on airplanes and in hard-backed chairs.But instead of getting better when she returned home to Greensboro, North Carolina, the pain got worse. “Looking back at a picture of me [at a conference] in Nashville, I was kind of a grey color,” Aron said.By the time she saw her OB-GYN, the pain was so bad that her physician sent her straight to the emergency department in Greensboro.Doctors at first thought that Aron had a kidney stone or infection. Then she was diagnosed with kidney cancer.When she sought a second opinion at Duke, she received what would turn out to be the correct diagnosis: a urothelial cancer that had already clawed its way into her kidney. Urothelial cancers include all cancers that grow out of cells that line the bladder and the ureters (tubes that drain urine from the kidneys to the bladder).Historically, people with advanced urothelial cancer live, on average, for sixteen months, with only 10% surviving five years or more on standard-of-care therapy.But doctors at Duke had a new treatment in mind for Aron that offered her much better odds. The only problem was, the combination therapy, developed by a medical oncologist at Duke Cancer Institute, was approved at that time only for a select population of patients. She would need help from friends and physicians at Duke and beyond to get the best treatment for her.
