Breast cancer patients and their oncologists are often confronted with choices regarding radiation therapy. Randomized trials help to guide these increasingly complex decisions. Nevertheless, for certain clinical scenarios, randomized trial data are either incomplete, or are not tailored to adequately inform physicians and patients in decision-making. In the candidate's proposal, the decision to add radiation therapy will be studied using two approaches - in the setting of incomplete trial data at the health services level (Aim 1) and at the patient level using decision analysis to individualize outcomes (Aims 2-3).
Aim 1 proposes to study decision-making at a population level using the SEER-Medicare database, by analyzing the factors that predict for the receipt of radiation therapy after mastectomy, The selection of patients who benefit from the addition of radiation in this setting is the subject of considerable controversy, due to the lack of complete data. In addition, the candidate will use decision analysis to bridge the gap between the large aggregates of patients studied in trials and the individual patient for two treatment decisions regarding radiation therapy.
Aim 2 will use decision analysis to study the tradeoffs between breast-conserving therapy (lumpectomy and radiation) versus mastectomy for invasive cancers as they vary with patient age at diagnosis.
Aim 3 is a decision analysis of the use of radiation therapy after breast-conserving surgery for small ductal carcinomas in situ versus surgery alone.
For Aims 2 and 3, the candidate will construct models to synthesize the available data to estimate specific outcomes about the complex tradeoffs associated with these decisions. Model results will include both recurrence-free survival and time with an intact breast for different ages, so that a patient can use the results to inform decision-making by selecting the most important and relevant outcome, allowing for treatment decisions that are aligned with her individual preferences. By studying factors predicting for the decision to add radiation therapy after mastectomy in the population, and tailoring the presentation of data from trials to best serve the individual, completion of these projects will improve decision-making about radiation therapy for breast cancer patients. The candidate's career development plan includes additional coursework in epidemiology and risk and decision science. The proposed combined education and research program, in addition to strong mentorship, will provide the candidate with the skills and experience necessary for a career as an independent outcomes researcher in breast cancer.
|Halasz, Lia M; Uno, Hajime; Hughes, Melissa et al. (2016) Comparative effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for patients with brain metastases from breast or non-small cell lung cancer. Cancer 122:2091-100|
|Punglia, Rinaa S; Burstein, Harold J; Weeks, Jane C (2012) Radiation therapy for ductal carcinoma in situ: a decision analysis. Cancer 118:603-11|
|Hoffman, Karen E; Neville, Bridget A; Mamon, Harvey J et al. (2012) Adjuvant therapy for elderly patients with resected gastric adenocarcinoma: population-based practices and treatment effectiveness. Cancer 118:248-57|
|Sher, D J; Tishler, R B; Annino, D et al. (2010) Cost-effectiveness of CT and PET-CT for determining the need for adjuvant neck dissection in locally advanced head and neck cancer. Ann Oncol 21:1072-7|
|Sher, David J; Wittenberg, Eve; Suh, W Warren et al. (2009) Partial-breast irradiation versus whole-breast irradiation for early-stage breast cancer: a cost-effectiveness analysis. Int J Radiat Oncol Biol Phys 74:440-6|
|Punglia, Rinaa S; Hughes, Melissa E; Edge, Stephen B et al. (2008) Factors associated with guideline-concordant use of radiotherapy after mastectomy in the national comprehensive cancer network. Int J Radiat Oncol Biol Phys 72:1434-40|
|Sher, David J; Wittenberg, Eve; Taghian, Alphonse G et al. (2008) Partial breast irradiation versus whole breast radiotherapy for early-stage breast cancer: a decision analysis. Int J Radiat Oncol Biol Phys 70:469-76|
|Punglia, Rinaa S; Burstein, Harold J; Winer, Eric P et al. (2008) Pharmacogenomic variation of CYP2D6 and the choice of optimal adjuvant endocrine therapy for postmenopausal breast cancer: a modeling analysis. J Natl Cancer Inst 100:642-8|