Kevin Oeffinger

Overview:

Kevin Oeffinger, MD, is a family physician, Professor in the Department of Medicine, and a member of the Duke Cancer Institute (DCI). He is founding Director of the DCI Center for Onco-Primary Care, and Director of the DCI Supportive Care and Survivorship Center. He has a long-standing track record of NIH-supported research in cancer screening and survivorship and has served in a leadership capacity in various cancer-focused and primary care-focused national committees and organizations, including the American Society of Clinical Oncology, the American Cancer Society, and the American Academy of Family Physicians. He is currently an Associate Editor for the Journal of the National Cancer Institute.

The three-fold mission of the DCI Center for Onco-Primary Care are are to: (1) deliver evidence-based, patient-centered, personalized health care across the cancer continuum by enhancing the interface between cancer specialists and primary care clinicians; (2) conduct innovative research with cutting-edge technology that can be translated to the community setting; and (3) train and educate the next generation of clinicians and researchers to extend this mission. 

Dr. Oeffinger's clinical expertise is managing survivors of pediatric and young adult cancer.

Positions:

Professor of Medicine

Medicine, Medical Oncology
School of Medicine

Professor in the Department of Community and Family Medicine

Family Medicine and Community Health
School of Medicine

Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1984

University of Texas Health Science Center San Antonio

Family Medicine Internship and Residency

Baylor College of Medicine

Family Medicine Academic Fellowship

Baylor College of Medicine

Advanced Research Training, Epidemiology And Genetics, Radiation Epidemiology

National Cancer Institute

Grants:

EMPOWER Study: Promoting BC Screening in Women Who Survived Childhood Cancer

Administered By
Duke Cancer Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Improving Treatment of Cardiovascular Risk Factors in Childhood Cancer Survivors

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
End Date

Childhood Cancer Survivor Study (CCSS)

Administered By
Duke Cancer Institute
Awarded By
St. Jude Children's Research Hospital
Role
Principal Investigator
Start Date
End Date

Generic Testing to Guide Pediatric Cancer Care and Follow Up: Using Anthracycline-associated Cardiac Toxicity as a Model for the Future

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
End Date

Exercise and QUality diet After Leukemia

Administered By
Duke Cancer Institute
Awarded By
Sloan Kettering Institute
Role
Principal Investigator
Start Date
End Date

Publications:

Radiation therapy related cardiac disease risk in childhood cancer survivors: Updated dosimetry analysis from the Childhood Cancer Survivor Study.

BACKGROUND AND PURPOSE: We previously evaluated late cardiac disease in long-term survivors in the Childhood Cancer Survivor Study (CCSS) based on heart radiation therapy (RT) doses estimated from an age-scaled phantom with a simple atlas-based heart model (HAtlas). We enhanced our phantom with a high-resolution CT-based anatomically realistic and validated age-scalable cardiac model (HHybrid). We aimed to evaluate how this update would impact our prior estimates of RT-related late cardiac disease risk in the CCSS cohort. METHODS: We evaluated 24,214 survivors from the CCSS diagnosed from 1970 to 1999. RT fields were reconstructed on an age-scaled phantom with HHybrid and mean heart dose (Dm), percent volume receiving ≥ 20 Gy (V20) and ≥ 5 Gy with V20 = 0 ( [Formula: see text] ) were calculated. We reevaluated cumulative incidences and adjusted relative rates of grade 3-5 Common Terminology Criteria for Adverse Events outcomes for any cardiac disease, coronary artery disease (CAD), and heart failure (HF) in association with Dm, V20, and [Formula: see text] (as categorical variables). Dose-response relationships were evaluated using piecewise-exponential models, adjusting for attained age, sex, cancer diagnosis age, race/ethnicity, time-dependent smoking history, diagnosis year, and chemotherapy exposure and doses. For relative rates, Dm was also considered as a continuous variable. RESULTS: Consistent with previous findings with HAtlas, reevaluation using HHybrid dosimetry found that, Dm ≥ 10 Gy, V20 ≥ 0.1%, and [Formula: see text]  ≥ 50% were all associated with increased cumulative incidences and relative rates for any cardiac disease, CAD, and HF. While updated risk estimates were consistent with previous estimates overall without statistically significant changes, there were some important and significant (P < 0.05) increases in risk with updated dosimetry for Dm in the category of 20 to 29.9 Gy and V20 in the category of 30% to 79.9%. When changes in the linear dose-response relationship for Dm were assessed, the slopes of the dose response were steeper (P < 0.001) with updated dosimetry. Changes were primarily observed among individuals with chest-directed RT with prescribed doses ≥ 20 Gy. CONCLUSION: These findings present a methodological advancement in heart RT dosimetry with improved estimates of RT-related late cardiac disease risk. While results are broadly consistent with our prior study, we report that, with updated cardiac dosimetry, risks of cardiac disease are significantly higher in two dose and volume categories and slopes of the Dm-specific RT-response relationships are steeper. These data support the use of contemporary RT to achieve lower heart doses for pediatric patients, particularly those requiring chest-directed RT.
Authors
Shrestha, S; Bates, JE; Liu, Q; Smith, SA; Oeffinger, KC; Chow, EJ; Gupta, AC; Owens, CA; Constine, LS; Hoppe, BS; Leisenring, WM; Qiao, Y; Weathers, RE; Court, LE; Pinnix, CC; Kry, SF; Mulrooney, DA; Armstrong, GT; Yasui, Y; Howell, RM
MLA Citation
Shrestha, Suman, et al. “Radiation therapy related cardiac disease risk in childhood cancer survivors: Updated dosimetry analysis from the Childhood Cancer Survivor Study.Radiother Oncol, vol. 163, Aug. 2021, pp. 199–208. Pubmed, doi:10.1016/j.radonc.2021.08.012.
URI
https://scholars.duke.edu/individual/pub1497241
PMID
34454975
Source
pubmed
Published In
Radiother Oncol
Volume
163
Published Date
Start Page
199
End Page
208
DOI
10.1016/j.radonc.2021.08.012

The Head and Neck Survivorship Tool (HN-STAR) Trial (WF-1805CD): A protocol for a cluster-randomized, hybrid effectiveness-implementation, pragmatic trial to improve the follow-up care of head and neck cancer survivors.

Survivors of head and neck cancer (HNC) can have multiple health concerns. To facilitate their care, we developed and pilot-tested a clinical informatics intervention, HN-STAR. HN-STAR elicits concerns online from HNC survivors prior to a routine oncology clinic visit. HN-STAR then presents tailored evidence-based clinical recommendations as a clinical decision support tool to be used during the visit where the oncology clinician and survivor select symptom management strategies and other actions. This generates a survivorship care plan (SCP). Online elicitation of health concerns occurs 3, 6, and 9 months after the clinic visit, generating an updated SCP each time. HN-STAR encompasses important methods of improving survivorship care (e.g., needs assessment, tailored interventions, dissemination of guidelines) and will be evaluated in a pragmatic trial to maximize external validity. This hybrid type 1 implementation-effectiveness trial tests HN-STAR effectiveness while studying barriers and facilitators to implementation in community oncology practices within the National Cancer Institute Community Oncology Research Program. Effectiveness will be measured as differences in key survivorship outcomes between HNC participants who do and do not use HN-STAR over one year after the clinic visit. The primary endpoint is HNC-specific quality of life; other outcomes include patient-centered measures and receipt of guideline-concordant care. Implementation outcomes will be assessed of survivors, providers, and clinic stakeholders. The hybrid design will provide insight into a dose-response relationship between the extent of implementation fidelity and effectiveness outcomes, as well as how to incorporate HN-STAR into standard practice outside the research setting.
Authors
Salz, T; Ostroff, JS; Nightingale, CL; Atkinson, TM; Davidson, EC; Jinna, SR; Kriplani, A; Lesser, GJ; Lynch, KA; Mayer, DK; Oeffinger, KC; Patil, S; Salner, AL; Weaver, KE
URI
https://scholars.duke.edu/individual/pub1483456
PMID
34023515
Source
pubmed
Published In
Contemp Clin Trials
Volume
107
Published Date
Start Page
106448
DOI
10.1016/j.cct.2021.106448

Longitudinal Evaluation of Neuromuscular Dysfunction in Long-term Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study.

BACKGROUND: Children treated for cancer are at risk for neuromuscular dysfunction, but data are limited regarding prevalence, longitudinal patterns, and long-term impact. METHODS: Longitudinal surveys from 25,583 childhood cancer survivors ≥5 years from diagnosis and 5,044 siblings from the Childhood Cancer Survivor Study were used to estimate the prevalence and cumulative incidence of neuromuscular dysfunction. Multivariable models adjusted for age, sex, race, and ethnicity estimated prevalence ratios (PR) of neuromuscular dysfunction in survivors compared with siblings, and associations with treatments and late health/socioeconomic outcomes. RESULTS: Prevalence of neuromuscular dysfunction was 14.7% in survivors 5 years postdiagnosis versus 1.5% in siblings [PR, 9.9; 95% confidence interval (CI), 7.9-12.4], and highest in survivors of central nervous system (CNS) tumors (PR, 27.6; 95% CI, 22.1-34.6) and sarcomas (PR, 11.5; 95% CI, 9.1-14.5). Cumulative incidence rose to 24.3% in survivors 20 years postdiagnosis (95% CI, 23.8-24.8). Spinal radiotherapy and increasing cranial radiotherapy dose were associated with increased prevalence of neuromuscular dysfunction. Platinum exposure (vs. none) was associated with neuromuscular dysfunction (PR, 1.8; 95% CI, 1.5-2.1), even after excluding survivors with CNS tumors, cranial/spinal radiotherapy, or amputation. Neuromuscular dysfunction was associated with concurrent or later obesity (PR, 1.1; 95% CI, 1.1-1.2), anxiety (PR, 2.5; 95% CI, 2.2-2.9), depression (PR, 2.1; 95% CI, 1.9-2.3), and lower likelihood of graduating college (PR, 0.92; 95% CI, 0.90-0.94) and employment (PR, 0.8; 95% CI, 0.8-0.9). CONCLUSIONS: Neuromuscular dysfunction is prevalent in childhood cancer survivors, continues to increase posttherapy, and is associated with adverse health and socioeconomic outcomes. IMPACT: Interventions are needed to prevent and treat neuromuscular dysfunction, especially in survivors with platinum and radiation exposure.
Authors
Rodwin, RL; Chen, Y; Yasui, Y; Leisenring, WM; Gibson, TM; Nathan, PC; Howell, RM; Krull, KR; Mohrmann, C; Hayashi, RJ; Chow, EJ; Oeffinger, KC; Armstrong, GT; Ness, KK; Kadan-Lottick, NS
MLA Citation
Rodwin, Rozalyn L., et al. “Longitudinal Evaluation of Neuromuscular Dysfunction in Long-term Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study.Cancer Epidemiol Biomarkers Prev, vol. 30, no. 8, Aug. 2021, pp. 1536–45. Pubmed, doi:10.1158/1055-9965.EPI-21-0154.
URI
https://scholars.duke.edu/individual/pub1484669
PMID
34099519
Source
pubmed
Published In
Cancer Epidemiol Biomarkers Prev
Volume
30
Published Date
Start Page
1536
End Page
1545
DOI
10.1158/1055-9965.EPI-21-0154

Impact of Risk-Adapted Therapy for Pediatric Hodgkin Lymphoma on Risk of Long-Term Morbidity: A Report From the Childhood Cancer Survivor Study.

PURPOSE: To determine the incidence of serious chronic health conditions among survivors of pediatric Hodgkin lymphoma (HL), compare by era of therapy and by selected cancer therapies, and provide estimates of risks associated with contemporary therapy. METHODS: Assessing 2,996 5-year HL survivors in the Childhood Cancer Survivor Study diagnosed from 1970 to 1999, we examined the cumulative incidence of severe to fatal chronic conditions (grades 3-5) using self-report conditions, medically confirmed subsequent malignant neoplasms, and cause of death based on the National Death Index. We used multivariable regression models to estimate hazard ratios (HRs) per decade and by key treatment exposures. RESULTS: HL survivors were of a mean age of 35.6 years (range, 12-58 years). The cumulative incidence of any grade 3-5 condition by 35 years of age was 31.4% (95% CI, 29.2 to 33.5). Females were twice as likely (HR, 2.1; 95% CI, 1.8 to 2.4) to have a grade 3-5 condition compared with males. From the 1970s to the 1990s, there was a 20% reduction (HR, 0.8; 95% CI, 0.7 to 0.9) in decade-specific risk of a grade 3-5 condition (P trend = .002). In survivors who had a recurrence and/or hematopoietic cell transplant, the risk of a grade 3-5 condition was substantially elevated, similar to that of survivors treated with high-dose, extended-field radiotherapy (HR, 1.2; 95% CI, 0.9 to 1.5). Compared with survivors treated with chest radiotherapy ≥ 35 Gy in combination with an anthracycline or alkylator, a contemporary regimen for low-intermediate risk HL was estimated to lead to a 40% reduction in risk of a grade 3-5 condition (HR, 0.6; 95% CI, 0.4 to 0.8). CONCLUSION: This study demonstrates that risk-adapted therapy for pediatric HL has resulted in a significant reduction in serious long-term outcomes.
Authors
Oeffinger, KC; Stratton, KL; Hudson, MM; Leisenring, WM; Henderson, TO; Howell, RM; Wolden, SL; Constine, LS; Diller, LR; Sklar, CA; Nathan, PC; Castellino, SM; Barnea, D; Smith, SA; Hutchinson, RJ; Armstrong, GT; Robison, LL
MLA Citation
Oeffinger, Kevin C., et al. “Impact of Risk-Adapted Therapy for Pediatric Hodgkin Lymphoma on Risk of Long-Term Morbidity: A Report From the Childhood Cancer Survivor Study.J Clin Oncol, vol. 39, no. 20, July 2021, pp. 2266–75. Pubmed, doi:10.1200/JCO.20.01186.
URI
https://scholars.duke.edu/individual/pub1494229
PMID
33630659
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
39
Published Date
Start Page
2266
End Page
2275
DOI
10.1200/JCO.20.01186

Hodgkin Lymphoma Survivors: We Need to Do Better.

Authors
Henderson, TO; Oeffinger, KC
MLA Citation
Henderson, Tara O., and Kevin C. Oeffinger. “Hodgkin Lymphoma Survivors: We Need to Do Better.J Natl Cancer Inst, vol. 113, no. 6, June 2021, pp. 654–55. Pubmed, doi:10.1093/jnci/djaa196.
URI
https://scholars.duke.edu/individual/pub1486224
PMID
33351151
Source
pubmed
Published In
J Natl Cancer Inst
Volume
113
Published Date
Start Page
654
End Page
655
DOI
10.1093/jnci/djaa196