Carol Hahn

Overview:

Development of Evidence Based Clinical Practice Guidelines for Radiation Oncology.

Optimizing Quality of Care in Radiation Oncology and Development of Quality Measures.

Disparities in care for oncology patients between tertiary care and community hospitals.

Assessment of Neuropsychologic Function in Brain Tumor Patients and the metabolic and functional changes induced by Radiation Therapy.

Positions:

Professor Emeritus of Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1990

Georgetown University

Publications:

A Multidisciplinary Consensus Recommendation on a Synoptic Radiation Treatment Summary: A Commission on Cancer Workgroup Report.

PURPOSE: The radiation treatment summary provides a clinical and technical overview of a patient's full course of radiation therapy. Despite its importance to multiple stakeholders, there is no widely followed radiation treatment summary template. METHODS AND MATERIALS: The Commission on Cancer convened a multistakeholder workgroup to develop a synoptic radiation treatment summary template. The workgroup included individuals with expertise in radiation, medical and surgical oncology, medical physics, oncology informatics, cancer registry, electronic medical record systems, treatment planning systems, and registry information systems. The workgroup iterated a template until consensus was achieved. RESULTS: The consensus radiation treatment summary template is divided into 3 sections that allows for a mix of structured and free text. The first section, "Radiation Course Summary," is meant to provide information that is of broad interest and in a manner that is potentially accessible to patients, their families, and nononcology-trained care team members. The second section, "Anatomic Target Summary," provides information that is potentially useful to oncology-trained care team members who will be primarily interested in which anatomies were irradiated, by what modality, and to what cumulative dose. The third section, "Delivered Prescriptions," summarizes technical information that is primarily of interest and accessible to radiation oncology-trained clinicians, registrars, and researchers. CONCLUSIONS: We have proposed a consensus template with 3 sections to meet the needs of a diverse set of consumers. We recommend that providers, professional societies, and accreditation bodies with interest in the radiation treatment summary continue collaborative efforts to test, iterate, and drive adoption of a synoptic template.
Authors
Christodouleas, JP; Anderson, N; Gabriel, P; Greene, R; Hahn, C; Kessler, S; Mayo, CS; McNutt, T; Shulman, LN; Smith, BD; West, J; Williamson, T
MLA Citation
Christodouleas, John P., et al. “A Multidisciplinary Consensus Recommendation on a Synoptic Radiation Treatment Summary: A Commission on Cancer Workgroup Report.Pract Radiat Oncol, vol. 10, no. 6, Nov. 2020, pp. 389–401. Pubmed, doi:10.1016/j.prro.2020.01.002.
URI
https://scholars.duke.edu/individual/pub1428963
PMID
31988040
Source
pubmed
Published In
Pract Radiat Oncol
Volume
10
Published Date
Start Page
389
End Page
401
DOI
10.1016/j.prro.2020.01.002

Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline.

PURPOSE: In patients with early-stage breast cancer treated with breast-conserving surgery, randomized trials have found little difference in local control and survival outcomes between patients treated with conventionally fractionated (CF-) whole breast irradiation (WBI) and those receiving hypofractionated (HF)-WBI. However, it remains controversial whether these results apply to all subgroups of patients. We therefore developed an evidence-based guideline to provide direction for clinical practice. METHODS AND MATERIALS: A task force authorized by the American Society for Radiation Oncology weighed evidence from a systematic literature review and produced the recommendations contained herein. RESULTS: The majority of patients in randomized trials were aged 50 years or older, had disease Stage pT1-2 pN0, did not receive chemotherapy, and were treated with a radiation dose homogeneity within ±7% in the central axis plane. Such patients experienced equivalent outcomes with either HF-WBI or CF-WBI. Patients not meeting these criteria were relatively underrepresented, and few of the trials reported subgroup analyses. For patients not receiving a radiation boost, the task force favored a dose schedule of 42.5 Gy in 16 fractions when HF-WBI is planned. The task force also recommended that the heart should be excluded from the primary treatment fields (when HF-WBI is used) due to lingering uncertainty regarding late effects of HF-WBI on cardiac function. The task force could not agree on the appropriateness of a tumor bed boost in patients treated with HF-WBI. CONCLUSION: Data were sufficient to support the use of HF-WBI for patients with early-stage breast cancer who met all the aforementioned criteria. For other patients, the task force could not reach agreement either for or against the use of HF-WBI, which nevertheless should not be interpreted as a contraindication to its use.
Authors
Smith, BD; Bentzen, SM; Correa, CR; Hahn, CA; Hardenbergh, PH; Ibbott, GS; McCormick, B; McQueen, JR; Pierce, LJ; Powell, SN; Recht, A; Taghian, AG; Vicini, FA; White, JR; Haffty, BG
MLA Citation
Smith, Benjamin D., et al. “Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline.Int J Radiat Oncol Biol Phys, vol. 81, no. 1, Sept. 2011, pp. 59–68. Pubmed, doi:10.1016/j.ijrobp.2010.04.042.
URI
https://scholars.duke.edu/individual/pub733144
PMID
20638191
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Volume
81
Published Date
Start Page
59
End Page
68
DOI
10.1016/j.ijrobp.2010.04.042

Phase I/II trial of intravenous Doxil and whole abdomen hyperthermia in patients with refractory ovarian cancer.

OBJECTIVE: A phase I/II study of Doxil combined with whole abdomen hyperthermia was conducted in patients with refractory ovarian cancer. Liposomal doxorubicin combined with hyperthermia has been shown to increase both liposomal delivery and drug extravasation into tumour xenografts resulting in enhanced cytotoxic effects. PATIENTS AND METHODS: Thirty patients with either recurrent or persistent epithelial ovarian cancer were enrolled. All patients had either measurable or assessable disease. Patients received intravenous (IV) Doxil at a dose of 40 mg m-2 as a 1-h infusion followed by whole abdomen hyperthermia. The phase I portion of the study was performed to determine the maximal tolerated dose (MTD) of hyperthermia. Quality of life (QoL) was performed at baseline, prior to each cycle and every 3 months. Plasma pharmacokinetic studies were performed with the first cycle. RESULTS: Ten patients participated in the phase I portion of the study which demonstrated that the MTD of hyperthermia was 60 min after either average vaginal and rectal temperatures of 40 degrees C had been achieved or after 30 min of power application, whichever was shorter. All 30 patients were either paclitaxel and/or platinum resistant initially or developed resistant disease. The median number of prior chemotherapeutic regimens was three (range 2-8) and six patients had been previously treated with Doxil. There were three partial responses for a response rate of 10% (95% CI: [2%, 27%]) and eight patients (27%; 95% CI: [12%, 46%]) had disease stabilization. The median time to progression or death was 3.4 months (95% CI: [2.6, 5.2]) and the median survival was 10.8 months (95% CI: [8.8, 17.4]). Twelve patients (40%) experienced palmar-plantar erythrodysesthesia (PPE), but only four (13%) experienced grade 3-4 PPE toxicity. Doxil systemic exposure was higher in those with grade 3-4 PPE compared to those with no PPE. None of the patients had grade 3-4 thermal toxicity due to hyperthermia. QoL was not decreased in patients responding to therapy. CONCLUSIONS: Therapy with intravenous Doxil and whole abdomen hyperthermia for patients with platinum/paclitaxel resistant ovarian cancer is feasible and does not negatively impact quality of life.
Authors
Alvarez Secord, A; Jones, EL; Hahn, CA; Petros, WP; Yu, D; Havrilesky, LJ; Soper, JT; Berchuck, A; Spasojevic, I; Clarke-Pearson, DL; Prosnitz, LR; Dewhirst, MW
MLA Citation
Alvarez Secord, A., et al. “Phase I/II trial of intravenous Doxil and whole abdomen hyperthermia in patients with refractory ovarian cancer.Int J Hyperthermia, vol. 21, no. 4, June 2005, pp. 333–47. Pubmed, doi:10.1080/02656730500110155.
URI
https://scholars.duke.edu/individual/pub714709
PMID
16019859
Source
pubmed
Published In
International Journal of Hyperthermia : the Official Journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group
Volume
21
Published Date
Start Page
333
End Page
347
DOI
10.1080/02656730500110155

Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline.

PURPOSE: To provide guidance to physicians and patients with regard to the use of external beam radiotherapy, endobronchial brachytherapy, and concurrent chemotherapy in the setting of palliative thoracic treatment for lung cancer, based on available evidence complemented by expert opinion. METHODS AND MATERIALS: A Task Force authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors synthesized and assessed evidence from 3 systematic reviews on the following topics: (1) dose fractionation in thoracic external beam radiotherapy (EBRT); (2) clinical utility of initial and salvage endobronchial brachytherapy (EBB); and (3) use of concurrent chemotherapy (CC) with palliative thoracic radiotherapy. Practice guideline recommendations were produced and are contained herein. RESULTS: Studies suggest that higher dose/fractionation palliative EBRT regimens (eg, 30 Gy/10 fraction equivalent or greater) are associated with modest improvements in survival and total symptom score, particularly in patients with good performance status. As these improvements are associated with an increase in esophageal toxicity, various shorter EBRT dose/fractionation schedules (eg, 20 Gy in 5 fractions, 17 Gy in 2 weekly fractions, 10 Gy in 1 fraction), which provide good symptomatic relief with fewer side effects, can be used for patients requesting a shorter treatment course and/or in those with a poor performance status. No defined role for EBB in the routine initial palliative treatment of chest disease has been demonstrated; however, EBB can be a reasonable option for the palliation of endobronchial lesions causing obstructive symptomatology including lung collapse, or for hemoptysis after EBRT failure. The integration of concurrent chemotherapy with palliative intent/fractionated radiotherapy is not currently supported by the medical literature. CONCLUSION: This Guideline is intended to serve as a guide for the use of EBRT, EBB, and CC in thoracic palliation of lung cancer outside the clinical trial setting. Further prospective clinical investigations with relevant palliative endpoints into the respective roles of EBB and CC/targeted therapy in the thoracic palliation of lung cancer are warranted, given the current state of the medical literature in these areas.
Authors
Rodrigues, G; Videtic, GMM; Sur, R; Bezjak, A; Bradley, J; Hahn, CA; Langer, C; Miller, KL; Moeller, BJ; Rosenzweig, K; Movsas, B
MLA Citation
Rodrigues, George, et al. “Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline.Pract Radiat Oncol, vol. 1, no. 2, Apr. 2011, pp. 60–71. Pubmed, doi:10.1016/j.prro.2011.01.005.
URI
https://scholars.duke.edu/individual/pub751377
PMID
25740118
Source
pubmed
Published In
Practical Radiation Oncology
Volume
1
Published Date
Start Page
60
End Page
71
DOI
10.1016/j.prro.2011.01.005

Prospective assessment of quality of life in ovarian cancer patients receiving whole abdomen hyperthermia and liposomal doxorubicin.

PURPOSE: Prospective assessment of quality of life (QoL) in patients with refractory, residual or recurrent ovarian cancer receiving whole abdomen hyperthermia and intravenous liposomal doxorubicin chemotherapy. METHODS: Treatment consisted of six cycles of intravenous liposomal doxorubicin at 40 mg m2 followed by whole abdomen hyperthermia with each cycle delivered every 4 weeks. QoL assessment was performed at baseline, prior to each cycle of chemotherapy and every 3 months during follow-up using self-administered questionnaires. Global QoL was rated on a seven-point scale and specific domains of QoL, disease related symptoms and treatment related toxicity were rated on a four-point scale. RESULTS: Thirty-two patients were enrolled on the study and 129 QoL questionnaires were completed. Average age was 57.9 (range 45-76); nine patients had persistent and 23 recurrent disease. Ten patients completed six cycles of therapy. Three patients returned follow-up surveys. Subjects rated their overall QoL and health at baseline as above average with mean scores 5.10 (95% CI=4.62-5.58) and 4.66 (95% CI=4.23-5.08), respectively. No significant change in overall QoL was found between baseline and cycles 4-6 of therapy. Mean ratings of overall health and subject reported differences in QoL between cycles were not significantly changed during therapy. Limited follow-up data were available, but scores suggest possible improvement in QoL for patients completing all therapy. Subjects rated the greatest negative impact on QoL in areas of role functioning and social functioning, where the mean (SD) over all cycles was 2.00 (0.67) and 1.98 (0.70), respectively. For physical symptoms, fatigue and sleep disturbance had the most negative impact on QoL with means (SD) of 2.26 (0.62) and 1.91 (0.70). The moderate treatment related toxicity seen in this study did not significantly impact patients reported QoL. CONCLUSIONS: Patients with unfavourable ovarian cancer responding to intravenous liposomal doxorubicin and whole abdomen hyperthermia maintained above average QoL during therapy. Limited data on patients completing protocol therapy demonstrated possible improvement in QoL.
Authors
Hahn, CA; Jones, EL; Blivin, JL; Sanders, LL; Yu, D; Dewhirst, MW; Secord, AA; Prosnitz, LR
MLA Citation
Hahn, C. A., et al. “Prospective assessment of quality of life in ovarian cancer patients receiving whole abdomen hyperthermia and liposomal doxorubicin.Int J Hyperthermia, vol. 21, no. 4, June 2005, pp. 349–57. Pubmed, doi:10.1080/02656730400022260.
URI
https://scholars.duke.edu/individual/pub714734
PMID
16019860
Source
pubmed
Published In
International Journal of Hyperthermia : the Official Journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group
Volume
21
Published Date
Start Page
349
End Page
357
DOI
10.1080/02656730400022260