Gretchen Kimmick

Overview:

Breast cancer; treatment of breast cancer; management of menopausal symptoms in breast cancer survivors; survivorship issues after breast cancer; supportive care in managment of cancer patients; breast cancer and treatment of cancer in older persons; diagnosis and management of cancer in underserved populations.

Positions:

Professor of Medicine

Medicine, Medical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1989

Wake Forest University

M.S. 2000

Wake Forest University

Medical Resident, Medicine

University of Florida

Fellow in Oncology, Medicine

North Carolina Baptist Hospital

Grants:

A Phase II Study of Neratinib in Metastatic HER2 Non-amplified by HER2 Mutant Breast Cancer

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

Publications:

Patient-reported outcomes in the Translational Breast Cancer Research Consortium.

Members of the Translational Breast Cancer Research Consortium conducted an expert-driven literature review to identify a list of domains and to evaluate potential measures of these domains for inclusion in a list of preferred measures. Measures were included if they were easily available, free of charge, and had acceptable psychometrics based on published peer-reviewed analyses. A total of 22 domains and 52 measures were identified during the selection process. Taken together, these measures form a reliable and validated list of measurement tools that are easily available and used in multiple cancer trials to assess patient-reported outcomes in relevant patients.
Authors
Bowen, DJ; Shinn, EH; Gregrowski, S; Kimmick, G; Dominici, LS; Frank, ES; Smith, KL; Rocque, G; Ruddy, KJ; Pollastro, T; Melisko, M; Ballinger, TJ; Fayanju, OM; Wolff, AC
MLA Citation
Bowen, Deborah J., et al. “Patient-reported outcomes in the Translational Breast Cancer Research Consortium..” Cancer, Nov. 2019. Pubmed, doi:10.1002/cncr.32615.
URI
https://scholars.duke.edu/individual/pub1421501
PMID
31743427
Source
pubmed
Published In
Cancer
Published Date
DOI
10.1002/cncr.32615

A feasible and acceptable multicultural psychosocial intervention targeting symptom management in the context of advanced breast cancer.

OBJECTIVE: Advanced breast cancer patients around the world experience high symptom burden (ie, distress, pain, and fatigue) and are in need of psychosocial interventions that target symptom management. This study examined the feasibility, acceptability, and engagement of a psychosocial intervention that uses cognitive-behavioral strategies along with mindfulness and values-based activity to enhance patients' ability to manage symptoms of advanced disease in a cross-cultural setting (United States and Singapore). Pre-treatment to post-treatment outcomes for distress, pain, and fatigue were compared between intervention recipients and waitlisted controls. METHODS: A pilot randomized controlled trial included women with advanced breast cancer (N = 85) that were recruited in the United States and Singapore. Participants either received the four session intervention or were put on a waitlist. Descriptive statistics and effect size of symptom change were calculated. RESULTS: The psychosocial intervention was found to be feasible as indicated through successful trial accrual, low study attrition (15% ), and high intervention adherence (77% completed all sessions). Acceptability (ie, program satisfaction and cultural sensitivity) and engagement to the study intervention (ie, practice of skills taught) were also high. Anxiety, depression, and fatigue scores remained stable or improved among intervention participants while the same symptoms worsened in the control group. In general, effect sizes are larger in the US sample compared with the Singapore sample. CONCLUSIONS: The cognitive-behavioral, mindfulness, and values-based intervention is feasible, acceptable, and engaging for advanced breast cancer patients in a cross-cultural setting and has potential for efficacy. Further larger-scaled study of intervention efficacy is warranted.
Authors
Teo, I; Vilardaga, JP; Tan, YP; Winger, J; Cheung, YB; Yang, GM; Finkelstein, EA; Shelby, RA; Kamal, AH; Kimmick, G; Somers, TJ
MLA Citation
URI
https://scholars.duke.edu/individual/pub1421436
PMID
31703146
Source
pubmed
Published In
Psychooncology
Published Date
DOI
10.1002/pon.5275

Decreasing incidence of upper age restriction enrollment criteria among cancer clinical trials.

BACKGROUND: Age disparities among cancer clinical trial participants are pervasive and worsening over time. Identification of factors associated with age disparities is critical to improve enrollment of older patients on trials. The incidence and impact of trial eligibility criteria that exclude patients on the basis of age remains opaque. METHODS: ClinicalTrials.gov was queried for completed oncologic randomized controlled trials (RCTs). Phase 3 RCTs assessing a therapeutic intervention among adult cancer patients were included. Trial eligibility criteria were assessed using the ClinicalTrials.gov website as well as trial publications and protocol documentation. RESULTS: Seven hundred and forty-two trials met inclusion criteria, with a total combined enrollment of 449,720 patients. Upper age restriction enrollment criteria were identified for 10.1% of RCTs; the median age cutoff for restricted trials was 72 years (interquartile range 70-80 years). Linear regression modeling revealed decreasing incidence of age restriction criteria over time, at a rate of -1.1% annually (p = .03); trials initiating enrollment in 2002-2005, for example, had a 16.1% rate of age-restrictive eligibility criteria, compared with 7.6% for trials initiating enrollment in 2010-2014. CONCLUSION: Use of eligibility criteria that explicitly exclude patients on the basis of age appears to be decreasing with time. Future efforts should aim to better characterize the relationship between eligibility criteria (such as those that exclude patients on the basis of specific organ function) and their association with age disparities among enrolled patients.
Authors
Ludmir, EB; Subbiah, IM; Mainwaring, W; Miller, AB; Lin, TA; Jethanandani, A; Espinoza, AF; Mandel, JJ; Fang, P; Smith, BD; Smith, GL; Pinnix, CC; Sedrak, MS; Kimmick, GG; Stinchcombe, TE; Jagsi, R; Thomas, CR; Fuller, CD; VanderWalde, NA
MLA Citation
Ludmir, Ethan B., et al. “Decreasing incidence of upper age restriction enrollment criteria among cancer clinical trials..” J Geriatr Oncol, Nov. 2019. Pubmed, doi:10.1016/j.jgo.2019.11.001.
URI
https://scholars.duke.edu/individual/pub1421647
PMID
31711757
Source
pubmed
Published In
J Geriatr Oncol
Published Date
DOI
10.1016/j.jgo.2019.11.001

Patient-Reported Toxicities During Chemotherapy Regimens in Current Clinical Practice for Early Breast Cancer.

BACKGROUND: This study explores the incidence of patient-reported major toxicity-symptoms rated "moderate," "severe," or "very severe"-for chemotherapy regimens commonly used in early breast cancer. PATIENTS AND METHODS: Female patients aged 21 years or older completed a validated Patient-Reported Symptom Monitoring instrument and rated 17 symptoms throughout adjuvant or neoadjuvant chemotherapy. Fisher's exact tests compared differences in percentages in symptom ratings, and general linear regression was used to model the incidence of patient-reported major toxicity. RESULTS: In 152 patients, the mean age was 54 years (range, 24-77), and 112 (74%) were white; 51% received an anthracycline-based regimen. The proportion of patients rating fatigue, constipation, myalgia, diarrhea, nausea, peripheral neuropathy, and swelling of arms or legs as a major toxicity at any time during chemotherapy varied significantly among four chemotherapy regimens (p < .05). The mean (SD) number of symptoms rated major toxicities was 6.3 (3.6) for anthracycline-based and 4.4 (3.5) for non-anthracycline-based regimens (p = .001; possible range, 0-17 symptoms). Baseline higher body mass index (p = .03), patient-reported Karnofsky performance status ≤80 (p = .0003), and anthracycline-based regimens (p = .0003) were associated with greater total number of symptoms rated major toxicities (alternative model: chemotherapy duration, p < .0001). Twenty-six percent of dose reductions (26 of 40), 75% of hospitalizations (15 of 20), and 94% of treatment discontinuations (15 of 16) were in anthracycline-based regimens. CONCLUSION: Capturing multiple toxicity outcomes throughout chemotherapy enables oncologists and patients to understand the range of side effects as they discuss treatment efficacies. Continuous symptom monitoring may aid in the timely development of interventions that minimize toxicity and improve outcomes. IMPLICATIONS FOR PRACTICE: This study investigated patient-reported toxicities for 17 symptoms recorded prospectively during adjuvant and neoadjuvant chemotherapy regimens for early breast cancer. An analysis of four commonly used chemotherapy regimens identified significant differences among regimens in both individual symptoms and total number of symptoms rated moderate, severe, or very severe. Longer chemotherapy regimens, such as anthracycline-based regimens followed by paclitaxel, had higher proportions of symptoms rated major toxicities. The inclusion of patient perspectives on multiple toxicity outcomes at the same time at multiple time points during chemotherapy has the potential for improving patient-provider communication regarding symptom management, patient satisfaction, and long-term clinical outcomes.
Authors
Nyrop, KA; Deal, AM; Shachar, SS; Basch, E; Reeve, BB; Choi, SK; Lee, JT; Wood, WA; Anders, CK; Carey, LA; Dees, EC; Jolly, TA; Reeder-Hayes, KE; Kimmick, GG; Karuturi, MS; Reinbolt, RE; Speca, JC; Muss, HB
MLA Citation
Nyrop, Kirsten A., et al. “Patient-Reported Toxicities During Chemotherapy Regimens in Current Clinical Practice for Early Breast Cancer..” Oncologist, vol. 24, no. 6, June 2019, pp. 762–71. Pubmed, doi:10.1634/theoncologist.2018-0590.
URI
https://scholars.duke.edu/individual/pub1362948
PMID
30552158
Source
pubmed
Published In
Oncologist
Volume
24
Published Date
Start Page
762
End Page
771
DOI
10.1634/theoncologist.2018-0590

Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503).

PURPOSE: Tools to estimate survival, such as ePrognosis ( http://eprognosis.ucsf.edu/carey2.php ), were developed for general, not cancer, populations. In older patients with breast cancer, accurate overall survival estimates would facilitate discussions about adjuvant therapies. METHODS: Secondary analyses were performed of data from two parallel breast cancer studies (CALGB/Alliance 49907/NCT000224102 and CALGB/Alliance 369901/NCT00068328). We included patients (n = 971) who were age 70 years and older with complete baseline quality of life data (194 from 49907; 777 from 369901). Estimated versus observed all-cause two-year mortality rates were compared. ePrognosis score was calculated based on age, sex, and daily function (derived from EORTC QLQ-C30). ePrognosis scores range from 0 to 10, with higher scores indicating worse prognosis based on mortality of community-dwelling elders and were categorized into three groups (0-2, 3-6, 7-10). Observed mortality rates were estimated using Kaplan-Meier methods. RESULTS: Patient mean age was 75.8 years (range 70-91) and 73% had stage I-IIA disease. Most patients were classified by ePrognosis as good prognosis (n = 562, 58% 0-2) and few (n = 18, 2% 7-10) poor prognosis. Two-year observed mortality rates were significantly lower than ePrognosis estimates for patients scoring 0-2 (2% vs 5%, p = 0.001) and 3-6 (8% vs 12%, p = 0.01). The same trend was seen with scores of 7-10 (23% vs 36%, p = 0.25). CONCLUSIONS: ePrognosis tool only modestly overestimates mortality rate in older breast cancer patients enrolled in two cooperative group studies. This tool, which estimates non-cancer mortality risk based on readily available clinical information may inform adjuvant therapy decisions but should be validated in non-clinical trial populations.
Authors
Kimmick, GG; Major, B; Clapp, J; Sloan, J; Pitcher, B; Ballman, K; Barginear, M; Freedman, RA; Artz, A; Klepin, HD; Lafky, JM; Hopkins, J; Winer, E; Hudis, C; Muss, H; Cohen, H; Jatoi, A; Hurria, A; Mandelblatt, J
MLA Citation
Kimmick, Gretchen G., et al. “Using ePrognosis to estimate 2-year all-cause mortality in older women with breast cancer: Cancer and Leukemia Group B (CALGB) 49907 and 369901 (Alliance A151503)..” Breast Cancer Res Treat, vol. 163, no. 2, June 2017, pp. 391–98. Pubmed, doi:10.1007/s10549-017-4188-6.
URI
https://scholars.duke.edu/individual/pub1241615
PMID
28283904
Source
pubmed
Published In
Breast Cancer Res Treat
Volume
163
Published Date
Start Page
391
End Page
398
DOI
10.1007/s10549-017-4188-6