Thomas LeBlanc

Overview:

Dr. LeBlanc is a medical oncologist, palliative care physician, and patient experience researcher.  His clinical practice focuses on the care of patients with hematologic malignancies, with a particular emphasis on myeloid conditions and acute leukemias including acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), myelodysplastic syndromes (MDS), and myeloproliferative neoplasms (MPNs / MPDs, CML).  He is an active member of the inpatient non-transplant hematologic malignancies care team, based on the 9100 ward of Duke University Hospital.

His research interests converge on common issues faced by people with cancer, particularly those with high-risk or relapsed/refractory hematologic malignancies. Issues of symptom burden and quality of life are of central importance in these settings, and may lead patients to face difficult decision-making scenarios. Dr. LeBlanc’s research explores the experience of patients and families in these settings, and aims to improve patients experiences living with blood cancers, including the involvement of specialist palliative care services to provide an extra layer of support along with their comprehensive cancer care, to improve symptom management and quality of life.

Dr. LeBlanc is the recipient of a Junior Career Development Award grant from the National Palliative Care Research Center (NPCRC), a Sojourns Scholars Leadership Award from the Cambia Health Foundation, and a Mentored Research Scholar Grant from the American Cancer Society. These grants have funded efforts to better understand the experience of patients living with AML, including studies of symptom burden, quality of life, distress, understanding of prognosis, and treatment decision-making. This work has been mentored by a team of expert researchers, including Drs. Amy Abernethy, James Tulsky, Karen Steinhauser, Kathryn Pollak, and Peter Ubel.  Dr. LeBlanc's work in palliative care research led to his recognition as an "Inspirational Leader under 40" by the American Academy of Hospice and Palliative Medicine (AAHPM), and "fellow" status from the Academy in 2016. Dr. LeBlanc was the 2017-18 Chair of the ASCO Ethics Committee, and Chairs the Scientific Review Committee of the NIH/NINR-funded Palliative Care Research Cooperative Group (PCRC; www.palliativecareresearch.org). He has served on various national guideline panels for AML, and for palliative/supportive care issues in oncology. 

He completed residency training in Internal Medicine at Duke, as well as fellowships in Medical Oncology and Hospice and Palliative Medicine.  He graduated from the Duke University School of Medicine, also earning a Master of Arts degree in Philosophy during that time, and served as Chief Medical Resident at the Durham VA Medical Center in 2010-11.  He holds board certifications in Medical Oncology, and in Hospice and Palliative Medicine.  He is actively involved with teaching of medical students and housestaff at Duke, particularly with regards to issues of patient-doctor communication, and is mentoring several Duke trainees on research projects.

Positions:

Associate Professor of Medicine

Medicine, Hematologic Malignancies and Cellular Therapy
School of Medicine

Associate 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. 2006

Duke University

Intern

Duke University School of Medicine

Resident

Duke University School of Medicine

Chief Medical Resident

Duke University School of Medicine

Fellowship, Hospice And Palliative Medicine

Duke University School of Medicine

Fellow, Medical Oncology

Duke University School of Medicine

Grants:

AC220-A-U302 trial

Administered By
Duke Clinical Research Institute
Awarded By
Daiichi Sankyo Inc
Role
Principal Investigator
Start Date
End Date

Prognostic understanding and decision-making in acute myeloid leukemia (AML)

Administered By
Duke Cancer Institute
Awarded By
American Cancer Society, Inc.
Role
Principal Investigator
Start Date
End Date

Randomized Trial of Inpatient Palliative Care for Patients with Hematologic Malignancies

Administered By
Duke Cancer Institute
Awarded By
Massachusetts General Hospital
Role
Principal Investigator
Start Date
End Date

Understanding Barriers to Oral Therapy Adherence in Adult/Older-Adult AML Patients (429 Oral)

Administered By
Duke Cancer Institute
Awarded By
Carevive Systems, Inc.
Role
Principal Investigator
Start Date
End Date

Palliative care and shared decision-making for patients with blood cancers

Administered By
Duke Cancer Institute
Awarded By
Cambia Health Foundation
Role
Principal Investigator
Start Date
End Date

Publications:

Oral adherence in adults with acute myeloid leukemia (AML): Results of a mixed methods study.

<jats:p> 105 </jats:p><jats:p> Background: The incidence of AML is increasing, in part due to an aging population. Amid established intravenous (IV) or subcutaneous chemotherapies , recent drug approvals have ushered in an era of oral medication (OM) approaches to treating AML, shifting the burden of daily adherence from clinicians to patients. We aimed to identify and summarize adherence to oral therapy in this population. Methods: Our mixed methods study design used focus groups (FG) and patient surveys. After IRB approval, 11 patients and 4 caregivers participated in 4 focus groups. Results were used to develop a 37-item OM adherence needs assessment. Subsequently, AML patients were recruited and consented at three cancer centers to complete surveys (online, at the clinic, hospital, or from home). Results: 100 patients completed the OM survey. Most were male (62%), racial/ethnic diversity (33%), &lt; 65 years (59%), and college-educated (52%). The to be taken was the most frequent and troublesome challenge. Loss of appetite was the most commonly reported and problematic side effect. Although half of the patients stated, “no side effect would cause them to stop taking OM”, another 25% indicated nausea would cause non-adherence. The best strategy to support taking OM was to make it part of the daily routine. Directions for taking OM were most commonly found on medication bottles or received from the health care team (HCT); patients felt HCTs were the best source of directions. Nearly 1/3 of patients indicated they skip the OM dose altogether when they forget to take it. When asked what would help improve adherence: smaller pills, easier packaging, and scheduling assistance were most frequently reported. Older individuals (&gt;65 years) had a slightly more positive attitude towards oral medication (p =.51). Younger patients (&lt;65 years) were more accepting of taking oral vs IV meds, (p = .03). Conclusions: This study represents the first assessment of OM adherence in patients with AML. Three themes emerged in FG transcript analysis that informed the development of a 37-item survey that was subsequently completed by 100 patients. Findings provide the basis for further exploration of interventions to enhance and increase adherence to OM regimens. </jats:p>
Authors
Bryant, AL; LeBlanc, TW; Albrecht, TA; Chan, Y-N; Richardson, J; Foster, MC; Dang, M; Owenby, S; Wujcik, D
MLA Citation
Bryant, Ashley Leak, et al. “Oral adherence in adults with acute myeloid leukemia (AML): Results of a mixed methods study.Journal of Clinical Oncology, vol. 37, no. 31_suppl, American Society of Clinical Oncology (ASCO), 2019, pp. 105–105. Crossref, doi:10.1200/jco.2019.37.31_suppl.105.
URI
https://scholars.duke.edu/individual/pub1453606
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
37
Published Date
Start Page
105
End Page
105
DOI
10.1200/jco.2019.37.31_suppl.105

What the HEC? Clinician Adherence to Evidence-Based Antiemetic Prophylaxis for Highly Emetogenic Chemotherapy.

BACKGROUND: Clinician adherence to antiemetic guidelines for preventing chemotherapy-induced nausea and vomiting (CINV) caused by highly emetogenic chemotherapy (HEC) remains poorly characterized. The primary aim of this study was to evaluate individual clinician adherence to HEC antiemetic guidelines. PATIENTS AND METHODS: A retrospective analysis of patients receiving HEC was conducted using the IBM Watson Explorys Electronic Health Record Database (2012-2018). HEC antiemetic guideline adherence was defined as prescription of triple prophylaxis (neurokinin-1 receptor antagonist [NK1 RA], serotonin type-3 receptor antagonist, dexamethasone) at initiation of cisplatin or anthracycline + cyclophosphamide (AC). Clinicians who prescribed ≥5 HEC courses were included and individual guideline adherence was assessed, noting the number of prescribing clinicians with >90% adherence. RESULTS: A total of 217 clinicians were identified who prescribed 2,543 cisplatin and 1,490 AC courses. Patients (N=4,033) were primarily women (63.3%) and chemotherapy-naïve (92%) with a mean age of 58.6 years. Breast (36%) and thoracic (19%) cancers were the most common tumor types. Guideline adherence rates of >90% were achieved by 35% and 58% of clinicians using cisplatin or AC, respectively. Omission of an NK1 RA was the most common practice of nonadherence. Variation in prophylaxis guideline adherence was considerable for cisplatin (mean, 71%; SD, 29%; coefficient of variation [CV], 0.40) and AC (mean, 84%; SD, 26%; CV, 0.31). CONCLUSIONS: Findings showed substantial gaps in clinician adherence to HEC CINV guidelines, including a high variability across clinicians. Clinicians should review their individual clinical practices and ensure adherence to evidence-based CINV guidelines to optimize patient care.
Authors
Roeland, EJ; Ruddy, KJ; LeBlanc, TW; Nipp, RD; Binder, G; Sebastiani, S; Potluri, R; Schmerold, L; Papademetriou, E; Schwartzberg, L; Navari, RM
MLA Citation
Roeland, Eric J., et al. “What the HEC? Clinician Adherence to Evidence-Based Antiemetic Prophylaxis for Highly Emetogenic Chemotherapy.J Natl Compr Canc Netw, vol. 18, no. 6, June 2020, pp. 676–81. Pubmed, doi:10.6004/jnccn.2019.7526.
URI
https://scholars.duke.edu/individual/pub1447442
PMID
32502985
Source
pubmed
Published In
J Natl Compr Canc Netw
Volume
18
Published Date
Start Page
676
End Page
681
DOI
10.6004/jnccn.2019.7526

Real-world experience with electronic patient reported outcomes and missing items: "Don't ask me irrelevant questions".

<jats:p> 99 </jats:p><jats:p> Background: Electronic patient-reported outcomes (ePROs) can improve quality of life and prolong survival in patients with cancer by enhancing the detection and tracking of unmet supportive care needs. However, there remain unanswered questions about how to handle missing ePRO data. We hypothesized that patients may skip specific questions they feel do not apply to them. We aimed to examine the relationship between patient demographics and missing items in a real-world ePRO dataset. Methods: We utilized a prospectively collected database of ePROs from oncology clinics administering Patient Care Monitor 2.0 (PCM), a validated symptom survey of 78 items for men and 86 for women. We tabulated the frequency of missing items by item and domain (emotional, functional and symptom-related), and examined these by age, gender, education, race and marital status. Results: In 20,986 encounters there were responses to at least 1 PCM item from 6,933 patients. On average just 1% of items were skipped per encounter. By domain, 12.3% of functional, 8.4% of symptom-related, and 1.6% of emotional constructs contained at least one missing item. The highest frequency of item non-response was seen in older patients (&gt;60yo) and those with high school education or less. The most frequently skipped items included: “attend a paid job” (10.7%), “reduced sexual enjoyment” (3.8%), and “running” (3.7%). These questions may be less relevant to older individuals, who, for example, quit running years earlier or are retired. Men had less missingness overall, except for “cooks for self” and “house work”, which may reflect traditional gender roles in the Southeast US. Conclusions: In a real-world ePRO implementation, items pertaining to more universal issues for cancer patients, like emotional well-being, have much lower rates of missingness, especially compared to functional items like “attend a paid job.” These results suggest that patients differentially complete ePROs based on perceived question relevance to them. The underlying driver behind individual item non-response may itself be an important data point in clinical care, warranting further study and discussion during clinic visits. </jats:p>
Authors
Rosett, HA; Locke, SC; Wolf, SP; Herring, K; Samsa, GP; Troy, JD; LeBlanc, TW
MLA Citation
Rosett, Heather A., et al. “Real-world experience with electronic patient reported outcomes and missing items: "Don't ask me irrelevant questions".Journal of Clinical Oncology, vol. 37, no. 31_suppl, American Society of Clinical Oncology (ASCO), 2019, pp. 99–99. Crossref, doi:10.1200/jco.2019.37.31_suppl.99.
URI
https://scholars.duke.edu/individual/pub1453607
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
37
Published Date
Start Page
99
End Page
99
DOI
10.1200/jco.2019.37.31_suppl.99

Acute care and hydration due to chemotherapy-induced nausea and vomiting (CINV) among patients receiving NEPA prophylaxis for anthracycline + cyclophosphamide (AC).

<jats:p> 112 </jats:p><jats:p> Background: In the US, the CMS OP-35 oncology outcome measure deems 30-day post-chemotherapy acute care involving nausea and emesis (NV) or 8 other toxicities as avoidable, with studies showing 15% of &gt; 2500 patients receiving anthracycline + cyclophosphamide (AC)-based chemotherapy had avoidable acute care, of which 32% involved NV. Our aim was to evaluate resource use (emergency department [ED] visits, inpatient admissions [IP], or hydration) in a prospective trial of women with breast cancer who received combination netupitant/palonosetron (NEPA) + dexamethasone (DEX) for CINV prophylaxis for AC-based chemotherapy. <jats:sup /> Methods: Women initiating AC received oral or IV NEPA + DEX. Pre-specified endpoints included safety, complete response, acute care (ED/IP), unplanned IV hydrations (as determined by investigator), days of CINV, and ≥3 days of CINV. We defined CINV as emesis or rescue drug use up to 5 days after AC, and defined concomitant ED/IP or hydrations in the same period as CINV-related. We limited our analysis to the first 2 cycles, the median duration in the NEPA study. Results: 402 patients received ≥1 cycle of AC and 391 completed 2 cycles. Nine patients had IP (none CINV-related), and 5 patients had a total of 6 ED visits (1 CINV-related). Three patients had a CINV-related unplanned hydration. Patients had ≥1 day of CINV in 172 of 793 cycles (21.7%); of these, the majority had symptom duration for 1-2 days, while 78 (9.8%) had ≥3 days of CINV in a cycle. Conclusions: In this prospective CINV prophylaxis study in women receiving AC chemotherapy, &lt; 1% of women receiving NEPA + DEX required acute care for CINV and &lt; 1% required unplanned hydrations for CINV. These rates are below previously reported CINV-related acute care rates for AC suggesting NEPA may help avoid CINV-related acute care. Clinical trial information: NCT03403712. </jats:p>
Authors
Roeland, E; Navari, RM; Ruddy, KJ; LeBlanc, TW; Clark-Snow, RA; Wickham, RS; Binder, G; Bailey, WL; Schwartzberg, LS
MLA Citation
Roeland, Eric, et al. “Acute care and hydration due to chemotherapy-induced nausea and vomiting (CINV) among patients receiving NEPA prophylaxis for anthracycline + cyclophosphamide (AC).Journal of Clinical Oncology, vol. 37, no. 31_suppl, American Society of Clinical Oncology (ASCO), 2019, pp. 112–112. Crossref, doi:10.1200/jco.2019.37.31_suppl.112.
URI
https://scholars.duke.edu/individual/pub1453608
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
37
Published Date
Start Page
112
End Page
112
DOI
10.1200/jco.2019.37.31_suppl.112

Randomized Trial of Inpatient Palliative Care Intervention for Patients Hospitalized for Hematopoietic Stem Cell Transplantation (HCT)

Authors
El-Jawahri, AR; LeBlanc, TW; Vandusen, H; Traeger, L; Greer, J; Pirl, W; Jackson, V; Spitzer, TR; McAfee, SL; Chen, Y-B; Lee, SJ; Temel, J
MLA Citation
El-Jawahri, Areej R., et al. “Randomized Trial of Inpatient Palliative Care Intervention for Patients Hospitalized for Hematopoietic Stem Cell Transplantation (HCT).” Biology of Blood and Marrow Transplantation, vol. 23, no. 3, 2017, pp. S54–S54.
URI
https://scholars.duke.edu/individual/pub1451661
Source
wos-lite
Published In
Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation
Volume
23
Published Date
Start Page
S54
End Page
S54

Research Areas:

Aged
Attitude of Health Personnel
Attitude to Death
Attitude to Health
Cardiovascular Diseases
Clinical Competence
Clinical Trials as Topic
Cognition Disorders
Communication
Comparative Effectiveness Research
Decision Making
Diffusion of Innovation
Dyspnea
Ethics
Evidence-Based Medicine
Guideline Adherence
Health Services Research
Hematologic Neoplasms
Hospice Care
Information Dissemination
Inpatients
Jargon
Leukemia
Lung Neoplasms
Lymphoma
Medical education
Myelodysplastic Syndromes
Myeloproliferative Disorders
Neoplasms
Nonverbal Communication
Odds Ratio
Oncology Service, Hospital
Outcome Assessment (Health Care)
Oxygen
Pain
Pain Management
Palliative Care
Patient Selection
Patient-Centered Care
Perception
Prognosis
Quality of Health Care
Statistics as Topic
Terminal Care
Treatment Outcome
Withholding Treatment