Thomas LeBlanc

Overview:

I am a medical oncologist, palliative care physician, and patient experience researcher, and I serve as Chief Patient Experience and Safety Officer for the Duke Cancer Institute. My 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).  

As founding Director of the Duke Cancer Patient Experience Research Program (CPEP), my research investigates common issues faced by people with cancer, including issues of symptom burden, quality of life, psychological distress, prognostic understanding, and treatment decision-making. This work aims to improve patients' experiences living with serious illnesses like blood cancers, including the integration of specialist palliative care services to provide an extra layer of support along with their comprehensive cancer care. More broadly, our team in CPEP conducts various studies of patient experience and outcomes issues in oncology, including retrospective chart review studies, comparative effectiveness work, prospective observational studies and registries, and qualitative research, along with efforts to facilitate the integration of patient-generated health data (PGHD) into routine cancer care processes, such as with electronic patient-reported outcome measures (ePROs) and other mobile health interventions (mHealth). 

This work has led to recognition as an "Inspirational Leader under 40" by the American Academy of Hospice and Palliative Medicine (AAHPM), "Fellow" status from the Academy in 2016, the 2018 international "Clinical Impact Award" from the European Association for Palliative Care, and the AAHPM "Early Career Investigator" award in 2020. I served as 2017-18 Chair of the ASCO Ethics Committee, and currently Chair the Scientific Review Committee of the NIH/NINR-funded Palliative Care Research Cooperative Group (PCRC; www.palliativecareresearch.org). I have served on various national guideline panels for AML and for palliative/supportive care issues in oncology, and was inducted as a Fellow of the American Society of Clinical Oncology (FASCO) in 2021. To date I have published over 180 Medline-indexed articles, and several chapters in prominent textbooks of oncology and palliative medicine.

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:

Code status transitions in patients with high-risk acute myeloid leukemia.

Patients with high-risk acute myeloid leukemia (AML) often experience intensive medical care at the end of life (EOL), including high rates of hospitalizations and intensive care unit (ICU) admissions. Despite this, studies examining code status transitions are lacking. We conducted a mixed-methods study of 200 patients with high-risk AML enrolled in supportive care studies at Massachusetts General Hospital between 2014 and 2021. We defined high-risk AML as relapsed/refractory or diagnosis at age ≥60. We used a consensus-driven medical record review to characterize code status transitions. At diagnosis, 86.0% (172/200) of patients were "full code" (38.5% presumed, 47.5% confirmed) and 8.5% had restrictions on life-sustaining therapies. Overall, 57.0% of patients experienced a transition during the study period. The median time from the last transition to death was 2 days (range, 0-350). Most final transitions (71.1%) were to comfort measures near EOL; only 60.5% of patients participated in these last transitions. We identified 3 conversation types leading to transitions: informative conversations focusing on futility after clinical deterioration (51.0%), anticipatory conversations at the time of acute deterioration (32.2%), and preemptive conversations (15.6%) before deterioration. Younger age (B = 0.04; P = .002) and informative conversations (B = -2.79; P < .001) were associated with shorter time from last transition to death. Over two-thirds of patients were "presumed full code" at diagnosis of high-risk AML, and most experienced code status transitions focused on the futility of continuing life-sustaining therapies near EOL. These results suggest that goals-of-care discussions occur late in the illness course for patients with AML and warrant interventions to increase earlier discussions regarding EOL preferences.
Authors
Abrams, HR; Nipp, RD; Traeger, L; Lavoie, MW; Reynolds, MJ; Ufere, NN; Wang, AC; Boateng, K; LeBlanc, TW; El-Jawahri, A
MLA Citation
Abrams, Hannah R., et al. “Code status transitions in patients with high-risk acute myeloid leukemia.Blood Adv, vol. 6, no. 14, July 2022, pp. 4208–15. Pubmed, doi:10.1182/bloodadvances.2022007009.
URI
https://scholars.duke.edu/individual/pub1520175
PMID
35537113
Source
pubmed
Published In
Blood Adv
Volume
6
Published Date
Start Page
4208
End Page
4215
DOI
10.1182/bloodadvances.2022007009

Bridging New Technology Into Clinical Practice With Mobile Apps, Electronic Patient-Reported Outcomes, and Wearables.

With sophisticated mobile and wearable technologies available, there has been interest in leveraging these devices to help gather and analyze patient-generated health data (PGHD). This information could be used to better address health concerns, aid in treatment decision-making, and guide interventional strategies to improve outcomes. Among PGHD, electronic patient-reported outcomes, direct reports of patient experience usually collected via validated scales and questionnaires, are increasingly integrated into routine clinical practice to monitor patient status. Electronic patient-reported outcomes have been shown to improve outcomes, including symptom control, quality of life, and overall survival, in several clinical trials. Electronic patient-reported outcome collection is now being implemented across broader clinical practice settings but with limited evaluation of impact thus far. Wearable devices and mobile apps provide opportunities to collect additional PGHD, including continuous physiologic measures, and to generate algorithms with which to monitor patients with cancer and guide interventions. In this article, we discuss several topics related to PGHD and technology, including electronic patient-reported outcomes, mobile apps, and wearable devices and how their introduction into oncology care has the potential to improve the collection and use of PGHD in the future. We also highlight the challenges and future directions needed for mobile and wearable technologies to provide meaningful information that can be acted upon and thus can improve oncologic care.
Authors
Dzimitrowicz, HE; Blakely, LJ; Jones, LW; LeBlanc, TW
MLA Citation
Dzimitrowicz, Hannah E., et al. “Bridging New Technology Into Clinical Practice With Mobile Apps, Electronic Patient-Reported Outcomes, and Wearables.Am Soc Clin Oncol Educ Book, vol. 42, Apr. 2022, pp. 1–6. Pubmed, doi:10.1200/EDBK_350550.
URI
https://scholars.duke.edu/individual/pub1520250
PMID
35522912
Source
pubmed
Published In
Am Soc Clin Oncol Educ Book
Volume
42
Published Date
Start Page
1
End Page
6
DOI
10.1200/EDBK_350550

Distress in a pandemic: The association of the coronavirus disease-2019 (COVID-19) pandemic with distress and quality of life in hematopoietic stem cell transplantation (HSCT).

<jats:p> 7032 </jats:p><jats:p> Background: The global COVID-19 pandemic has drastically disrupted cancer care, potentially exacerbating patients’ distress levels. Patients with hematologic malignancies undergoing HSCT may be especially vulnerable to this pandemic stress given their well-documented heightened psychological distress and impaired quality of life (QOL). However, the association of the COVID-19 pandemic with distress and QOL is not well understood. Methods: We conducted a cross-sectional analysis of data from 205 patients with hematologic malignancies undergoing HSCT who were enrolled in a multi-site, randomized supportive care trial. We compared baseline pre-HSCT distress (depression, anxiety, and posttraumatic stress disorder [PTSD] symptoms) and QOL between participants enrolled pre-COVID-19 (i.e., 03/2019-01/2020) and during the COVID-19 pandemic (i.e., 03/2020-01/2021). We used the Hospital Anxiety &amp; Depression Scale, PTSD Checklist, and Functional Assessment of Cancer Therapy-Bone Marrow Transplant to assess symptoms of depression, anxiety, and PTSD, as well as QOL respectively. We used regression models adjusting for age, gender, race, relationship status, and cancer diagnosis to examine the relationship between the period of enrollment and patient-reported distress and QOL. Results: Prior to COVID-19, 124 participants enrolled, and 81 participants enrolled during the COVID-19 pandemic. The two cohorts had similar baseline demographic and disease risk factors. Most participants were non-Hispanic (n = 185; 90.2%), White (n = 138; 86.3%), and female (n = 131; 64.5%) with a mean (SD) age of 54.9 (11.7) years. In multivariate regression models, enrollment during COVID-19 was not associated with pre-HSCT depression (B = 0.004; 95% CI, -0.02 to 0.03; p = 0.73), anxiety (B = 0.008; 95% CI, -0.01 to 0.03; p = 0.44), PTSD (B = 0.004; 95% CI, -0.004 to 0.01; p = 0.35) symptoms or QOL (B = -0.003; 95% CI, -0.02 to 0.01; p = 0.68). Conclusions: Contrary to the widespread notion that the COVID-19 pandemic has worsened distress in patients with cancer, we found no differences in pre-HSCT distress or QOL in patients with hematologic malignancies undergoing HSCT prior to or during the COVID-19 pandemic. Our findings highlight the need to comprehensively explore the multifactorial causes (e.g., illness experience, treatment burden) of distress and QOL deficits in HSCT recipients irrespective of the COVID-19 pandemic. </jats:p>
Authors
Amonoo, HL; Topping, CEW; Clay, MA; LeBlanc, TW; Greer, JA; Lee, S; Temel, J; El-Jawahri, A
MLA Citation
Amonoo, Hermioni L., et al. “Distress in a pandemic: The association of the coronavirus disease-2019 (COVID-19) pandemic with distress and quality of life in hematopoietic stem cell transplantation (HSCT).Journal of Clinical Oncology, vol. 39, no. 15_suppl, American Society of Clinical Oncology (ASCO), 2021, pp. 7032–7032. Crossref, doi:10.1200/jco.2021.39.15_suppl.7032.
URI
https://scholars.duke.edu/individual/pub1503256
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
39
Published Date
Start Page
7032
End Page
7032
DOI
10.1200/jco.2021.39.15_suppl.7032

The association between changes in symptoms or quality of life and overall survival in outpatients with advanced cancer.

BACKGROUND: Several prognostic tools have been developed to aid clinicians in survival prediction. However, changes in symptoms are rarely included in established prognostic systems. We aimed to investigate the influence of changes in symptoms and quality of life (QOL) on survival time in outpatients with advanced cancer. METHODS: Study subjects included a subgroup of those with longitudinal symptom and QOL data within a larger, single-site parent study. We assessed patients' symptoms and QOL at enrollment and follow-up at an approximately 3-month interval. Patients' symptoms were evaluated by the Korean version of the Edmonton Symptom Assessment System (K-ESAS). QOL was checked by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Participants were categorized into three groups by changes in symptoms or QOL. These groups were: improved (having at least a one level of improvement in the response scale), stable (no change), or worsened (at least a one level of worsening in the scale). We compared survival time in the improved plus stable vs. worsened groups, using a log-rank test. RESULTS: We analyzed 60 patients, with a median survival time of 346 days. In the Worsened group, depression (P<0.01) and sleep disturbance (P<0.01) by K-ESAS, and dyspnea (P<0.03) per the EORTC QLQ-C30, were statistically significantly related to shorter survival time compared to 'improved and stable' group. There was no relationship between changes in other symptoms, overall QOL, and survival. CONCLUSIONS: Longitudinal assessment of depression, sleep disturbance and dyspnea may be useful in prognostication of patients with advanced cancer. Further studies are needed to confirm our findings with more consecutive assessments in diverse populations.
Authors
Hiratsuka, Y; Kim, YJ; Suh, S-Y; Won, SH; Choi, SE; LeBlanc, TW; Kang, B; Lee, SW; Suh, KJ; Kim, J-W; Kim, SH; Kim, JW; Lee, K-W
MLA Citation
Hiratsuka, Yusuke, et al. “The association between changes in symptoms or quality of life and overall survival in outpatients with advanced cancer.Ann Palliat Med, vol. 11, no. 7, July 2022, pp. 2338–48. Pubmed, doi:10.21037/apm-22-33.
URI
https://scholars.duke.edu/individual/pub1520249
PMID
35542972
Source
pubmed
Published In
Ann Palliat Med
Volume
11
Published Date
Start Page
2338
End Page
2348
DOI
10.21037/apm-22-33

Reply to Paul and Lewis.

Authors
Kwekkeboom, KL; Serlin, RC; Ward, SE; LeBlanc, TW; Ogunseitan, A; Cleary, J
MLA Citation
Kwekkeboom, Kristine L., et al. “Reply to Paul and Lewis.Pain, vol. 163, no. 3, Mar. 2022, p. e499. Pubmed, doi:10.1097/j.pain.0000000000002449.
URI
https://scholars.duke.edu/individual/pub1510067
PMID
35148291
Source
pubmed
Published In
Pain
Volume
163
Published Date
Start Page
e499
DOI
10.1097/j.pain.0000000000002449

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