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:

Low-touch, team-based care for co-morbidity management in cancer patients: the ONE TEAM randomized controlled trial.

BACKGROUND: As treatments for cancer have improved, more people are surviving cancer. However, compared to people without a history of cancer, cancer survivors are more likely to die of cardiovascular disease (CVD). Increased risk for CVD-related mortality among cancer survivors is partially due to lack of medication adherence and problems that exist in care coordination between cancer specialists, primary care physicians, and cardiologists. METHODS/DESIGN: The Onco-primary care networking to support TEAM-based care (ONE TEAM) study is an 18-month cluster-randomized controlled trial with clustering at the primary care clinic level. ONE TEAM compares the provision of the iGuide intervention to patients and primary care providers versus an education-only control. For phase 1, at the patient level, the intervention includes video vignettes and a live webinar; provider-level interventions include electronic health records-based communication and case-based webinars. Participants will be enrolled from across North Carolina one of their first visits with a cancer specialist (e.g., surgeon, radiation or medical oncologist). We use a sequential multiple assignment randomized trial (SMART) design. Outcomes (measured at the patient level) will include Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of management of three CVD comorbidities using laboratory testing (glycated hemoglobin [A1c], lipid profile) and blood pressure measurements; (2) medication adherence assessed pharmacy refill data using Proportion of Days Covered (PDC); and (3) patient-provider communication (Patient-Centered Communication in Cancer Care, PCC-Ca-36). Primary care clinics in the intervention arm will be considered non-responders if 90% or more of their participating patients do not meet the modified HEDIS quality metrics at the 6-month measurement, assessed once the first enrollee from each practice reaches the 12-month mark. Non-responders will be re-randomized to either continue to receive the iGuide 1 intervention, or to receive the iGuide 2 intervention, which includes tailored videos for participants and specialist consults with primary care providers. DISCUSSION: As the population of cancer survivors grows, ONE TEAM will contribute to closing the CVD outcomes gap among cancer survivors by optimizing and integrating cancer care and primary care teams. ONE TEAM is designed so that it will be possible for others to emulate and implement at scale. TRIAL REGISTRATION: This study (NCT04258813) was registered in clinicaltrals.gov on February 6, 2020.
Authors
Zullig, LL; Shahsahebi, M; Neely, B; Hyslop, T; Avecilla, RAV; Griffin, BM; Clayton-Stiglbauer, K; Coles, T; Owen, L; Reeve, BB; Shah, K; Shelby, RA; Sutton, L; Dinan, MA; Zafar, SY; Shah, NP; Dent, S; Oeffinger, KC
MLA Citation
Zullig, Leah L., et al. “Low-touch, team-based care for co-morbidity management in cancer patients: the ONE TEAM randomized controlled trial.Bmc Fam Pract, vol. 22, no. 1, Nov. 2021, p. 234. Pubmed, doi:10.1186/s12875-021-01569-8.
URI
https://scholars.duke.edu/individual/pub1501851
PMID
34794388
Source
pubmed
Published In
Bmc Family Practice
Volume
22
Published Date
Start Page
234
DOI
10.1186/s12875-021-01569-8

A Novel Locus on 6p21.2 for Cancer Treatment-Induced Cardiac Dysfunction Among Childhood Cancer Survivors.

BACKGROUND: Adult survivors of childhood cancer are at increased risk of cardiac late effects. METHODS: Using whole-genome sequencing data from 1870 survivors of European ancestry in the St. Jude Lifetime Cohort (SJLIFE) study, genetic variants were examined for association with ejection fraction (EF) and clinically assessed cancer therapy-induced cardiac dysfunction (CCD). Statistically significant findings were validated in 301 SJLIFE survivors of African ancestry and 4020 survivors of European ancestry from the Childhood Cancer Survivor Study. All statistical tests were 2-sided. RESULTS: A variant near KCNK17 showed genome-wide significant association with EF (rs2815063-A: EF reduction = 1.6%; P = 2.1 × 10-8) in SJLIFE survivors of European ancestry, which replicated in SJLIFE survivors of African ancestry (EF reduction = 1.5%; P = .004). The rs2815063-A also showed a 1.80-fold (P = .008) risk of severe or disabling or life-threatening CCD and replicated in 4020 Childhood Cancer Survivor Study survivors of European ancestry (odds ratio = 1.40; P = .04). Notably, rs2815063-A was specifically associated among survivors exposed to doxorubicin only, with a stronger effect on EF (3.3% EF reduction) and CCD (2.97-fold). Whole blood DNA methylation data in 1651 SJLIFE survivors of European ancestry showed statistically significant correlation of rs2815063-A with dysregulation of KCNK17 enhancers (false discovery rate <5%), which replicated in 263 survivors of African ancestry. Consistently, the rs2815063-A was associated with KCNK17 downregulation based on RNA sequencing of 75 survivors. CONCLUSIONS: Leveraging the 2 largest cohorts of childhood cancer survivors in North America and survivor-specific polygenomic functional data, we identified a novel risk locus for CCD, which showed specificity with doxorubicin-induced cardiac dysfunction and highlighted dysregulation of KCNK17 as the likely molecular mechanism underlying this genetic association.
Authors
Sapkota, Y; Ehrhardt, MJ; Qin, N; Wang, Z; Liu, Q; Qiu, W; Shelton, K; Shao, Y; Plyler, E; Mulder, HL; Easton, J; Michael, JR; Burridge, PW; Wang, X; Wilson, CL; Jefferies, JL; Chow, EJ; Oeffinger, KC; Morton, LM; Li, C; Yang, JJ; Zhang, J; Bhatia, S; Mulrooney, DA; Hudson, MM; Robison, LL; Armstrong, GT; Yasui, Y
MLA Citation
Sapkota, Yadav, et al. “A Novel Locus on 6p21.2 for Cancer Treatment-Induced Cardiac Dysfunction Among Childhood Cancer Survivors.J Natl Cancer Inst, vol. 114, no. 8, Aug. 2022, pp. 1109–16. Pubmed, doi:10.1093/jnci/djac115.
URI
https://scholars.duke.edu/individual/pub1524357
PMID
35698272
Source
pubmed
Published In
J Natl Cancer Inst
Volume
114
Published Date
Start Page
1109
End Page
1116
DOI
10.1093/jnci/djac115

Underdiagnosis and Undertreatment of Modifiable Cardiovascular Risk Factors Among Survivors of Childhood Cancer.

Background Determine the prevalence and predictors associated with underdiagnosis and undertreatment of modifiable cardiovascular disease (CVD) risk factors (hypertension, dyslipidemia, glucose intolerance/diabetes) among adult survivors of childhood cancer at high risk of premature CVD. Methods and Results This was a cross-sectional study of adult-aged survivors of childhood cancer treated with anthracyclines or chest radiotherapy, recruited across 9 US metropolitan regions. Survivors completed questionnaires and in-home clinical assessments. The comparator group was a matched sample from the National Health and Nutrition Examination Survey. Multivariable logistic regression estimated the risk (odds ratios) of CVD risk factor underdiagnosis and undertreatment among survivors compared with the National Health and Nutrition Examination Survey. Survivors (n=571; median age, 37.7 years and 28.5 years from cancer diagnosis) were more likely to have a preexisting CVD risk factor than the National Health and Nutrition Examination Survey (n=345; P<0.05 for all factors). While rates of CVD risk factor underdiagnosis were similar (27.1% survivors versus 26.1% National Health and Nutrition Examination Survey; P=0.73), survivors were more likely undertreated (21.0% versus 13.9%, P=0.007; odds ratio, 1.8, 95% CI, 1.2-2.7). Among survivors, the most underdiagnosed and undertreated risk factors were hypertension (18.9%) and dyslipidemia (16.3%), respectively. Men and survivors who were overweight/obese were more likely to be underdiagnosed and undertreated. Those with multiple adverse lifestyle factors were also more likely undertreated (odds ratio, 2.2, 95% CI, 1.1-4.5). Greater health-related self-efficacy was associated with reduced undertreatment (odds ratio, 0.5; 95% CI, 0.3-0.8). Conclusions Greater awareness of among primary care providers and cardiologists, combined with improving self-efficacy among survivors, may mitigate the risk of underdiagnosed and undertreated CVD risk factors among adult-aged survivors of childhood cancer. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03104543.
Authors
Chow, EJ; Chen, Y; Armstrong, GT; Baldwin, L-M; Cai, CR; Gibson, TM; Hudson, MM; McDonald, A; Nathan, PC; Olgin, JE; Syrjala, KL; Tonorezos, ES; Oeffinger, KC; Yasui, Y
MLA Citation
Chow, Eric J., et al. “Underdiagnosis and Undertreatment of Modifiable Cardiovascular Risk Factors Among Survivors of Childhood Cancer.J Am Heart Assoc, vol. 11, no. 12, June 2022, p. e024735. Pubmed, doi:10.1161/JAHA.121.024735.
URI
https://scholars.duke.edu/individual/pub1524230
PMID
35674343
Source
pubmed
Published In
Journal of the American Heart Association
Volume
11
Published Date
Start Page
e024735
DOI
10.1161/JAHA.121.024735

Impact of Cardiac Substructure Dosimetry on Late Cardiac Risk: A Report From the Childhood Cancer Survivor Study (CCSS).

<h4>Purpose/objective(s)</h4>Prior estimates of radiation (RT)-associated cardiac disease risk in childhood cancer survivors are based on estimates of RT dose to the entire heart. We aimed to evaluate whether cardiac substructure RT dosimetry improves estimation of late cardiac disease risk.<h4>Materials/methods</h4>We determined the cumulative incidence of CTCAE grade 3 - 5 cardiac disease (heart failure, coronary artery disease, valvular disease, arrhythmia, or pericardial disease) among 25,481 5-year survivors from CCSS diagnosed 1970 - 1999. Median age at diagnosis was 6.1 years (range 0 - 20) and at last follow-up was 29.8 years (5.6 - 65.9). We considered a single composite endpoint of any cardiac disease to best identify which substructures to prioritize for avoidance in RT planning to minimize the absolute risk of cardiac disease. We reconstructed RT fields for irradiated survivors (n = 12,228) on an age-scaled phantom and estimated mean RT dose to the heart, four chambers, four valves, and the left anterior descending (LAD), circumflex, main (LM), and right coronary arteries. Adjusted piecewise exponential models (including cumulative anthracycline dose) evaluated associations between mean RT dose to each structure and outcomes. Each substructure was individually added to a model with mean whole heart RT dose and the fit was assessed via the likelihood-ratio test to ascertain which substructures improved prediction of cardiac risk beyond whole heart dose.<h4>Results</h4>At 35 years from diagnosis, the cumulative incidence of any cardiac disease was 7.0% (95% CI 6.5 - 7.6). When adding each substructure separately to a model with mean whole heart dose, the addition of mean LAD (χ<sup>2</sup> = 29.1) or LM (χ<sup>2</sup> = 34.6) RT dose significantly improved the risk estimation of any cardiac disease (P < 0.01). Among survivors with mean whole heart doses < 10 Gy, increasing mean LAD but not mean LM doses significantly increased risk of late cardiac disease. Even among those with a mean heart dose of < 5 Gy, mean LAD dose of ≥10 Gy was associated with a more than three-fold increased risk of cardiac disease (Table 1).<h4>Conclusion</h4>Even among survivors with low mean heart doses (< 5 Gy), mean LAD doses ≥10 Gy increased risk of cardiac disease. Thus, for pediatric RT planning we recommend limiting mean LAD dose to < 10 Gy, even when mean heart dose constraints can be achieved. Table 1. Relative rate of grade 3 - 5 cardiac disease in childhood cancer survivors by RT dose to the heart and LAD.
Authors
Bates, JE; Shrestha, S; Liu, Q; Smith, S; Mulrooney, DA; Leisenring, WM; Gibson, T; Robison, LL; Chow, EJ; Oeffinger, KC; Armstromg, GT; Constine, LS; Hoppe, BS; Lee, C; Yasui, Y; Howell, RM
MLA Citation
Bates, J. E., et al. “Impact of Cardiac Substructure Dosimetry on Late Cardiac Risk: A Report From the Childhood Cancer Survivor Study (CCSS).International Journal of Radiation Oncology, Biology, Physics, vol. 111, no. 3S, 2021, pp. S83–84. Epmc, doi:10.1016/j.ijrobp.2021.07.200.
URI
https://scholars.duke.edu/individual/pub1503213
PMID
34700645
Source
epmc
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
111
Published Date
Start Page
S83
End Page
S84
DOI
10.1016/j.ijrobp.2021.07.200

Cardiometabolic Comorbidities in Cancer Survivors: JACC: CardioOncology State-of-the-Art Review.

There are nearly 17 million cancer survivors in the United States, including those who are currently receiving cancer therapy with curative intent and expected to be long-term survivors, as well as those with chronic cancers such as metastatic disease or chronic lymphocytic leukemia, who will receive cancer therapy for many years. Current clinical practice guidelines focus on lifestyle interventions, such as exercise and healthy eating habits, but generally do not address management strategies for clinicians or strategies to increase adherence to medications. We discuss 3 cardiometabolic comorbidities among cancer survivors and present the prevalence of comorbidities prior to a cancer diagnosis, treatment of comorbidities during cancer therapy, and management considerations of comorbidities in long-term cancer survivors or those on chronic cancer therapy. Approaches to support medication adherence and potential methods to enhance a team approach to optimize care of the individual with cancer across the continuum of disease are discussed.
Authors
Zullig, LL; Sung, AD; Khouri, MG; Jazowski, S; Shah, NP; Sitlinger, A; Blalock, DV; Whitney, C; Kikuchi, R; Bosworth, HB; Crowley, MJ; Goldstein, KM; Klem, I; Oeffinger, KC; Dent, S
MLA Citation
Zullig, Leah L., et al. “Cardiometabolic Comorbidities in Cancer Survivors: JACC: CardioOncology State-of-the-Art Review.Jacc Cardiooncol, vol. 4, no. 2, June 2022, pp. 149–65. Pubmed, doi:10.1016/j.jaccao.2022.03.005.
URI
https://scholars.duke.edu/individual/pub1524782
PMID
35818559
Source
pubmed
Published In
Jacc Cardiooncol
Volume
4
Published Date
Start Page
149
End Page
165
DOI
10.1016/j.jaccao.2022.03.005