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:

Material, behavioral, and psychological financial hardship among survivors of childhood cancer in the Childhood Cancer Survivor Study.

BACKGROUND: Medical financial burden includes material, behavioral, and psychological hardship and has been underinvestigated among adult survivors of childhood cancer. METHODS: A survey from 698 survivors and 210 siblings from the Childhood Cancer Survivor Study was analyzed. The intensity of financial hardship was estimated across 3 domains: 1) material, including conditions that arise from medical expenses; 2) behavioral, including coping behaviors to manage medical expenses; and 3) psychological hardship resulting from worries about medical expenses and insurance, as measured by the number of instances of each type of financial hardship (0, 1-2, and ≥3 instances). Multivariable logistic regressions were conducted to examine the clinical and sociodemographic predictors of experiencing financial hardship (0-2 vs ≥3 instances). RESULTS: The intensity of financial hardship did not significantly differ between survivors and siblings. Survivors reported more instances of material hardship than siblings (1-2 instances: 27.2% of survivors vs 22.6% of siblings; ≥3 instances: 15.9% of survivors vs 11.4% siblings; overall P = .03). In multivariable regressions, insurance was protective against all domains of financial hardship (behavioral odds ratio [OR], 0.12; 95% confidence interval [CI], 0.06-0.22; material OR, 0.37; 95% CI, 0.19-0.71; psychological OR, 0.10; 95% CI, 0.05-0.21). Survivors who were older at diagnosis, female, and with chronic health conditions generally had higher levels of hardship. Brain radiation and alkylating agents were associated with higher levels of hardship. CONCLUSIONS: Material, behavioral, and psychological financial burden among survivors of childhood cancer is common.
Authors
Fair, D; Park, ER; Nipp, RD; Rabin, J; Hyland, K; Kuhlthau, K; Perez, GK; Nathan, PC; Armstrong, GT; Oeffinger, KC; Robison, LL; Leisenring, W; Kirchhoff, AC
MLA Citation
Fair, Douglas, et al. “Material, behavioral, and psychological financial hardship among survivors of childhood cancer in the Childhood Cancer Survivor Study.Cancer, vol. 127, no. 17, Sept. 2021, pp. 3214–22. Pubmed, doi:10.1002/cncr.33613.
URI
https://scholars.duke.edu/individual/pub1484995
PMID
34061973
Source
pubmed
Published In
Cancer
Volume
127
Published Date
Start Page
3214
End Page
3222
DOI
10.1002/cncr.33613

Subsequent malignant neoplasms in the childhood cancer survivor study: Occurrence of cancer types in which human papillomavirus is an established etiologic risk factor

Background: Human papillomavirus (HPV)-associated subsequent malignant neoplasms (SMNHPV) in childhood cancer survivors are poorly understood. Methods: The cumulative risk of SMNHPV was assessed among 24,363 Childhood Cancer Survivor Study participants. Standardized incidence ratios (SIRs) and absolute excess risk were calculated using age-matched, sex-matched, and calendar year rates from the Surveillance, Epidemiology, and End Results program. Poisson regression models identified SMNHPV risk factors, evaluating relative SIRs (rSIR) and 95% confidence intervals (95% CIs). Results: In total, 46 survivors developed an SMNHPV (median age, 31 years [range, 10-56 years]; median time from primary cancer, 21 years [range, 9-35 years]). SMNHPV sites included oropharynx (N = 44), anorectum (N = 6), uterine cervix (N = 2), and vulva (N = 2). The 33-year cumulative incidence was 0.3% (95% CI, 0.2%-0.4%), and the SIR was nearly 3-fold that of the general population (SIR, 2.86; 95% CI, 2.05-4.00). Female survivors were not at increased risk of cervical or vulvar cancers compared with the general population. All survivors had an elevated risk of oropharyngeal SMNHPV (males: SIR, 4.06; 95% CI, 2.37-6.97; females: SIR, 8.44; 95% CI 4.88-14.61) and anorectal SMNHPV (males: SIR, 13.56; 95% CI, 5.09-36.13; females: SIR, 9.15; 95% CI, 2.29-36.61). Males (vs females: rSIR, 1.99; 95% CI, 1.00-3.94); head, neck, and pelvic radiotherapy doses >3000 centigray (vs none: rSIR, 2.35; 95% CI, 1.11-4.97); and cisplatin-equivalent doses >400 mg/m2 (vs none: rSIR, 4.51; 95% CI, 1.78-11.43) were associated with increased SMNHPV SIRs in multivariable analysis. Conclusions: Childhood cancer survivors are at increased risk for SMN in sites susceptible to HPV-associated malignancies. Further research examining HPV in the etiology of SMN and the promotion of HPV vaccination and surveillance guidelines for SMNHPV in cancer survivors is warranted.
Authors
Henderson, TO; Fowler, BW; Hamann, HA; Nathan, PC; Whitton, J; Leisenring, WM; Oeffinger, KC; Neglia, JP; Turcotte, LM; Arnold, MA; Conces, MR; Howell, RM; Robison, LL; Armstrong, GT; Alexander, KA
URI
https://scholars.duke.edu/individual/pub1499911
Source
scopus
Published In
Cancer
Published Date
DOI
10.1002/cncr.33922

Late-onset kidney failure in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

<h4>Background</h4>The incidence of and risk factors for late-onset kidney failure among survivors over the very long term remains understudied.<h4>Materials and methods</h4>A total of 25,530 childhood cancer survivors (median follow-up 22.3 years, interquartile range 17.4-28.8) diagnosed between 1970 and 1999, and 5045 siblings from the Childhood Cancer Survivor Study were assessed for self-reported late-onset kidney failure, defined as dialysis, renal transplantation, or death attributable to kidney disease. Piecewise exponential models evaluated associations between risk factors and the rate of late-onset kidney failure.<h4>Results</h4>A total of 206 survivors and 10 siblings developed late-onset kidney failure, a 35-year cumulative incidence of 1.7% (95% confidence interval [CI] = 1.4-1.9) and 0.2% (95% confidence interval [CI] = 0.1-0.4), respectively, corresponding to an adjusted rate ratio (RR) of 4.9 (95% CI = 2.6-9.2). High kidney dose from radiotherapy (≥15Gy; RR = 4.0, 95% CI = 2.1-7.4), exposure to high-dose anthracycline (≥250 mg/m<sup>2</sup>; RR = 1.6, 95% CI = 1.0-2.6) or any ifosfamide chemotherapy (RR = 2.6, 95% CI = 1.2-5.7), and nephrectomy (RR = 1.9, 95% CI = 1.0-3.4) were independently associated with elevated risk for late-onset kidney failure among survivors. Survivors who developed hypertension, particularly in the context of prior nephrectomy (RR = 14.4, 95% CI = 7.1-29.4 hypertension with prior nephrectomy; RR = 5.9, 95% CI = 3.3-10.5 hypertension without prior nephrectomy), or diabetes (RR = 2.2, 95%CI = 1.2-4.2) were also at elevated risk for late-onset kidney failure.<h4>Conclusions</h4>Survivors of childhood cancer are at increased risk for late-onset kidney failure. Kidney dose from radiotherapy ≥15 Gy, high-dose anthracycline, any ifosfamide, and nephrectomy were associated with increased risk of late-onset kidney failure among survivors. Successful diagnosis and management of modifiable risk factors such as diabetes and hypertension may mitigate the risk for late-onset kidney failure. The association of late-onset kidney failure with anthracycline chemotherapy represents a novel finding that warrants further study.
Authors
Dieffenbach, BV; Liu, Q; Murphy, AJ; Stein, DR; Wu, N; Madenci, AL; Leisenring, WM; Kadan-Lottick, NS; Christison-Lagay, ER; Goldsby, RE; Howell, RM; Smith, SA; Oeffinger, KC; Yasui, Y; Armstrong, GT; Weldon, CB; Chow, EJ; Weil, BR
MLA Citation
Dieffenbach, Bryan V., et al. “Late-onset kidney failure in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.European Journal of Cancer (Oxford, England : 1990), vol. 155, Sept. 2021, pp. 216–26. Epmc, doi:10.1016/j.ejca.2021.06.050.
URI
https://scholars.duke.edu/individual/pub1494218
PMID
34391054
Source
epmc
Published In
European Journal of Cancer
Volume
155
Published Date
Start Page
216
End Page
226
DOI
10.1016/j.ejca.2021.06.050

Radiation therapy related cardiac disease risk in childhood cancer survivors: Updated dosimetry analysis from the Childhood Cancer Survivor Study.

BACKGROUND AND PURPOSE: We previously evaluated late cardiac disease in long-term survivors in the Childhood Cancer Survivor Study (CCSS) based on heart radiation therapy (RT) doses estimated from an age-scaled phantom with a simple atlas-based heart model (HAtlas). We enhanced our phantom with a high-resolution CT-based anatomically realistic and validated age-scalable cardiac model (HHybrid). We aimed to evaluate how this update would impact our prior estimates of RT-related late cardiac disease risk in the CCSS cohort. METHODS: We evaluated 24,214 survivors from the CCSS diagnosed from 1970 to 1999. RT fields were reconstructed on an age-scaled phantom with HHybrid and mean heart dose (Dm), percent volume receiving ≥ 20 Gy (V20) and ≥ 5 Gy with V20 = 0 ( [Formula: see text] ) were calculated. We reevaluated cumulative incidences and adjusted relative rates of grade 3-5 Common Terminology Criteria for Adverse Events outcomes for any cardiac disease, coronary artery disease (CAD), and heart failure (HF) in association with Dm, V20, and [Formula: see text] (as categorical variables). Dose-response relationships were evaluated using piecewise-exponential models, adjusting for attained age, sex, cancer diagnosis age, race/ethnicity, time-dependent smoking history, diagnosis year, and chemotherapy exposure and doses. For relative rates, Dm was also considered as a continuous variable. RESULTS: Consistent with previous findings with HAtlas, reevaluation using HHybrid dosimetry found that, Dm ≥ 10 Gy, V20 ≥ 0.1%, and [Formula: see text]  ≥ 50% were all associated with increased cumulative incidences and relative rates for any cardiac disease, CAD, and HF. While updated risk estimates were consistent with previous estimates overall without statistically significant changes, there were some important and significant (P < 0.05) increases in risk with updated dosimetry for Dm in the category of 20 to 29.9 Gy and V20 in the category of 30% to 79.9%. When changes in the linear dose-response relationship for Dm were assessed, the slopes of the dose response were steeper (P < 0.001) with updated dosimetry. Changes were primarily observed among individuals with chest-directed RT with prescribed doses ≥ 20 Gy. CONCLUSION: These findings present a methodological advancement in heart RT dosimetry with improved estimates of RT-related late cardiac disease risk. While results are broadly consistent with our prior study, we report that, with updated cardiac dosimetry, risks of cardiac disease are significantly higher in two dose and volume categories and slopes of the Dm-specific RT-response relationships are steeper. These data support the use of contemporary RT to achieve lower heart doses for pediatric patients, particularly those requiring chest-directed RT.
Authors
Shrestha, S; Bates, JE; Liu, Q; Smith, SA; Oeffinger, KC; Chow, EJ; Gupta, AC; Owens, CA; Constine, LS; Hoppe, BS; Leisenring, WM; Qiao, Y; Weathers, RE; Court, LE; Pinnix, CC; Kry, SF; Mulrooney, DA; Armstrong, GT; Yasui, Y; Howell, RM
MLA Citation
Shrestha, Suman, et al. “Radiation therapy related cardiac disease risk in childhood cancer survivors: Updated dosimetry analysis from the Childhood Cancer Survivor Study.Radiother Oncol, vol. 163, Aug. 2021, pp. 199–208. Pubmed, doi:10.1016/j.radonc.2021.08.012.
URI
https://scholars.duke.edu/individual/pub1497241
PMID
34454975
Source
pubmed
Published In
Radiother Oncol
Volume
163
Published Date
Start Page
199
End Page
208
DOI
10.1016/j.radonc.2021.08.012

The Head and Neck Survivorship Tool (HN-STAR) Trial (WF-1805CD): A protocol for a cluster-randomized, hybrid effectiveness-implementation, pragmatic trial to improve the follow-up care of head and neck cancer survivors.

Survivors of head and neck cancer (HNC) can have multiple health concerns. To facilitate their care, we developed and pilot-tested a clinical informatics intervention, HN-STAR. HN-STAR elicits concerns online from HNC survivors prior to a routine oncology clinic visit. HN-STAR then presents tailored evidence-based clinical recommendations as a clinical decision support tool to be used during the visit where the oncology clinician and survivor select symptom management strategies and other actions. This generates a survivorship care plan (SCP). Online elicitation of health concerns occurs 3, 6, and 9 months after the clinic visit, generating an updated SCP each time. HN-STAR encompasses important methods of improving survivorship care (e.g., needs assessment, tailored interventions, dissemination of guidelines) and will be evaluated in a pragmatic trial to maximize external validity. This hybrid type 1 implementation-effectiveness trial tests HN-STAR effectiveness while studying barriers and facilitators to implementation in community oncology practices within the National Cancer Institute Community Oncology Research Program. Effectiveness will be measured as differences in key survivorship outcomes between HNC participants who do and do not use HN-STAR over one year after the clinic visit. The primary endpoint is HNC-specific quality of life; other outcomes include patient-centered measures and receipt of guideline-concordant care. Implementation outcomes will be assessed of survivors, providers, and clinic stakeholders. The hybrid design will provide insight into a dose-response relationship between the extent of implementation fidelity and effectiveness outcomes, as well as how to incorporate HN-STAR into standard practice outside the research setting.
Authors
Salz, T; Ostroff, JS; Nightingale, CL; Atkinson, TM; Davidson, EC; Jinna, SR; Kriplani, A; Lesser, GJ; Lynch, KA; Mayer, DK; Oeffinger, KC; Patil, S; Salner, AL; Weaver, KE
URI
https://scholars.duke.edu/individual/pub1483456
PMID
34023515
Source
pubmed
Published In
Contemp Clin Trials
Volume
107
Published Date
Start Page
106448
DOI
10.1016/j.cct.2021.106448