Susan Dent

Overview:

Medical Oncologist with a focus on breast cancer
Associate Director of Breast Cancer Clinical Research
Co-Director Duke Cardio-Oncology Program

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. 1990

McMaster University (Canada)

Internal Medicine

Royal College of Physicians (United Kingdom)

Medical Oncology

Royal College of Physicians (United Kingdom)

Grants:

CardiovAscular Risk profile and Treatment patterns in ER+HER2 - Advanced Breast Cancer: A retrospective cohort study (CAREB)

Administered By
Duke Cancer Institute
Awarded By
Novartis Pharmaceuticals Corporation
Role
Principal Investigator
Start Date
End Date

A PHASEIB/III STUDY OF IPATASERTIB PLUS PALBOCICLIB AND FULVESTRANT VERSUS PLACEBO PLUS PALBOCICLIB AND FULVESTRANT IN HORMONE RECEPTOR POSITIVE AND HER2 NEGATIVE LOCALLY ADVANCED UNRESECTABLE OR METASTATIC BREAST CANCER

Administered By
Duke Cancer Institute
Awarded By
F. Hoffmann-La Roche Ltd
Role
Principal Investigator
Start Date
End Date

Translational Breast Cancer Research Consortium 2021 Infrastructure (BCRF)

Administered By
Duke Cancer Institute
Awarded By
Susan G. Komen Breast Cancer Foundation
Role
Principal Investigator
Start Date
End Date

Translational Breast Cancer Research Consortium 2021 Infrastructure - SGK

Administered By
Duke Cancer Institute
Awarded By
Susan G. Komen Breast Cancer Foundation
Role
Principal Investigator
Start Date
End Date

Publications:

Cardiac Computed Tomography in Cardio-Oncology: JACC: CardioOncology Primer

Cancer patients and survivors have elevated cardiovascular risk when compared with noncancer patients. Cardio-oncology has emerged as a new subspecialty to comanage and address cardiovascular complications in cancer patients such as heart failure, atherosclerotic cardiovascular disease (ASCVD), valvular heart disease, pericardial disease, and arrhythmias. Cardiac computed tomography (CT) can be helpful in identifying both clinical and subclinical ASCVD in cancer patients and survivors. Radiation therapy treatment planning CT scans and cancer staging/re-staging imaging studies can quantify calcium scores which can identify pre-existing subclinical ASCVD. Cardiac CT can be helpful in the evaluation of cardiac tumors and pericardial diseases, especially in patients who cannot tolerate or have a contraindication to cardiac magnetic resonance. In this review, we describe the optimal utilization of cardiac CT in cancer patients, including risk assessment for ASCVD and identification of cancer treatment-related cardiovascular toxicity.
Authors
Lopez-Mattei, JC; Yang, EH; Ferencik, M; Baldassarre, LA; Dent, S; Budoff, MJ
MLA Citation
Lopez-Mattei, J. C., et al. “Cardiac Computed Tomography in Cardio-Oncology: JACC: CardioOncology Primer.” Jacc: Cardiooncology, vol. 3, no. 5, Dec. 2021, pp. 635–49. Scopus, doi:10.1016/j.jaccao.2021.09.010.
URI
https://scholars.duke.edu/individual/pub1507877
Source
scopus
Published In
Jacc: Cardiooncology
Volume
3
Published Date
Start Page
635
End Page
649
DOI
10.1016/j.jaccao.2021.09.010

Comparison of Framingham risk score and chest-CT identified coronary artery calcification in breast cancer patients to predict cardiovascular events.

BACKGROUND: In breast cancer patients, coincidental detection of CAC at chest CT may be important in determining cardiovascular (CV) outcomes and facilitate CV disease primary prevention strategies. METHODS: 408 consecutive breast cancer patients referred to cardiac oncology clinic were included in the study. 256 patients without a prior history of coronary artery disease had undergone a chest CT. CT images were reviewed to detect CAC. Framingham risk score (FRS) was calculated and patient electronic medical records were interrogated to document the incidence of a composite clinical end point of all-cause mortality and cardiac events (coronary revascularization, heart failure hospitalization and de novo atrial fibrillation). Prevalence of statin prescribing was also collected. RESULTS: Patients were followed for a median of 6.5 years. 112 clinical events occurred. Clinical follow up was 98%. CAC was found in 26% of patients. On multivariable analysis, CAC and advance cancer stage, but not FRS predicted the composite clinical end point (OR for CAC 2.59, p < 0.01). CAC but not FRS also predicted the incidence of cardiac events (OR for CAC 4.90, p < 0.01). CAC was present in 7.3% of patients with low FRS; none had been prescribed a statin. In patients with CAC and FRS ≥ 10%, 45% were not on a statin. CONCLUSION: CAC is a common coincidental finding at CT chest in breast cancer patients referred to cardiac oncology. CAC but not FRS was predictive of composite clinical events and cardiac events. Detection of CAC at chest CT could alter the prescribing of primary prevention strategies to help prevent future cardiac events in breast cancer patients.
Authors
Phillips, WJ; Johnson, C; Law, A; Turek, M; Small, AR; Dent, S; Ruddy, TD; Beanlands, RS; Chow, BJW; Small, GR
MLA Citation
Phillips, William J., et al. “Comparison of Framingham risk score and chest-CT identified coronary artery calcification in breast cancer patients to predict cardiovascular events.Int J Cardiol, vol. 289, Aug. 2019, pp. 138–43. Pubmed, doi:10.1016/j.ijcard.2019.01.056.
URI
https://scholars.duke.edu/individual/pub1507895
PMID
30696608
Source
pubmed
Published In
Int J Cardiol
Volume
289
Published Date
Start Page
138
End Page
143
DOI
10.1016/j.ijcard.2019.01.056

The Framingham risk score underestimates the risk of cardiovascular events in the HER2-positive breast cancer population.

INTRODUCTION: Patients with breast cancer (bca) who overexpress her2 (the human epidermal growth factor receptor 2) are at risk for cardiotoxicity when treated with anthracycline-based chemotherapy and her2-targeted agents. The Framingham risk score (frs) is a validated tool that stratifies patients into high-, intermediate-, or low-risk groups and calculates their 10-year risk of developing cardiovascular disease (cvd) based on past medical history, systolic blood pressure, and measurement of serum lipids. We retrospectively analyzed patients with her2-positive bca to determine whether the frs predicts adverse cardiovascular (CV) events or cardiotoxicity in patients treated using anthracyclines or her2-targeted therapy, or both. METHODS: The frs was determined for patients with bca referred to The Ottawa Hospital Cardiology-Oncology Clinic from October 2008 to August 2014. The patients were stratified into high (≥20%), intermediate (10%-20%), and low (<10%) 10-year cv risk groups. Primary outcomes included cvd-related hospitalizations and deaths, and cardiotoxicity [drop in left ventricular ejection fraction (lvef) of >10% to a lvef ≤50%]. RESULTS: Of the 152 patients included in the analysis (median follow-up: 40.7 months; range: 3.5-263 months), 47 (31%) were classified as high risk; 36 (24%), as intermediate risk; and 69 (45%), as low-risk. The number of cvd-related hospitalizations and deaths was 22, for an overall prevalence of 14%, with significantly more events occurring in high-risk than in low-risk patients (odds ratio: 4.18; 95% confidence limits: 1.47, 11.89). The frs predicted a 10-year risk of any cv event of 11.2% and underestimated the actual rate of cv events in the entire cohort. High frs was not associated with cardiotoxicity (p = 0.82). CONCLUSIONS: In a population of patients with her2-positive bca referred to a cardiology-oncology clinic, the frs does not accurately predict the risk of cv events or cardiotoxicity.
Authors
Law, W; Johnson, C; Rushton, M; Dent, S
MLA Citation
Law, W., et al. “The Framingham risk score underestimates the risk of cardiovascular events in the HER2-positive breast cancer population.Curr Oncol, vol. 24, no. 5, Oct. 2017, pp. e348–53. Pubmed, doi:10.3747/co.24.3684.
URI
https://scholars.duke.edu/individual/pub1507909
PMID
29089804
Source
pubmed
Published In
Current Oncology (Toronto, Ont.)
Volume
24
Published Date
Start Page
e348
End Page
e353
DOI
10.3747/co.24.3684

Risk Model-Guided Antiemetic Prophylaxis vs Physician's Choice in Patients Receiving Chemotherapy for Early-Stage Breast Cancer: A Randomized Clinical Trial.

IMPORTANCE: Despite multiple patient-centered factors being associated with the risk of chemotherapy-induced nausea and vomiting (CINV), these factors are rarely considered when making antiemetic recommendations. OBJECTIVE: To compare risk model-guided (RMG) antiemetic prophylaxis with physician's choice (PC) in patients receiving chemotherapy for early-stage breast cancer. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial of 324 patients with early-stage breast cancer undergoing chemotherapy (cyclophosphamide and an anthracycline) for the first time at 2 specialty cancer care centers in Ottawa from April 10, 2012, to September 2, 2014. Patients were randomized to either the RMG arm (n = 154) or the PC control arm (n = 170). Prior to each cycle of chemotherapy patients in the RMG group were categorized as low or high risk for CINV, and their antiemetic treatments were adjusted accordingly. INTERVENTIONS: Patients considered to be at low risk received standard dexamethasone and a 5-HT3 antagonist, while those at high risk also received aprepitant with or without olanzapine, based on their risk level. The PC control group received antiemetic agents according to the treating physician's discretion. MAIN OUTCOMES AND MEASURES: The primary end points were control of both nausea and vomiting in the acute posttreatment period (first 24 hours after therapy) and in the delayed posttreatment period (days 2-5 after therapy). RESULTS: The total numbers of chemotherapy cycles delivered in the RMG and PC control groups were 497 and 551 respectively. In the acute period, significantly more patients in the RMG group reported no nausea (53.7% [95% CI, 49.2%-58.1%] vs 41.6% [95% CI, 37.4%-45.3%]; P < .001) and no vomiting (91.8% [95% CI, 89.0%-94.0%] vs 82.2% [95% CI, 78.8%-85.3%]; P < .001) compared with the PC control group. Similarly, significantly more patients in the RMG group reported no nausea (39.6% [95% CI, 35.3%-44.1%] vs 30.7% [95% CI, 26.8%-34.7%]; P = .01) and no vomiting (87.1% [95% CI, 83.8%-90.0%) vs 78.0% [95% CI, 74.3%-81.4%]; P < .001) in the delayed period respectively. CONCLUSIONS AND RELEVANCE: In this trial, the RMG antiemetic prophylaxis led to improved control of acute and delayed CINV compared with physician's choice of therapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01913990.
Authors
Clemons, M; Bouganim, N; Smith, S; Mazzarello, S; Vandermeer, L; Segal, R; Dent, S; Gertler, S; Song, X; Wheatley-Price, P; Dranitsaris, G
MLA Citation
Clemons, Mark, et al. “Risk Model-Guided Antiemetic Prophylaxis vs Physician's Choice in Patients Receiving Chemotherapy for Early-Stage Breast Cancer: A Randomized Clinical Trial.Jama Oncol, vol. 2, no. 2, Feb. 2016, pp. 225–31. Pubmed, doi:10.1001/jamaoncol.2015.3730.
URI
https://scholars.duke.edu/individual/pub1507925
PMID
26562292
Source
pubmed
Published In
Jama Oncol
Volume
2
Published Date
Start Page
225
End Page
231
DOI
10.1001/jamaoncol.2015.3730

Clinical Experience of Patients Referred to a Multidisciplinary Cardiac Oncology Clinic: An Observational Study

Cardiotoxicity is the second leading cause of long-Term morbidity and mortality among cancer survivors. The purpose of this retrospective observational study is to report on the clinical and cardiac outcomes in patients with early stage and advanced cancer who were referred to our multidisciplinary cardiac oncology clinic (COC). A total of 428 patients were referred to the COC between October 2008 and January 2013. The median age of patients at time of cancer diagnosis was 60. Almost half of patients who received cancer therapy received first-line chemotherapy alone (169, 41.7%), of which 84 (49.7%) were exposed to anthracyclines. The most common reasons for referral to the cardiac oncology clinic were decreased LVEF (34.6%), prechemotherapy assessment (11.9%), and arrhythmia (8.4%). A total of 175 (40.9%) patients referred to the COC were treated with cardiac medications. The majority (331, 77.3%) of patients were alive as of January 2013, and 93 (21.7%) patients were deceased. Through regular review of cardiac oncology clinic referral patterns, management plans, and patient outcomes, we aim to continuously improve delivery of cardiac care to our patient population and optimize cardiac health.
Authors
Sulpher, J; Mathur, S; Graham, N; Crawley, F; Turek, M; Johnson, C; Stadnick, E; Law, A; Wentzell, J; Dent, S
MLA Citation
Sulpher, J., et al. “Clinical Experience of Patients Referred to a Multidisciplinary Cardiac Oncology Clinic: An Observational Study.” Journal of Oncology, vol. 2015, Jan. 2015. Scopus, doi:10.1155/2015/671232.
URI
https://scholars.duke.edu/individual/pub1507955
Source
scopus
Published In
Journal of Oncology
Volume
2015
Published Date
DOI
10.1155/2015/671232