Gretchen Kimmick

Overview:

Breast cancer; treatment of breast cancer; management of menopausal symptoms in breast cancer survivors; survivorship issues after breast cancer; supportive care in managment of cancer patients; breast cancer and treatment of cancer in older persons; diagnosis and management of cancer in underserved populations.

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. 1989

Wake Forest University

M.S. 2000

Wake Forest University

Medical Resident, Medicine

University of Florida

Fellow in Oncology, Medicine

North Carolina Baptist Hospital

Grants:

A Phase II Study of Neratinib in Metastatic HER2 Non-amplified by HER2 Mutant Breast Cancer

Administered By
Duke Cancer Institute
Awarded By
Washington University
Role
Principal Investigator
Start Date
End Date

Publications:

Patient-reported treatment toxicity and adverse events in Black and White women receiving chemotherapy for early breast cancer.

PURPOSE: It is not known whether chemotherapy-related symptom experiences differ between Black and White women with early breast cancer (Stage I-III) receiving current chemotherapy regimens and, in turn, influences dose delay, dose reduction, early treatment discontinuation, or hospitalization. METHODS: Patients self-reported their race and provided symptom reports for 17 major side effects throughout chemotherapy. Toxicity and adverse events were analyzed separately for anthracycline and non-anthracycline regimens. Fisher's exact tests and two-sample t-tests compared baseline patient characteristics. Modified Poisson regression estimated relative risks of moderate, severe, or very severe (MSVS) symptom severity, and chemotherapy-related adverse events.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.no changes RESULTS: In 294 patients accrued between 2014 and 2020, mean age was 58 (SD13) and 23% were Black. For anthracycline-based regimens, the only significant difference in MSVS symptoms was in lymphedema (41% Black vs 20% White, p = .04) after controlling for axillary surgery. For non-anthracycline regimens, the only significant difference was MSVS peripheral neuropathy (41% Blacks vs. 23% White) after controlling for taxane type (p = .05) and diabetes (p = .05). For all other symptoms, severity scores were similar. Dose reduction differed significantly for non-anthracycline regimens (49% Black vs. 25% White, p = .01), but not for anthracycline regimens or in dose delay, early treatment discontinuation, or hospitalization for either regimen. CONCLUSION: Except for lymphedema and peripheral neuropathy, Black and White patients reported similar symptom severity during adjuvant chemotherapy. Dose reductions in Black patients were more common for non-anthracycline regimens. In this sample, there were minimal differences in patient-reported symptoms and other adverse outcomes in Black versus White patients.
Authors
Nyrop, KA; Damone, EM; Deal, AM; Wheeler, SB; Charlot, M; Reeve, BB; Basch, E; Shachar, SS; Carey, LA; Reeder-Hayes, KE; Dees, EC; Jolly, TA; Kimmick, GG; Karuturi, MS; Reinbolt, RE; Speca, JC; Wood, WA; Muss, HB
MLA Citation
Nyrop, K. A., et al. “Patient-reported treatment toxicity and adverse events in Black and White women receiving chemotherapy for early breast cancer.Breast Cancer Res Treat, Nov. 2021. Pubmed, doi:10.1007/s10549-021-06439-6.
URI
https://scholars.duke.edu/individual/pub1500892
PMID
34739658
Source
pubmed
Published In
Breast Cancer Res Treat
Published Date
DOI
10.1007/s10549-021-06439-6

Patient-reported symptom severity, interference with daily activities, and adverse events in older and younger women receiving chemotherapy for early breast cancer.

BACKGROUND: To the authors' knowledge, it is unknown whether patient-reported symptom severity and symptom interference with daily activities differ between younger (aged <65 years) and older (aged ≥65 years) women receiving similar chemotherapy regimens for early breast cancer (EBC). METHODS: Study participants rated 17 side effects of chemotherapy regimens currently in use in clinical practice (2014-2019). RESULTS: Of 284 women with EBC (stage I-III), approximately 57% were aged <65 years and 43% were aged ≥65 years. For anthracycline-based regimens, a higher percentage of younger women reported moderate, severe, or very severe (MSVS) hot flashes (49% vs 18%) (P < .001). For nonanthracycline regimens, a higher percentage of younger women reported MSVS hot flashes (38% vs 19%) (P = .009) and a lower percentage reported MSVS arthralgia (28% vs 49%) (P = .005). With regard to symptom interference with daily activities, a higher percentage of younger women being treated with anthracycline-based regimens reported MSVS hot flashes (32% vs 7%) (P = .001) and myalgia (38% vs 18%) (P = .02). For nonanthracycline chemotherapy, a higher percentage of younger women reported MSVS interference for hot flashes (26% vs 9%) (P = .006) and lower percentages reported abdominal pain (13% vs 28%) (P = .02). Overall, there were no significant differences noted among younger versus older patients with regard to hospitalizations (19% vs 12%; P = .19), dose reductions (34% vs 31%; P = .50), dose delays (22% vs 25%; P = .59), or early treatment discontinuation (16% vs 16%; P = .9546). CONCLUSIONS: Older and younger women with EBC who were treated with identical chemotherapy regimens generally experienced similar levels of symptom severity, symptom-related interference with daily activities, and adverse events. LAY SUMMARY: In this study, women receiving chemotherapy for early breast cancer rated the severity of 17 symptoms and symptom interference with their activities of daily living. Older (aged ≥65 years) and younger (aged <65 years) women who received identical chemotherapy regimens generally experienced similar levels of symptom severity, symptom-related interference with daily activities, and adverse events.
Authors
Nyrop, KA; Deal, AM; Chen, YT; Reeve, BB; Basch, EM; Wood, WA; Shachar, SS; Carey, LA; Reeder-Hayes, KE; Dees, EC; Jolly, TA; Kimmick, GG; Karuturi, MS; Reinbolt, RE; Speca, JC; Lee, JT; Brenizer, A; Muss, HB
MLA Citation
Nyrop, Kirsten A., et al. “Patient-reported symptom severity, interference with daily activities, and adverse events in older and younger women receiving chemotherapy for early breast cancer.Cancer, vol. 127, no. 6, Mar. 2021, pp. 957–67. Pubmed, doi:10.1002/cncr.33329.
URI
https://scholars.duke.edu/individual/pub1465204
PMID
33216355
Source
pubmed
Published In
Cancer
Volume
127
Published Date
Start Page
957
End Page
967
DOI
10.1002/cncr.33329

Older adult participation in cancer clinical trials: A systematic review of barriers and interventions.

Cancer is a disease of aging and, as the world's population ages, the number of older persons with cancer is increasing and will make up a growing share of the oncology population in virtually every country. Despite this, older patients remain vastly underrepresented in research that sets the standards for cancer treatments. Consequently, most of what we know about cancer therapeutics is based on clinical trials conducted in younger, healthier patients, and effective strategies to improve clinical trial participation of older adults with cancer remain sparse. For this systematic review, the authors evaluated published studies regarding barriers to participation and interventions to improve participation of older adults in cancer trials. The quality of the available evidence was low and, despite a literature describing multifaceted barriers, only one intervention study aimed to increase enrollment of older adults in trials. The findings starkly amplify the paucity of evidence-based, effective strategies to improve participation of this underrepresented population in cancer trials. Within these limitations, the authors provide their opinion on how the current cancer research infrastructure must be modified to accommodate the needs of older patients. Several underused solutions are offered to expand clinical trials to include older adults with cancer. However, as currently constructed, these recommendations alone will not solve the evidence gap in geriatric oncology, and efforts are needed to meet older and frail adults where they are by expanding clinical trials designed specifically for this population and leveraging real-world data.
Authors
Sedrak, MS; Freedman, RA; Cohen, HJ; Muss, HB; Jatoi, A; Klepin, HD; Wildes, TM; Le-Rademacher, JG; Kimmick, GG; Tew, WP; George, K; Padam, S; Liu, J; Wong, AR; Lynch, A; Djulbegovic, B; Mohile, SG; Dale, W; Cancer and Aging Research Group (CARG),
MLA Citation
Sedrak, Mina S., et al. “Older adult participation in cancer clinical trials: A systematic review of barriers and interventions.Ca Cancer J Clin, vol. 71, no. 1, Jan. 2021, pp. 78–92. Pubmed, doi:10.3322/caac.21638.
URI
https://scholars.duke.edu/individual/pub1462416
PMID
33002206
Source
pubmed
Published In
Ca: a Cancer Journal for Clinicians
Volume
71
Published Date
Start Page
78
End Page
92
DOI
10.3322/caac.21638

Effects of Breast Cancer Adjuvant Chemotherapy Regimens on Expression of the Aging Biomarker, p16INK4a.

Background: Although chemotherapy saves lives, increasing evidence shows that chemotherapy accelerates aging. We previously demonstrated that mRNA expression of p16INK4a , a biomarker of senescence and molecular aging, increased early and dramatically after beginning adjuvant anthracycline-based regimens in early stage breast cancer patients. Here, we determined if changes in p16INK4a expression vary by chemotherapy regimen among early stage breast cancer patients. Methods: We conducted a study of stage I-III breast cancer patients receiving adjuvant or neoadjuvant chemotherapy. p16INK4a expression was analyzed prechemotherapy and postchemotherapy (median 6.2 months after the last chemotherapy) in peripheral blood T lymphocytes. Chemotherapy-induced change in p16INK4a expression was compared among regimens. All statistical tests were 2-sided. Results: In 146 women, chemotherapy was associated with a statistically significant increase in p16INK4a expression (accelerated aging of 17 years; P < .001). Anthracycline-based regimens were associated with the largest increases (accelerated aging of 23 to 26 years; P ≤ .008). Nonanthracycline-based regimens demonstrated a much smaller increase (accelerated aging of 9 to 11 years; P ≤ .15). In addition to the type of chemotherapy regimen, baseline p16INK4a levels, but not chronologic age or race, were also associated with the magnitude of increases in p16INK4a . Patients with lower p16INK4a levels at baseline were more likely to experience larger increases. Conclusions: Our findings suggest that the aging effects of chemotherapy may be influenced by both chemotherapy type and the patient's baseline p16INK4a level. Measurement of p16INK4a expression is not currently available in the clinic, but nonanthracycline regimens offering similar efficacy as anthracycline regimens might be favored.
Authors
Shachar, SS; Deal, AM; Reeder-Hayes, KE; Nyrop, KA; Mitin, N; Anders, CK; Carey, LA; Dees, EC; Jolly, TA; Kimmick, GG; Karuturi, MS; Reinbolt, RE; Speca, JC; Muss, HB
MLA Citation
Shachar, Shlomit S., et al. “Effects of Breast Cancer Adjuvant Chemotherapy Regimens on Expression of the Aging Biomarker, p16INK4a.Jnci Cancer Spectr, vol. 4, no. 6, Dec. 2020, p. pkaa082. Pubmed, doi:10.1093/jncics/pkaa082.
URI
https://scholars.duke.edu/individual/pub1470910
PMID
33409457
Source
pubmed
Published In
Jnci Cancer Spectrum
Volume
4
Published Date
Start Page
pkaa082
DOI
10.1093/jncics/pkaa082

Factors associated with falls in older women with breast cancer: the use of a brief geriatric screening tool in clinic.

PURPOSE: Unintentional falls and breast cancer are common among older women, but the associations between them are understudied. We aimed to identify factors associated with falls in older women with breast cancer. METHODS: We retrospectively reviewed clinical records of older women with breast cancer at Duke Medical Center who had completed the Senior Adult Oncology Program geriatric assessment. Characteristics were compared between women had had at least one fall in the past year and those who did not. Pearson's Chi-square tests and t tests were used for comparison of groups' characteristics. Logistic regression determined factors associated with falling. RESULTS: We identified 425 women, age 76.2 years (range 65-89 years), at the time of the assessment. 118 (27.8%) women reported a fall in the prior year. Age, race, ethnicity, and time since diagnosis (all p > 0.05) were similar between groups. In univariate analyses, metastatic disease (p = 0.023) and history of endocrine therapy (p = 0.042) were more common among women who fell. Women who fell had lower systolic (p = 0.001), diastolic (p < 0.001) blood pressures, and SpO2 (p = 0.018). Women who had fallen had a higher Charlson Comorbidity Index (CCI: p = 0.033), and were more likely to report using a walking aide (p < 0.001), nutritional issues (p = 0.006), and depression symptoms (p = 0.038). In multivariate analysis, falling was associated with low DBP (OR 0.93; p = 0.0017), low SpO2 (OR 0.79; p = 0.0169), a higher CCI (OR 1.23; p = 0.0076), and depression symptoms (OR 1.61; p = 0.039). CONCLUSIONS: Among older women with breast cancer, depressive symptoms, higher comorbidity level, and vital sign measurements were associated with having fallen.
Authors
Bartlett, DB; Broadwater, G; White, HK; Shelby, R; Zullig, LL; Robertson, J; Kanesvaran, R; Cohen, HJ; Kimmick, G
MLA Citation
Bartlett, David B., et al. “Factors associated with falls in older women with breast cancer: the use of a brief geriatric screening tool in clinic.Breast Cancer Res Treat, vol. 184, no. 2, Nov. 2020, pp. 445–57. Pubmed, doi:10.1007/s10549-020-05862-5.
URI
https://scholars.duke.edu/individual/pub1456216
PMID
32794062
Source
pubmed
Published In
Breast Cancer Res Treat
Volume
184
Published Date
Start Page
445
End Page
457
DOI
10.1007/s10549-020-05862-5