Thomas LeBlanc

Overview:

Dr. LeBlanc is a medical oncologist, palliative care physician, and patient experience researcher.  His 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).  He is an active member of the inpatient non-transplant hematologic malignancies care team, based on the 9100 ward of Duke University Hospital.

His research interests converge on common issues faced by people with cancer, particularly those with high-risk or relapsed/refractory hematologic malignancies. Issues of symptom burden and quality of life are of central importance in these settings, and may lead patients to face difficult decision-making scenarios. Dr. LeBlanc’s research explores the experience of patients and families in these settings, and aims to improve patients experiences living with blood cancers, including the involvement of specialist palliative care services to provide an extra layer of support along with their comprehensive cancer care, to improve symptom management and quality of life.

Dr. LeBlanc is the recipient of a Junior Career Development Award grant from the National Palliative Care Research Center (NPCRC), a Sojourns Scholars Leadership Award from the Cambia Health Foundation, and a Mentored Research Scholar Grant from the American Cancer Society. These grants have funded efforts to better understand the experience of patients living with AML, including studies of symptom burden, quality of life, distress, understanding of prognosis, and treatment decision-making. This work has been mentored by a team of expert researchers, including Drs. Amy Abernethy, James Tulsky, Karen Steinhauser, Kathryn Pollak, and Peter Ubel.  Dr. LeBlanc's work in palliative care research led to his recognition as an "Inspirational Leader under 40" by the American Academy of Hospice and Palliative Medicine (AAHPM), and "fellow" status from the Academy in 2016. Dr. LeBlanc was the 2017-18 Chair of the ASCO Ethics Committee, and Chairs the Scientific Review Committee of the NIH/NINR-funded Palliative Care Research Cooperative Group (PCRC; www.palliativecareresearch.org). He has served on various national guideline panels for AML, and for palliative/supportive care issues in oncology. 

He completed residency training in Internal Medicine at Duke, as well as fellowships in Medical Oncology and Hospice and Palliative Medicine.  He graduated from the Duke University School of Medicine, also earning a Master of Arts degree in Philosophy during that time, and served as Chief Medical Resident at the Durham VA Medical Center in 2010-11.  He holds board certifications in Medical Oncology, and in Hospice and Palliative Medicine.  He is actively involved with teaching of medical students and housestaff at Duke, particularly with regards to issues of patient-doctor communication, and is mentoring several Duke trainees on research projects.

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:

Palliative care and coping in patients with acute myeloid leukemia (AML): Mediation analysis of data from a randomized clinical trial

Authors
Nelson, A; Kavanaugh, A; Webb, J; Jackson, V; O'Connor, N; Bhatnagar, B; Fathi, A; Brunner, A; Greer, J; Temel, J; LeBlanc, T; El-Jawahri, A
MLA Citation
URI
https://scholars.duke.edu/individual/pub1476375
Source
wos-lite
Published In
Psycho Oncology
Volume
30
Published Date
Start Page
11
End Page
11

Patient Experiences with Liposomal Daunorubicin and Cytarabine (CPX-351) Versus Conventional Induction Regimens: An Analysis of Patient-Reported Outcomes Data from a Prospective Trial

<jats:p>Background: CPX-351 (Vyxeos®; daunorubicin and cytarabine liposome for injection) is a treatment for adults with newly diagnosed AML with myelodysplasia-related changes or therapy-related AML. Intensive induction chemotherapy causes marked symptom burden, quality of life (QOL) impairment, and psychological distress, but data on the patient experience with CPX-351 are lacking. We aimed to compare the patient experience of physician-chosen CPX-351 to standard induction regimens using validated patient-reported outcome (PRO) measures collected prospectively in a randomized clinical trial.</jats:p> <jats:p>Methods: This was an exploratory analysis of a US, multi-site supportive care trial in AML (NCT02975869). PRO assessments were collected at baseline, 2 weeks later (when studies show patients feel their worst during a typical induction hospitalization), and then at 1, 3, and 6 months. PROs assessed the following patient experience domains: symptoms (Edmonton Symptom Assessment Scale [ESAS]), QOL (FACT-Leukemia and FACT-TOI), anxiety (HADS-A), depression (HADS-D), and post-traumatic stress (PTSD Checklist). All analyses were adjusted for baseline PROs, patient age, receipt of additional targeted therapy, and supportive care interventions. Analysis of covariance models were used to find adjusted 2-week PRO scores by treatment, and logistic regression models were used to find adjusted odds ratios (aOR) for dichotomous PROs at 2 weeks. Linear mixed effects models were used to estimate adjusted mean between-group differences in PROs across the 6-month study period (reported as B). Given the exploratory nature of this study, we defined a 2-sided P value of &amp;lt;0.20 as hypothesis-generating, consistent with standard approaches to exploratory analysis, and not to imply significance.</jats:p> <jats:p>Results: Across 4 sites, we enrolled 109 patients with newly diagnosed AML. Thirty-five (32%) received CPX-351 and 74 (68%) received a standard regimen (72 received 7+3, 1 received FLAG, and 1 received MEC). Baseline sociodemographic characteristics and PROs were similar across groups. Mean age was 67 years (SD: 6.8) in the CPX-351 group and 65.2 (SD: 8.9) in the standard group. Most patients were white (&amp;gt;90%) and partnered (&amp;gt;70%). At 2 weeks, those receiving CPX-351 had better PRO scores (adjusted means) for symptoms (ESAS total score: 25.89 vs 31.73; P = 0.11) and depression (HADS-D: 5.17 vs 7.0; P = 0.08); CPX-351 was favored on all other PROs, including quality of life (FACT-Leu: 118.02 vs 112.56; P = 0.44), anxiety (HADS-A: 4.51 vs 5.27; P = 0.465), and PTSD symptoms (PTSD-checklist: 27.08 vs 28.16; P = 0.6). At 2 weeks, patients receiving CPX-351 were less likely to have worsening ESAS total symptoms (45.7% vs 54.1%; aOR = 0.52; P = 0.172), physical symptoms (45.7% vs 63.5%; aOR = 0.41; P = 0.064), and clinically significant depression symptoms (27.3% vs 37.7%; aOR = 0.48; P = 0.159), but no difference in clinically significant anxiety symptoms (28.9% vs 30.3%; aOR = 0.62; P = 0.392). In longitudinal analyses, those receiving CPX-351 had better QOL (FACT-TOI: B = 6.41; P = 0.173), lower anxiety (B = −1.47; P = 0.153), less depression symptoms (B = −1.58; P = 0.09), and less leukemia symptoms (B = 3.67; P = 0.16), but no differences in total symptom burden (ESAS: B = −0.06; P = 0.988) or in PTSD symptoms (PTSD Checklist: B = 2.23; P = 0.354). While patients receiving CPX-351 had a longer index hospitalization length of stay compared to standard induction (mean of 44.3 vs 39 days; P = 0.072), they also had fewer hospitalizations during the 6-month follow-up period (2.82 vs 3.55; P = 0.158). Furthermore, the total number of days hospitalized after the index admission was lower for those receiving CPX-351 (17.71 vs 22.27 days; P = 0.199). Patients receiving CPX-351 had an average of 94.08 days alive and out of the hospital, while those receiving standard induction had 91.85 days (P = 0.849).</jats:p> <jats:p>Conclusions: This exploratory analysis supports the observation that patients receiving CPX-351 may have an overall better patient experience during induction treatment, as measured by validated PROs assessing symptoms, QOL, mood, and PTSD. Our ability to draw more definitive conclusions is limited by sample size and the fact that treatment with CPX-351 is only indicated for certain AML subtypes, resulting in a non-random allocation to treatment groups and potential differences in clinical outcomes.</jats:p> <jats:sec> <jats:title>Disclosures</jats:title> <jats:p>Leblanc: AstraZeneca: Research Funding; Agios, AbbVie, and Bristol Myers Squibb/Celgene: Speakers Bureau; UpToDate: Patents &amp; Royalties: Royalties; American Cancer Society, BMS, Duke University, NINR/NIH, Jazz Pharmaceuticals, Seattle Genetics: Research Funding; AbbVie, Agios, Amgen, AstraZeneca, CareVive, BMS/Celgene, Daiichi-Sankyo, Flatiron, Helsinn, Heron, Otsuka, Medtronic, Pfizer, Seattle Genetics, Welvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Morris:Jazz Pharmaceuticals: Current Employment, Current equity holder in publicly-traded company. Hooks:Jazz Pharmaceuticals: Current Employment, Current equity holder in publicly-traded company. El-Jawahri:Jazz Pharmaceuticals: Research Funding.</jats:p> </jats:sec>
Authors
Leblanc, TW; Morris, S; Hooks, M; Locke, SC; El-Jawahri, A
MLA Citation
Leblanc, Thomas W., et al. “Patient Experiences with Liposomal Daunorubicin and Cytarabine (CPX-351) Versus Conventional Induction Regimens: An Analysis of Patient-Reported Outcomes Data from a Prospective Trial.” Blood, vol. 136, no. Supplement 1, American Society of Hematology, 2020, pp. 29–30. Crossref, doi:10.1182/blood-2020-139727.
URI
https://scholars.duke.edu/individual/pub1474467
Source
crossref
Published In
Blood
Volume
136
Published Date
Start Page
29
End Page
30
DOI
10.1182/blood-2020-139727

Examining Healthcare Resource Utilization (HCRU) and Costs in US Patients Diagnosed with Relapsed Acute Myeloid Leukemia (AML)

Authors
Tabah, A; Knoth, R; Huggar, D; Copher, RM; Cao, Z; Lipkin, C; Leblanc, TW
MLA Citation
Tabah, Ashley, et al. “Examining Healthcare Resource Utilization (HCRU) and Costs in US Patients Diagnosed with Relapsed Acute Myeloid Leukemia (AML).” Clinical Lymphoma Myeloma & Leukemia, vol. 20, 2020, pp. S181–S181.
URI
https://scholars.duke.edu/individual/pub1466809
Source
wos-lite
Published In
Clinical Lymphoma, Myeloma & Leukemia
Volume
20
Published Date
Start Page
S181
End Page
S181

Real-world examination of remission patterns in patients (pts) with acute myeloid leukemia (AML).

Authors
Tabah, A; Huggar, D; Brady, BL; Jariwala-Parikh, K; Copher, R; LeBlanc, TW
MLA Citation
Tabah, Ashley, et al. “Real-world examination of remission patterns in patients (pts) with acute myeloid leukemia (AML).Journal of Clinical Oncology, vol. 38, no. 15, 2020.
URI
https://scholars.duke.edu/individual/pub1475364
Source
wos-lite
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
38
Published Date

The patient experience of ABVD treatment in Hodgkin lymphoma: a retrospective cohort study of patient-reported distress.

PURPOSE: Psychological distress is prevalent in Hodgkin lymphoma (HL). Many patients, regardless of prognosis, receive ABVD chemotherapy as first-line treatment, but few studies have specifically examined the nature of distress during this shared treatment experience. METHODS: We conducted a retrospective study of patient-reported distress in HL patients receiving ABVD treatment at a single tertiary care facility. Distress was measured using the National Comprehensive Cancer Network Distress Thermometer and Problem List (PL). We used descriptive statistics and generalized estimating equations to assess the prevalence of distress and specific problem items during treatment and associations with patient- and disease-related factors. RESULTS: We collected data from 50 patients comprising 467 unique encounters, with 369/467 (79.0%) reporting a distress thermometer score. Median distress score was 2 (IQR: 0-5), but actionable distress (distress thermometer ≥4) was noted for 118/369 (32.0%) encounters. Actionable distress was only related to having a prior cancer, which conferred lower odds of actionable distress (OR 0.23, 95% CI 0.07-0.74, p=0.01) Physical and emotional problems were reported for 287/369 (77.8%) and 125/369 (33.9%) visits, respectively. Female patients had greater odds of both physical (OR 3.17, 95% CI 1.32-7.66, p=0.01) and emotional (OR 3.31, 95% CI 1.25-8.73, p=0.02) problems. CONCLUSION: ABVD treatment is associated with a high frequency of actionable distress, with physical and emotional problems acting as primary drivers. Female patients may be particularly vulnerable, while cancer survivors may be uniquely resilient. These findings demonstrate the need to thoroughly screen for and appropriately tailor distress management strategies for HL patients during treatment with ABVD.
Authors
Tarnasky, AM; Troy, JD; LeBlanc, TW
MLA Citation
Tarnasky, Aaron M., et al. “The patient experience of ABVD treatment in Hodgkin lymphoma: a retrospective cohort study of patient-reported distress.Support Care Cancer, Feb. 2021. Pubmed, doi:10.1007/s00520-021-06044-9.
URI
https://scholars.duke.edu/individual/pub1474363
PMID
33576877
Source
pubmed
Published In
Support Care Cancer
Published Date
DOI
10.1007/s00520-021-06044-9

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