Thomas LeBlanc

Overview:

I am a medical oncologist, palliative care physician, and patient experience researcher, and I serve as Chief Patient Experience and Safety Officer for the Duke Cancer Institute. My 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).  

As founding Director of the Duke Cancer Patient Experience Research Program (CPEP), my research investigates common issues faced by people with cancer, including issues of symptom burden, quality of life, psychological distress, prognostic understanding, and treatment decision-making. This work aims to improve patients' experiences living with serious illnesses like blood cancers, including the integration of specialist palliative care services to provide an extra layer of support along with their comprehensive cancer care. More broadly, our team in CPEP conducts various studies of patient experience and outcomes issues in oncology, including retrospective chart review studies, comparative effectiveness work, prospective observational studies and registries, and qualitative research, along with efforts to facilitate the integration of patient-generated health data (PGHD) into routine cancer care processes, such as with electronic patient-reported outcome measures (ePROs) and other mobile health interventions (mHealth). 

This work has led to recognition as an "Inspirational Leader under 40" by the American Academy of Hospice and Palliative Medicine (AAHPM), "Fellow" status from the Academy in 2016, the 2018 international "Clinical Impact Award" from the European Association for Palliative Care, and the AAHPM "Early Career Investigator" award in 2020. I served as 2017-18 Chair of the ASCO Ethics Committee, and currently Chair the Scientific Review Committee of the NIH/NINR-funded Palliative Care Research Cooperative Group (PCRC; www.palliativecareresearch.org). I have served on various national guideline panels for AML and for palliative/supportive care issues in oncology, and was inducted as a Fellow of the American Society of Clinical Oncology (FASCO) in 2021. To date I have published over 180 Medline-indexed articles, and several chapters in prominent textbooks of oncology and palliative medicine.

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:

Rural-urban disparities in place of death in hematologic malignancies in the U.S. 2003-2019.

Authors
Hussaini, SQ; Blackford, AL; Gupta, A; Sedhom, R; Cross, SH; Warraich, H; LeBlanc, TW
MLA Citation
Hussaini, Syed Qasim, et al. “Rural-urban disparities in place of death in hematologic malignancies in the U.S. 2003-2019.Blood Adv, June 2022. Pubmed, doi:10.1182/bloodadvances.2022007276.
URI
https://scholars.duke.edu/individual/pub1524615
PMID
35703573
Source
pubmed
Published In
Blood Adv
Published Date
DOI
10.1182/bloodadvances.2022007276

A cross-sectional observational study of health-related quality of life in adults with multiple myeloma.

BACKGROUND: The purpose of this manuscript is to describe health-related quality of life (HRQoL) outcomes in a United States (US)-based sample of multiple myeloma (MM) patients and identify characteristics associated with poor HRQoL. PATIENTS AND METHODS: MM patients identified through the Tumor Registry of a Southeastern US medical center were mailed surveys assessing patient characteristics and HRQoL outcomes. HRQoL outcomes were measured using PROMIS short form instruments which included measures of global health (global physical health and global mental health), physical function, and ability to participate in social roles and activities (social function). HRQoL domain scores were summarized, and best subset linear regression was used to identify predictors of HRQoL. RESULTS: A total of 690 patients completed and returned surveys for a response rate of 64.7%. Respondents reported global physical health (44.9), global mental health (47.5), and physical function (44.1) significantly worse than the general population mean of 50 (p < .0001). Social function (49.5) did not differ significantly (p = .09). Worse socioeconomic status, higher comorbidities, not being in remission, and past receipt of radiation therapy were significantly associated with worse HRQoL. Treatment status and time since diagnosis were not associated with HRQoL outcomes. CONCLUSIONS: Patients with MM have significantly worse HRQoL than the general population. These findings warrant increased attention from clinicians and researchers. More research is needed to better describe the relationship between treatment patterns and HRQoL in patients with MM, and to identify effective interventions.
Authors
LeBlanc, MR; Bryant, AL; LeBlanc, TW; Yang, Q; Sellars, E; Chase, CC; Smith, SK
MLA Citation
LeBlanc, Matthew R., et al. “A cross-sectional observational study of health-related quality of life in adults with multiple myeloma.Support Care Cancer, vol. 30, no. 6, June 2022, pp. 5239–48. Pubmed, doi:10.1007/s00520-022-06943-5.
URI
https://scholars.duke.edu/individual/pub1512627
PMID
35262791
Source
pubmed
Published In
Support Care Cancer
Volume
30
Published Date
Start Page
5239
End Page
5248
DOI
10.1007/s00520-022-06943-5

Factors Associated with Health Care Utilization at the End of Life for Patients with Acute Myeloid Leukemia.

Background: Patients (≥60 years) with acute myeloid leukemia (AML) often receive intense health care utilization at the end of life (EOL). However, factors associated with their health care use at the EOL are unknown. Methods: We conducted a secondary analysis of 168 deceased patients with AML within the United States. We assessed quality of life (QOL) (Functional-Assessment-Cancer-Therapy-Leukemia), and psychological distress (Hospital-Anxiety-and-Depression Scale [HADS]; Patient-Health-Questionnaire-9 [PHQ-9]) at diagnosis. We used multivariable logistic regression models to examine the association between patient-reported factors and the following outcomes: (1) hospitalizations in the last 7 days of life, (2) receipt of chemotherapy in the last 30 days of life, and (3) hospice utilization. Results: About 66.7% (110/165) were hospitalized in the last 7 days of life, 51.8% (71/137) received chemotherapy in the last 30 days of life, and 40.7% (70/168) utilized hospice. In multivariable models, higher education (odds ratio [OR] = 1.54, p = 0.006) and elevated baseline depression symptoms (PHQ-9: OR = 1.09, p = 0.028) were associated with higher odds of hospitalization in the last seven days of life, while higher baseline QOL (OR = 0.98, p = 0.009) was associated with lower odds of hospitalization at the EOL. Higher baseline depression symptoms were associated with receipt of chemotherapy at the EOL (HADS-Depression: OR = 1.10, p = 0.042). Higher education was associated with lower hospice utilization (OR = 0.356, p = 0.024). Conclusions: Patients with AML who are more educated, with higher baseline depression symptoms and lower QOL, were more likely to experience high health care utilization at the EOL. These populations may benefit from interventions to optimize the quality of their EOL care.
Authors
Vaughn, DM; Johnson, PC; Jagielo, AD; Topping, CEW; Reynolds, MJ; Kavanaugh, AR; Webb, JA; Fathi, AT; Hobbs, G; Brunner, A; O'Connor, N; Luger, S; Bhatnagar, B; LeBlanc, TW; El-Jawahri, A
MLA Citation
Vaughn, Dagny M., et al. “Factors Associated with Health Care Utilization at the End of Life for Patients with Acute Myeloid Leukemia.J Palliat Med, vol. 25, no. 5, May 2022, pp. 749–56. Pubmed, doi:10.1089/jpm.2021.0249.
URI
https://scholars.duke.edu/individual/pub1502926
PMID
34861118
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
25
Published Date
Start Page
749
End Page
756
DOI
10.1089/jpm.2021.0249

Clinicians' Understanding of Preferences and Values of People with Hematological Malignancies at the End of Life: Concurrent Surveys.

Background: People with hematological malignancies can deteriorate rapidly to a terminal event and have variable levels of engagement when transitioning to palliative and end-of-life care. Objectives: To describe end-of-life care values and preferences of people with hematological malignancies and explore whether these align with hematology clinicians' perceptions. Design: Two matched anonymous quantitative cross-sectional surveys explored: (1) patients' values and preferences around manner and timing of discussions regarding life expectancy and prognosis, involvement in decision making, and concurrent integration of palliative care with active treatment; and (2) clinicians' perceptions of their patients' values and preferences in relation to prognostic information. Settings/Participants: Concurrent online national surveys of people with hematological malignancies known to the Leukemia Foundation of Australia, and clinicians in Australia with membership to the Hematology Society of Australia and New Zealand. Results: Five hundred nine (38% response rate) patients (median age 64 [min 20, max 89, interquartile range 56-70]) and 272 clinicians (21% response rate) responded to the survey. If their health was deteriorating, most patients wanted honest prognostic and life expectancy information (87%); welcomed involvement in decision making (94%); felt they would be comfortable talking to the treating team about the possibility of death (86%); and would be comfortable seeing someone from a specialist palliative care team (74%). Clinicians generally underestimated most of these responses. Conclusion: Although our findings indicate that most people believe they would be comfortable discussing prognosis, life expectancy, and wishes at the end of life, clinicians were largely unaware of their preferences. This highlights the need to embed values clarification in routine care for each patient and family.
Authors
Button, E; Cardona, M; Huntley, K; Gavin, NC; LeBlanc, TW; Olsen, A; Smith, M; Yates, P
MLA Citation
Button, Elise, et al. “Clinicians' Understanding of Preferences and Values of People with Hematological Malignancies at the End of Life: Concurrent Surveys.J Palliat Med, Apr. 2022. Pubmed, doi:10.1089/jpm.2021.0490.
URI
https://scholars.duke.edu/individual/pub1517829
PMID
35443803
Source
pubmed
Published In
Journal of Palliative Medicine
Published Date
DOI
10.1089/jpm.2021.0490

Venous Thromboembolism in Patients with Cancer Receiving Specialist Palliative Care.

CONTEXT: The prevalence of venous thromboembolism (VTE) in patients with cancer is particularly high at disease progression and during relapse. Patients cared for in specialized palliative care units (SPCU) are rarely included in VTE studies. Objective: We sought to study the prevalence, clinical characteristics, and survival of individuals with VTE in an SPCU setting. METHODS: We retrospectively included 2707 consecutive individuals with active cancer managed at a SPCU. Data were summarized using descriptive statistics and frequency for categorical variables. Overall survival was estimated by Kaplan-Meier and comparisons by log-rank test. Thrombotic events were confirmed by imaging. RESULTS: We studied 1984(73.3%) women and 723 (26.7%) men. The overall prevalence of thrombosis was 22.2% with only 6.2% occurring after initiating SPCU care, and was higher in women (24.6% vs 15.8%), particularly with gynecological tumors (cervical: 30.5%, ovarian: 29.2%). Median survival was slightly longer for patients without VTE (80 days [IQR21-334] and 69 days [IQR 25-235]; p = 0.03). CONCLUSIONS: Prevalence of VTE was high and varied by tumor origin. VTE may impact survival. Though median survival is short, some patients are followed over months, suggesting that in the absence of high bleeding risk, treatment for thrombosis in an attempt to decrease the morbidity of re-thrombosis should be considered. On the other hand, few patients developed symptomatic VTE during SPCU care, making generalized primary prophylaxis probably unwarranted. Customizing anticoagulation for the risk of hemorrhage and physical performance is essential.
Authors
Allende-Pérez, SR; Cesarman-Maus, G; Peña-Nieves, A; Arcos, A; Baz-Gutiérrez, P; Robles, J; LeBlanc, TW
MLA Citation
Allende-Pérez, Silvia Rosa, et al. “Venous Thromboembolism in Patients with Cancer Receiving Specialist Palliative Care.Clin Appl Thromb Hemost, vol. 28, Jan. 2022, p. 10760296221081120. Pubmed, doi:10.1177/10760296221081121.
URI
https://scholars.duke.edu/individual/pub1511671
PMID
35225029
Source
pubmed
Published In
Clin Appl Thromb Hemost
Volume
28
Published Date
Start Page
10760296221081121
DOI
10.1177/10760296221081121

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