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:

End-of-life care quality outcomes among Medicare beneficiaries with hematologic malignancies.

Patients with hematologic malignancies are thought to receive more aggressive end-of-life (EOL) care and have suboptimal hospice use compared with patients with solid tumors, but descriptions of EOL outcomes from comprehensive cohorts have been lacking. We used the population-based Surveillance, Epidemiology, and End Results-Medicare dataset to describe hospice use and indicators of aggressive EOL care among Medicare beneficiaries who died of hematologic malignancies in 2008-2015. Overall, 56.5% of decedents used hospice services for median 9 days (interquartile range, 3-27), 33.0% died in an acute hospital setting, 36.8% had an intensive care unit (ICU) admission in the last 30 days of life, and 13.3% received chemotherapy within the last 14 days of life. Hospice use was associated with 96% lower probability of inpatient death (adjusted risk ratio [aRR], 0.038; 95% confidence interval [CI], 0.035-0.042), 44% lower probability of an ICU stay in the last 30 days of life (aRR, 0.56; 95% CI, 0.54-0.57), and 62% decrease in chemotherapy use in the last 14 days of life (aRR, 0.38; 95% CI, 0.35-0.41). Hospice enrollees spent on average 41% fewer days as inpatient during the last month of life (adjusted means ratio, 0.59; 95% CI, 0.57-0.60) and had 38% lower mean Medicare spending in the last month of life (adjusted means ratio, 0.62; 95% CI, 0.61-0.64). These associations were consistent across histologic subgroups. In conclusion, EOL care quality outcomes and hospice enrollment were suboptimal among older decedents with hematologic cancers, but hospice use was associated with a consistent decrease in aggressive care at EOL.
Authors
Egan, PC; LeBlanc, TW; Olszewski, AJ
MLA Citation
Egan, Pamela C., et al. “End-of-life care quality outcomes among Medicare beneficiaries with hematologic malignancies.Blood Advances, vol. 4, no. 15, Aug. 2020, pp. 3606–14. Epmc, doi:10.1182/bloodadvances.2020001767.
URI
https://scholars.duke.edu/individual/pub1455154
PMID
32766855
Source
epmc
Published In
Blood Advances
Volume
4
Published Date
Start Page
3606
End Page
3614
DOI
10.1182/bloodadvances.2020001767

Digital Supportive Care Awareness and Navigation (D-SCAN): Qualitative and Quantitative Results of a Pilot Randomized Trial in Patients with Advanced Cancer

Authors
Hildenbrand, J; Corbett, C; Davis, D; Herring, K; Locke, S; Troy, J; Wolf, S; Zafar, Y; Atlee, D; Chilcott, J; Manassei, H; McCoy, C; Pendergraft, T; Patierno, S; LeBlanc, T
MLA Citation
Hildenbrand, Jordan, et al. “Digital Supportive Care Awareness and Navigation (D-SCAN): Qualitative and Quantitative Results of a Pilot Randomized Trial in Patients with Advanced Cancer.” Journal of Pain and Symptom Management, vol. 60, no. 1, 2020, pp. 272–272.
URI
https://scholars.duke.edu/individual/pub1451088
Source
wos-lite
Published In
Journal of Pain and Symptom Management
Volume
60
Published Date
Start Page
272
End Page
272

Caregiver-Guided Pain Management for Advanced Cancer: Results of a Randomized Controlled Trial

Authors
Porter, L; LeBlanc, T; Bull, J; Hanson, L
MLA Citation
Porter, Laura, et al. “Caregiver-Guided Pain Management for Advanced Cancer: Results of a Randomized Controlled Trial.” Journal of Pain and Symptom Management, vol. 60, no. 1, 2020, pp. 192–93.
URI
https://scholars.duke.edu/individual/pub1451662
Source
wos-lite
Published In
Journal of Pain and Symptom Management
Volume
60
Published Date
Start Page
192
End Page
193

Health Care Resource Utilization and Costs Among Medicare Beneficiaries Newly Diagnosed With Peripheral T-cell Lymphoma: A Retrospective Claims Analysis

Authors
Shah, A; Petrilla, A; Rebeira, M; Feliciano, J; Lisano, J; LeBlanc, TW
MLA Citation
Shah, Anne, et al. “Health Care Resource Utilization and Costs Among Medicare Beneficiaries Newly Diagnosed With Peripheral T-cell Lymphoma: A Retrospective Claims Analysis.” Clinical Lymphoma Myeloma and Leukemia, Elsevier BV, July 2020. Crossref, doi:10.1016/j.clml.2020.07.011.
URI
https://scholars.duke.edu/individual/pub1453127
Source
crossref
Published In
Clinical Lymphoma, Myeloma & Leukemia
Published Date
DOI
10.1016/j.clml.2020.07.011

Early Palliative Care Services and End-of-Life Care in Medicare Beneficiaries with Hematologic Malignancies: A Population-Based Retrospective Cohort Study.

Background: Patients with hematologic malignancies (HM) often receive aggressive care at the end of life (EOL). Early palliative care (PC) has been shown to improve EOL care outcomes, but its benefits are less established in HM than in solid tumors. Objectives: We sought to describe the use of billed PC services among Medicare beneficiaries with HM. We hypothesized that receipt of early PC services (rendered >30 days before death) may be associated with less aggressive EOL care. Design: Retrospective cohort analysis Setting/Subjects: Using the Surveillance, Epidemiology, and End Results-Medicare registry, we studied patients with leukemia, lymphoma, myeloma, myelodysplastic syndrome, or myeloproliferative neoplasm who died between 2001 and 2015. Measurements: We described trends in the use of PC services and evaluated the association between early PC services and metrics of EOL care aggressiveness. Results: Among 139,191 decedents, the proportion receiving PC services increased from 0.4% in 2001 to 13.3% in 2015. Median time from first encounter to death was 10 days and 84.3% of encounters occurred during hospitalizations. In patients who survived >30 days from diagnosis (N = 120,741), the use of early PC services was more frequent in acute leukemia, women, and black patients, among other characteristics. Early PC services were associated with increased hospice use and decreased health care utilization at the EOL. Conclusion: Among patients with HM, there was an upward trend in PC services, and early PC services were associated with less aggressive EOL care. Our results support the need for prospective trials of early PC in HM.
Authors
Rao, VB; Belanger, E; Egan, PC; LeBlanc, TW; Olszewski, AJ
MLA Citation
URI
https://scholars.duke.edu/individual/pub1449343
PMID
32609039
Source
pubmed
Published In
Journal of Palliative Medicine
Published Date
DOI
10.1089/jpm.2020.0006

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