Dawn Provenzale

Overview:

Dr. Provenzale is Director of GI Outcomes Research at Duke University and the Director of the Durham Epidemiologic Research and Information Center (ERIC). She directs a research program that integrates observational research, measurement of patient-centered outcomes and decision making to investigate patient-oriented research questions in gastrointestinal cancer screening, surveillance and quality of care. Dr. Provenzale also directs the training program for GI fellows committed to careers in health services research.

Research:

Ongoing projects include CanCORS, an NCI/VA funded consortium to measure quality of lung and colorectal cancer care in VA and non-VA settings, and the development and dissemination of CCQMS, a cancer care quality measurement system. Additional studies are developing a cancer tissue repository for microarray studies.

Positions:

Professor of Medicine

Medicine, Gastroenterology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1984

Albany Medical College

Medical Resident, Medicine

University of North Carolina at Chapel Hill

Fellow in Gastroenterology, Medicine

Tufts University

Fellow in Clinical Decision Making, Medicine

Tufts University

Grants:

IPA - Teresa C Day

Administered By
Medicine, Gastroenterology
Role
Principal Investigator
Start Date
End Date

IPA Teresa Day

Administered By
Medicine, Gastroenterology
Role
Principal Investigator
Start Date
End Date

IPA - Jane T. Kolimaga

Administered By
Medicine, Gastroenterology
Role
Principal Investigator
Start Date
End Date

IPA Agreement

Administered By
Medicine, Gastroenterology
Awarded By
Veterans Administration Medical Center
Role
Principal Investigator
Start Date
End Date

Gastrointestinal Cancer Screening and Surveillance

Administered By
Medicine, Gastroenterology
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Publications:

Clinical and Molecular Features of Post-Colonoscopy Colorectal Cancers.

BACKGROUND & AIMS: Post-colonoscopy colorectal cancers (PCCRCs) may arise from missed lesions or due to molecular features of tumors that allow them to grow rapidly. We aimed to compare clinical, pathology, and molecular features of PCCRCs (those detected within 6-60 months of colonoscopy) and detected CRCs (those detected within 6 months of a colonoscopy). METHODS: Within a population-based cross-sectional study of incident CRC cases in Utah (from 1995 through 2009), we identified PCCRCs (those cancers that developed within 5 years of a colonoscopy) and matched the patients by age, sex, and hospital site to patients with detected CRC. Archived specimens were retrieved and tested for microsatellite instability (MSI), CpG island methylation, and mutations in KRAS and BRAF. There were 2659 cases of CRC diagnosed within the study window; 6% of these (n = 159) were defined as PCCRCs; 84 of these cases had tissue available and were matched to 84 subjects with detected CRC. RESULTS: Higher proportions of PCCRCs than detected CRCs formed in the proximal colon (64% vs 44%; P = .016) and were of an early stage (86% vs 69%; P = .040). MSI was observed in 32% of PCCRCs compared with 13% of detected CRCs (P = .005). The other molecular features were found in similar proportions of PCCRCs and detected CRCs. In a multivariable logistic regression, MSI (odds ratio, 4.20; 95% CI, 1.58-11.14) was associated with PCCRC. There was no difference in 5-year survival between patients with PCCRCs vs detected CRCs. CONCLUSION: In this population-based cross-sectional study of incident CRC cases in Utah, we found PCCRCs to be more likely to arise in the proximal colon and demonstrate MSI, so PCCRCs and detected CRC appear to have different features or processes of tumorigenesis. Additional studies are needed to determine if post-colonoscopy cancers arise through a specific genetic pathway.
Authors
Samadder, NJ; Neklason, D; Snow, A; Samowitz, W; Cessna, MH; Rowe, K; Sandhu, I; Boucher, K; Pappas, L; Smith, KR; Wong, J; Curtin, K; Provenzale, D; Burt, RW
MLA Citation
Samadder, N. Jewel, et al. “Clinical and Molecular Features of Post-Colonoscopy Colorectal Cancers..” Clin Gastroenterol Hepatol, vol. 17, no. 13, Dec. 2019, pp. 2731-2739.e2. Pubmed, doi:10.1016/j.cgh.2019.02.040.
URI
https://scholars.duke.edu/individual/pub1380049
PMID
30930275
Source
pubmed
Published In
Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
Volume
17
Published Date
Start Page
2731
End Page
2739.e2
DOI
10.1016/j.cgh.2019.02.040

Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool.

BACKGROUND: Adapting screening strategy to colorectal cancer (CRC) risk may improve efficiency for all stakeholders however limited tools for such risk stratification exist. Colorectal cancers usually evolve from advanced neoplasms that are present for years. We applied the National Cancer Institute (NCI) CRC Risk Assessment Tool, which calculates future risk of CRC, to determine whether it could be used to predict current advanced neoplasia (AN) in a veteran cohort undergoing a baseline screening colonoscopy. METHODS: This was a prospective assessment of the relationship between future CRC risk predicted by the NCI tool, and the presence of AN at screening colonoscopy. Family, medical, dietary and physical activity histories were collected at the time of screening colonoscopy and used to calculate absolute CRC risk at 5, 10 and 20 years. Discriminatory accuracy was assessed. RESULTS: Of 3121 veterans undergoing screening colonoscopy, 94% had complete data available to calculate risk (N = 2934, median age 63 years, 100% men, and 15% minorities). Prevalence of AN at baseline screening colonoscopy was 11 % (N = 313). For tertiles of estimated absolute CRC risk at 5 years, AN prevalences were 6.54% (95% CI, 4.99, 8.09), 11.26% (95% CI, 9.28-13.24), and 14.21% (95% CI, 12.02-16.40). For tertiles of estimated risk at 10 years, the prevalences were 6.34% (95% CI, 4.81-7.87), 11.25% (95% CI, 9.27-13.23), and 14.42% (95% CI, 12.22-16.62). For tertiles of estimated absolute CRC risk at 20 years, current AN prevalences were 7.54% (95% CI, 5.75-9.33), 10.53% (95% CI, 8.45-12.61), and 12.44% (95% CI, 10.2-14.68). The area under the curve for predicting current AN was 0.60 (95% CI; 0.57-0.63, p < 0.0001) at 5 years, 0.60 (95% CI, 0.57-0.63, p < 0.0001) at 10 years and 0.58 (95% CI, 0.54-0.61, p < 0.0001) at 20 years. CONCLUSION: The NCI tool had modest discriminatory function for estimating the presence of current advanced neoplasia in veterans undergoing a first screening colonoscopy. These findings are comparable to other clinically utilized cancer risk prediction models and may be used to inform the benefit-risk assessment of screening, particularly for patients with competing comorbidities and lower risk, for whom a non-invasive screening approach is preferred.
Authors
Musselwhite, LW; Redding, TS; Sims, KJ; O'Leary, MC; Hauser, ER; Hyslop, T; Gellad, ZF; Sullivan, BA; Lieberman, D; Provenzale, D
MLA Citation
Musselwhite, Laura W., et al. “Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool..” Bmc Cancer, vol. 19, no. 1, Nov. 2019. Pubmed, doi:10.1186/s12885-019-6204-1.
URI
https://scholars.duke.edu/individual/pub1421458
PMID
31718588
Source
pubmed
Published In
Bmc Cancer
Volume
19
Published Date
Start Page
1097
DOI
10.1186/s12885-019-6204-1

An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial.

BACKGROUND: Colorectal cancer is the fourth most commonly diagnosed cancer in the United States. Approximately 3-10% of the population has an increased risk for colorectal cancer due to family history and warrants more frequent or intensive screening. Yet, < 50% of that high-risk population receives guideline-concordant care. Systematic collection of family health history and decision support may improve guideline-concordant screening for patients at increased risk of colorectal cancer. We seek to test the effectiveness of a web-based, systematic family health history collection tool and decision support platform (MeTree) to improve risk assessment and appropriate management of colorectal cancer risk among patients in the Department of Veterans Affairs primary care practices. METHODS: In this ongoing randomized controlled trial, primary care providers at the Durham Veterans Affairs Health Care System and the Madison VA Medical Center are randomized to immediate intervention or wait-list control. Veterans are eligible if assigned to enrolled providers, have an upcoming primary care appointment, and have no conditions that would place them at increased risk for colorectal cancer (such as personal history, adenomatous polyps, or inflammatory bowel disease). Those with a recent lower endoscopy (e.g. colonoscopy, sigmoidoscopy) are excluded. Immediate intervention patients put their family health history information into a web-based platform, MeTree, which provides both patient- and provider-facing decision support reports. Wait-list control patients access MeTree 12 months post-consent. The primary outcome is the risk-concordant colorectal cancer screening referral rate obtained via chart review. Secondary outcomes include patient completion of risk management recommendations (e.g. colonoscopy) and referral for genetic consultation. We will also conduct an economic analysis and an assessment of providers' experience with MeTree clinical decision support recommendations to inform future implementation efforts if the intervention is found to be effective. DISCUSSION: This trial will assess the feasibility and effectiveness of patient-collected family health history linked to decision support to promote risk-appropriate screening in a large healthcare system such as the Department of Veterans Affairs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02247336 . Registered on 25 September 2014.
Authors
Goldstein, KM; Fisher, DA; Wu, RR; Orlando, LA; Coffman, CJ; Grubber, JM; Rakhra-Burris, T; Wang, V; Scheuner, MT; Sperber, N; Datta, SK; Nelson, RE; Strawbridge, E; Provenzale, D; Hauser, ER; Voils, CI
MLA Citation
Goldstein, Karen M., et al. “An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial..” Trials, vol. 20, no. 1, Oct. 2019. Pubmed, doi:10.1186/s13063-019-3659-y.
URI
https://scholars.duke.edu/individual/pub1414998
PMID
31590688
Source
pubmed
Published In
Trials
Volume
20
Published Date
Start Page
576
DOI
10.1186/s13063-019-3659-y

NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 2.2019.

Identifying individuals with hereditary syndromes allows for improved cancer surveillance, risk reduction, and optimized management. Establishing criteria for assessment allows for the identification of individuals who are carriers of pathogenic genetic variants. The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal provide recommendations for the assessment and management of patients with high-risk colorectal cancer syndromes. These NCCN Guidelines Insights focus on criteria for the evaluation of Lynch syndrome and considerations for use of multigene testing in the assessment of hereditary colorectal cancer syndromes.
Authors
Gupta, S; Provenzale, D; Llor, X; Halverson, AL; Grady, W; Chung, DC; Haraldsdottir, S; Markowitz, AJ; Slavin, TP; Hampel, H; CGC,; Ness, RM; Weiss, JM; Ahnen, DJ; Chen, L-M; Cooper, G; Early, DS; Giardiello, FM; Hall, MJ; Hamilton, SR; Kanth, P; Klapman, JB; Lazenby, AJ; Lynch, PM; Mayer, RJ; Mikkelson, J; CGC,; Peter, S; Regenbogen, SE; Dwyer, MA; CGC,; Ogba, N
MLA Citation
Gupta, Samir, et al. “NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 2.2019..” J Natl Compr Canc Netw, vol. 17, no. 9, Sept. 2019, pp. 1032–41. Pubmed, doi:10.6004/jnccn.2019.0044.
URI
https://scholars.duke.edu/individual/pub1412431
PMID
31487681
Source
pubmed
Published In
J Natl Compr Canc Netw
Volume
17
Published Date
Start Page
1032
End Page
1041
DOI
10.6004/jnccn.2019.0044

Race, Poverty, and Mental Health Drive Colorectal Cancer Screening Disparities in the Veterans Health Administration.

INTRODUCTION: Colorectal cancer (CRC) is a common but largely preventable malignancy. Screening is recommended for all adults aged 50-75 years; however, screening rates are low nationally and vary by patient factors and across health care systems. It is currently unknown whether there are inequities in CRC screening rates by patient sociodemographic and/or clinical factors in the Veterans Health Administration (VA) where the majority of patients are CRC screening-eligible age and CRC is the third most commonly diagnosed cancer. METHODS: We performed a retrospective cohort study using VA national clinical performance and quality data to determine the overall CRC screening rate, rates by patient sociodemographic and clinical factors, and predictors of screening adjusting for patient and system factors. We also determined whether disparities in screening exist in VA. RESULTS: The overall CRC screening rate in VA was 81.5%. Screening rates were lowest among American Indians/Alaska Natives [75.3%; adjusted odds ratio (aOR)=0.77, 95% confidence interval (CI)=0.65-0.90], those with serious mental illness (75.8%; aOR=0.65, 95% CI=0.61-0.69), those with substance abuse (76.9%; aOR=0.76, 95% CI=0.72-0.80), and those in the lowest socioeconomic status quintile (79.5%; aOR=1.10-1.31 for quintiles 2-5 vs. lowest quintile 1). Increasing age, Hispanic ethnicity, black race, Asian race, and high comorbidity were significant predictors of screening uptake. CONCLUSIONS: Many racial/ethnic disparities in CRC screening documented in non-VA settings do not exist in VA. Nonetheless, overall high VA CRC screening rates have not reached American Indians/Alaska Natives, low socioeconomic status groups, and those with mental illness and substance abuse. These groups might benefit from additional targeted efforts to increase screening uptake.
Authors
May, FP; Yano, EM; Provenzale, D; Steers, WN; Washington, DL
MLA Citation
May, Folasade P., et al. “Race, Poverty, and Mental Health Drive Colorectal Cancer Screening Disparities in the Veterans Health Administration..” Med Care, vol. 57, no. 10, Oct. 2019, pp. 773–80. Pubmed, doi:10.1097/MLR.0000000000001186.
URI
https://scholars.duke.edu/individual/pub1406802
PMID
31415338
Source
pubmed
Published In
Med Care
Volume
57
Published Date
Start Page
773
End Page
780
DOI
10.1097/MLR.0000000000001186