Mary Linton B Peters, MD MS, FACP is a Gastrointestinal Oncologist at Beth Israel Deaconess Medical Center (BIDMC) and Assistant Professor of Medicine at Harvard Medical School. Her research interests are in medical decision making, clinical trial design, and the genetics of pancreatic cancer.
Mary Linton completed her SB in Biology from MIT in 1992 and received an MS in Engineering-Economic Systems (Medical Decision Analysis) from Stanford University in 1995. Prior to her medical education, she was a Partner at Strategic Decisions Group in the Life Sciences practice. She received her MD from University of Massachusetts Medical School in 2011, completed Internal Medicine residency at BIDMC in 2014, and completed Hematology/Oncology fellowship at BIDMC in 2017. She is a fellow of the American College of Physicians and of the Society of Decision Professionals.
Her initial academic and professional experience was in decision analysis and disease modeling, first at Stanford and then at Strategic Decisions Group. In recognition of this expertise, she was elected Fellow of the Society of Decision Professionals. As part of her medical training, she gained experience in clinical research and health outcomes modeling, including dedicated research training during medical school and residency, and Harvard Catalyst courses in biostatistics and grant writing. Dr. Peters was selected to attend the AACR/ASCO Methods in Clinical Cancer Research workshop, developing a Phase 2 protocol in cholangiocarcinoma. She has worked with MGH’s Institute for Technology Assessment (ITA) since 2015. Mentored by Dr Pari Pandharipande, past director of the ITA, they developed a model of MRI screening strategies for first-degree family members of pancreatic ductal adenocarcinoma (PDAC) patients, the basis for Dr. Peter's current research into the cost-effectiveness of germline genetic testing in this disease. In March 2020 she was awarded a K08 to support this work. Upon completion of a fellowship in June 2017, she joined the faculty at BIDMC in the Medical Oncology division, with a clinical focus in GI Oncology and specifically hepatobiliary and pancreatic malignancies. In early 2020 she was promoted to Assistant Professor and became a senior scientist at the ITA. I am DF/HCC lead PI for 4 clinical trials and Site PI for 12 clinical trials largely in hepatobiliary cancers.
Selected Publications
Peters, Mary Linton B.; Eckel, Andrew; Lietz, Anna; Seguin, Claudia; Mueller, Peter; Hur, Chin; Pandharipande, Pari V.
In: Pancreatology, vol. 22, iss. 6, pp. 760-769, 2022, ISSN: 1424-3903.
@article{PETERS2022,
title = {Genetic testing to guide screening for pancreatic ductal adenocarcinoma: Results of a microsimulation model},
author = {Mary Linton B. Peters and Andrew Eckel and Anna Lietz and Claudia Seguin and Peter Mueller and Chin Hur and Pari V. Pandharipande},
url = {https://www.sciencedirect.com/science/article/pii/S1424390322001703},
doi = {https://doi.org/10.1016/j.pan.2022.05.003},
issn = {1424-3903},
year = {2022},
date = {2022-09-22},
urldate = {2022-05-31},
journal = {Pancreatology},
volume = {22},
issue = {6},
pages = {760-769},
abstract = {Background
First-degree relatives (FDRs) of patients with pancreatic ductal adenocarcinoma (PDAC) have elevated PDAC risk, partially due to germline genetic variants. We evaluated the potential effectiveness of genetic testing to target MRI-based screening among FDRs.
Methods
We used a microsimulation model of PDAC, calibrated to Surveillance, Epidemiology, and End Results (SEER) data, to estimate the potential life expectancy (LE) gain of screening for each of the following groups of FDRs: indviduals who test positive for each of eight variants associated with elevated PDAC risk (e.g., BRCA2, CDKN2A); individuals who test negative; and individuals who do not test. Screening was assumed to take place if LE gains were achievable. We simulated multiple screening approaches, defined by starting age and frequency. Sensitivity analysis evaluated changes in results given varying model assumptions.
Results
For women, 92% of mutation carriers had projected LE gains from screening for PDAC, if screening strategies (start age, frequency) were optimized. Among carriers, LE gains ranged from 0.1 days (ATM + women screened once at age 70) to 510 days (STK11+ women screened annually from age 40). For men, LE gains were projected for all mutation carriers, ranging from 0.2 days (BRCA1+ men screened once at age 70) to 620 days (STK11+ men screened annually from age 40). For men and women who did not undergo genetic testing, or for whom testing showed no variant, screening yielded small LE benefit (0\textendash2.1 days).
Conclusions
Genetic testing of FDRs can inform targeted PDAC screening by identifying which FDRs may benefit.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background
First-degree relatives (FDRs) of patients with pancreatic ductal adenocarcinoma (PDAC) have elevated PDAC risk, partially due to germline genetic variants. We evaluated the potential effectiveness of genetic testing to target MRI-based screening among FDRs.
Methods
We used a microsimulation model of PDAC, calibrated to Surveillance, Epidemiology, and End Results (SEER) data, to estimate the potential life expectancy (LE) gain of screening for each of the following groups of FDRs: indviduals who test positive for each of eight variants associated with elevated PDAC risk (e.g., BRCA2, CDKN2A); individuals who test negative; and individuals who do not test. Screening was assumed to take place if LE gains were achievable. We simulated multiple screening approaches, defined by starting age and frequency. Sensitivity analysis evaluated changes in results given varying model assumptions.
Results
For women, 92% of mutation carriers had projected LE gains from screening for PDAC, if screening strategies (start age, frequency) were optimized. Among carriers, LE gains ranged from 0.1 days (ATM + women screened once at age 70) to 510 days (STK11+ women screened annually from age 40). For men, LE gains were projected for all mutation carriers, ranging from 0.2 days (BRCA1+ men screened once at age 70) to 620 days (STK11+ men screened annually from age 40). For men and women who did not undergo genetic testing, or for whom testing showed no variant, screening yielded small LE benefit (0–2.1 days).
Conclusions
Genetic testing of FDRs can inform targeted PDAC screening by identifying which FDRs may benefit.
First-degree relatives (FDRs) of patients with pancreatic ductal adenocarcinoma (PDAC) have elevated PDAC risk, partially due to germline genetic variants. We evaluated the potential effectiveness of genetic testing to target MRI-based screening among FDRs.
Methods
We used a microsimulation model of PDAC, calibrated to Surveillance, Epidemiology, and End Results (SEER) data, to estimate the potential life expectancy (LE) gain of screening for each of the following groups of FDRs: indviduals who test positive for each of eight variants associated with elevated PDAC risk (e.g., BRCA2, CDKN2A); individuals who test negative; and individuals who do not test. Screening was assumed to take place if LE gains were achievable. We simulated multiple screening approaches, defined by starting age and frequency. Sensitivity analysis evaluated changes in results given varying model assumptions.
Results
For women, 92% of mutation carriers had projected LE gains from screening for PDAC, if screening strategies (start age, frequency) were optimized. Among carriers, LE gains ranged from 0.1 days (ATM + women screened once at age 70) to 510 days (STK11+ women screened annually from age 40). For men, LE gains were projected for all mutation carriers, ranging from 0.2 days (BRCA1+ men screened once at age 70) to 620 days (STK11+ men screened annually from age 40). For men and women who did not undergo genetic testing, or for whom testing showed no variant, screening yielded small LE benefit (0–2.1 days).
Conclusions
Genetic testing of FDRs can inform targeted PDAC screening by identifying which FDRs may benefit.
Mueller, Peter P.; Chen, Qiushi; Ayer, Turgay; Nemutlu, Gizem; Hajjar, Ali; Bethea, Emily D.; Peters, Mary Linton B.; Lee, Brian P.; Janjua, Naveed Z.; Kanwal, Fasiha; Chhatwal, Jagpreet
Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication. Journal Article
In: Journal of hepatology, vol. 77, iss. 1, pp. 55-62, 2022, ISSN: 1600-0641.
@article{Mueller2022,
title = {Duration and cost-effectiveness of hepatocellular carcinoma surveillance in hepatitis C patients after viral eradication.},
author = {Peter P. Mueller and Qiushi Chen and Turgay Ayer and Gizem Nemutlu and Ali Hajjar and Emily D. Bethea and Mary Linton B. Peters and Brian P. Lee and Naveed Z. Janjua and Fasiha Kanwal and Jagpreet Chhatwal},
url = {https://pubmed.ncbi.nlm.nih.gov/35157959/},
doi = {10.1016/j.jhep.2022.01.027},
issn = {1600-0641},
year = {2022},
date = {2022-07-01},
urldate = {2022-02-01},
journal = {Journal of hepatology},
volume = {77},
issue = {1},
pages = {55-62},
abstract = {Successful treatment of chronic hepatitis C with oral direct-acting antiviral (DAA) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop surveillance. We developed a microsimulation model of the natural history of HCC in hepatitis C individuals with advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. We compared biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) versus no surveillance. In virologically-cured patients with cirrhosis, the ICER of biannual surveillance remained below $150,000 per additional quality-adjusted life year (QALY) (range: $79,500-$94,800) when surveillance was stopped at age 70, irrespective of the start age (40-65). Compared with no surveillance, surveillance per 1000 cirrhosis patients detected 130 additional HCCs in 'very early'/early stage and yielded 51 additional QALYs. In virologically-cured patients with advanced fibrosis, the ICER of biannual surveillance remained below $150,000/QALY (range: $124,600-$129,800) when surveillance was stopped at age 60, irrespective of the start age (40-50). Compared with no surveillance, surveillance per 1000 advanced fibrosis patients detected 24 additional HCCs in 'very early'/early stage and yielded 12 additional QALYs. Biannual surveillance for HCC in virologically-cured hepatitis C patients is cost-effective until the age of 70 for cirrhosis patients, and until the age of 60 for patients with stable advanced fibrosis. Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing liver cancer. The value of lifelong screening for liver cancer in these individuals is not known. By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based bi-annual screening for liver cancer is cost-effective up to age 70 in those having cirrhosis and up to age 60 in those having stable advanced fibrosis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Successful treatment of chronic hepatitis C with oral direct-acting antiviral (DAA) leads to virological cure, however, the subsequent risk of hepatocellular carcinoma (HCC) persists. Our objective was to evaluate the cost-effectiveness of biannual surveillance for HCC in patients cured of hepatitis C and the optimal age to stop surveillance. We developed a microsimulation model of the natural history of HCC in hepatitis C individuals with advanced fibrosis or cirrhosis who achieved virological cure with oral DAAs. We used published data on HCC incidence, tumor progression, real-world HCC surveillance adherence, and costs and utilities of different health states. We compared biannual HCC surveillance using ultrasound and alpha-fetoprotein for varying durations of surveillance (from 5 years to lifetime) versus no surveillance. In virologically-cured patients with cirrhosis, the ICER of biannual surveillance remained below $150,000 per additional quality-adjusted life year (QALY) (range: $79,500-$94,800) when surveillance was stopped at age 70, irrespective of the start age (40-65). Compared with no surveillance, surveillance per 1000 cirrhosis patients detected 130 additional HCCs in 'very early'/early stage and yielded 51 additional QALYs. In virologically-cured patients with advanced fibrosis, the ICER of biannual surveillance remained below $150,000/QALY (range: $124,600-$129,800) when surveillance was stopped at age 60, irrespective of the start age (40-50). Compared with no surveillance, surveillance per 1000 advanced fibrosis patients detected 24 additional HCCs in 'very early'/early stage and yielded 12 additional QALYs. Biannual surveillance for HCC in virologically-cured hepatitis C patients is cost-effective until the age of 70 for cirrhosis patients, and until the age of 60 for patients with stable advanced fibrosis. Individuals who are cured of hepatitis C using oral antiviral drugs remain at risk of developing liver cancer. The value of lifelong screening for liver cancer in these individuals is not known. By simulating the life course of hepatitis C cured individuals, we found that ultrasound-based bi-annual screening for liver cancer is cost-effective up to age 70 in those having cirrhosis and up to age 60 in those having stable advanced fibrosis.
Santoro, Stephanie L.; Peters, Mary Linton B.
K Awards: The Journey of a Thousand Steps. Journal Article
In: Annals of internal medicine, 2021, ISSN: 1539-3704, ().
@article{Santoro2021a,
title = {K Awards: The Journey of a Thousand Steps.},
author = {Stephanie L. Santoro and Mary Linton B. Peters},
url = {https://pubmed.ncbi.nlm.nih.gov/34781710/},
doi = {10.7326/M21-2692},
issn = {1539-3704},
year = {2021},
date = {2021-11-01},
journal = {Annals of internal medicine},
keywords = {},
pubstate = {aheadofprint},
tppubtype = {article}
}
Grossman, Joseph E.; Muthuswamy, Lakshmi; Huang, Ling; Akshinthala, Dipikaa; Perea, Sofia; Gonzalez, Raul S.; Tsai, Leo L.; Cohen, Jonah; Bockorny, Bruno; Bullock, Andrea J.; Schlechter, Benjamin; Peters, Mary Linton B.; Conahan, Catherine; Narasimhan, Supraja; Lim, Christine; Davis, Roger B.; Besaw, Robert; Sawhney, Mandeep S.; Pleskow, Douglas; Berzin, Tyler M.; Smith, Martin; Kent, Tara S.; Callery, Mark; Muthuswamy, Senthil K.; Hidalgo, Manuel
Organoid Sensitivity Correlates with Therapeutic Response in Patients with Pancreatic Cancer. Journal Article
In: Clinical cancer research : an official journal of the American Association for Cancer Research, 2021, ISSN: 1557-3265, ().
@article{Grossman2021,
title = {Organoid Sensitivity Correlates with Therapeutic Response in Patients with Pancreatic Cancer.},
author = {Joseph E. Grossman and Lakshmi Muthuswamy and Ling Huang and Dipikaa Akshinthala and Sofia Perea and Raul S. Gonzalez and Leo L. Tsai and Jonah Cohen and Bruno Bockorny and Andrea J. Bullock and Benjamin Schlechter and Mary Linton B. Peters and Catherine Conahan and Supraja Narasimhan and Christine Lim and Roger B. Davis and Robert Besaw and Mandeep S. Sawhney and Douglas Pleskow and Tyler M. Berzin and Martin Smith and Tara S. Kent and Mark Callery and Senthil K. Muthuswamy and Manuel Hidalgo},
url = {https://pubmed.ncbi.nlm.nih.gov/34789479/},
doi = {10.1158/1078-0432.CCR-20-4116},
issn = {1557-3265},
year = {2021},
date = {2021-11-01},
journal = {Clinical cancer research : an official journal of the American Association for Cancer Research},
abstract = {Pancreatic ductal adenocarcinoma (PDAC) remains a significant health issue. For most patients there are no options for targeted therapy and existing treatments are limited by toxicity. The HOPE trial (Harnessing Organoids for PErsonalized Therapy) was a pilot feasibility trial aiming to prospectively generate patient derived organoids (PDOs) from patients with PDAC and test their drug sensitivity and correlation with clinical outcomes. PDOs were established from a heterogeneous population of patients with PDAC including both basal and classical PDAC subtypes. A method for classifying PDOs as sensitive or resistant to chemotherapy regimens was developed to predict the clinical outcome of study subjects. Drug sensitivity testing on PDOs correlated with clinical responses to treatment in individual patients. These data support the investigation of PDOs to guide treatment in prospective interventional trials in PDAC.},
keywords = {},
pubstate = {aheadofprint},
tppubtype = {article}
}
Pancreatic ductal adenocarcinoma (PDAC) remains a significant health issue. For most patients there are no options for targeted therapy and existing treatments are limited by toxicity. The HOPE trial (Harnessing Organoids for PErsonalized Therapy) was a pilot feasibility trial aiming to prospectively generate patient derived organoids (PDOs) from patients with PDAC and test their drug sensitivity and correlation with clinical outcomes. PDOs were established from a heterogeneous population of patients with PDAC including both basal and classical PDAC subtypes. A method for classifying PDOs as sensitive or resistant to chemotherapy regimens was developed to predict the clinical outcome of study subjects. Drug sensitivity testing on PDOs correlated with clinical responses to treatment in individual patients. These data support the investigation of PDOs to guide treatment in prospective interventional trials in PDAC.
Chamberlain, Christina X; Faust, Elizabeth; Goldschmidt, Debbie; Webster, Nathan; Boscoe, Audra N; Macaulay, Dendy; Peters, Mary Linton B.
Burden of illness for patients with cholangiocarcinoma in the United States: a retrospective claims analysis. Journal Article
In: Journal of gastrointestinal oncology, vol. 12, pp. 658–668, 2021, ISSN: 2078-6891, ().
@article{Chamberlain2021,
title = {Burden of illness for patients with cholangiocarcinoma in the United States: a retrospective claims analysis.},
author = {Christina X Chamberlain and Elizabeth Faust and Debbie Goldschmidt and Nathan Webster and Audra N Boscoe and Dendy Macaulay and Mary Linton B. Peters},
url = {https://pubmed.ncbi.nlm.nih.gov/34012657/},
doi = {10.21037/jgo-20-544},
issn = {2078-6891},
year = {2021},
date = {2021-04-01},
journal = {Journal of gastrointestinal oncology},
volume = {12},
pages = {658--668},
abstract = {Advanced cholangiocarcinoma (CCA) is associated with considerable morbidity and mortality. Novel second-line treatments for advanced CCA underscore the need to understand treatment patterns and economic burden of illness in clinical practice. This retrospective, claims-based study using Optum's de-identified Clinformatics Data Mart Database [2007-2019] selected patients with CCA who experienced failure of a line of therapy containing either gemcitabine or fluorouracil. The index date was defined based on evidence of treatment failure: date of last administration of the gemcitabine- or fluorouracil-based regimen plus 28 days, or initiation date of the next-line systemic therapy. Treatment patterns, healthcare resource use (HRU), costs, and survival were assessed during the follow-up period (index until death or end of eligibility). A total of 1,298 patients met inclusion criteria and had a mean age of 69.1 years. There were 958 patients (73.8%) with intrahepatic and 275 patients (21.2%) with extrahepatic CCA. Average follow-up was 7.5 months. Almost 40% of patients did not receive another line of therapy after the index date. Among the 784 patients who received another line of therapy, 40.3% used fluorouracil-based therapy, 30.7% used gemcitabine-based therapy, and 29.3% used capecitabine-based therapy. Total mean per patient per month CCA-related healthcare costs were $7,743, with medical services ($6,685) a larger driver of monthly costs relative to treatment costs ($1,058). Median overall survival (OS) was 5.3 months among all patients. Many patients with advanced CCA do not initiate additional therapy after failure of gemcitabine or fluorouracil treatment, and there is considerable variation in treatments among those who do. This study highlights the high costs and unmet need for a standard of care in this patient population.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Advanced cholangiocarcinoma (CCA) is associated with considerable morbidity and mortality. Novel second-line treatments for advanced CCA underscore the need to understand treatment patterns and economic burden of illness in clinical practice. This retrospective, claims-based study using Optum's de-identified Clinformatics Data Mart Database [2007-2019] selected patients with CCA who experienced failure of a line of therapy containing either gemcitabine or fluorouracil. The index date was defined based on evidence of treatment failure: date of last administration of the gemcitabine- or fluorouracil-based regimen plus 28 days, or initiation date of the next-line systemic therapy. Treatment patterns, healthcare resource use (HRU), costs, and survival were assessed during the follow-up period (index until death or end of eligibility). A total of 1,298 patients met inclusion criteria and had a mean age of 69.1 years. There were 958 patients (73.8%) with intrahepatic and 275 patients (21.2%) with extrahepatic CCA. Average follow-up was 7.5 months. Almost 40% of patients did not receive another line of therapy after the index date. Among the 784 patients who received another line of therapy, 40.3% used fluorouracil-based therapy, 30.7% used gemcitabine-based therapy, and 29.3% used capecitabine-based therapy. Total mean per patient per month CCA-related healthcare costs were $7,743, with medical services ($6,685) a larger driver of monthly costs relative to treatment costs ($1,058). Median overall survival (OS) was 5.3 months among all patients. Many patients with advanced CCA do not initiate additional therapy after failure of gemcitabine or fluorouracil treatment, and there is considerable variation in treatments among those who do. This study highlights the high costs and unmet need for a standard of care in this patient population.
Xu, Wenxin; Piper-Vallillo, Andrew J; Bindal, Poorva; Wischhusen, Jonathan; Patel, Jaymin M; Costa, Daniel B; Peters, Mary Linton B.
Time to SARS-CoV-2 clearance among patients with cancer and COVID-19. Journal Article
In: Cancer Medicine, vol. 10, no. 5, pp. 1545-1549, 2021, ISSN: 2045-7634, ().
@article{Xu2021,
title = {Time to SARS-CoV-2 clearance among patients with cancer and COVID-19.},
author = {Wenxin Xu and Andrew J Piper-Vallillo and Poorva Bindal and Jonathan Wischhusen and Jaymin M Patel and Daniel B Costa and Mary Linton B. Peters},
url = {https://pubmed.ncbi.nlm.nih.gov/33560590/},
doi = {10.1002/cam4.3708},
issn = {2045-7634},
year = {2021},
date = {2021-03-01},
journal = {Cancer Medicine},
volume = {10},
number = {5},
pages = {1545-1549},
abstract = {For cancer patients, coronavirus disease 19 (COVID-19) infection can lead to delays in cancer therapy both due to the infection itself and due to the need to minimize exposure to other patients and to staff. Clearance guidelines have been proposed, but expected time to clearance has not been established. We identified all patients at a tertiary care hospital cancer center between 25 March 2020 and 6 June 2020 with a positive nasopharyngeal reverse transcriptase polymerase chain reaction (RT-PCR) test for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a cancer-related visit within 3 years, and at least one follow-up assay. We determined the time to clearance using American Society of Clinical Oncology (ASCO), the UK National Institute for Health and Care Excellence (UK-NICE), and Centers for Disease Control and Prevention (CDC) criteria. A matched non-cancer comparison cohort was also identified. Thirty-two cancer patients were identified. Nineteen were cleared by ASCO criteria, with estimated median time to clearance of 50 days. Fourteen patients resumed chemotherapy prior to clearance. Using UK-NICE criteria, median time to clearance would have been 31 days, and using CDC criteria, it would have been 13 days. The matched non-cancer cohort had similar clearance time, but with less frequent testing. SARS-CoV-2 clearance times differ substantially depending on the criteria used and may be prolonged in cancer patients. This could lead to a delay in cancer care, increased use of clearance testing, and extension of infection control precautions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
For cancer patients, coronavirus disease 19 (COVID-19) infection can lead to delays in cancer therapy both due to the infection itself and due to the need to minimize exposure to other patients and to staff. Clearance guidelines have been proposed, but expected time to clearance has not been established. We identified all patients at a tertiary care hospital cancer center between 25 March 2020 and 6 June 2020 with a positive nasopharyngeal reverse transcriptase polymerase chain reaction (RT-PCR) test for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a cancer-related visit within 3 years, and at least one follow-up assay. We determined the time to clearance using American Society of Clinical Oncology (ASCO), the UK National Institute for Health and Care Excellence (UK-NICE), and Centers for Disease Control and Prevention (CDC) criteria. A matched non-cancer comparison cohort was also identified. Thirty-two cancer patients were identified. Nineteen were cleared by ASCO criteria, with estimated median time to clearance of 50 days. Fourteen patients resumed chemotherapy prior to clearance. Using UK-NICE criteria, median time to clearance would have been 31 days, and using CDC criteria, it would have been 13 days. The matched non-cancer cohort had similar clearance time, but with less frequent testing. SARS-CoV-2 clearance times differ substantially depending on the criteria used and may be prolonged in cancer patients. This could lead to a delay in cancer care, increased use of clearance testing, and extension of infection control precautions.
Raber, Inbar; Peters, Mary Linton B.; Asnani, Aarti
In Reply. Journal Article
In: The oncologist, vol. 25, pp. e1255–e1256, 2020, ISSN: 1549-490X, ().
@article{Raber2020a,
title = {In Reply.},
author = {Inbar Raber and Mary Linton B. Peters and Aarti Asnani},
url = {https://pubmed.ncbi.nlm.nih.gov/32436313/},
doi = {10.1634/theoncologist.2020-0119},
issn = {1549-490X},
year = {2020},
date = {2020-08-01},
urldate = {2020-08-01},
journal = {The oncologist},
volume = {25},
pages = {e1255--e1256},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Raber, Inbar; Warack, Sarah; Kanduri, Jaya; Pribish, Abby; Godishala, Anuradha; Abovich, Arielle; Orbite, Anna; Dommaraju, Sujithraj; Frazer, Morgan; Peters, Mary Linton B.; Asnani, Aarti
Fluoropyrimidine-Associated Cardiotoxicity: A Retrospective Case-Control Study. Journal Article
In: The oncologist, vol. 25, pp. e606–e609, 2020, ISSN: 1549-490X, ().
@article{Raber2020,
title = {Fluoropyrimidine-Associated Cardiotoxicity: A Retrospective Case-Control Study.},
author = {Inbar Raber and Sarah Warack and Jaya Kanduri and Abby Pribish and Anuradha Godishala and Arielle Abovich and Anna Orbite and Sujithraj Dommaraju and Morgan Frazer and Mary Linton B. Peters and Aarti Asnani},
url = {https://pubmed.ncbi.nlm.nih.gov/32162823/},
doi = {10.1634/theoncologist.2019-0762},
issn = {1549-490X},
year = {2020},
date = {2020-03-01},
journal = {The oncologist},
volume = {25},
pages = {e606--e609},
abstract = {The fluoropyrimidines, 5-fluorouracil (5-FU) and capecitabine, are commonly used chemotherapeutic agents that have been associated with coronary vasospasm. In this retrospective case-control study, we identified patients at our institution who received 5-FU or capecitabine in 2018. We compared characteristics of patients who experienced cardiotoxicity with controls. We described phenotypes and outcomes of cardiotoxic cases. We identified 177 patients who received fluoropyrimidines. After adjudication, 4.5% of the cohort met the criteria for cardiovascular toxicity. Coronary artery disease was more common among cases than controls (38% vs. 7%, p < .05). There was also a trend toward increased prevalence of cardiovascular risk factors in cases compared with controls. Most cardiotoxic cases had chest pain, although a minority of cases presented with nonischemic cardiomyopathy. Cardiotoxicity phenotypes associated with fluoropyrimidine use are not limited to coronary vasospasm. Cardiac risk factors and ischemic heart disease were highly prevalent among patients with cardiotoxicity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The fluoropyrimidines, 5-fluorouracil (5-FU) and capecitabine, are commonly used chemotherapeutic agents that have been associated with coronary vasospasm. In this retrospective case-control study, we identified patients at our institution who received 5-FU or capecitabine in 2018. We compared characteristics of patients who experienced cardiotoxicity with controls. We described phenotypes and outcomes of cardiotoxic cases. We identified 177 patients who received fluoropyrimidines. After adjudication, 4.5% of the cohort met the criteria for cardiovascular toxicity. Coronary artery disease was more common among cases than controls (38% vs. 7%, p < .05). There was also a trend toward increased prevalence of cardiovascular risk factors in cases compared with controls. Most cardiotoxic cases had chest pain, although a minority of cases presented with nonischemic cardiomyopathy. Cardiotoxicity phenotypes associated with fluoropyrimidine use are not limited to coronary vasospasm. Cardiac risk factors and ischemic heart disease were highly prevalent among patients with cardiotoxicity.
Tramontano, Angela; Chen, Yufan; Watson, Tina; Eckel, Andrew; Sheehan, Deirdre; Peters, Mary Linton B.; Pandharipande, Pari; Hur, Chin; Kong, Chung Yin
Pancreatic cancer treatment costs, including patient liability, by phase of care and treatment modality, 2000-2013. Journal Article
In: Medicine, vol. 98, no. 49, pp. e18082, 2019, ISSN: 1536-5964, ().
@article{Tramontano2019a,
title = {Pancreatic cancer treatment costs, including patient liability, by phase of care and treatment modality, 2000-2013.},
author = {Angela Tramontano and Yufan Chen and Tina Watson and Andrew Eckel and Deirdre Sheehan and Mary Linton B. Peters and Pari Pandharipande and Chin Hur and Chung Yin Kong},
url = {https://www.ncbi.nlm.nih.gov/pubmed/31804317},
doi = {10.1097/MD.0000000000018082},
issn = {1536-5964},
year = {2019},
date = {2019-12-01},
journal = {Medicine},
volume = {98},
number = {49},
pages = {e18082},
abstract = {Our study provides phase-specific cost estimates for pancreatic cancer based on stage and treatment. We compare treatment costs between the different phases and within the stage and treatment modality subgroups. Our cohort included 20,917 pancreatic cancer patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed between 2000 and 2011. We allocated costs into four phases of care-staging (or surgery), initial, continuing, and terminal- and calculated the total, cancer-attributable, and patient-liability costs in 2018 US dollars. We fit linear regression models using log transformation to determine whether costs were predicted by age and calendar year. Monthly cost estimates were high during the staging and surgery phases, decreased over the initial and continuing phases, and increased during the three-month terminal phase. Overall, the linear regression models showed that cancer-attributable costs either remained stable or increased by year, and either were unaffected by age or decreased with older age; continuing phase costs for stage II patients increased with age. Our estimates demonstrate that pancreatic cancer costs can vary widely by stage and treatment received. These cost estimates can serve as an important baseline foundation to guide resource allocation for cancer care and research in the future.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Our study provides phase-specific cost estimates for pancreatic cancer based on stage and treatment. We compare treatment costs between the different phases and within the stage and treatment modality subgroups. Our cohort included 20,917 pancreatic cancer patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed between 2000 and 2011. We allocated costs into four phases of care-staging (or surgery), initial, continuing, and terminal- and calculated the total, cancer-attributable, and patient-liability costs in 2018 US dollars. We fit linear regression models using log transformation to determine whether costs were predicted by age and calendar year. Monthly cost estimates were high during the staging and surgery phases, decreased over the initial and continuing phases, and increased during the three-month terminal phase. Overall, the linear regression models showed that cancer-attributable costs either remained stable or increased by year, and either were unaffected by age or decreased with older age; continuing phase costs for stage II patients increased with age. Our estimates demonstrate that pancreatic cancer costs can vary widely by stage and treatment received. These cost estimates can serve as an important baseline foundation to guide resource allocation for cancer care and research in the future.
Peters, Mary Linton B.; Stobie, Lindsey; Dudley, Beth; Karloski, Eve; Allen, Kyle; Speare, Virginia; Dolinsky, Jill S; Tian, Yuan; DeLeonardis, Kim; Krejdovsky, Jill; Button, Arlene; Lim, Cynthia; Borazanci, Erkut; Brand, Randall; Tung, Nadine
Family communication and patient distress after germline genetic testing in individuals with pancreatic ductal adenocarcinoma. Journal Article
In: Cancer, 2019, ISSN: 1097-0142, ().
@article{Peters2019,
title = {Family communication and patient distress after germline genetic testing in individuals with pancreatic ductal adenocarcinoma.},
author = {Mary Linton B. Peters and Lindsey Stobie and Beth Dudley and Eve Karloski and Kyle Allen and Virginia Speare and Jill S Dolinsky and Yuan Tian and Kim DeLeonardis and Jill Krejdovsky and Arlene Button and Cynthia Lim and Erkut Borazanci and Randall Brand and Nadine Tung},
url = {https://www.ncbi.nlm.nih.gov/pubmed/30980401},
doi = {10.1002/cncr.32077},
issn = {1097-0142},
year = {2019},
date = {2019-04-01},
journal = {Cancer},
abstract = {Germline genetic testing currently is recommended for patients with pancreatic ductal adenocarcinoma (PDAC). In the current study, the authors assessed how often results are communicated to first-degree relatives within 3 months and the emotional impact of testing on patients. A total of 148 patients who were newly diagnosed with PDAC and who had undergone testing of 32 cancer susceptibility genes at 3 academic centers were selected; 71% participated. Subjects completed the Multidimensional Impact of Cancer Risk Assessment (MICRA) and a family communication survey. The results of both surveys were assessed at 3 months according to the genetic test result (positive, negative, or variant of unknown significance [VUS]) and whether a patient met criteria for genetic testing. A total of 99 patients completed the MICRA survey and 104 completed the family communication survey. The average age of the patients was 67 years, 47% were female, 29% had stage III/IV (AJCC 8th edition) disease, and 42% met genetic testing criteria. Approximately 80% of patients told at least 1 first-degree relative about their result. There was a trend toward greater disclosure among patients who tested positive (93% vs 77% for those with a VUS result [P = .149] and 74% for those who tested negative [P = .069]). Patients not meeting genetic testing criteria were less likely to disclose results (69% vs 93%; P = .003). MICRA scores did not differ by test result, age, stage of disease, or sex. The rate of result communication was high, although it was lower among patients who did not meet genetic testing criteria, those who tested negative, or those who had a VUS result. Testing-associated distress was similar across patient groups, and was comparable to that reported by other patients with cancer. Improved communication for all patients is crucial given the prognosis of PDAC, which limits time for disclosure.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Germline genetic testing currently is recommended for patients with pancreatic ductal adenocarcinoma (PDAC). In the current study, the authors assessed how often results are communicated to first-degree relatives within 3 months and the emotional impact of testing on patients. A total of 148 patients who were newly diagnosed with PDAC and who had undergone testing of 32 cancer susceptibility genes at 3 academic centers were selected; 71% participated. Subjects completed the Multidimensional Impact of Cancer Risk Assessment (MICRA) and a family communication survey. The results of both surveys were assessed at 3 months according to the genetic test result (positive, negative, or variant of unknown significance [VUS]) and whether a patient met criteria for genetic testing. A total of 99 patients completed the MICRA survey and 104 completed the family communication survey. The average age of the patients was 67 years, 47% were female, 29% had stage III/IV (AJCC 8th edition) disease, and 42% met genetic testing criteria. Approximately 80% of patients told at least 1 first-degree relative about their result. There was a trend toward greater disclosure among patients who tested positive (93% vs 77% for those with a VUS result [P = .149] and 74% for those who tested negative [P = .069]). Patients not meeting genetic testing criteria were less likely to disclose results (69% vs 93%; P = .003). MICRA scores did not differ by test result, age, stage of disease, or sex. The rate of result communication was high, although it was lower among patients who did not meet genetic testing criteria, those who tested negative, or those who had a VUS result. Testing-associated distress was similar across patient groups, and was comparable to that reported by other patients with cancer. Improved communication for all patients is crucial given the prognosis of PDAC, which limits time for disclosure.