Patricia A. Ganz, MD

Breast cancer survivors face a myriad of physical and emotional challenges after completion of their cancer treatments. BCRF funds are supporting a range of research activities in Dr. Ganz's laboratory that are primarily focused on a better understanding of who is at risk for post-treatment persistent symptoms such as fatigue, depression, sleep disturbance and cognitive problems. Her team especially focuses on the latter issues, popularly known as "chemobrain." They have conducted laboratory studies in the past year showing that some women are genetically predisposed to have more severe symptoms after breast cancer treatment, especially chemotherapy. In parallel, they have developed and are testing a five-week group intervention to help women who are suffering from cognitive problems (memory, concentration) after treatments, and are showing early encouraging results with the program.

Dr. Ganz has initiated several efforts to advance clinical care for breast cancer survivors. One of the studies she is conducting is a comparison study of breast cancer follow-up care for women treated at UCLA, both those who have and have not received a survivorship care plan. In connection with her BCRF-supported ASCO Professorship in Comparative Effectiveness Research, she has submitted grant proposal for a comparative effectiveness study at a community medical center affiliated with UCLA's Survivorship Center of Excellence. Dr. Ganz is also mentoring junior faculty in breast cancer comparative effectiveness research. In addition, she and one of her junction colleagues have initiated an evaluation of the survivorship care program at the county hospital affiliated with the survivorship center.

BCRF funding has been also been applied towards a study through the National Surgical Adjuvant Breast and Bowel Project led by Dr. Ganz. Clinical trials focus primarily on the efficacy of a treatment -- does it prolong survival or disease-free survival? The final outcomes and interpretation of clinical trials are often enhanced through collection of patient reported outcomes (PROs) related to symptoms and quality of life that reflect the experience of the patients receiving the therapy, especially when one treatment arm is expected to be substantially more toxic than the other.

A second kind of outcome study, less frequently included in this setting, is a cost of care study; however, such research is equally important for the interpretation of how best to implement the results of clinical trials in breast cancer once a trial has been completed. As new targeted therapies demonstrate benefit in advanced metastatic breast cancer, they are being moved into the adjuvant treatment of breast cancer. These new agents bring substantial promise for higher cure rates when added to standard adjuvant therapy but can also add substantially to the cost of care. The increased cost of care includes the drug itself, which may be considerable, along with additional costs that can be incurred due to increased toxicities resulting in additional office visits, prescribed medications to manage toxicities, as well as increased hospitalizations. Collecting this type of data prospectively, during the conduct of the trial, is essential in order to assess the additional cost burden of administering a new agent. BCRF funds are allowing researchers to collect data on the extra costs incurred by women who receive the new agent everolimus (Affinitor®) in addition to standard endocrine adjuvant therapy, in a large randomized trial, to determine whether or not the benefits of therapy outweigh the costs. BCRF support will help with the development of the questionnaire to collect the cost data as well as modest support for the additional data collection by the clinical trials staff. The team has started working on amending the study protocol and development of the data collection questionnaire.

Mid-year Progress: Dr. Ganz's team finished a large study of 190 women who had in-depth cognitive testing during the year after treatment ended, before and after endocrine therapy started. Through BCRF support, they have been following these women with annual questionnaires to examine further late effects of treatment. They have found a close association between self-reported cognitive complaints and cognitive testing, as well as blood levels of inflammation. These study participants are invited back for a comprehensive in-person follow-up visit that will re-test their cognitive function as well as examine blood tests and brain wave (EEG) tests to determine whether or not initial difficulties with cognitive functioning persist. Dr. Ganz and colleagues have also tested an intervention to help women improve their memory and concentration, and demonstrated improvements on repeat testing along with improvements in EEG tests. These encouraging findings are now being evaluated in a small randomized study as a preliminary step before a larger definitive trial. Recruitment to the intervention trial is going well, with 31 women enrolled and plans to enroll another 20-30 women in the coming months.

In her BCRF-supported ASCO Professorship in Comparative Effectiveness Research, Dr. Ganz is actively mentoring two individuals: Erin Hahn, MPH, a doctoral student in the UCLA School of Public Health, continues her training with Dr. Ganz and has advanced to candidacy for her doctoral degree. One of the main papers of Ms. Hahn's dissertation is an examination of the follow-up care outcomes for breast cancer survivors at UCLA and whether they received care that was concordant with ASCO guidelines. These results were presented at the recent ASCO Quality of Care meeting and are being prepared for publication.

Ms. Hahn is also working on another comparative effectiveness project with Dr. Ganz that is looking at the quality of survivorship care across five University of California (UC) Comprehensive Cancer Centers. The research team is trying to understand how post-treatment care is delivered at each site, and how to improve the coordination and quality of care. They have completed key informant interviews at each of the sites and a manuscript has been submitted for publication describing the results. Additional data from a patient survey has been completed and preliminarily reported at the ASCO Quality of Care meeting and a paper is being prepared for publication.

Melinda Maggard Gibbons, MD, is an Associate Professor of Surgery, who is transitioning to an independent research career with a focus on quality of care in underserved breast cancer patients. With Dr. Ganz's guidance, she has conducted an evaluation of the survivorship program at UCLA-Olive View Medical Center, a public facility providing care to underserved women with breast cancer. Several manuscripts are in preparation that will describe the study findings. Based on this evaluation of the survivorship care services provided by a nurse practitioner at this facility, she is looking for ways to transition these patients to primary care so that many of their chronic medical care needs can be met. Dr. Gibbons has recently been awarded two years of pilot funding to conduct this research at UCLA-Olive View Medical Center.

Bio:
Dr. Patricia A. Ganz is a medical oncologist who has spent the past 20 years doing systematic research on the health-related quality of life impact of cancer and its treatment. She currently holds an American Cancer Society Clinical Research Professorship, and is Professor in the UCLA Schools of Medicine and Public Health. She serves as an Associate Editor for the Journal of Clinical Oncology and the Journal of the National Cancer Institute. She has also been actively involved in measurement of quality of life endpoints in clinical trials, with leadership roles in the Southwest Oncology Group (SWOG) and the National Surgical Adjuvant Breast and Bowel Project (NSABP).

Through her research she has contributed to our understanding of how women adjust to the diagnosis of breast cancer, including its effects on their physical, emotional, social, and sexual well-being. She has completed several studies that have examined quality of life in breast cancer survivors, and is completing a study funded by the National Cancer Institute that evaluates an intervention for breast cancer patients who have completed their treatments and are "Preparing for Survivorship." Dr. Ganz is a founding member of the National Coalition for Cancer Survivorship (NCCS), and was previously awarded The Breast Cancer Research Foundation's Jill Rose Award and the Susan G. Komen Professor of Survivorship.

Dr. Ganz has been selected as the first recipient of the ASCO Research Professorship in Comparative Effectiveness Research. The professorship honors outstanding researchers who have made and are continuing to make significant contributions that have changed the direction of breast cancer research and who will provide mentorship to junior researchers. Dr. Ganz will receive $500,000 over five years which will enable her to investigate comparative effectiveness in breast cancer and train future generations of researchers in this field. The Comparative Effectiveness Research Professorship in Breast Cancer was established at ASCO this year with a grant from BCRF, so it is especially heartening that Dr. Ganz was independently selected by the ASCO Awards Committee.