Patricia A. Ganz, MD
Distinguished University Professor, Schools of Medicine and Public Health
Director, Cancer Prevention & Control Research
Jonsson Comprehensive Cancer Center
University of California, Los Angeles, CA
Member, BCRF Scientific Advisory Board
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.
2013-2014 BCRF Project:
(The Estée Lauder Award)
BCRF funds are supporting a range of research activities in Dr. Ganz’s laboratory that are primarily focused on improving cognitive function in breast cancer survivors who have persistent memory and concentration problems. In addition, Dr. Ganz’s group is planning to do long-term follow-up of women who have been exposed to endocrine adjuvant therapy to learn about whether this therapy leads to worsening cognitive problems over time. They are repeating many of the biological studies that were performed in these patients during their first year after diagnosis to see how these may have changed. They are adding new studies that may provide greater insight into the reasons why some women have persistent long-term difficulties with thinking and memory. Specifically, in the coming year, they will focus on completion of a phase II randomized controlled cognitive rehabilitation study, and long-term, in person follow-up of the Mind Body Study breast cancer survivor cohort study participants. In addition, Dr. Ganz is actively mentoring two individuals as part of the BCRF-supported outcomes research professorship awarded by the Conquer Cancer Foundation of the American Society of Clinical Oncology (ASCO).
BCRF funds have supported Dr Ganz’s research examining the impact of breast cancer treatments on cognitive complaints, popularly known as “chemobrain.” Her team has 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 neurocognitive testing, as well as blood levels of inflammation. Using BCRF funding, the researchers are inviting these same women 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. Recruitment for this in-person follow-up visit is going very well, and a number of novel tests have been added, to further understand why some women may have persistent cognitive complaints. The researchers are about to initiate a new pilot brain imaging study to examine whether markers of brain injury associated with Alzheimer’s disease and brain trauma may also be involved in the cognitive changes that breast cancer survivors report. In addition, recent analyses from the parent study demonstrate a significant association between initiation of endocrine adjuvant therapy and language and communication related cognitive complaints, and an interaction with prior hormone therapy. Dr. Ganz and her team are trying to develop a better understanding of who is at risk for these endocrine therapy related complaints.
Also, BCRF funding has been also been applied towards a National Surgical Adjuvant Breast and Bowel Project (NSABP) study also 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,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. BCRF funds in 2012-2013 allowed the NSABP to amend a major treatment protocol studying the new drug everolimus (Affinitor®) to add a cost of care study to a quality of life component. Without this funding and opportunity to add this component, investigators would have missed the opportunity to learn about whether the drug adds to the burden of health care utilization and costs for women who receive it. The revision of the trial has been completed, and it will be launched shortly. This research aims to provide a complete picture of the benefits and risks of this new therapy for breast cancer.
BCRF funding has permitted the researchers to collect data on additional services that may occur alongside the use of a new targeted breast cancer treatment that is being evaluated in a recently launched adjuvant treatment trial. This will facilitate an examination of both the benefits (extended survival), quality of life impact, and value (costs) of this targeted treatment at the end of the trial. Without the real time collection of data concerning side effects that may require additional tests and medical treatments, we would not be able to estimate the additional cost of this new treatment. The increased cost of care includes the drug itself, which is 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. The clinical trial opening was delayed until the fall of 2013. As of mid-January 2014, 25 patients have been registered on the trial with 1 patient in the substudy for quality of life and cost component. The researchers expect the monthly accrual to the trial to accelerate as more clinical sites open the trial.
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.