Kevin Oeffinger

Overview:

Kevin Oeffinger, MD, is a family physician, Professor in the Department of Medicine, and a member of the Duke Cancer Institute (DCI). He is founding Director of the DCI Center for Onco-Primary Care, and Director of the DCI Supportive Care and Survivorship Center. He has a long-standing track record of NIH-supported research in cancer screening and survivorship and has served in a leadership capacity in various cancer-focused and primary care-focused national committees and organizations, including the American Society of Clinical Oncology, the American Cancer Society, and the American Academy of Family Physicians. He is currently an Associate Editor for the Journal of the National Cancer Institute.

The three-fold mission of the DCI Center for Onco-Primary Care are are to: (1) deliver evidence-based, patient-centered, personalized health care across the cancer continuum by enhancing the interface between cancer specialists and primary care clinicians; (2) conduct innovative research with cutting-edge technology that can be translated to the community setting; and (3) train and educate the next generation of clinicians and researchers to extend this mission. 

Dr. Oeffinger's clinical expertise is managing survivors of pediatric and young adult cancer.

Positions:

Professor of Medicine

Medicine, Medical Oncology
School of Medicine

Professor in the Department of Community and Family Medicine

Family Medicine and Community Health
School of Medicine

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. 1984

University of Texas Health Science Center San Antonio

Family Medicine Internship and Residency

Baylor College of Medicine

Family Medicine Academic Fellowship

Baylor College of Medicine

Advanced Research Training, Epidemiology And Genetics, Radiation Epidemiology

National Cancer Institute

Grants:

EMPOWER Study: Promoting BC Screening in Women Who Survived Childhood Cancer

Administered By
Duke Cancer Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Improving Treatment of Cardiovascular Risk Factors in Childhood Cancer Survivors

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
End Date

Childhood Cancer Survivor Study (CCSS)

Administered By
Duke Cancer Institute
Awarded By
St. Jude Children's Research Hospital
Role
Principal Investigator
Start Date
End Date

Generic Testing to Guide Pediatric Cancer Care and Follow Up: Using Anthracycline-associated Cardiac Toxicity as a Model for the Future

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
End Date

Exercise and QUality diet After Leukemia

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
End Date

Publications:

Life Expectancy of Adult Survivors of Childhood Cancer Over 3 Decades.

Importance: Advances in childhood and adolescent cancer treatment have been associated with increased rates of cure during the past 3 decades; however, improvement in adult life expectancy for these individuals has not yet been reported. Objectives: To project long-term survival and assess whether life expectancy will improve among adult survivors of childhood cancer who were treated in more recent decades. Design, Setting, and Participants: A microsimulation model of competing mortality risks was developed using data from the Childhood Cancer Survivor Study on 5-year survivors of childhood cancer diagnosed between 1970 and 1999. The model included (1) late recurrence, (2) treatment-related late effects (health-related [subsequent cancers, cardiac events, pulmonary conditions, and other] and external causes), and (3) US background mortality rates. Exposures: Treatment subgroups (no treatment or surgery only, chemotherapy alone, radiotherapy alone, and radiotherapy with chemotherapy) and individuals with acute lymphoblastic leukemia during childhood by era (1970-1979, 1980-1989, and 1990-1999). Main Outcomes and Measures: Conditional life expectancy (defined as the number of years a 5-year survivor can expect to live), cumulative cause-specific mortality risk, and 10-year mortality risks conditional on attaining ages of 30, 40, 50, and 60 years. Results: Among the hypothetical cohort of 5-year survivors of childhood cancer representative of the Childhood Cancer Survivor Study participants (44% female and 56% male; mean [SD] age at diagnosis, 7.3 [5.6] years), conditional life expectancy was 48.5 years (95% uncertainty interval [UI], 47.6-49.6 years) for 5-year survivors diagnosed in 1970-1979, 53.7 years (95% UI, 52.6-54.7 years) for those diagnosed in 1980-1989, and 57.1 years (95% UI, 55.9-58.1 years) for those diagnosed in 1990-1999. Compared with individuals without a history of cancer, these results represented a gap in life expectancy of 25% (95% UI, 24%-27%) (16.5 years [95% UI, 15.5-17.5 years]) for those diagnosed in 1970-1979, 19% (95% UI, 17%-20%) (12.3 years [95% UI, 11.3-13.4 years]) for those diagnosed in 1980-1989, and 14% (95% UI, 13%-16%) (9.2 years [95% UI, 8.3-10.4 years]) for those diagnosed in 1990-1999. During the 3 decades, the proportion of survivors treated with chemotherapy alone increased (from 18% in 1970-1979 to 54% in 1990-1999), and the life expectancy gap in this chemotherapy-alone group decreased from 11.0 years (95% UI, 9.0-13.1 years) to 6.0 years (95% UI, 4.5-7.6 years). In contrast, during the same time frame, only modest improvements in the gap in life expectancy were projected for survivors treated with radiotherapy (21.0 years [95% UI, 18.5-23.2 years] to 17.6 years [95% UI, 14.2-21.2 years]) or with radiotherapy and chemotherapy (17.9 years [95% UI, 16.7-19.2 years] to 14.8 years [95% UI, 13.1-16.7 years]). For the largest group of survivors by diagnosis-those with acute lymphoblastic leukemia-the gap in life expectancy decreased from 14.7 years (95% UI, 12.8-16.5 years) in 1970-1979 to 8.0 years (95% UI, 6.2-9.7 years). Conclusions and Relevance: Evolving treatment approaches are projected to be associated with improved life expectancy after treatment for pediatric cancer, in particular among those who received chemotherapy alone for their childhood cancer diagnosis. Despite improvements, survivors remain at risk for shorter lifespans, especially when radiotherapy was included as part of their childhood cancer treatment.
Authors
Yeh, JM; Ward, ZJ; Chaudhry, A; Liu, Q; Yasui, Y; Armstrong, GT; Gibson, TM; Howell, R; Hudson, MM; Krull, KR; Leisenring, WM; Oeffinger, KC; Diller, L
MLA Citation
Yeh, Jennifer M., et al. “Life Expectancy of Adult Survivors of Childhood Cancer Over 3 Decades.Jama Oncol, Jan. 2020. Pubmed, doi:10.1001/jamaoncol.2019.5582.
URI
https://scholars.duke.edu/individual/pub1428591
PMID
31895405
Source
pubmed
Published In
Jama Oncol
Published Date
DOI
10.1001/jamaoncol.2019.5582

Longitudinal pain and pain interference in long-term survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

© 2020 American Cancer Society Background: The objective of this study was to characterize the prevalence and risk of pain, pain interference, and recurrent pain in adult survivors of childhood cancer in comparison with siblings. Methods: This study analyzed longitudinal data from survivors (n = 10,012; 48.7% female; median age, 31 years [range, 17-57 years]; median time since diagnosis, 23 years) and siblings (n = 3173) from the Childhood Cancer Survivor Study. Survivors were diagnosed between 1970 and 1986 at 1 of 26 participating sites. Associations between risk factors (demographics, cancer-related factors, and psychological symptoms) and pain, pain interference, and recurrent pain (5 years apart) were assessed with multinomial logistic regression. Path analyses examined cross-sectional associations between risk factors and pain outcomes. Results: Twenty-nine percent of survivors reported moderate to severe pain, 20% reported moderate to extreme pain interference, and 9% reported moderate to severe recurrent pain. Female sex, a sarcoma/bone tumor diagnosis, and severe/life-threatening chronic medical conditions were associated with recurrent pain. Depression and anxiety were associated with increased risk for all pain outcomes. Poor vitality mediated the effects of anxiety on high pain and pain interference (root mean square error of approximation, 0.002). Conclusions: A large proportion of adult survivors report moderate to severe pain and pain interference more than 20 years after their diagnosis. Increased screening and early intervention for pain interference and recurrent pain are warranted.
Authors
Karlson, CW; Alberts, NM; Liu, W; Brinkman, TM; Annett, RD; Mulrooney, DA; Schulte, F; Leisenring, WM; Gibson, TM; Howell, RM; Srivastava, D; Oeffinger, KC; Robison, LL; Armstrong, GT; Zeltzer, LK; Krull, KR
MLA Citation
URI
https://scholars.duke.edu/individual/pub1437295
Source
scopus
Published In
Cancer
Published Date
DOI
10.1002/cncr.32853

Incidence of and risk factors for late cholecystectomy in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

© 2020 Elsevier Ltd Background: Gallbladder disease and need for cholecystectomy are common and significant contributors to patient morbidity and healthcare costs. Childhood cancer survivors are at elevated risk for developing cholelithiasis. However, their incidence of and risk factors for late (>5 years from diagnosis) cholecystectomy have not been studied. Methods: A total of 25,549 survivors (median age at diagnosis 6.9 years, range 0–21.0; current age 30.7 years, range 5.6–65.9) diagnosed between 1970 and 1999 and 5037 siblings were queried for self-reported cholecystectomy occurring five or more years from primary cancer diagnosis. Piecewise exponential models evaluated associations between cancer treatment exposures and late cholecystectomy. Results: Over a median follow-up period of 21.9 and 26.0 years, respectively, 789 survivors and 168 siblings underwent late cholecystectomy (cumulative incidence 7.2%, 95% confidence interval [CI] = 6.5–7.8% and 6.6%, 95% CI = 5.4–7.6%, respectively; rate ratio [RR] = 1.3, 95% CI = 1.1–1.5). Compared with siblings, survivors of acute lymphoblastic leukaemia (RR = 1.4, 95% CI = 1.2–1.8), soft tissue sarcoma (RR = 1.4, 95% CI = 1.0–1.8) and bone cancer (RR = 1.3, 95% CI = 1.0–1.8) were at the greatest risk. In addition to attained age, female sex and increasing body mass index, exposure to high-dose (≥750 mg/m2) platinum chemotherapy (RR = 2.6, 95% CI = 1.5–4.5), vinca alkaloid chemotherapy (RR = 1.4, 95% CI = 1.1–1.8) or total body irradiation (TBI; RR = 2.2, 95% CI = 1.2–4.2) were each associated with late cholecystectomy. Conclusions: Independent of traditional risk factors for gallbladder disease, exposure to high-dose platinum chemotherapy, vinca alkaloid chemotherapy or TBI increased risk for late cholecystectomy. These findings should inform current long-term follow-up guidelines and education regarding risk for late cholecystectomy.
Authors
Dieffenbach, BV; Li, N; Madenci, AL; Murphy, AJ; Barnea, D; Gibson, TM; Tonorezos, ES; Leisenring, WM; Howell, RM; Diller, LR; Liu, Q; Chow, EJ; Armstrong, GT; Yasui, Y; Oeffinger, KC; Weldon, CB; Weil, BR
MLA Citation
Dieffenbach, B. V., et al. “Incidence of and risk factors for late cholecystectomy in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.” European Journal of Cancer, vol. 133, July 2020, pp. 4–13. Scopus, doi:10.1016/j.ejca.2020.03.004.
URI
https://scholars.duke.edu/individual/pub1441977
Source
scopus
Published In
European Journal of Cancer
Volume
133
Published Date
Start Page
4
End Page
13
DOI
10.1016/j.ejca.2020.03.004

Adherence to Surveillance for Second Malignant Neoplasms and Cardiac Dysfunction in Childhood Cancer Survivors: A Childhood Cancer Survivor Study.

PURPOSE: To evaluate childhood cancer survivors' adherence to surveillance protocols for late effects of treatment and to determine the factors affecting adherence. METHODS: Between 2014 and 2016, 11,337 survivors and 2,146 siblings in the Childhood Cancer Survivor Study completed a survey ascertaining adherence to Children's Oncology Group (COG) guidelines for survivors at high risk for second malignant neoplasms or cardiac dysfunction and to the American Cancer Society (ACS) cancer screening guidelines for average-risk populations. Adherence rates and factors affecting adherence were analyzed. RESULTS: Median age at diagnosis was 7 years (range, 0-20.9 years), and median time from diagnosis was 29 years (range, 15-47 years). Among high-risk survivors, adherence to COG breast, colorectal, skin, and cardiac surveillance was 12.6% (95% CI, 10.0% to 15.3%), 37.0% (34.1% to 39.9%), 22.3% (21.2% to 23.4%), and 41.4% (40.1% to 42.7%), respectively. Among average-risk survivors, adherence to ACS breast, cervical, and colorectal screening was 57.1% (53.2% to 61.0%), 83.6% (82.7% to 84.5%), and 68.5% (64.7% to 72.2%), respectively. Twenty-seven percent of survivors and 20.0% of primary care providers (PCPs) had a survivorship care plan (SCP). For high-risk survivors, SCP possession was associated with increased adherence to COG breast (22.3% v. 8.1%; prevalence ratio [PR], 2.52; CI, 1.59 to 4.01), skin (34.8% v 23.0%; PR, 1.16; CI, 1.01 to 1.33), and cardiac (67.0% v 33.1%; PR, 1.73; CI, 1.55 to 1.92) surveillance. For high-risk survivors, PCP possession of a SCP was associated only with increased adherence to COG skin cancer surveillance (36.9% v 23.2%; PR, 1.24; CI, 1.08 to 1.43). CONCLUSION: Guideline adherence is suboptimal. Although survivor SCP possession is associated with better adherence, few survivors and PCPs have one. New strategies to improve adherence are needed.
Authors
Yan, AP; Chen, Y; Henderson, TO; Oeffinger, KC; Hudson, MM; Gibson, TM; Neglia, JP; Leisenring, WM; Ness, KK; Ford, JS; Robison, LL; Armstrong, GT; Yasui, Y; Nathan, PC
MLA Citation
Yan, Adam P., et al. “Adherence to Surveillance for Second Malignant Neoplasms and Cardiac Dysfunction in Childhood Cancer Survivors: A Childhood Cancer Survivor Study.J Clin Oncol, vol. 38, no. 15, May 2020, pp. 1711–22. Pubmed, doi:10.1200/JCO.19.01825.
URI
https://scholars.duke.edu/individual/pub1434289
PMID
32142393
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
38
Published Date
Start Page
1711
End Page
1722
DOI
10.1200/JCO.19.01825

Whole-body magnetic resonance imaging as surveillance for subsequent malignancies in preadolescent, adolescent, and young adult survivors of germline retinoblastoma: An update.

BACKGROUND:Germline retinoblastoma (Rb) survivors are at lifelong risk for developing subsequent malignancies (SMNs). Optimal surveillance modalities are needed to detect SMN at an early stage in this high-risk cohort. We investigated the use of rapid whole-body magnetic resonance imaging (WB-MRI) as a noninvasive screening modality in this cohort. PROCEDURE:WB-MRI was performed in asymptomatic preadolescent, adolescent, or young adult survivors of germline Rb from February 1, 2008 to December 31, 2018 at a tertiary cancer center. We calculated sensitivity and specificity of WB-MRI and rate of false-positive findings requiring additional evaluation. RESULTS:Overall, 110 WB-MRI were performed in 47 germline Rb survivors (51% female; median age at initial WB-MRI: 15.5 years [range 8-25.3]). Patients received 1-10 annual WB-MRI examinations (median: two). Thirteen patients had an abnormal WB-MRI; three findings were deemed to be likely benign and were not evaluated further. Ten patients required dedicated imaging and three required biopsy; two patients were diagnosed with localized high-grade osteosarcoma, while the other eight had benign findings. One patient was diagnosed with secondary osteosarcoma 3 months after normal WB-MRI. In total, there were 96 true negatives, 11 false positives, two true positives, and one false negative. The sensitivity of WB-MRI in this cohort was 66.7% (95% confidence interval [CI], 14.2-96.0) and the specificity was 89.7% (95% CI, 83.6-93.7). CONCLUSIONS:Based on our 10-year experience, surveillance WB-MRI appears to have limited utility as a surveillance modality for SMN in germline Rb survivors. Alternate screening modalities should be investigated.
Authors
Friedman, DN; Hsu, M; Moskowitz, CS; Francis, JH; Lis, E; Fleischut, MH; Oeffinger, KC; Walsh, M; Tonorezos, ES; Sklar, CA; Abramson, DH; Dunkel, IJ
MLA Citation
Friedman, Danielle Novetsky, et al. “Whole-body magnetic resonance imaging as surveillance for subsequent malignancies in preadolescent, adolescent, and young adult survivors of germline retinoblastoma: An update.Pediatric Blood & Cancer, May 2020, p. e28389. Epmc, doi:10.1002/pbc.28389.
URI
https://scholars.duke.edu/individual/pub1441726
PMID
32386119
Source
epmc
Published In
Pediatric Blood & Cancer
Published Date
Start Page
e28389
DOI
10.1002/pbc.28389