Advancing Patient Centered Oncology Practice, Advocacy, and Policy
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Session presented on Saturday, July 23, 2016: Deborah Watkins Bruner, RN, PhD, FAAN, is an internationally renowned researcher, scholar, and mentor. She has been continuously and well-funded in leading multi-disciplinary teams in patient-reported outcomes (PROs), sexual health, large national clinical trials focused on understanding and improving symptoms, as well as studies seeking to improve minority accrual to clinical trials. Dr. Bruner has worked for over two decades with the U. S. National Cancer Clinical Trials Network to conduct state of the art clinical trials to inform practice. PRACTICE CHANGING RESEARCH and MENTORSHIP: Examples of her research include: (PROs): Dr. Bruner developed the first PRO/QoL trial for the radiation therapy (RT) clinical trials group (RTOG) which led to a paradigm shift in RTOG from a focus on survival to include a patient-centered bio-behavioral approach. She was the co-investigator on the NIH PROMIS initiative and on the separate NCI initiative to develop and validate the PRO version of the Common Toxicity Criteria-Adverse Event (CTCAE) reporting system. She has served as PI of 3 and Co-I for 11 national clinical trials where she has used PROs to document significant, practice changing outcomes. For example, RTOG 9714 found that 1 fraction of RT for bone mets is equivalent in pain relief to 10 fractions, and has changed clinical practice guidelines. Sexual health: Dr. Bruner developed and validated an instrument, the Vaginal Sound, for the measure of vaginal length for women treated with pelvic RT. She also reported on one of the few studies to quantify RT-related vaginal changes in women treated with vaginal brachytherapy for gynecologic cancers. She was PI of 2 large national clinical trials of male sexual dysfunction: RTOG 0215 found that sildenafil for erectile function after RT + antiandrogens for prostate cancer has some effect, but only in a subset (25%) of men: RTOG 0831 reported that tadalafil does not prevent erectile dysfunction in men treated with RT for prostate cancer. Comparative effectiveness: Dr. Bruner has had 5 funded studies in the area of comparative effectiveness, primarily focused on preferences and utilities. One recent example of her work was a comparison of 3-dimensional conformal RT (3D-CRT) to intensity modulated RT (IMRT) which demonstrated a lack of patient reported benefit, in contrast to physician reported toxicity reduction, calling into question the cost-effectiveness of the more expensive IMRT modality. Her body of work has led to over 145 peer-reviewed journal articles, 5 books and 11 book chapters. Dr. Bruner earned her PhD at the University of Pennsylvania in 1999 and has been continuously funded since 1998. This has culminated in being ranked among the top 5% of all NIH researchers in the world according to the Blue Ridge Institute. Dr. Bruner is also the Director of Faculty Mentoring in the School of Nursing, Emory University. She is/has been primary mentor on 5 career development/K- awards. She has been primary mentor for 5 post-doctoral; 5 pre-doctoral; and 10 undergraduate students. ADVOCACY: Dr. Bruner has focused on advocacy in two areas: improving access to clinical trials for African Americans and other minorities and to incorporating the patient voice in clinical research vis-a-vis PROS. In the first area of focus, she has published on a novel scientific methodology, social marketing, to improve recruitment of minorities for research which led to a 60% African American (AA) recruitment rate into a prostate cancer study, which was unprecedented in an institution with catchments of only 18% AA and clinical accrual of about 5-10% AAs. In the second area of focus, she has worked to develop, make publicly available and methodically incorporate PROs in national clinical trials. POLICY: Dr. Bruner's research contributions have changed clinical practice guidelines and have been incorporated into course curriculum, and training and guideline manuals for radiation oncology nurses throughout the U.S. and globally. Her work has led to her appointment to multiple high level U.S. national committees and positions that set national policy. Most recently, she recently received a United States Presidential Appointment to the National Cancer Institute (NCI) National Cancer Advisory Board (NCAB), which advises the President on national cancer strategic directions and policy.