Researchers from the Haslam College of Business, working with two other East Tennessee institutions, have found a correlation between the life expectancy of metastatic breast cancer patients and a treatment plan based on primary tumor receptors rather than metastatic tumors.
The presence of tumor receptors — proteins that indicate whether the cancer grows in response to hormones — has been a major diagnostic tool in the fight against breast cancer for decades. Each year in the United States approximately 6,000 women with MBC must choose between treatment plans focused on the receptor status of either their original tumors or the sites where the cancer has metastasized. These women have what medical professionals refer to as MBC with discordant receptors, where the primary tumor receptors differ from the metastatic tumor receptors. Insufficient research-based evidence exists to inform treatment guidelines for national and international standards in these situations.
A peer-reviewed study published in the latest edition of the American Journal of Hematology/Oncology sheds new light on the issue. Conducted by T. Allen Pannell Jr., Timothy J. Panella and Russell L. Zaretzki, the study seeks to provide evidence that changes to first-line treatment plans can harm patient outcomes.
Pannell, director of the business analytics program at Lincoln Memorial University, initiated the study following the loss of his wife, Amy Foster, in January 2014. Foster, a choral teacher and concert pianist, lived approximately three years following her initial breast cancer diagnosis and only six months past her cancer reoccurrence. She had MBC with discordant receptors.
Pannell was working on his dissertation in statistics at the Haslam College of Business when his wife was first diagnosed. During Foster's illness his focus shifted from doctoral student to caregiver, and following her death he changed his dissertation study.
"As a husband and caregiver, I was powerless against the cancer," Pannell said. "When a key decision in Amy's care appeared to shorten her life, I became more interested in researching that decision than finishing my dissertation. That research led me to believe data was available to determine the right decision for other women in similar situations."
He discussed his idea with Zaretzki, associate professor of business analytics at Haslam and Pannell's dissertation chair. Zaretzki approved the change of course and helped him design the statistical analysis.
"It wasn't an easy task for him, and many other people would have given up and moved on," Zaretzki said of Pannell's choice to change dissertation topics. "Technically, he used 30 years of experience in analytics and industrial problem solving to break down the issue. Once he did that, the solution was obvious, and his work now paves the way for future researchers to do more definitive studies with larger populations.
The two approached Panella, a UT Medical Center oncologist, to assist with the medical aspects of his study. Panella had no idea why a business analyst wanted 15 minutes of his time, but after hearing his theory agreed to help with the study.
"I remember Allen coming to my office with this big idea a year or two ago," Panella said. "I was skeptical about such a daunting project. It is a complicated topic even for a breast cancer expert. This wasn't his field, not his hospital. Yet he had an idea based on his wife's care, and he took on the task and completed it. I think this research will make a difference."
Following an expansive review of research published before November 2014, the researchers conducted a retrospective analysis of the tumor registry at the University of Tennessee Cancer Institute and reviewed the charts of patients with recurrent metastatic disease between 2000 and 2014. The study encompassed 317 patient records, yielding 124 with complete information. A total of 14 cases fit all criteria for the study. Of the 14, eight patients were treated for MBC on the basis of their primary tumor status and six were treated on the basis of their metastatic status. Outcomes from those cases showed that patients with MBC with discordant results who followed treatment plans based on their primary tumors survived for 48 months, compared to 8.4 months for those who followed treatment plans based on their metastatic tumors.
While the sample size is statistically small, the results of the study are clear: the status of the primary tumor should take precedence when developing the first-line treatment plan for a patient with newly diagnosed recurrent metastatic breast cancer. Further research, engaging additional researchers and cancer centers, will increase the sample size and breadth of the study.
Pannell, Panella and Zaretzki are working to get their study in the hands of the national and international organizations that develop standards of care.
Katie Williams, Haslam College of Business (865-974-3589, firstname.lastname@example.org)
Kate Reagan, LMU (423-869-6389, email@example.com)