After a business doctoral student lost his wife to a recurrence of breast cancer, he put his analytical skills to work to help doctors determine which course of treatment would be most effective for women battling a certain type of breast cancer.
T. Allen Pannell Jr., who earned his doctorate from UT in 2015, is now director of the business analytics program at Lincoln Memorial University. He collaborated with Russell L. Zaretzki, associate professor of business analytics in UT’s Haslam College of Business, and Timothy J. Panella, a medical oncologist at the UT Medical Center, on research that indicates 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 approximately 6,000 women in the United States with MBC must choose between treatment plans focused on the receptor status of their original tumors or on 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 are the opposite of the metastatic tumor receptors. At present, there is insufficient research-based evidence to create treatment standards for these situations.
The study— peer reviewed and published in the latest edition of the American Journal of Hematology/Oncology—sheds new light on the issue and could help women living with MBC.
Pannell 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 partway through his dissertation in statistics at UT when his wife was first diagnosed. During her illness his focus shifted from doctoral student to caregiver, and following Foster’s death he changed his dissertation study.
“As a husband and caregiver, I was powerless against the cancer,” said Pannell. “When a key decision in Amy’s care appeared to shorten her life, I became more interested in researching that decision than finishing my own dissertation. That research led me to believe data was available to determine the right decision for other women in similar situations.”
He discussed this idea with Zaretzki, his 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. “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 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 the theory he 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 analyzed 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 based on their primary tumor status and six were treated based on their metastatic status. Outcomes from those cases showed that patients with MBC who had discordant results and followed treatment plans based on their primary tumors survived for 48 months, compared with 8.4 months for those who followed treatment plans based on metastatic tumors.
While the sample size is statistically small, the results of the study are clear: where discordance would indicate different treatments, 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 recommend standards of care.
Tyra Haag (865-974-5460, firstname.lastname@example.org)