Deborah Watkins Bruner

Emory University, Atlanta, Georgia, United States

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Publications (135)671.42 Total impact

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    ABSTRACT: To integrate the patient perspective into adverse event reporting, the National Cancer Institute developed a patient-reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). To assess the construct validity, test-retest reliability, and responsiveness of PRO-CTCAE items. A total of 975 adults with cancer undergoing outpatient chemotherapy and/or radiation therapy enrolled in this questionnaire-based study between January 2011 and February 2012. Eligible participants could read English and had no clinically significant cognitive impairment. They completed PRO-CTCAE items on tablet computers in clinic waiting rooms at 9 US cancer centers and community oncology practices at 2 visits 1 to 6 weeks apart. A subset completed PRO-CTCAE items during an additional visit 1 business day after the first visit. Primary comparators were clinician-reported Eastern Cooperative Oncology Group Performance Status (ECOG PS) and the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30). A total of 940 of 975 (96.4%) and 852 of 940 (90.6%) participants completed PRO-CTCAE items at visits 1 and 2, respectively. At least 1 symptom was reported by 938 of 940 (99.8%) participants. Participants' median age was 59 years; 57.3% were female, 32.4% had a high school education or less, and 17.1% had an ECOG PS of 2 to 4. All PRO-CTCAE items had at least 1 correlation in the expected direction with a QLQ-C30 scale (111 of 124, P < .05 for all). Stronger correlations were seen between PRO-CTCAE items and conceptually related QLQ-C30 domains. Scores for 94 of 124 PRO-CTCAE items were higher in the ECOG PS 2 to 4 vs 0 to 1 group (58 of 124, P < .05 for all). Overall, 119 of 124 items met at least 1 construct validity criterion. Test-retest reliability was 0.7 or greater for 36 of 49 prespecified items (median [range] intraclass correlation coefficient, 0.76 [0.53-.96]). Correlations between PRO-CTCAE item changes and corresponding QLQ-C30 scale changes were statistically significant for 27 prespecified items (median [range] r = 0.43 [0.10-.56]; all P ≤ .006). Evidence demonstrates favorable validity, reliability, and responsiveness of PRO-CTCAE in a large, heterogeneous US sample of patients undergoing cancer treatment. Studies evaluating other measurement properties of PRO-CTCAE are under way to inform further development of PRO-CTCAE and its inclusion in cancer trials.
    08/2015; DOI:10.1001/jamaoncol.2015.2639
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    ABSTRACT: Despite well-documented disparities in cancer pain outcomes among African Americans, surprisingly little research exists on adherence to analgesia for cancer pain in this group. We compared analgesic adherence for cancer-related pain over a 3-month period between African Americans and Whites using Medication Event Monitoring System [MEMS]. Patients (n=207) were recruited from outpatient medical oncology clinics of an academic medical center in Philadelphia [>18 years of age, diagnosed with solid tumors or multiple myeloma, with cancer-related pain, and at least one prescription of oral around-the-clock analgesic (ATC)]. African Americans reported significantly greater cancer pain (P<.001), were less likely than Whites to have a prescription of long acting opioids (P<.001), and more likely to have a negative pain management index (P<.001). There were considerable differences between African Americans and Whites in the overall MEMS dose adherence, i.e., percentage of the total number of prescribed doses that were actually taken (53% vs. 74%, P<.001). On sub-analysis, analgesic adherence rates for African Americans ranged from 34% (for weak opioids) to 63% (for long acting opioids). Unique predictors of analgesic adherence varied by race; income levels, analgesic side-effects, and fear of distracting providers predicted analgesic adherence for African Americans but not for Whites. Despite evidence of disparities in cancer pain outcomes among African Americans, surprisingly little research exists on African Americans' adherence to analgesia for cancer pain. This prospective study employs objective measures to compare adherence to prescribed pain medications between African American and White patients with cancer pain. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
    The journal of pain: official journal of the American Pain Society 06/2015; DOI:10.1016/j.jpain.2015.05.009 · 4.22 Impact Factor
  • Cancer Research 05/2015; 75(9 Supplement):PD4-7-PD4-7. DOI:10.1158/1538-7445.SABCS14-PD4-7 · 9.28 Impact Factor
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    ABSTRACT: BACKGROUND The authors analyzed a preliminary report of patient-reported outcomes (PROs) among men who received high-dose radiation therapy (RT) on Radiation Therapy Oncology Group study 0126 (a phase 3 dose-escalation trial) with either 3-dimensional conformal RT (3D-CRT) or intensity-modulated RT (IMRT).METHODS Patients in the 3D-CRT group received 55.8 gray (Gy) to the prostate and proximal seminal vesicles and were allowed an optional field reduction; then, they received 23.4 Gy to the prostate only. Patients in the IMRT group received 79.2 Gy to the prostate and proximal seminal vesicles. PROs were assessed at 0 months (baseline), 3 months, 6 months, 12 months, and 24 months and included bladder and bowel function assessed with the Functional Alterations due to Changes in Elimination (FACE) instrument and erectile function assessed with the International Index of Erectile Function (IIEF). Analyses included the patients who completed all data at baseline and for at least 1 follow-up assessment, and the results were compared with an imputed data set.RESULTSOf 763 patients who were randomized to the 79.2-Gy arm, 551 patients and 595 patients who responded to the FACE instrument and 505 patients and 577 patients who responded to the IIEF were included in the completed and imputed analyses, respectively. There were no significant differences between modalities for any of the FACE or IIEF subscale scores or total scores at any time point for either the completed data set or the imputed data set.CONCLUSIONS Despite significant reductions in dose and volume to normal structures using IMRT, this robust analysis of 3D-CRT and IMRT demonstrated no difference in patient-reported bowel, bladder, or sexual functions for similar doses delivered to the prostate and proximal seminal vesicles with IMRT compared with 3D-CRT delivered either to the prostate and proximal seminal vesicles or to the prostate alone. Cancer 2015. © 2015 American Cancer Society.
    Cancer 03/2015; 121(14). DOI:10.1002/cncr.29362 · 4.90 Impact Factor
  • Journal of Sexual Medicine 01/2015; 12:25-25. · 3.15 Impact Factor
  • D. Bruner · K. Flynn · L. Lin · J. Reese · K. Weinfurt
    Journal of Sexual Medicine 01/2015; 12:27-27. · 3.15 Impact Factor
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    ABSTRACT: BACKGROUND Although fatigue, sleep disturbance, depression, and anxiety are associated with pain in breast cancer patients, it is unknown whether acupuncture can decrease these comorbid symptoms in cancer patients with pain. The objective of this study was to evaluate the effect of electroacupuncture (EA) on fatigue, sleep, and psychological distress in breast cancer survivors who experience joint pain related to aromatase inhibitors (AIs).METHODS The authors performed a randomized controlled trial of an 8-week course of EA compared with a waitlist control (WLC) group and a sham acupuncture (SA) group in postmenopausal women with breast cancer who self-reported joint pain attributable to AIs. Fatigue, sleep disturbance, anxiety, and depression were measured using the Brief Fatigue Inventory (BFI), the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS). The effects of EA and SA versus WLC on these outcomes were evaluated using mixed-effects models.RESULTSOf the 67 randomly assigned patients, baseline pain interference was associated with fatigue (Pearson correlation coefficient [r]=0.75; P < .001), sleep disturbance (r=0.38; P=.0026), and depression (r=0.58; P < .001). Compared with the WLC condition, EA produced significant improvements in fatigue (P=.0095), anxiety (P=.044), and depression (P=.015) and a nonsignificant improvement in sleep disturbance (P=.058) during the 12-week intervention and follow-up period. In contrast, SA did not produce significant reductions in fatigue or anxiety symptoms but did produce a significant improvement in depression compared with the WLC condition (P=.0088).CONCLUSIONS Compared with usual care, EA produced significant improvements in fatigue, anxiety, and depression; whereas SA improved only depression in women experiencing AI-related arthralgia. Cancer 2014. © 2014 American Cancer Society.
    Cancer 12/2014; 120(23). DOI:10.1002/cncr.28917 · 4.90 Impact Factor
  • Katherine A. Yeager · Jesse Bruner · Stephanie L. Pugh · Deborah Watkins Bruner
    Cancer Epidemiology Biomarkers & Prevention 11/2014; 23(11 Supplement):A71-A71. DOI:10.1158/1538-7755.DISP13-A71 · 4.32 Impact Factor
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    L.A. Kachnic · D.W. Bruner · M.M. Qureshi · G.A. Russo
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    ABSTRACT: Purpose/Objective(s): Vaginal stenosis (VS) is a recognized complication of pelvic and/or vaginal radiation therapy (RT). However, there is no consensus on its definition, diagnosis, prevention and treatment. As such, an internet-based survey was designed to assess radiation oncologists’ perceptions and practices concerning VS. Materials/Methods: After obtaining IRB exemption, a 24-item survey assessing the signs/symptoms, risk factors, diagnosis, prevention, treatment and impact of VS on women’s sexual health was distributed to 2200 Radiation Therapy Oncology Group (RTOG) members. Descriptivestatistics were calculated for all items. Chi-square tests examined differences in categorical responses by gender, experience level, practice setting and types of malignancies treated. Results: 233 (10.5%) completed the entire survey (99% radiation oncologists; 63% males; 52% academic [vs community], 46% >15 years [vs �15] in practice). Twelve%, 21%, and 68% report treating only GYN tumors (endometrial and cervical), only non-GYN female (rectal, anal, bladder), or both, respectively. Regarding risk factors, 78% attribute VS to pelvic RT alone, 91% to vaginal brachytherapy (VB) alone and 98% to combined pelvic RT and VB. Women without a cervix and post-menopausal status were considered at higher risk. VS risk was felt to be equal for obese vs non-obese and <70 vs �70 years of age. All respondents agree that VS is a clinical diagnosis, and no objective test is available. Reported VS symptoms include dyspareunia, and vaginal pain, dryness, and/or bleeding (100%, 90%, 85% and 72%, respectively); 65% indicate all four are reported. Vaginal dilator (VD) use is the only reported treatment of VS; 95% provide VDs to patients, and most commonly recommend initiating <6 weeks after RT completion (59%), 3 sessions per week (62%), for 2-10 minutes per session (64%), and for >1 year (70%). No difference in any response is found when examined by gender, experience level or practice setting. However, those who treat only GYN vs no GYN cancers are more likely to perform a vaginal exam before, during, or after RT (p Z 0.005, <0.001, 0.003, respectively), to distribute written in addition to verbal instructions regarding VD use (p Z 0.002), to have vaginal bleeding reported after RT (p Z 0.001), and to refer patients to a sexual councilor (p Z 0007). Conclusion: This is the first large-scale survey of radiation oncologists’ perceptions and practices regarding vaginal stenosis. While VS is a recognized complication of treating pelvic malignancies, and the majority of respondents use vaginal dilators, there is no consensus on its risk factors, diagnosis, treatment and prevention. Prospective research, including symptom-management clinical trials, is therefore warranted.
    American Society for Radiation Oncology 56th Annual Meeting, San Francisco, CA; 11/2014
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    ABSTRACT: The standard approach for documenting symptomatic adverse events (AEs) in cancer clinical trials involves investigator reporting using the National Cancer Institute’s (NCI’s) Common Terminology Criteria for Adverse Events (CTCAE). Because this approach underdetects symptomatic AEs, the NCI issued two contracts to create a patient-reported outcome (PRO) measurement system as a companion to the CTCAE, called the PRO-CTCAE. This Commentary describes development of the PRO-CTCAE by a group of multidisciplinary investigators and patient representatives and provides an overview of qualitative and quantitative studies of its measurement properties. A systematic evaluation of all 790 AEs listed in the CTCAE identified 78 appropriate for patient self-reporting. For each of these, a PRO-CTCAE plain language term in English and one to three items characterizing the frequency, severity, and/or activity interference of the AE were created, rendering a library of 124 PRO-CTCAE items. These items were refined in a cognitive interviewing study among patients on active cancer treatment with diverse educational, racial, and geographic backgrounds. Favorable measurement properties of the items, including construct validity, reliability, responsiveness, and between-mode equivalence, were determined prospectively in a demographically diverse population of patients receiving treatments for many different tumor types. A software platform was built to administer PRO-CTCAE items to clinical trial participants via the internet or telephone interactive voice response and was refined through usability testing. Work is ongoing to translate the PRO-CTCAE into multiple languages and to determine the optimal approach for integrating the PRO-CTCAE into clinical trial workflow and AE analyses. It is envisioned that the PRO-CTCAE will enhance the precision and patient-centeredness of adverse event reporting in cancer clinical research.
    JNCI Journal of the National Cancer Institute 09/2014; 106(9):dju244-dju244. DOI:10.1093/jnci/dju244 · 15.16 Impact Factor
  • Brain Behavior and Immunity 09/2014; 40:e37. DOI:10.1016/j.bbi.2014.06.148 · 6.13 Impact Factor
  • International journal of radiation oncology, biology, physics 09/2014; 90(1):S571. DOI:10.1016/j.ijrobp.2014.05.1723 · 4.18 Impact Factor
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    Terry A Badger · Margaret Heitkemper · Kathryn A Lee · Deborah Watkins Bruner
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    ABSTRACT: The goal of the Patient-Reported Outcomes Measurement Information System (PROMIS) is to create efficient, reliable, and valid assessments of adult and child health. The nursing science literature in which PROMIS measures are used is rapidly expanding. Investigators have been encouraged to consider the integration of PROMIS measures into both descriptive studies and clinical trials. Doing this has created opportunities and challenges for investigators. This article highlights three projects to show the perspectives of nurse scientists who incorporated PROMIS measures into their research. The first project describes advantages of PROMIS to allow for comparisons of a study population with a national sample and to compliment legacy measures. The second project examines issues in the translation of tools for region-specific Hispanic populations. The third project provides a perspective on the use of PROMIS measures to capture cancer-related fatigue and to develop new components of a sexual function scale. As indicated by these three examples, nurse scientists can contribute an important role in moving the PROMIS initiative forward. Results from these types of projects also move symptom science forward within a more interdisciplinary approach to common measures of interest.
    Nursing Outlook 09/2014; 62(5):332-338. DOI:10.1016/j.outlook.2014.06.009 · 1.83 Impact Factor
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    Thomas M Pisansky · Deborah W Bruner · Richard E Greenberg
    JAMA The Journal of the American Medical Association 08/2014; 312(7):748-9. DOI:10.1001/jama.2014.7923 · 30.39 Impact Factor
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    ABSTRACT: To investigate the diagnostic accuracy of ultrasound histogram features in the quantitative assessment of radiation-induced parotid gland injury and to identify potential imaging biomarkers for radiation-induced xerostomia (dry mouth)-the most common and debilitating side effect after head-and-neck radiotherapy (RT).
    Academic Radiology 08/2014; 21(10):1304–1313. DOI:10.1016/j.acra.2014.05.017 · 2.08 Impact Factor
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    ABSTRACT: There is no consensus as to what symptoms or quality-of-life (QOL) domains should be measured as patient-reported outcomes (PROs) in ovarian cancer clinical trials. A panel of experts convened by the National Cancer Institute reviewed studies published between January 2000 and August 2011. The results were included in and combined with an expert consensus-building process to identify the most salient PROs for ovarian cancer clinical trials. We identified a set of PROs specific to ovarian cancer: abdominal pain, bloating, cramping, fear of recurrence/disease progression, indigestion, sexual dysfunction, vomiting, weight gain, and weight loss. Additional PROs identified in parallel with a group charged with identifying the most important PROs across cancer types were anorexia, cognitive problems, constipation, diarrhea, dyspnea, fatigue, nausea, neuropathy, pain, and insomnia. Physical and emotional domains were considered to be the most salient domains of QOL. Findings of the review and consensus process provide good support for use of these ovarian cancer-specific PROs in ovarian cancer clinical trials.
    JNCI Journal of the National Cancer Institute 07/2014; 106(7). DOI:10.1093/jnci/dju128 · 15.16 Impact Factor
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    ABSTRACT: We identified a standard core set of patient-reported symptoms and health-related quality-of-life (HRQOL) domains to be assessed in head and neck (H&N) cancer clinical trials. The core symptom and HRQOL domain scores were used to guide recommendations by a working group of experts as part of a National Cancer Institute Symptom Management and HRQOL Clinical Trials Planning Meeting. A PubMed search was conducted using the search terms of "health-related quality of life" and "head & neck cancer," limited to publications from January 1, 2000, to December 31, 2010. Fifty-four articles were used to guide the choice of recommendations. Twenty-nine symptoms and nine domains were identified, from which 12 H&N-specific core symptoms and HRQOL domains were recommended: swallowing, oral pain, skin changes, dry mouth, dental health, opening mouth/trismus, taste, excess/thick mucous/saliva, shoulder disability/motion, voice/hoarseness, social domain, and functional domain. This core set of 12 H&N-specific, patient-reported symptoms and HRQOL domains should be assessed in future H&N cancer clinical trials.
    JNCI Journal of the National Cancer Institute 07/2014; 106(7). DOI:10.1093/jnci/dju127 · 15.16 Impact Factor
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    ABSTRACT: The National Cancer Institute's Symptom Management and Health-Related Quality of Life Steering Committee held a clinical trials planning meeting (September 2011) to identify a core symptom set to be assessed across oncology trials for the purposes of better understanding treatment efficacy and toxicity and to facilitate cross-study comparisons. We report the results of an evidence-synthesis and consensus-building effort that culminated in recommendations for core symptoms to be measured in adult cancer clinical trials that include a patient-reported outcome (PRO).
    JNCI Journal of the National Cancer Institute 07/2014; 106(7). DOI:10.1093/jnci/dju129 · 15.16 Impact Factor
  • T Liu · D Yu · J Beitler · S Tridandapani · D Bruner · W Curran · X Yang
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    ABSTRACT: Purpose: Xerostomia (dry mouth), secondary to parotid-gland injury, is a distressing side-effect in head-and-neck radiotherapy (RT). This study&apos;s purpose is to develop a novel ultrasound technique to quantitatively evaluate post-RT parotid-gland injury.
    Medical Physics 06/2014; 41(6):571-571. DOI:10.1118/1.4889673 · 3.01 Impact Factor

Publication Stats

2k Citations
671.42 Total Impact Points


  • 2012–2015
    • Emory University
      Atlanta, Georgia, United States
  • 2014
    • University of Texas MD Anderson Cancer Center
      • Division of Radiation Oncology
      Houston, Texas, United States
  • 2008–2013
    • University of Pennsylvania
      • School of Nursing
      Philadelphia, Pennsylvania, United States
  • 2008–2011
    • William Penn University
      Filadelfia, Pennsylvania, United States
  • 2009–2010
    • The Philadelphia Center
      Filadelfia, Pennsylvania, United States
  • 1990–2009
    • Fox Chase Cancer Center
      • Department of Radiation Oncology
      Filadelfia, Pennsylvania, United States
  • 2000
    • Icahn School of Medicine at Mount Sinai
      Manhattan, New York, United States