Deborah Watkins Bruner

Emory University, Atlanta, Georgia, United States

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Publications (142)709.34 Total impact

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    ABSTRACT: Patients with head and neck cancer (HNC) receiving intensity-modulated radiation therapy (IMRT) have particularly high rates of fatigue, and pre- and post-radiotherapy fatigue are prognostic factors for pathologic tumor responses and poor survival. Although inflammation has been proposed as one of the potential mechanisms of fatigue in cancer patients, findings have not been consistent, and there is a dearth of longitudinal studies. Accordingly, we conducted a prospective study in 46 HNC patients pre- and one-month post-IMRT. Fatigue was measured by the Multidimensional Fatigue Inventory (MFI)-20 at both time points along with the assessment of peripheral blood inflammatory markers including interleukin (IL)-6, soluble tumor necrosis factor receptor 2, and C-reactive protein (CRP) and gene expression. Generalized estimating equations were used to examine the association between inflammatory markers and fatigue. Gene enrichment analysis using MetaCore Software was performed using up-regulated genes that were significantly associated with IMRT and fatigue. Significant associations between fatigue and IL-6 as well as CRP, which were independent of time, were observed. In addition the change in fatigue from pre- to post-IMRT was positively associated with the change in IL-6 and CRP. Analysis of up-regulated gene transcripts as a function of IMRT and fatigue revealed overrepresentation of transcripts related to the defense response and nuclear factor kappa B. In conclusion, our findings support the hypotheses that inflammation is associated with fatigue over time in HNC patients. Future studies on how inflammation contributes to fatigue as well as strategies targeting inflammation to reduce fatigue are warranted.
    Brain Behavior and Immunity 10/2015; DOI:10.1016/j.bbi.2015.10.016 · 5.89 Impact Factor

  • Brain Behavior and Immunity 10/2015; 49:e28-e29. DOI:10.1016/j.bbi.2015.06.115 · 5.89 Impact Factor
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    ABSTRACT: IntroductionThe Patient-Reported Outcomes Measurement Information System (PROMIS)® Sexual Function and Satisfaction measure (SexFS) version 1.0 was developed with cancer populations. There is a need to expand the SexFS and provide evidence of its validity in diverse populations.AimThe aim of this study was to describe the development of the SexFS v2.0 and present preliminary evidence for its validity.Methods Development built on version 1.0, plus additional review of extant items, discussions with 15 clinical experts, 11 patient focus groups (including individuals with diabetes, heart disease, anxiety, depression, and/or are lesbian, gay, bisexual, or aged 65 or older), 48 cognitive interviews, and psychometric evaluation in a random sample of U.S. adults plus an oversample for specific sexual problems (2281 men, 1686 women). We examined differential item functioning (DIF) by gender and sexual activity. We examined convergent and known-groups validity.ResultsThe final set of domains includes 11 scored scales (interest in sexual activity, lubrication, vaginal discomfort, clitoral discomfort, labial discomfort, erectile function, orgasm ability, orgasm pleasure, oral dryness, oral discomfort, satisfaction), and six nonscored item pools (screeners, sexual activities, anal discomfort, therapeutic aids, factors interfering with sexual satisfaction, bother). Domains from version 1.0 were reevaluated and improved. Domains considered applicable across gender and sexual activity status, namely interest, orgasm, and satisfaction, were found to have significant DIF. We identified subsets of items in each domain that provided consistent measurement across these important respondent groups. Convergent and known-groups validity was supported.Conclusions The SexFS version 2.0 has several improvements and enhancements over version 1.0 and other extant measures, including expanded evidence for validity, scores centered around norms for sexually active U.S. adults, new domains, and a final set of items applicable for both men and women and those sexually active with a partner and without. The SexFS is customizable, allowing users to select relevant domains and items for their study. Weinfurt KP, Lin L, Bruner DW, Cyranowski JM, Dombeck CB, Hahn EA, Jeffery DD, Luecht RM, Magasi S, Porter LS, Reese JB, Reeve BB, Shelby RA, Smith AW, Willse JT, and Flynn KE. Development and Initial Validation of the PROMIS® Sexual Function and Satisfaction Measures Version 2.0. J Sex Med **;**:**–**.
    Journal of Sexual Medicine 09/2015; 12(9). DOI:10.1111/jsm.12966 · 3.15 Impact Factor
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    ABSTRACT: Hot flashes are a common and debilitating symptom among survivors of breast cancer. This study aimed at evaluating the effects of electroacupuncture (EA) versus gabapentin (GP) for hot flashes among survivors of breast cancer, with a specific focus on the placebo and nocebo effects. We conducted a randomized controlled trial involving 120 survivors of breast cancer experiencing bothersome hot flashes twice per day or greater. Participants were randomly assigned to receive 8 weeks of EA or GP once per day with validated placebo controls (sham acupuncture [SA] or placebo pills [PPs]). The primary end point was change in the hot flash composite score (HFCS) between SA and PP at week 8, with secondary end points including group comparisons and additional evaluation at week 24 for durability of treatment effects. By week 8, SA produced significantly greater reduction in HFCS than did PP (-2.39; 95% CI, -4.60 to -0.17). Among all treatment groups, the mean reduction in HFCS was greatest in the EA group, followed by SA, GP, and PP (-7.4 v -5.9 v -5.2 v -3.4; P = < .001). The pill groups had more treatment-related adverse events than did the acupuncture groups: GP (39.3%), PP (20.0%), EA (16.7%), and SA (3.1%), with P = .005. By week 24, HFCS reduction was greatest in the EA group, followed by SA, PP, and GP (-8.5 v -6.1 v -4.6 v -2.8; P = .002). Acupuncture produced larger placebo and smaller nocebo effects than did pills for the treatment of hot flashes. EA may be more effective than GP, with fewer adverse effects for managing hot flashes among breast cancer survivors; however, these preliminary findings need to be confirmed in larger randomized controlled trials with long-term follow-up. © 2015 by American Society of Clinical Oncology.
    Journal of Clinical Oncology 08/2015; DOI:10.1200/JCO.2015.60.9412 · 18.43 Impact Factor
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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
  • Deborah Watkins Bruner · Stephanie L Pugh · Katherine A Yeager · Jesse Bruner · Walter Curran ·
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    ABSTRACT: To assess how accrual to clinical trials is related to US minority population density relative to clinical trial site location and distance traveled to Radiation Therapy Oncology Group (RTOG) clinical trial sites. Data included member site address and ZIP codes, patient accrual, and patient race or ethnicity and ZIP code. Geographic Information System maps were developed for overall, Latino, and African American accrual to trials by population density. The Kruskal-Wallis test was used to assess differences in distance traveled by site, type of trial, and race or ethnicity. From 2006 to 2009, 6168 patients enrolled on RTOG trials. The RTOG US site distribution is generally concordant with overall population density. Sites with highest accrual are located throughout the United States and parts of Canada and do not cluster, nor does highest minority accrual cluster in areas of highest US minority population density. Of the 4913 US patients with complete data, patients traveled a median of 11.6 miles to participate in clinical trials. Whites traveled statistically longer distances (12.9 miles; P<.0001) to participate, followed by Latinos (8.22 miles) and African Americans (5.85 miles). Patients were willing to drive longer distances to academic sites than community sites, and there was a trend toward significantly longer median travel for therapeutic versus cancer control or metastatic trials. Location matters, but only to a degree, for minority compared with nonminority participation in clinical trials. Geographic Information System tools help identify gaps in geographic access and travel burden for clinical trials participation. Strategies that emerged using these tools are discussed. Copyright © 2015 Elsevier Inc. All rights reserved.
    International journal of radiation oncology, biology, physics 07/2015; DOI:10.1016/j.ijrobp.2015.06.041 · 4.26 Impact Factor
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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; 16(9). DOI:10.1016/j.jpain.2015.05.009 · 4.01 Impact Factor
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    Cancer Research 05/2015; 75(9 Supplement):PD4-7-PD4-7. DOI:10.1158/1538-7445.SABCS14-PD4-7 · 9.33 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 · 4.89 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 · 4.89 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 · 4.13 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 · 12.58 Impact Factor

  • Brain Behavior and Immunity 09/2014; 40:e37. DOI:10.1016/j.bbi.2014.06.148 · 5.89 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 · 1.59 Impact Factor

Publication Stats

2k Citations
709.34 Total Impact Points


  • 2012-2015
    • Emory University
      Atlanta, Georgia, United States
    • Memorial Sloan-Kettering Cancer Center
      New York, New York, 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

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