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Advisory Committee Chair

Russell Griffin

Advisory Committee Members

Andres Azuero

Gabrielle Rocque

Kelly Kenzik

Mackenzie Fowler

Document Type

Dissertation

Date of Award

1-1-2025

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Cancer is one of the leading causes of mortality and morbidity in the United States. In addition to their cancer, nearly 50% of individuals have a comorbid condition. This adds complexity to the treatment of these patients as it may delay cancer diagnosis or treatment or prevent treatment all together. Lab-values are an important tool to measure comorbidities and end-organ damage as they are routinely captured as part of standard of care and the basis of clinician decision making. However, despite the widespread multimorbidity and how crucial they are to decision making, few studies assess the association of lab abnormalities with treatment outcomes. In addition, clinical trials often exclude patients with lab abnormalities despite these patients potentially receiving the treatment after it is put on the market. There have been many calls to broaden exclusion criteria in respect to lab-values in cancer clinical trials. Therefore, this dissertation contains three research projects to better understand the relationship between routinely captured lab-values and treatment-related outcomes in patients with cancer. First, we will compare the time-to-treatment discontinuation and overall survival for those with and without lab abnormalities. Second, we will examine an optimal cut-point at which an abnormal lab-value is associated with worsening symptoms after cancer treatment initiation. Third, we will use lab values alongside other patient demographic and clinical information to create patient profiles and assess these profiles for risks of dose modifications. These contributions will help in our understanding of how patients with lab-abnormalities fair on their cancer treatment and provide more crucial information in the call to modernize cancer clinical trials.

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