Allen Pannell talks about his late wife, Amy Foster.
KNOXVILLE, Tenn. — Allen Pannell didn’t plan to get into breast cancer research. He was deep into a doctoral dissertation on statistical models for the mortgage industry when his wife, Amy Foster, died of breast cancer in January 2014. That changed his focus.
“In simple terms, I lost interest in that based on what happened,” said Pannell, now assistant professor of analytics and director of the master’s in analytics program at Lincoln Memorial University. “Three and a half years earlier than that, I didn’t know a thing in the world about breast cancer.”
He was working on his doctorate in analytics at the University of Tennessee. Pannell was almost out of time when Foster died, but his three-member review committee agreed to let him change subjects.
“I did my dissertation on breast cancer,” Pannell said. “I’m thankful to UT for letting me do that, because I was in the business school in the analytics departments. Nobody in there had ever done anything on breast cancer.”
Four years became four months
Foster was 45 when she died, less than four months after their first wedding anniversary: Oct. 6, 2013.
“I remember it because we spent it in the Sevier County hospital,” Pannell said. “That was pretty much the first day of the end, based on what we saw there.”
Pannell is sharing his story this October, which is recognized nationally as Breast Cancer Awareness Month.
His wife had been doing fairly well on one type of chemotherapy, but that changed when she switched to a different drug. The reason for the switch: the receptors on tumor cells elsewhere in her body differed from those on her original breast tumor. Doctors urged using a drug targeted to the metastatic tumors, Pannell said.
This, it turned out, was probably a mistake. Foster had been given an estimated four years to live; but after changing treatments, she only lived four months, Pannell said.
Allen Pannell studied the relative effectiveness of targeting initial breast cancer tumors vs. related tumors that develop elsewhere in the body. His research has been published and he’s getting ready to present his results at a second conference. Hear him talk about what he found.
That choice is what he wanted to research. Russell Zaretzki, associate professor of business analytics at the Haslam College of Business and chairman of Pannell’s dissertation committee, approved the course change and helped design his statistical analysis, according to a UT news release.
Pannell, Zaretzki and Timothy Pannella reviewed all the relevant research they could find from before November 2014. Panella, also on Pannell’s dissertation committee, is an oncologist at UT Medical Center and associate professor at UT Graduate School of Medicine.
Pannell read the charts of all patients with metastatic breast cancer from 2000 to 2014 at UT Cancer Institute. Among those 317 patient records, he found just 14 which fit all criteria for his study. Of those, eight patients had been treated based on the characteristics of their primary tumors, and six were treated based on their metastatic tumors’ characteristics. Those treated based on their primary tumors survived an average of 48 months, while those treated on secondary tumors lived only 8.4 months on average.
The results were persuasive enough to influence Panella’s treatment recommendations for his breast cancer patients.
“It might be two or three patients per month that I might treat differently because of this research, as opposed to what I used to do,” Panella said.
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Pannell received his doctorate in 2015. He published his research in the American Journal of Hematology/Oncology under the title “The Prognostic Impact of Determining Treatment Plans Based on Discordant Metatastic Tumor Receptors on Relapse.”
He gave a presentation at the 2016 Miami Breast Cancer Conference, and in October will present again at the Metastatic Breast Cancer Conference in Houston. There, Pannell hopes to connect with authors of those related papers, who had far larger sample sizes than his.
A broader survey of cases is essential to advance the research and publicize its conclusions, he said.
There are three types of receptors on breast cancer tumors, Pannell said.
“Every breast cancer patient has those measures, and they’re either positive or negative,” he said. In about 30% of breast cancer patients, the disease spreads beyond the breast, most often to bones, lungs, liver and brain — and in about 20% of those cases, the receptor type on the metastatic tumors is different from the original, Pannell said.
“The best minds in the world say, ‘If that happens, we don’t know what to do,’” he said. But the general opinion is to treat the receptors on metastatic tumors, he said. That’s what Pannell hopes to change.
Since 1989, there have been about 50 medical journal articles that touch on the topic, or come near it, but don’t expressly ask which receptors to target. However, they do hint at the conclusion that the original tumor should be the target, he said.
At LMU, Pannell has his analytics students working on a breast cancer problem from a business perspective. In a three-semester practicum, they’re evaluating the timing of mammograms for breast cancer diagnosis on the basis of insurance costs and quality of life, he said. That’s an active debate; historically, women were recommended to get regular mammograms starting at age 40, but the current government recommendation is age 50, Pannell said.
The business analytics students are using data to solve a practical problem, and the subject lets Pannell continue in the field of cancer-related research, he said.
About 252,000 women are diagnosed with breast cancer every year, and one woman in eight will get it eventually, according to the American Cancer Society.
“Approximately one-third of those will die from it,” he said.
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The good news is that treatment has greatly improved, especially with early detection, Pannell said.
About 6,000 American women each year have to choose between treatment plans for metastatic breast cancer, according to UT.
The journal in which Pannell’s research was published is good, but with limited circulation, so it hasn’t garnered the attention which would go to an article in a major publication such as the New England Journal of Medicine, Panella said.
Also limiting its impact is the small size of the study’s sample, he said; research based on broad participation gets more attention.
“In order for it to be worldwide you would have to triple the number of patients,” Panella said.
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