Scholars@Duke
Cara L. McDermott

Cara L. McDermott

Assistant Professor in Medicine
Medicine, Geriatrics and Palliative Care

Scholarly Works

Second-Generation Antipsychotics for Depression in Serious Illness: A First-Line Augmentation Strategy.

Journal article J Pain Symptom Manage · August 2026 Depression in serious illness is common, disabling, and often requires rapid improvement. Traditional antidepressants may take weeks to work, whereas second-generation antipsychotics (SGAs) have evidence for faster onset and robust augmentation effects in ... Full text Link to item Cite

Ketamine for Depression in Serious Illness: Evidence, Safety, and Practical Approaches.

Journal article J Pain Symptom Manage · August 2026 Patients with serious illnesses and short prognoses often experience depression and suicidal ideation. Traditional antidepressants are limited by delayed onset, creating a need for rapidly acting therapies. In this Palliative Care Rounds, we examine the ev ... Full text Link to item Cite

Psychostimulants for Depression in Serious Illness: Limited Evidence, Select Indications.

Journal article J Pain Symptom Manage · July 2026 Depression is common in serious illness, yet traditional antidepressants have a delayed onset. Psychostimulants offer potentially rapid symptom relief, but their evidence base for depression, especially in medically complex patients, remains unclear. In th ... Full text Link to item Cite

Drug Burden Index and Its Association With Functional Outcomes in Patients Receiving Hemodialysis.

Journal article Kidney Med · June 2026 RATIONALE & OBJECTIVE: Psychoactive potentially inappropriate medications (PIMs) are associated with morbidity and mortality in the dialysis population. However, little evidence exists on the association of psychoactive PIMs with functional status, an outc ... Full text Link to item Cite

C35-15 It’s Better to Have Some Medication Than No Medication: Barriers and Facilitators to Deprescribing in Older Adults With Chronic Obstructive Pulmonary Disease

Conference American Journal of Respiratory and Critical Care Medicine · May 1, 2026 AbstractRationalePeople living with chronic obstructive pulmonary disease (COPD) have a high medication burden, which in turn i ... Full text Cite

Association Between Polypharmacy and Physical Function in Middle-aged Adults: Findings from the CARDIA Function Study.

Journal article J Gen Intern Med · February 2026 BACKGROUND: Polypharmacy (≥ 5 medications) and potentially inappropriate medications (PIM; per Beers criteria) are common in midlife. Polypharmacy and PIM use are associated with poor physical function and adverse health outcomes in older age, but the asso ... Full text Link to item Cite

A Patient-Informed Framework of Financial Strain Among Adults with Multimorbidity.

Journal article J Gen Intern Med · February 2026 BACKGROUND: Over one-quarter of adults have multimorbidity. Patients with multimorbidity are more likely to struggle to afford their care than patients without multimorbidity, but their experiences with financial strain have not been fully described. OBJEC ... Full text Link to item Cite

Characterizing Intervention Components and Complexity of Nonpharmacologic Healthcare Interventions to Manage Distress Behaviors in Older Adults.

Journal article J Appl Gerontol · January 2026 Distress behaviors are common in residential care settings and contribute to staff burnout and poor quality of life for older adults. While nonpharmacologic interventions reduce distress behaviors, implementation in routine care remains challenging. Our st ... Full text Link to item Cite

A "PalliPulm" framework to improve palliative care education and practice in pulmonary-critical care medicine: an official American Thoracic Society Workshop Report.

Journal article Ann Am Thorac Soc · January 1, 2026 Despite numerous calls to action, palliative care remains inadequately integrated into pulmonary-critical care medicine (PCCM) practice and is de-emphasized in PCCM education. Barriers to specialty palliative care demonstrate a clear need for efficient and ... Full text Link to item Cite

Evaluating Generative AI for Deprescribing: Accuracy, Safety, and Clinical Utility

Conference Innovation in Aging · December 1, 2025 AbstractLimited geriatrics and pharmacy resources in VA Medical Centers (VAMCs) necessitate innovative strategies to enhance deprescribing efforts. Generative AI platforms, such as OpenAI, have the potent ... Full text Cite

PReventing Injury in Skilled nursing facilities through optimizing Medications (PRISM), a protocol for a cluster randomized trial to reduce injurious falls in post-acute care.

Journal article Trials · September 26, 2025 BACKGROUND: Patients who receive post-acute care in a skilled nursing facility (SNF) following a fracture are at high risk for subsequent fall-related injuries. Optimizing medication management may mitigate this risk. This manuscript describes the protocol ... Full text Open Access Link to item Cite

"I Need Electricity to Live": An Analysis of GoFundMe Campaigns for Obstructive Lung Disease

Conference American Journal of Respiratory and Critical Care Medicine · May 1, 2025 AbstractRATIONALE: Raising money through online crowdfunding platforms is a popular way to pay for medical expenses. Analyzing medical crowdfunding campaigns can illuminate the financial struggles that pa ... Full text Cite

Medical crowdfunding for persons with dementia and their families

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 2025 Link to item Cite

Medical crowdfunding for persons with dementia and their families

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 2025 Link to item Cite

Opioids and benzodiazepines in oncology: Perspectives on coprescribing and mitigating risks.

Journal article J Geriatr Oncol · March 2025 INTRODUCTION: Opioids and benzodiazepines are commonly prescribed for cancer symptoms. In combination, they can increase the risk of adverse events, particularly for older adults with multimorbidity, who represent most patients with cancer. We aimed to und ... Full text Link to item Cite

Patient characteristics and use for bevacizumab in ophthalmology and oncology in a distributed research network.

Journal article J Manag Care Spec Pharm · February 1, 2025 BACKGROUND: Although bevacizumab and its biosimilars are commonly used, there are limited real-world data on bevacizumab use in the United States, especially biosimilar bevacizumab used in ophthalmologic conditions. OBJECTIVE: To evaluate use patterns and ... Full text Link to item Cite

Examining Medical Interventions in Older Adults with Limited Life Expectancy-Opportunities and Challenges for De-implementation.

Journal article Sage Open Aging · 2025 PURPOSE: The benefits and harms of medical interventions shift as patients age, calling for re-evaluation of each intervention's appropriateness and alignment with patients' preferences. Continued use of medical interventions when harms outweigh benefits i ... Full text Link to item Cite

LIVING WITH MULTIMORBIDITY AND FINANCIAL TOXICITY: A PATIENT- AND CLINICIAN-INFORMED FRAMEWORK

Conference Innovation in Aging · December 31, 2024 AbstractMost older adults in the US have multimorbidity (2+ serious illnesses). Living with multimorbidity impacts patient quality of life, specifically managing the symptoms of multiple diseases and accompa ... Full text Cite

Fall Risk and Medication Use Near End of Life Among Adults With Chronic Obstructive Pulmonary Disease.

Journal article Chronic Obstr Pulm Dis · November 22, 2024 BACKGROUND: Falls are frequent among people with chronic obstructive pulmonary disease (COPD) and are associated with increased morbidity, mortality, and health care costs. Understanding modifiable medication factors that contribute to fall risk is an impo ... Full text Link to item Cite

Utilization and patient characteristics for the trastuzumab reference and biosimilars, and other human epidermal growth factor receptor 2 inhibitors in the United States.

Journal article J Manag Care Spec Pharm · October 2024 BACKGROUND: Trastuzumab is an antihuman epidermal growth factor receptor 2 monoclonal antibody used to treat breast and other cancers. Trastuzumab biosimilars were approved in the United States beginning in 2017. Utilization information on these biosimilar ... Full text Link to item Cite

Criteria for Enrollment of Patients With COPD in Palliative Care Trials: A Systematic Review.

Journal article J Pain Symptom Manage · June 2024 CONTEXT: Use of palliative care interventions in chronic obstructive pulmonary disease (COPD) has increased in recent years and inclusion criteria used to identify patients with COPD appropriate for palliative care vary widely. We evaluated the inclusion c ... Full text Link to item Cite

Factors Associated With Hospital Admission in the Last Month: A Retrospective Single Center Analysis.

Journal article Journal of pain and symptom management · June 2024 ContextDriven by concerns about care quality, patient experience, and national metrics, health systems are increasingly focusing on identifying risk factors for patients who are hospitalized in the last month of life.ObjectiveTo evaluate ... Full text Cite

Factors Associated with Hospital Admission in the Last Month of Life

Conference JOURNAL OF PAIN AND SYMPTOM MANAGEMENT · May 2024 Link to item Cite

The landscape of real-world evidence of rituximab utilization and clinical outcomes in patients with cancer, rheumatoid arthritis, and multiple sclerosis: A scoping review.

Journal article J Manag Care Spec Pharm · May 2024 BACKGROUND: Rituximab (RTX) is an anti-CD20 monoclonal antibody that is used to treat various conditions in cancer, rheumatoid arthritis (RA), and multiple sclerosis (MS). Although RTX has been used in the United States for almost 3 decades, questions rema ... Full text Link to item Cite

Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults: A Review.

Journal article JAMA · April 23, 2024 IMPORTANCE: Falls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures. OBSERVATIONS: Falls result from age-related physiologic changes compounded by ... Full text Link to item Cite

Patient-Informed Framework to Address Financial Toxicity in Multimorbidity

Conference JOURNAL OF THE AMERICAN GERIATRICS SOCIETY · April 2024 Link to item Cite

Health Care Team Interventions to Reduce Distress Behaviors in Older Adults: A Systematic Review.

Journal article Clin Gerontol · 2024 OBJECTIVES: This review examines health care team-focused interventions on managing persistent or recurrent distress behaviors among older adults in long-term residential or inpatient health care settings. METHODS: We searched interventions addressing heal ... Full text Link to item Cite

Real-world switching and discontinuation outcomes of infliximab biosimilars in patients with rheumatoid arthritis: A scoping review.

Journal article J Manag Care Spec Pharm · September 2023 BACKGROUND: Infliximab (IFX) was one of the first tumor necrosis factor inhibitors developed to treat rheumatoid arthritis (RA) and has transformed the treatment and management of many chronic inflammatory diseases. Large-scale studies in the real-world se ... Full text Link to item Cite

Utilization, user characteristics, and adverse outcomes of insulin glargine originators and follow-on drug in patients with diabetes in the United States.

Journal article J Manag Care Spec Pharm · July 2023 BACKGROUND: The first follow-on drug (Basaglar) of the originator insulin glargine (Lantus), a long-acting insulin for treatment of type 1 and type 2 diabetes mellitus (T1DM, T2DM), was approved in 2015 in the United States. Information on the uptake, user ... Full text Link to item Cite

Targets and study design for symptom-focused trials aimed at patients with cirrhosis: An expert consensus.

Journal article Hepatol Commun · June 1, 2023 BACKGROUND: Symptom-focused trials are critically needed for patients with cirrhosis. However, this work would benefit from standard processes and validated measures. METHODS: A writing group was formed among hepatologists, nurses, palliative care provider ... Full text Open Access Link to item Cite

Effect of the COVID-19 Pandemic on Place of Death Among Medicaid and Commercially Insured Patients With Cancer in Washington State.

Journal article J Clin Oncol · March 10, 2023 PURPOSE: The COVID-19 pandemic-related disruptions in health care delivery might have affected end-of-life care in patients with cancer. We examined changes in place of death and hospice support for Medicaid and commercially insured patients during the pan ... Full text Link to item Cite

Identification of cancer chemotherapy regimens and patient cohorts in administrative claims: challenges, opportunities, and a proposed algorithm.

Journal article J Med Econ · 2023 BACKGROUND: Real-world evidence is a valuable source of information in healthcare. This study describes the challenges and successes during algorithm development to identify cancer cohorts and multi-agent chemotherapy regimens from claims data to perform a ... Full text Link to item Cite

Polypharmacy, chemotherapy receipt, and medication-related out-of-pocket costs at end of life among commercially insured adults with advanced cancer.

Journal article J Oncol Pharm Pract · June 2022 BACKGROUND: Polypharmacy raises the risk of drug-drug interactions and adverse events among patients with cancer. Most polypharmacy research has focused on adults age 65 or older enrolled in Medicare insurance. To better inform pharmacy practice and cancer ... Full text Link to item Cite

Advance Care Planning Documentation and Intensity of Care at the End of Life for Adults With Congestive Heart Failure, Chronic Kidney Disease, and Both Illnesses.

Journal article J Pain Symptom Manage · February 2022 CONTEXT: Heart failure (HF) and chronic kidney disease (CKD) are associated with high morbidity and mortality, especially in combination, yet little is known about the impact of these conditions together on end-of-life care. OBJECTIVES: Compare end-of-life ... Full text Link to item Cite

Cost data in implementation science: categories and approaches to costing.

Journal article Implement Sci · January 28, 2022 A lack of cost information has been cited as a barrier to implementation and a limitation of implementation research. This paper explains how implementation researchers might optimize their measurement and inclusion of costs, building on traditional econom ... Full text Link to item Cite

BBCIC Research Network Analysis of First-Cycle Prophylactic G-CSF Use in Patients Treated With High-Neutropenia Risk Chemotherapy.

Journal article J Natl Compr Canc Netw · August 16, 2021 BACKGROUND: Chemotherapy-induced febrile neutropenia (FN) is prevented or minimized with granulocyte colony-stimulating factors (G-CSFs). Several G-CSF biosimilars are approved in the United States. The Biologics and Biosimilars Collective Intelligence Con ... Full text Link to item Cite

The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients With Multimorbidity.

Journal article Am J Hosp Palliat Care · August 2021 PURPOSE: Multimorbidity is associated with increased intensity of end-of-life healthcare. This association has been examined by number but not type of conditions. Our purpose was to understand how intensity of care is influenced by multimorbidity within sp ... Full text Link to item Cite

Patient Characteristics and Utilization Patterns of Short-Acting Recombinant Granulocyte Colony-Stimulating Factor (G-CSF) Biosimilars Compared to Their Reference Product.

Journal article Drugs Real World Outcomes · June 2021 BACKGROUND: Data on short-acting recombinant granulocyte colony-stimulating factor (G-CSF) biosimilar utilization from claims data in the USA are limited. OBJECTIVE: To evaluate patient baseline characteristics and utilization patterns for short-acting G-C ... Full text Link to item Cite

Utilization patterns and characteristics of users of biologic anti-inflammatory agents in a large, US commercially insured population.

Journal article Pharmacol Res Perspect · February 2021 We report utilization patterns and characteristics of patients treated with biologic anti-inflammatory agents in a large commercially insured patient population in the United States. We identified adult (age ≥18 years) patients receiving biologic anti-infl ... Full text Link to item Cite

The Association between Chronic Conditions, End-of-Life Health Care Use, and Documentation of Advance Care Planning among Patients with Cancer.

Journal article J Palliat Med · October 2020 Background: Multiple chronic conditions (MCCs) are associated with increased intensity of end-of-life (EOL) care, but their effect is not well explored in patients with cancer. Objective: We examined EOL health care intensity and advance care planning (ACP ... Full text Link to item Cite

Capture of biologic and biosimilar dispensings in a consortium of U.S.-based claims databases: Utilization of national drug codes and Healthcare Common Procedure Coding System modifiers in medical claims.

Journal article Pharmacoepidemiol Drug Saf · July 2020 PURPOSE: To assess the capture of biologics (originator and biosimilar) in the Biologics and Biosimilars Collective Intelligence Consortium (BBCIC) Distributed Research Network (DRN), with a focus on medical claim National Drug Code (NDC), a new data field ... Full text Link to item Cite

Novel Data Linkages to Characterize Palliative and End-Of-Life Care: Challenges and Considerations.

Journal article J Pain Symptom Manage · November 2019 CONTEXT: Working groups have called for linkages of existing and diverse databases to improve quality measurement in palliative and end-of-life (EOL) care, but limited data are available on the challenges of using different data sources to measure such car ... Full text Link to item Cite

Pragmatic methods to avoid intensive care unit admission when it does not align with patient and family goals.

Journal article Lancet Respir Med · July 2019 For patients with chronic, life-limiting illnesses, admission to the intensive care unit (ICU) near the end of life might not improve patient outcomes or be consistent with patient and family values, goals, and preferences. In this context, advance care pl ... Full text Link to item Cite

Pharmacologic Management of Agitation in Patients with Dementia

Journal article Current Geriatrics Reports · March 1, 2019 Purpose of Review: Agitation is common among older adults with dementia; its origin may be multi-factorial, and it is often difficult to treat. In this paper, we summarize current knowledge and offer considerations on pharmacologic management of behavioral ... Full text Cite

Polypharmacy and medication costs at end of life among commercially insured adults age 65 and older with cancer.

Conference Journal of Clinical Oncology · December 1, 2018 65 Background: Polypharmacy, or the concurrent use of multiple medications, may expose patients to drug-drug interactions and excessive costs. There are limited data on polypharmacy for commercially insured older adults, primaril ... Full text Cite

Depression and Health Care Utilization at End of Life Among Older Adults With Advanced Non-Small-Cell Lung Cancer.

Journal article J Pain Symptom Manage · November 2018 CONTEXT: Limited data exist regarding how depression diagnosed at different times relative to a cancer diagnosis may affect healthcare utilization at end of life (EOL). OBJECTIVES: To assess the relationship between depression and health care utilization a ... Full text Link to item Cite

How do clinics perform across multiple end of life metrics?

Conference Journal of Clinical Oncology · November 1, 2017 86 Background: National bodies have proposed a number of metrics to measure quality of care at the end of life (EOL). MACRA legislation allows clinics to select the metrics they report to CMS. The self-selection of reported metri ... Full text Cite

Polypharmacy and out-of-pocket medication costs in the last month of life among commercially insured patients with advanced cancer: Insights from linking a regional cancer registry and insurance claims.

Conference Journal of Clinical Oncology · November 1, 2017 79 Background: Polypharmacy, defined as the concurrent use of multiple medications, may expose patients to drug-drug interactions and excessive medication costs. Patients with advanced cancer may benefit from medication discontin ... Full text Cite

End-of-Life Services Among Patients With Cancer: Evidence From Cancer Registry Records Linked With Commercial Health Insurance Claims.

Journal article J Oncol Pract · November 2017 PURPOSE: Despite guidelines emphasizing symptom management over aggressive treatment, end-of-life care for persons with cancer in the United States is highly variable. In consultation with a regional collaboration of patients, providers, and payers, we inv ... Full text Link to item Cite

Development of cancer care episodes to measure costs for breast, colorectal, and non-small cell lung cancer.

Conference Journal of Clinical Oncology · March 10, 2017 29 Background: Cancer care costs are rising, creating concerns about affordability. As a result, delivery systems are creating alternative payment structures to lower costs while maintaining or improving quality. As cancer care d ... Full text Cite

Health care utilization and costs at end of life among patients with leukemia or lymphoma in a regional cancer registry-insurance claims linked database.

Conference Journal of Clinical Oncology · October 9, 2016 184 Background: End-of-life (EOL) care for persons with hematologic malignancies is variable and often involves high-intensity services at death approaches, which may not reflect patient or family preferences. We characterized he ... Full text Cite

Predicting Low Accrual in the National Cancer Institute's Cooperative Group Clinical Trials.

Journal article J Natl Cancer Inst · February 2016 BACKGROUND: The extent to which trial-level factors differentially influence accrual to trials has not been comprehensively studied. Our objective was to evaluate the empirical relationship and predictive properties of putative risk factors for low accrual ... Full text Link to item Cite

Nonrelapse mortality and mycophenolic acid exposure in nonmyeloablative hematopoietic cell transplantation.

Journal article Biol Blood Marrow Transplant · August 2013 We evaluated the pharmacodynamic relationships between mycophenolic acid (MPA), the active metabolite of mycophenolate mofetil (MMF), and outcomes in 308 patients after nonmyeloablative hematopoietic cell transplantation. Patients were conditioned with tot ... Full text Link to item Cite

A comparison of approaches for association studies of polymorphisms and colorectal cancer risk.

Journal article Colorectal Dis · September 2012 AIM: Meta-analyses have been used to evaluate associations between polymorphisms and colorectal cancer risk, but the quality of individual studies used to inform them may vary substantially. Our aim was to apply well-established quality-control criteria to ... Full text Link to item Cite

A pilot study of website information regarding aromatase inhibitors: dietary supplement interactions.

Journal article J Altern Complement Med · November 2011 OBJECTIVES: Patients who have hormone receptor-positive breast cancer and who are taking aromatase inhibitors (AIs) should understand the benefits and risks of concomitant dietary supplement (DS) use. The International Society for Integrative Oncology (SIO ... Full text Link to item Cite

Health care use and primary prophylaxis with colony-stimulating factors

Journal article Value in Health · January 1, 2011 Objectives: We examined health care use in conjunction with primary prophylaxis use of colony stimulating factors (CSF) during patients' initial course of chemotherapy. Methods: This retrospective cohort study identified adults aged 25 years and older with ... Full text Cite

Colony-stimulating factor prescribing patterns in patients receiving chemotherapy for cancer.

Journal article Am J Manag Care · September 2010 OBJECTIVE: To examine variables influencing colony-stimulating factor (CSF) prescription as primary prophylaxis versus other use during patients' initial chemotherapy course among a large sample of health insurance records. STUDY DESIGN: Retrospective coho ... Link to item Cite

Will knowledge of gene-based colorectal cancer disease risk influence quality of life and screening behavior? Findings from a population-based study.

Journal article Public Health Genomics · 2010 BACKGROUND: Several gene variants conveying a modestly increased risk for disease have been described for colorectal cancer. Patient acceptance of gene variant testing in clinical practice is not known. We evaluated the potential impact of hypothetical col ... Full text Link to item Cite

Sensitivity of administrative claims to identify incident cases of lung cancer: a comparison of 3 health plans.

Journal article J Manag Care Pharm · October 2009 BACKGROUND: Administrative claims are readily available, but their usefulness for identifying persons with non-small cell lung cancer (NSCLC) is relatively unknown, particularly for younger persons and those enrolled in Medicaid. OBJECTIVES: To determine t ... Full text Link to item Cite

Completion of radiotherapy for local and regional head and neck cancer in medicare.

Journal article Arch Otolaryngol Head Neck Surg · September 2009 OBJECTIVE: To identify factors associated with interruption or early discontinuation of treatment in patients receiving radiotherapy for head and neck cancer, because it is believed that such treatment interruption or early discontinuation increases the ri ... Full text Link to item Cite