Scholars@Duke
Syed Yousuf Zafar

Syed Yousuf Zafar

Adjunct Professor in the Department of Medicine
Medicine, Medical Oncology
yousuf.zafar@duke.edu
Duke Box 3505, Durham, NC 27710
Seeley G. Mudd Building, Rm 43, 10 Bryan Searle Dr., DUMC 3505, Durham, NC 27710

Selected Publications

Food insecurity prior to hematopoietic stem cell transplant is associated with malnutrition and worse outcomes.

Journal Article Bone Marrow Transplant · June 2025 Food insecurity (FI), defined as the lack of continuous access to adequate food, affects 17-55% of cancer patients. Effects may be exacerbated in hematopoietic stem cell transplant (HSCT) patients, who face nutritional challenges due to treatment side effe ... Full text Link to item Cite

Association Between Delayed/Forgone Medical Care and Resource Utilization Among Women with Breast Cancer in the United States.

Journal Article Ann Surg Oncol · April 2025 BACKGROUND: Although high treatment costs of breast cancer care are well documented, the relationship between delayed/forgone (D/F) care and resource utilization among patients with breast cancer is unknown. This study sought to investigate the relationshi ... Full text Link to item Cite

Screening for Financial Toxicity in Oncology Research and Practice: A Narrative Review.

Journal Article JCO Oncol Pract · January 2025 Financial toxicity (FT) is now a well-recognized issue affecting many patients with cancer and their families. The field is rapidly moving from a focus on describing this problem to efforts to optimize screening and identify management solutions. There are ... Full text Link to item Cite

Machine Learning for Targeted Advance Care Planning in Cancer Patients: A Quality Improvement Study.

Journal Article J Pain Symptom Manage · December 2024 CONTEXT: Prognostication challenges contribute to delays in advance care planning (ACP) for patients with cancer near the end of life (EOL). OBJECTIVES: Examine a quality improvement mortality prediction algorithm intervention's impact on ACP documentation ... Full text Link to item Cite

Financial Toxicity and Quality of Life in Patients Undergoing Stem-Cell Transplant Evaluation: A Single-Center Analysis.

Journal Article JCO Oncol Pract · March 2024 PURPOSE: We investigated the prevalence of financial toxicity in a population undergoing hematopoietic cell transplantation (HCT) evaluation and measured its impact on post-transplant clinical and health-related quality-of-life outcomes. MATERIALS AND METH ... Full text Link to item Cite

Reflections on the Financial Toxicity of Cancer: 10 Years Later.

Journal Article Oncologist · August 3, 2023 This commentary reflects on the decade since the publication of an article on the financial toxicity of cancer treatment and the international recognition of the scope and depth of the problem, in the hope that the coming decade is characterized by evaluat ... Full text Link to item Cite

Modifiable patient-reported factors associated with cancer-screening knowledge and participation in a community-based health assessment.

Journal Article Am J Surg · April 2023 BACKGROUND: We sought to identify modifiable factors associated with cancer screening in a community-based health assessment. METHODS: 24 organizations at 47 community events in central North Carolina distributed a 91-item survey from April-December 2017. ... Full text Link to item Cite

Modifiable Barriers and Facilitators for Breast Cancer Care: A Thematic Analysis of Patient and Provider Perspectives.

Journal Article J Surg Res · April 2023 INTRODUCTION: We sought to examine patient and provider perspectives regarding modifiable contributors to breast cancer treatment and to assess perceptual alignment between these two groups. MATERIALS: Participants were women≥18 y with stage 0-IV breast ca ... Full text Link to item Cite

A single-site pilot feasibility randomized trial of a supportive care mobile application intervention for patients with advanced cancer and caregivers.

Journal Article Support Care Cancer · October 2022 PURPOSE: Mobile health interventions can improve patient care. We developed the Digital Supportive Care Awareness and Navigation (D-SCAN) application (app) to facilitate symptom monitoring and use/awareness of cancer supportive care resources. This study t ... Full text Link to item Cite

Evaluating a couple communication skills training (CCST) intervention for advanced cancer: study protocol for a randomized controlled trial.

Journal Article Trials · August 26, 2022 BACKGROUND: For patients and their intimate partners, advanced cancer poses significant challenges that can negatively impact both individuals and their relationship. Prior studies have found evidence that couple-based communication skills interventions ca ... Full text Link to item Cite

How can healthcare organizations improve cost-of-care conversations? A qualitative exploration of clinicians' perspectives.

Journal Article Patient Educ Couns · August 2022 OBJECTIVES: Clinicians increasingly believe they should discuss costs with their patients. We aimed to learn what strategies clinicians, clinic leaders, and health systems can use to facilitate vital cost-of-care conversations. METHODS: We conducted focus ... Full text Link to item Cite

Communicating Research to Non-Researcher Audiences: A Panel Discussion From the National Cancer Institute's Future of Cancer Health Economics Research Conference.

Journal Article J Natl Cancer Inst Monogr · July 5, 2022 With rising health-care costs and increasing patient financial strain, health economics research has never been more relevant to the lay public. This manuscript summarizes the discussion from the "Communicating Health Economics Research to Non-Researcher A ... Full text Link to item Cite

Association of High-Deductible Health Plan Enrollment With Spending on and Use of Lenalidomide Therapy Among Commercially Insured Patients With Multiple Myeloma.

Journal Article JAMA Netw Open · June 1, 2022 IMPORTANCE: High-deductible health plans (HDHPs) require high upfront cost-sharing, which has been associated with suboptimal anticancer medication uptake and adherence. Whether HDHP enrollment has limited the affordability and use of lenalidomide therapy ... Full text Link to item Cite

Patient-reported distress as an early warning sign of unmet palliative care needs and increased healthcare utilization in patients with advanced cancer.

Journal Article Support Care Cancer · April 2022 INTRODUCTION: Cancer patients' sources of distress are often unaddressed, and patient-reported distress data could be utilized to identify those with unmet and impending care needs. We explored the association between moderate/severe distress and healthcar ... Full text Link to item Cite

Role of financial toxicity in perpetuating health disparities.

Journal Article Trends Cancer · April 2022 Rising costs of cancer care drive patient financial toxicity (FT) that perpetuates known health disparities in access and quality cancer treatment. This Review discusses how FT is a barrier to cancer research and treatment, and discusses potential solution ... Full text Link to item Cite

Low-touch, team-based care for co-morbidity management in cancer patients: the ONE TEAM randomized controlled trial.

Journal Article BMC Fam Pract · November 18, 2021 BACKGROUND: As treatments for cancer have improved, more people are surviving cancer. However, compared to people without a history of cancer, cancer survivors are more likely to die of cardiovascular disease (CVD). Increased risk for CVD-related mortality ... Full text Link to item Cite

Mobile Application to Identify Cancer Treatment-Related Financial Assistance: Results of a Randomized Controlled Trial.

Journal Article JCO Oncol Pract · October 2021 PURPOSE: Insured patients with cancer face high treatment-related, out-of-pocket (OOP) costs and often cannot access financial assistance. We conducted a randomized, controlled trial of Bridge, a patient-facing app designed to identify eligible financial r ... Full text Link to item Cite

Developing, Implementing, and Validating a Social Toxicity Assessment Tool of Cancer.

Journal Article JCO Glob Oncol · September 2021 PURPOSE: The social impact of cancer on patients and their family is well known. Yet, unlike with physical and financial toxicities, no validated tools are available to measure this impact. This study aimed at developing, validating, and implementing a nov ... Full text Link to item Cite

Financial burden, distress, and toxicity in cardiovascular disease.

Journal Article Am Heart J · August 2021 Cardiovascular disease (CVD) is a major source of financial burden and distress, which has 3 main domains: (1) psychological distress; (2) cost-related care non-adherence or medical care deferral, and (3) tradeoffs with basic non-medical needs. We propose ... Full text Link to item Cite

Cabozantinib and Panitumumab for RAS Wild-Type Metastatic Colorectal Cancer.

Journal Article Oncologist · June 2021 LESSONS LEARNED: Antitumor activity was observed in the study population. Dose modifications of cabozantinib improve long-term tolerability. Biomarkers are needed to identify patient populations most likely to benefit. Further study of cabozantinib with or ... Full text Link to item Cite

Patient Perspectives on the Financial Costs and Burdens of Breast Cancer Surgery.

Journal Article JCO Oncol Pract · June 2021 PURPOSE: Although financial toxicity is a well-documented aspect of cancer care, little is known about how patients narratively characterize financial experiences related to breast cancer treatment. We sought to examine these patient experiences through mi ... Full text Link to item Cite

Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer.

Journal Article N Engl J Med · April 1, 2021 BACKGROUND: No adjuvant treatment has been established for patients who remain at high risk for recurrence after neoadjuvant chemoradiotherapy and surgery for esophageal or gastroesophageal junction cancer. METHODS: We conducted CheckMate 577, a global, ra ... Full text Link to item Cite

Time to add screening for financial hardship as a quality measure?

Journal Article CA Cancer J Clin · March 2021 Cancer treatment is associated with financial hardship for many patients and families. Screening for financial hardship and referrals to appropriate resources for mitigation are not currently part of most clinical practices. In fact, discussions regarding ... Full text Link to item Cite

Does Cancer Treatment-Related Financial Distress Worsen Over Time?

Journal Article N C Med J · 2021 BACKGROUND Patients with cancer are at risk for both objective and subjective financial distress. Financial distress during treatment is adversely associated with physical and mental well-being. Little is known about whether patients' subjective financial ... Full text Link to item Cite

Couple Communication in Cancer: Protocol for a Multi-Method Examination.

Journal Article Front Psychol · 2021 Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples' ability to communicate effectively plays a major role in the psychological a ... Full text Link to item Cite

The Affordable Care Act's Medicaid Expansion and Impact Along the Cancer-Care Continuum: A Systematic Review.

Journal Article J Natl Cancer Inst · August 1, 2020 BACKGROUND: Health reform and the merits of Medicaid expansion remain at the top of the legislative agenda, with growing evidence suggesting an impact on cancer care and outcomes. A systematic review was undertaken to assess the association between Medicai ... Full text Link to item Cite

Reply to S. Boutayeb et al.

Journal Article JCO Oncol Pract · August 2020 Full text Link to item Cite

Current Practices for Screening and Management of Financial Distress at NCCN Member Institutions.

Journal Article J Natl Compr Canc Netw · July 2020 BACKGROUND: Financial distress from medical treatment is an increasing concern. Healthcare organizations may have different levels of organizational commitment, existing programs, and expected outcomes of screening and management of patient financial distr ... Full text Link to item Cite

Feasibility of Cancer Clinical Trial Enrollment Goals Based on Cancer Incidence.

Journal Article JCO Clin Cancer Inform · January 2020 PURPOSE: More than 20% of US clinical trials fail to accrue sufficiently. Our purpose was to provide a benchmark for better understanding clinical trial enrollment feasibility and to assess relative levels of competition for patients by cancer diagnosis. M ... Full text Open Access Link to item Cite

A phase Ib study of capecitabine and ziv-aflibercept followed by a phase II single-arm expansion cohort in chemotherapy refractory metastatic colorectal cancer.

Journal Article BMC Cancer · November 1, 2019 BACKGROUND: Patients with chemotherapy refractory metastatic colorectal cancer (CRC) have a poor prognosis and limited therapeutic options. In this phase Ib/II clinical trial, we established the maximum tolerated dose (MTD) and recommended phase II dose (R ... Full text Link to item Cite

Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons.

Conference Ann Surg Oncol · October 2019 BACKGROUND: Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer. METHODS: We conducted a self-administered, ... Full text Link to item Cite

A phase Ib study of the combination regorafenib with PF-03446962 in patients with refractory metastatic colorectal cancer (REGAL-1 trial).

Journal Article Cancer Chemother Pharmacol · October 2019 PURPOSE: This study aimed to evaluate the maximum tolerated dose (MTD) and recommended phase II dose (RPTD), as well as the safety and tolerability of PF-03446962, a monoclonal antibody targeting activin receptor like kinase 1 (ALK-1), in combination with ... Full text Link to item Cite

Financial Costs and Burden Related to Decisions for Breast Cancer Surgery.

Journal Article J Oncol Pract · August 2019 PURPOSE: Financial toxicity is a well-recognized adverse effect of cancer care, yet little is known about how women consider treatment costs when facing preference-sensitive decisions for breast cancer surgery or how surgical treatment choice affects finan ... Full text Link to item Cite

Assessing Key Stakeholders' Knowledge, Needs, and Preferences for Head and Neck Cancer Survivorship Care Plans.

Journal Article J Cancer Educ · June 2019 Cancer survivorship care plans (SCPs) are endorsed to support quality care for cancer survivors, but uptake is slow. We assessed knowledge, needs, and preferences for SCP content and delivery from a wide variety of stakeholders. We focused SCP content for ... Full text Open Access Link to item Cite

Financial Toxicity and Equitable Access to Clinical Trials.

Journal Article Am Soc Clin Oncol Educ Book · January 2019 Financial barriers to clinical trial enrollment are an area of active investigation. Financial toxicity as a concept describes how high costs and financial burden can lead to compromised care and outcomes. Despite the potential to yield large survival bene ... Full text Link to item Cite

Place of death for patients with cancer in the United States, 1999 through 2015: Racial, age, and geographic disparities.

Journal Article Cancer · November 15, 2018 BACKGROUND: Place of death is an essential component of high quality cancer care and comprehensive national trends and disparities in place of death are unknown. METHODS: Deidentified death certificate data were obtained via the National Center for Health ... Full text Link to item Cite

Health-Related Quality of Life: The Impact on Morbidity and Mortality.

Journal Article Surg Oncol Clin N Am · October 2018 In the age of ever-expanding treatments and precision medicine, the hope for cure remains the ultimate goal for patients and providers. Equally important to many patients is the quality of life achieved during and after treatment. Evidence suggests that ov ... Full text Link to item Cite

Financial burden among older, long-term cancer survivors: Results from the LILAC study.

Journal Article Cancer Med · September 2018 BACKGROUND: Increasing attention is being paid to financial burdens of cancer survivorship, but little is known about the prevalence and predictors of these burdens in older, long-term survivors. METHODS: We used data from 6012 participants diagnosed with ... Full text Link to item Cite

Going for Broke: A Longitudinal Study of Patient-Reported Financial Sacrifice in Cancer Care.

Journal Article J Oncol Pract · September 2018 PURPOSE: Patients with cancer are at risk for substantial treatment-related costs; however, little is known about patients' willingness to sacrifice to receive cancer care and how their attitudes and burden may change with time. PATIENTS AND METHODS: We co ... Full text Link to item Cite

A Phase I Trial of the IGF-1R Antibody Ganitumab (AMG 479) in Combination with Everolimus (RAD001) and Panitumumab in Patients with Advanced Cancer.

Journal Article Oncologist · July 2018 PURPOSE: This study evaluated the maximum tolerated dose or recommended phase II dose (RPTD) and safety and tolerability of the ganitumab and everolimus doublet regimen followed by the ganitumab, everolimus, and panitumumab triplet regimen. MATERIALS AND M ... Full text Link to item Cite

Defining Value of Cancer Therapeutics-A Health System Perspective.

Journal Article J Natl Cancer Inst · July 1, 2018 Because of the rising costs of cancer care and ongoing challenges in ensuring access to quality care, there is an increasing need to prioritize spending and define the benefits of therapy in proportion to costs. The term "value" has gained favor as means t ... Full text Link to item Cite

Health Care Disparities in Cancer Patients Receiving Radiation: Changes in Insurance Status After Medicaid Expansion Under the Affordable Care Act.

Conference Int J Radiat Oncol Biol Phys · May 1, 2018 PURPOSE: To compare insurance status in cancer patients receiving radiation before and after Medicaid expansion under the Patient Protection and Affordable Care Act (ACA), in both expanded and non-expanded states. METHODS AND MATERIALS: Newly diagnosed can ... Full text Link to item Cite

Financial toxicity and implications for cancer care in the era of molecular and immune therapies.

Journal Article Ann Transl Med · May 2018 Molecular and immune therapies have revolutionized cancer treatment and improved patient outcomes and survival. However, the pricing of these drugs has become an issue as the cost of cancer care continues to rise significantly. Cost sharing policies have i ... Full text Link to item Cite

Trends in Insurance Status Among Patients Diagnosed With Cancer Before and After Implementation of the Affordable Care Act.

Journal Article J Oncol Pract · February 2018 PURPOSE: The Affordable Care Act (ACA) aimed to increase insurance coverage through key provisions such as expansion of Medicaid eligibility and enforcement of an individual mandate. The objective of this study is to examine the impact of the ACA on insura ... Full text Link to item Cite

Geriatric Assessment: Precision Medicine for Older Adults With Cancer

Journal Article Journal of Oncology Practice · February 2018 Full text Cite

Ask Early and Ask Often: How Discussing Costs Could Save Your Patient's Life.

Journal Article N C Med J · 2018 Out-of-pocket spending continues to increase, particularly in cancer care. High out-of-pocket expenditures are associated with increased psychosocial distress, lower adherence, and higher mortality. In order to improve cancer-related outcomes, we must come ... Full text Link to item Cite

Links Between Communication and Relationship Satisfaction Among Patients With Cancer and Their Spouses: Results of a Fourteen-Day Smartphone-Based Ecological Momentary Assessment Study.

Journal Article Front Psychol · 2018 Cancer treatment poses significant challenges not just for those diagnosed with the disease but also for their intimate partners. Evidence suggests that couples' communication plays a major role in the adjustment of both individuals and in the quality of t ... Full text Open Access Link to item Cite

Financial Toxicity

Chapter · January 1, 2018 Financial toxicity is a relatively new term for a familiar but insufficiently examined phenomenon in the treatment and care of people with cancer. The term refers to the unintended and possibly unanticipated objective financial burden and subjective financ ... Full text Cite

Discussing Health Care Expenses in the Oncology Clinic: Analysis of Cost Conversations in Outpatient Encounters.

Journal Article J Oncol Pract · November 2017 PURPOSE: ASCO identified oncologist-patient conversations about cancer costs as an important component of high-quality care. However, limited data exist characterizing the content of these conversations. We sought to provide novel insight into oncologist-p ... Full text Link to item Cite

Out-of-Pocket Costs, Financial Distress, and Underinsurance in Cancer Care.

Journal Article JAMA Oncol · November 1, 2017 This cross-sectional survey study examines financial distress and cost expectations among patients with cancer presenting for anticancer therapy. ... Full text Link to item Cite

A randomized pilot trial of a videoconference couples communication intervention for advanced GI cancer.

Journal Article Psychooncology · July 2017 OBJECTIVE: This study aims to test the feasibility and preliminary efficacy of a couple-based communication intervention for advanced GI cancer delivered via videoconference. METHODS: Thirty-two couples were randomly assigned to either couples communicatio ... Full text Link to item Cite

Neoadjuvant long-course chemoradiation remains strongly favored over short-course radiotherapy by radiation oncologists in the United States.

Journal Article Cancer · April 15, 2017 BACKGROUND: Short-course radiotherapy (SC-RT) and long-course chemoradiotherapy (LC-CRT) are accepted neoadjuvant treatments of rectal cancer. In the current study, the authors surveyed US radiation oncologists to assess practice patterns and attitudes reg ... Full text Link to item Cite

The Role of Patient Financial Assistance Programs in Reducing Costs for Cancer Patients.

Journal Article J Manag Care Spec Pharm · April 2017 BACKGROUND: Limited transparency exists regarding eligibility and benefits for patient financial assistance programs (PAPs). OBJECTIVE: To describe oral anticancer medication costs, insurance coverage, and the degree of financial assistance provided by PAP ... Full text Link to item Cite

Transparency of Industry-Sponsored Oncology Patient Financial Assistance Programs Using a Patient-Centered Approach.

Journal Article J Oncol Pract · March 2017 OBJECTIVE: Pharmaceutical manufacturers sponsor drug-specific patient assistance programs that provide eligible patients with financial assistance, either in the form of providing the drug free of charge or copayment assistance. Describing these programs a ... Full text Link to item Cite

How Should We Intervene on the Financial Toxicity of Cancer Care? One Shot, Four Perspectives.

Journal Article Am Soc Clin Oncol Educ Book · 2017 The median price of a month of chemotherapy has increased by an order of magnitude during the past 20 years, far exceeding inflation over the same period. Along with rising prices, increases in cost sharing have forced patients to directly shoulder a great ... Full text Link to item Cite

Validation and Quality Assessment of the Kilimanjaro Cancer Registry.

Journal Article J Glob Oncol · December 2016 PURPOSE: Global cancer burden has increasingly shifted to low- and middle-income countries and is particularly pronounced in Africa. There remains a lack of comprehensive cancer information as a result of limited cancer registry development. In Moshi, Tanz ... Full text Open Access Link to item Cite

A Touchy Subject: Can Physicians Improve Value by Discussing Costs and Clinical Benefits With Patients?

Journal Article Oncologist · October 2016 A dramatic rise in the costs of health care—and cancer care in particular—has occurred over the last decade. Increasingly, these costs are being passed on to patients in the form of cost sharing, which can have a catastrophic effect on the financial well-b ... Full text Link to item Cite

Identifying cancer patients who alter care or lifestyle due to treatment-related financial distress.

Journal Article Psychooncology · June 2016 BACKGROUND: Cancer patients may experience financial distress as a side effect of their care. Little is known about which patients are at greatest risk for altering their care or lifestyle due to treatment-related financial distress. METHODS: We conducted ... Full text Link to item Cite

Comparing Unmet Needs to Optimize Quality: Characterizing Inpatient and Outpatient Palliative Care Populations.

Journal Article J Pain Symptom Manage · June 2016 CONTEXT: Palliative care (PC) consultation services are available in most hospitals; outpatient services are rapidly growing to meet the needs of patients at earlier stages of the disease trajectory. OBJECTIVES: We aimed to compare the unmet needs of PC pa ... Full text Link to item Cite

Association of Financial Strain With Symptom Burden and Quality of Life for Patients With Lung or Colorectal Cancer.

Journal Article J Clin Oncol · May 20, 2016 PURPOSE: To measure the association between patient financial strain and symptom burden and quality of life (QOL) for patients with new diagnoses of lung or colorectal cancer. PATIENTS AND METHODS: Patients participating in the Cancer Care Outcomes Researc ... Full text Link to item Cite

Financial Toxicity of Cancer Care: It's Time to Intervene.

Journal Article J Natl Cancer Inst · May 2016 Evidence suggests that a considerably large proportion of cancer patients are affected by treatment-related financial harm. As medical debt grows for some with cancer, the downstream effects can be catastrophic, with a recent study suggesting a link betwee ... Full text Link to item Cite

Physician Experience and Attitudes Toward Addressing the Cost of Cancer Care.

Journal Article J Oncol Pract · March 2016 PURPOSE: We surveyed US cancer doctors to examine current attitudes toward cost discussions and how they influence decision making and practice management. METHODS: We conducted a self-administered, anonymous, electronic survey of randomly selected physici ... Full text Link to item Cite

Abstract IA09: Intervening on the financial toxicity of cancer care

Conference Cancer Epidemiology, Biomarkers & Prevention · March 1, 2016 AbstractEvidence suggests that a considerably large proportion of cancer patients are affected by treatment-related financial harm. As medical debt grows for some with cancer, the down-stream effects can be ... Full text Cite

Ascertainment, classification, and impact of neoplasm detection during prolonged treatment with dual antiplatelet therapy with prasugrel vs. clopidogrel following acute coronary syndrome.

Journal Article Eur Heart J · January 21, 2016 AIMS: Studies have suggested increased cancer incidence associated with long-term dual antiplatelet therapy (DAPT) for acute coronary syndrome (ACS). We evaluated cancer incidence and treatment-related differences in an analysis of DAPT for ACS. METHODS AN ... Full text Link to item Cite

The Parity Paradigm: Can Legislation Help Reduce the Cost Burden of Oral Anticancer Medications?

Journal Article Value Health · January 2016 Over the last decade, there has been increased development and use of oral anticancer medications, which sometimes leads to high cost sharing for patients. Drug parity laws require insurance plans to cover oral anticancer medications with the same cost sha ... Full text Link to item Cite

The utility of cost discussions between patients with cancer and oncologists.

Journal Article Am J Manag Care · September 2015 OBJECTIVES: Patients with cancer can experience substantial financial burden. Little is known about patients' preferences for incorporating cost discussions into treatment decision making or about the ramifications of those discussions. The objective of th ... Link to item Cite

Best supportive care in clinical trials: review of the inconsistency in control arm design.

Journal Article Br J Cancer · June 30, 2015 BACKGROUND: Best supportive care (BSC) as a control arm in clinical trials is poorly defined. We conducted a review to evaluate clinical trials' concordance with published, consensus-based framework for BSC delivery in trials. METHODS: A consensus-based De ... Full text Link to item Cite

Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial.

Journal Article JAMA Intern Med · May 2015 IMPORTANCE: For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy fo ... Full text Link to item Cite

Population-based assessment of cancer survivors' financial burden and quality of life: a prospective cohort study.

Journal Article J Oncol Pract · March 2015 PURPOSE: The impact of financial burden among patients with cancer has not yet been measured in a way that accounts for inter-relationships between quality of life, perceived quality of care, disease status, and sociodemographic characteristics. PATIENTS A ... Full text Link to item Cite

Corrigendum.

Journal Article Future Oncol · 2015 Full text Link to item Cite

Is obesity an advantage in patients with colorectal cancer?

Journal Article Expert Rev Gastroenterol Hepatol · 2015 Obesity/higher BMI appears to be important determinants in the development of colon cancer as well as in predicting outcomes in the adjuvant setting in these patients. These associations seem to be stronger for men and tend to be 'J-shaped', with worse out ... Full text Link to item Cite

Patient experience and attitudes toward addressing the cost of breast cancer care.

Conference Oncologist · November 2014 BACKGROUND: The American Society of Clinical Oncology views patient-physician discussion of costs as a component of high-quality care. Few data exist on patients' views regarding how cost should be addressed in the clinic. METHODS: We distributed a self-ad ... Full text Link to item Cite

The implications of out-of-pocket cost of cancer treatment in the USA: a critical appraisal of the literature.

Journal Article Future Oncol · November 2014 Advances in cancer diagnosis and treatment have led to increased societal costs and out-of-pocket patient cost. We reviewed the literature on the impact of out-of-pocket cancer care costs on the patient experience, and described efforts made to address the ... Full text Link to item Cite

There is a mismatch between the medicare benefit package and the preferences of patients with cancer and their caregivers.

Journal Article J Clin Oncol · October 1, 2014 PURPOSE: To identify insured services that are most important to Medicare beneficiaries with cancer and their family caregivers when coverage is limited. METHODS: A total of 440 participants (patients, n = 246; caregivers, n = 194) were enrolled onto the C ... Full text Link to item Cite

Bridging the gap between financial distress and available resources for patients with cancer: a qualitative study.

Journal Article J Oncol Pract · September 2014 PURPOSE: Cancer treatment-related out-of-pocket costs create substantial financial distress for many patients. However, little work has been done to describe available financial resources and barriers to connecting those resources to patients. METHODS: Thi ... Full text Link to item Cite

Phase I study of capecitabine, oxaliplatin, bevacizumab, and everolimus in advanced solid tumors.

Journal Article Invest New Drugs · August 2014 PURPOSE: To define maximum tolerated dose (MTD), toxicities, and pharmacodynamics of capecitabine, oxaliplatin, bevacizumab, and everolimus in advanced solid tumor patients. DESIGN: This was a standard "3 + 3" dose-escalation trial. All subjects received b ... Full text Link to item Cite

A decision exercise to engage cancer patients and families in deliberation about Medicare coverage for advanced cancer care.

Journal Article BMC Health Serv Res · July 19, 2014 BACKGROUND: Concerns about unsustainable costs in the US Medicare program loom as the number of retirees increase and experiences serious and costly illnesses like cancer. Engagement of stakeholders, particularly cancer patients and their families, in prio ... Full text Link to item Cite

Prognosis and delay of diagnosis among Kaposi's sarcoma patients in Uganda: A cross-sectional study

Journal Article Infectious Agents and Cancer · May 20, 2014 Background: In low- and middle-income countries, the association between delay to treatment and prognosis for Kaposi's sarcoma (KS) patients is yet to be studied. Methods. This is a prospective study of HIV-infected adults with histologically-confirmed KS ... Full text Cite

Patient-oncologist cost communication, financial distress, and medication adherence.

Journal Article J Oncol Pract · May 2014 BACKGROUND: Little is known about the association between patient-oncologist discussion of cancer treatment out-of-pocket (OOP) cost and medication adherence, a critical component of quality cancer care. METHODS: We surveyed insured adults receiving antica ... Full text Link to item Cite

Self-reported financial burden and satisfaction with care among patients with cancer.

Journal Article Oncologist · April 2014 BACKGROUND: Health care-related costs and satisfaction are compelling targets for quality improvement in cancer care delivery; however, little is known about how financial burden affects patient satisfaction. METHODS: This was an observational, cross-secti ... Full text Link to item Cite

Phase I study of dasatinib in combination with capecitabine, oxaliplatin and bevacizumab followed by an expanded cohort in previously untreated metastatic colorectal cancer.

Journal Article Invest New Drugs · April 2014 PURPOSE: Dasatinib inhibits src family kinases and has anti-angiogenic properties. We conducted a phase I study of dasatinib, capecitabine, oxaliplatin, and bevacizumab (CapeOx/bevacizumab), with an expansion cohort in metastatic colorectal cancer (CRC). M ... Full text Link to item Cite

Patient-reported quality of supportive care among patients with colorectal cancer in the Veterans Affairs Health Care System.

Journal Article J Clin Oncol · March 10, 2014 PURPOSE: High-quality supportive care is an essential component of comprehensive cancer care. We implemented a patient-centered quality of cancer care survey to examine and identify predictors of quality of supportive care for bowel problems, pain, fatigue ... Full text Link to item Cite

Does comparative effectiveness research promote rationing of cancer care?

Journal Article Lancet Oncol · March 2014 Comparative effectiveness research aims to inform health-care decisions by patients, clinicians, and policy makers. However, questions related to what information is relevant, and how to view the relative attributes of alternative interventions have politi ... Full text Link to item Cite

Comparative effectiveness research: moving medical oncology forward.

Journal Article Semin Radiat Oncol · January 2014 Comparative effectiveness research (CER) is critically needed in medical oncology to improve the care being delivered to oncology patients. As medical oncologists are forced to rely on insufficient data as a part of daily treatment decision making, and as ... Full text Link to item Cite

Prognosis and delay of diagnosis among Kaposi's sarcoma patients in Uganda: a cross-sectional study.

Journal Article Infect Agent Cancer · 2014 BACKGROUND: In low- and middle-income countries, the association between delay to treatment and prognosis for Kaposi's sarcoma (KS) patients is yet to be studied. METHODS: This is a prospective study of HIV-infected adults with histologically-confirmed KS ... Full text Link to item Cite

It's time to have 'The talk': Cost communication and patient-centered care

Journal Article Oncology United States · January 1, 2014 Cite

Financial Distress, Use of Cost-Coping Strategies, and Adherence to Prescription Medication Among Patients With Cancer.

Journal Article J Oncol Pract · November 2013 The authors found that cost-related medication nonadherence was prevalent among patients with cancer who sought financial assistance. ... Full text Link to item Cite

Full disclosure--out-of-pocket costs as side effects.

Journal Article N Engl J Med · October 17, 2013 Full text Link to item Cite

Using NCCN clinical practice guidelines in oncology to measure the quality of colorectal cancer care in the veterans health administration.

Journal Article J Natl Compr Canc Netw · April 1, 2013 Clinical practice guidelines can be used to help develop measures of quality of cancer care. This article describes the use of a Cancer Care Quality Measurement System (CCQMS) to monitor these measures for colorectal cancer in the Veterans Health Administr ... Full text Link to item Cite

Enrollment of patients with lung and colorectal cancers onto clinical trials.

Journal Article J Oncol Pract · March 2013 PURPOSE: Only 2% to 5% of adult patients with cancer enroll onto clinical trials. We assessed simultaneously characteristics of patients and their physicians that may be independently associated with participation. METHODS: CanCORS, a National Cancer Insti ... Full text Link to item Cite

Chemotherapy use and patient treatment preferences in advanced colorectal cancer: a prospective cohort study.

Journal Article Cancer · February 15, 2013 Featured Publication BACKGROUND: The objective of this study was to determine how patient preferences guide the course of palliative chemotherapy for advanced colorectal cancer. METHODS: Eligible patients with metastatic colorectal cancer (mCRC) were enrolled nationwide in a p ... Full text Link to item Cite

Financial toxicity, Part I: a new name for a growing problem.

Journal Article Oncology (Williston Park) · February 2013 Featured Publication Link to item Cite

Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer.

Journal Article Psychooncology · January 2013 Featured Publication BACKGROUND: We measured the prevalence of stigma, self-blame, and perceived blame from others for their illness among men with colorectal cancer (CRC) and examined whether these factors were associated with depressive symptoms, independent of clinical and ... Full text Link to item Cite

The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient's experience.

Journal Article Oncologist · 2013 Featured Publication PURPOSE: Cancer patients carry rising burdens of health care-related out-of-pocket expenses, and a growing number of patients are considered "underinsured." Our objective was to describe experiences of insured cancer patients requesting copayment assistanc ... Full text Link to item Cite

A phase II study of capecitabine, oxaliplatin, and bevacizumab in the treatment of metastatic esophagogastric adenocarcinomas.

Journal Article Oncologist · 2013 Featured Publication BACKGROUND: Esophageal and gastric cancers often present at an advanced stage. Systemic chemotherapy is the mainstay of treatment, but survival with current regimens remains poor. We evaluated the safety, tolerability, and efficacy of the combination capec ... Full text Link to item Cite

Cancer registration needs assessment at a tertiary medical centre in Kilimanjaro, Tanzania.

Journal Article World Health Popul · 2013 Cancer burden is increasing in Africa more than in any other continent, but population-based tracking of cancer incidence is incomplete. Cancer registries can improve understanding of cancer incidence. To assess organizational readiness to sustain registry ... Full text Link to item Cite

Financial toxicity, Part I: a new name for a growing problem.

Journal Article Oncology Williston Park N Y · January 1, 2013 Cite

Financial toxicity, Part II: how can we help with the burden of treatment-related costs?

Journal Article Oncology Williston Park N Y · January 1, 2013 Cite

Prasugrel versus clopidogrel for acute coronary syndromes without revascularization.

Journal Article N Engl J Med · October 4, 2012 BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, ... Full text Link to item Cite

Phase I study of bevacizumab, everolimus, and panobinostat (LBH-589) in advanced solid tumors.

Journal Article Cancer Chemother Pharmacol · August 2012 Featured Publication PURPOSE: To define the maximum tolerated dose, clinical toxicities, and pharmacodynamics of bevacizumab, everolimus, and panobinostat (LBH-589) when administered in combination to patients with advanced solid tumor malignancies. EXPERIMENT DESIGN: Subjects ... Full text Link to item Cite

A phase I study of bevacizumab, everolimus and panitumumab in advanced solid tumors.

Journal Article Cancer Chemother Pharmacol · July 2012 Featured Publication PURPOSE: Preclinical data suggest concurrent inhibition of VEGF, mTOR and EGFR pathways may augment antitumor and antiangiogenic effects compared to inhibition of each pathway alone. This study evaluated the maximum tolerated dose/recommended phase II dose ... Full text Link to item Cite

Carcinoma of the ampulla of Vater: patterns of failure following resection and benefit of chemoradiotherapy.

Journal Article Ann Surg Oncol · May 2012 Featured Publication BACKGROUND: Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. We performed a single-institution outcomes analysis to define the role of concurrent chemoradiotherapy (CRT) in add ... Full text Link to item Cite

Refining a checklist for reporting patient populations and service characteristics in hospice and palliative care research.

Journal Article J Pain Symptom Manage · May 2012 Featured Publication CONTEXT: In specialist hospice and palliative care services, variations occur in diagnoses and prognoses of subpopulations referred, service configuration, and the health systems delivering care. These three levels of variation limit the ability to general ... Full text Link to item Cite

Gastrointestinal symptoms in cancer patients with advanced disease: new methodologies, insights, and a proposed approach.

Journal Article Curr Opin Support Palliat Care · March 2012 Featured Publication PURPOSE OF REVIEW: This review summarizes recent developments in the management of gastrointestinal symptoms experienced by cancer patients and provides a framework for education, assessment and monitoring, and treatment. RECENT FINDINGS: Although many via ... Full text Link to item Cite

Consensus-based standards for best supportive care in clinical trials in advanced cancer.

Journal Article Lancet Oncol · February 2012 Featured Publication Best supportive care is poorly defined in clinical trials, and a standard framework for delivery of such care is needed, using best available evidence and allowing replication of studies. We convened a panel of 36 experts to develop consensus statements vi ... Full text Link to item Cite

Early dissemination of bevacizumab for advanced colorectal cancer: a prospective cohort study.

Journal Article BMC Cancer · August 16, 2011 Featured Publication BACKGROUND: We describe early dissemination patterns for first-line bevacizumab given for metastatic colorectal cancer treatment. METHODS: We analyzed patient surveys and medical records for a population-based cohort with metastatic colorectal cancer treat ... Full text Link to item Cite

A phase I study of bevacizumab (B) in combination with everolimus (E) and erlotinib (E) in advanced cancer (BEE).

Journal Article Cancer Chemother Pharmacol · February 2011 Featured Publication PURPOSE: VEGF, mTOR, and EGFR inhibitors have demonstrated anti-tumor and anti-angiogenic effects alone and in combination with each other. This study evaluated the safety, tolerability, and pharmacokinetics of bevacizumab, everolimus, and erlotinib combin ... Full text Link to item Cite

The need for a re-evaluation of best supportive care studies reported to date.

Journal Article Br J Cancer · February 1, 2011 Featured Publication Full text Link to item Cite

Capecitabine in the management of colorectal cancer.

Journal Article Cancer Manag Res · 2011 Featured Publication 5-Fluorouracil has been a mainstay in the treatment of colorectal cancer for nearly five decades; however, the use of oral formulations of the medication has been gaining increasing traction since capecitabine was approved for use in adjuvant settings by t ... Full text Link to item Cite

A phase II trial of bevacizumab plus everolimus for patients with refractory metastatic colorectal cancer.

Journal Article Oncologist · 2011 Featured Publication PURPOSE: For patients with metastatic colorectal cancer (mCRC), no standard therapy exists after progression on 5-fluorouracil, oxaliplatin, irinotecan, bevacizumab, and cetuximab or panitumumab. Preclinical data demonstrated that combined vascular endothe ... Full text Link to item Cite

A strategy to advance the evidence base in palliative medicine: formation of a palliative care research cooperative group.

Journal Article J Palliat Med · December 2010 Featured Publication BACKGROUND: Palliative medicine has made rapid progress in establishing its scientific and clinical legitimacy, yet the evidence base to support clinical practice remains deficient in both the quantity and quality of published studies. Historically, the co ... Full text Open Access Link to item Cite

Validation of the Patient Care Monitor (Version 2.0): a review of system assessment instrument for cancer patients.

Journal Article J Pain Symptom Manage · October 2010 Featured Publication CONTEXT: The Patient Care Monitor (PCM) is a review of systems survey delivered by means of an electronic patient-reported outcomes (ePRO) data capture system that uses wireless tablet computers. Although the PCM 1.0 is validated, the updated PCM 2.0 has n ... Full text Link to item Cite

Establishing a regional, multisite database for quality improvement and service planning in community-based palliative care and hospice.

Journal Article J Palliat Med · August 2010 Featured Publication BACKGROUND: Outpatient palliative care, an evolving delivery model, seeks to improve continuity of care across settings and to increase access to services in hospice and palliative medicine (HPM). It can provide a critical bridge between inpatient palliati ... Full text Open Access Link to item Cite

Quality of nonmetastatic colorectal cancer care in the Department of Veterans Affairs.

Journal Article J Clin Oncol · July 1, 2010 Featured Publication PURPOSE: The Veterans Affairs (VA) healthcare system treats approximately 3% of patients with cancer in the United States each year. We measured the quality of nonmetastatic colorectal cancer (CRC) care in VA as indicated by concordance with National Compr ... Full text Link to item Cite

Electronic patient-reported data capture as a foundation of rapid learning cancer care.

Journal Article Med Care · June 2010 Featured Publication BACKGROUND: "Rapid learning healthcare" presents a new infrastructure to support comparative effectiveness research. By leveraging heterogeneous datasets (eg, clinical, administrative, genomic, registry, and research), health information technology, and so ... Full text Link to item Cite

Management of gastrointestinal symptoms in advanced cancer patients: the rapid learning cancer clinic model.

Journal Article Curr Opin Support Palliat Care · March 2010 Featured Publication PURPOSE OF REVIEW: Gastrointestinal symptoms are prevalent, often persistent, and detrimental to patients' quality of life. This review discusses evaluation of gastrointestinal symptoms as patient-reported outcomes (PROs) and presents an information techno ... Full text Link to item Cite

Adverse events among the elderly receiving chemotherapy for advanced non-small-cell lung cancer.

Journal Article J Clin Oncol · February 1, 2010 Featured Publication PURPOSE: To describe chemotherapy use and adverse events (AEs) for advanced-stage, non-small-cell lung cancer (NSCLC) in community practice, including descriptions according to variation by age. METHODS: We interviewed patients with newly diagnosed, stages ... Full text Link to item Cite

Standards for palliative care delivery in oncology settings.

Journal Article Cancer J · 2010 Featured Publication This review aims to describe available standards for delivery of palliative and supportive care for cancer patients and discuss to what extent these guidelines have been evaluated and disseminated into standard care. Ovid searches were conducted to identif ... Full text Link to item Cite

Treatment-related toxicity and supportive care in metastatic colorectal cancer.

Journal Article J Support Oncol · 2010 Featured Publication As survival of metastatic colorectal cancer (mCRC) increases, patients have more exposure to chemotherapy and related toxicity. The objective is to determine how toxicity patterns affect care. Via a population-based strategy, mCRC cases diagnosed between J ... Link to item Cite

Improving the methodologic and ethical validity of best supportive care studies in oncology: lessons from a systematic review.

Journal Article J Clin Oncol · November 10, 2009 Featured Publication PURPOSE: To systematically review the best supportive care (BSC) literature and to evaluate the ethical and methodologic validity issues by using widely acknowledged criteria. METHODS: Two search strings that included both cancer and supportive as terms (w ... Full text Link to item Cite

Longitudinal patterns of chemotherapy use in metastatic colorectal cancer.

Journal Article J Oncol Pract · September 2009 Featured Publication Multiple agents and combination therapies available to patients with advanced colorectal cancer have significantly improved survival and provided an opportunity for individualization of care, allowing clinicians and patients to prioritize risks and benefit ... Full text Link to item Cite

Quality management of potential chemotherapy-induced neutropenic complications: evaluation of practice in an academic medical center.

Journal Article Support Care Cancer · June 2009 Featured Publication GOALS: Management of the risk of potential chemotherapy-induced neutropenic complications such as febrile neutropenia (FN) and severe neutropenia (SN) is a quality of care priority. How frequently does care at our institution conform to established guideli ... Full text Link to item Cite

Bevacizumab (B) plus everolimus (E) in refractory metastatic colorectal cancer (mCRC).

Journal Article J Clin Oncol · May 20, 2009 4080 Background: For patients (pts) with mCRC, no standard therapy exists after progression on 5-FU, oxaliplatin, irinotecan, bevacizumab, and/or cetuximab/panitumumab. Preclinical data demonstrate combined VEGF and mTOR inhibition has greater anti-angioge ... Link to item Cite

Electronic patient-reported data capture as the foundation of a learning health care system.

Journal Article J Clin Oncol · May 20, 2009 6522 Background: In a "learning healthcare system" clinical decisions are supported by accurate information delivered at point of care; information gathered today iteratively informs future care and research. METHODS: Customized software on wireless tablet ... Link to item Cite

Detailing of gastrointestinal symptoms in cancer patients with advanced disease: new methodologies, new insights, and a proposed approach.

Journal Article Curr Opin Support Palliat Care · March 2009 Featured Publication PURPOSE OF REVIEW: This review summarizes recent developments in the palliative management of gastrointestinal symptoms experienced by advanced cancer patients and provides a framework for detailing that encompasses education, assessment and monitoring, an ... Full text Link to item Cite

To the editor

Journal Article Journal of Clinical Oncology · February 10, 2009 Full text Cite

Decision making and quality of life in the treatment of cancer: a review.

Journal Article Support Care Cancer · February 2009 Featured Publication INTRODUCTION: Complexity in decision making for cancer treatment arises from many factors. When considering how to treat patients, physicians prioritize factors such as stage of disease, patient age, and comorbid illnesses. However, physicians must balance ... Full text Link to item Cite

Use of tablet personal computers for sensitive patient-reported information.

Journal Article J Support Oncol · 2009 Featured Publication Notebook-style computers (e/Tablets) are increasingly replacing paper methods for collecting patient-reported information. Discrepancies in data between these methods have been found in oncology for sexuality-related questions. A study was performed to for ... Link to item Cite

Comorbidity, age, race and stage at diagnosis in colorectal cancer: a retrospective, parallel analysis of two health systems.

Journal Article BMC Cancer · November 25, 2008 Featured Publication BACKGROUND: Stage at diagnosis plays a significant role in colorectal cancer (CRC) survival. Understanding which factors contribute to a more advanced stage at diagnosis is vital to improving overall survival. Comorbidity, race, and age are known to impact ... Full text Open Access Link to item Cite

Comorbidity, age, race and stage at diagnosis in colorectal cancer: A retrospective, parallel analysis of two health systems

Journal Article BMC Cancer · November 25, 2008 Background: Stage at diagnosis plays a significant role in colorectal cancer (CRC) survival. Understanding which factors contribute to a more advanced stage at diagnosis is vital to improving overall survival. Comorbidity, race, and age are known to impact ... Full text Cite

Defining best supportive care.

Journal Article J Clin Oncol · November 1, 2008 Featured Publication Full text Link to item Cite

Malignancy after solid organ transplantation: an overview.

Journal Article Oncologist · July 2008 Featured Publication With improving survival following solid organ transplantation, clinicians must be aware of post-transplant complications. One increasingly frequent complication is the development of malignancy after transplantation. The most common malignancies encountere ... Full text Link to item Cite

Monoclonal antibodies to EGFR: What does the future hold?

Journal Article Oncology · July 1, 2007 Cite