Cary P Gross MD
Professor of Medicine (General Medicine) and of Epidemiology (Chronic Diseases)
Cancer policy; Health policy; Comparative effectiveness; Cancer outcomes; Research ethics and integrity
Current ProjectsWe are conducting several cohort studies to determine the relation between patient comorbidity burden, and functional outcomes after cancer treatment in older persons. We are assessing the relation between multimorbidity and the risk-benefit radio associated with screening colonoscopy. The over-arching aim of this line of inquiry is to further our understanding of how multimorbidity and age affect the risks and benefits of cancer screening. Working with collaborators at the University of North Carolina, Chapel Hill and Mt. Sinai, we are also developing an educational tool for informing older persons with chronic illnesses about the benefits of cancer screening.
Our group is also assessing the complex relation between age, multimorbidity, and effectiveness of new radiation modalities in the treatment of common malignancies.
Cancer in older persons:
Cancer is commonly a disease of the elderly, and elderly cancer patients tend to have worse outcomes than their younger counterparts. This is likely due, at least in part, to the myriad of non–cancer problems that tend to accrue with age. We are exploring the manner in which non–cancer chronic illnesses affect the care and outcomes of older patients with colorectal cancer. Using a large population-based cohort of cancer patients as well as qualitative interview studies, we will identify how these conditions affect cancer outcomes as well as how physicians and patients incorporate comorbid conditions into their treatment preferences and goals.
Clinical Research: Methodologic and Ethical considerations:
A common criticism of clinical trials is the enrolled patients are highly selected and may not represent patients in the general population. We have identified patient, provider, and health system factors that influence trial enrollment, and have clarified the impact of highly selective eligibility criteria on study generalizability. Our analyses of racial disparities have suggested that decreased access to healthcare is a major culprit in the persistence of disparities in trial participation. I have also studied the political and ethical issues involved in the organization and funding of biomedical research, with a particular focus on relations between industry, academia, and healthcare providers. We have analyzed the scope and impact of financial conflict of interest on clinical research, as well as the perspectives of trial participants on provider and institutional conflicts.