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.
Extensive Research Description
We 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.
- Gross CP, Long JB, Ross JS, Abu-Khalaf MM, Wang R, Killelea BK, Gold HT, Chagpar AB, Ma X. The Cost of Breast Cancer Screening in the Medicare Population. JAMA Internal Med. 2013 11;173(3):220-6.
- Greysen SR, Johnson D, Kind T, Chretien KC, Gross CP, Young A, Chaudhry HJ. Exploring Standards for Online Professionalism: A national study of state medical board propensity to investigate reported violations. Ann Internal Med. 2013;158(2):124-30.
- Yu JB, Soulos PR, Herrin J, Cramer LD, Potosky AL, Roberts KB, Gross CP. Proton versus Intensity Modulated Radiotherapy for Prostate Cancer: Patterns of Care and Early Toxicity. J Natl Cancer Inst. 2013;105 (1):25-32.
- Vashi AA, Fox JP, Carr BG, D'Onofrio G, Pines JM, Ross JS, Gross CP. Use of hospital-based acute care among patients recently discharged from the hospital. JAMA 2013;309(4):364-71
- Soulos PR, Yu JB, Roberts KB, Raldow AC, Herrin J, Long JB, Gross CP. Assessing the impact of a cooperative group trial on breast cancer care in the Medicare population. J Clin Oncol. 2012, 30:1601-7
- Makarov DV, Desai R, Yu JB, Sharma R, Abraham N, Albertsen P, Krumholz HM, Penson D, and Gross CP. Appropriate And Inappropriate Imaging Rates For Prostate Cancer Go Hand In Hand By Region, As If Set By Thermostat. Health Affairs. 2012, 31: 730-740
- Raldow AC, Presley CJ, Yu JB, Sharma R, Cramer LD, Soulos PR, Long JB, Makarov DV, Gross CP. The relationship between clinical benefit and receipt of curative therapy for prostate cancer. Arch Intern Med. 2012, 172:362-3.
- Gross CP, Andersen MS, Krumholz HM, McAvay GJ, Proctor D, Tinetti ME. The Relation between Medicare Screening Reimbursement and Stage at Diagnosis for Older Patients with Colon Cancer. JAMA 2006296:2815-2822.
- Gross CP, McAvay GJ, Krumholz HM, Paltiel AD, Bhasin D, Tinetti ME. The effect of age and chronic illness on life expectancy after a diagnosis of colorectal cancer: Implications for screening. Annals of Internal Medicine 2006145:646-653.
- Smith BD, Haffty BG, Buchholz TA, Smith GL, Galusha DH, Bekelman JE, Gross CP. Effectiveness of radiation therapy in older women with ductal carcinoma in situ. Journal of the National Cancer Institute 200698:1302-1310.
- Falit BP, Gross CP. Access to Experimental Drugs for Terminally Ill Patients. JAMA 2008;300:2793-2795 (Commentary).