Research & Publications
As Director of Yale's Cancer Outcomes Public Policy & Effectiveness Research (COPPER; http://copper.yale.edu/).Center, the over-arching theme of my work is the disconnect between evidence generated from clinical research and the needs of members of patients in the "real-world" setting, outside of clinical trials. Ongoing investigations focus on the comparative effectiveness of different approaches to cancer screening and treatment, the complex interplay of factors affecting the value of cancer care, and the abandonment of low-value approaches to cancer care. Bioethics and research integrity are also a major interest; my work has focused on the scope and impact of financial conflicts, as well as identifying and overcoming barriers to sharing research data as part of the YODA project at Yale (http://yoda.yale.edu/ )
Specialized Terms: Cancer policy; Health policy; Comparative effectiveness; Cancer outcomes; Research ethics and integrity
Extensive Research Description
I am the Director of the COPPER Center at Yale, which aims to improve cancer care and to decrease the burden of cancer on individual patients and society, and to increase equity and patient-centeredness in cancer care. The Center is comprised of researchers and clinicians from across the Yale Schools of Medicine (General Medicine, Geriatrics, Oncology, Radiation Oncology, Dermatology, and Pediatrics), Public Health, and Nursing. We also provide training and mentorship to the next generation of cancer policy and outcomes researchers. Please see the COPPER website for a full description of the team and our work (http://copper.yale.edu/).
I have received NIH-funding from 2002 through the present time, with grants supporting the investigation of barriers to clinical trial enrollment, the impact of non-cancer illnesses on older persons with cancer, and the dissemination of new approaches to cancer screening and treatment into clinical practice.Currently, my collaborators and I are recipients of an NCI Provocative Questions grant, which aims to apply the concept of “social contagion” to cancer practice, shedding new light on the role of physicians and physician patient-sharing networks in the adoption of unproven technologies and the abandonment of proven ineffective treatments in cancer care.
Our recent grant through the American Cancer Society explores trends in breast cancer screening from both a clinical and policy perspective. Partnering with the Blue Cross Blue Shield Alliance for Health Research, we are assessing the association between state breast density legislation and the adoption of new breast imaging modalities, as well as evaluating the effectiveness of these newer approaches to breast cancer screening.
I am particularly interested in cancer in older persons. Cancer is an aging-related disease, 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. To provide greater clarity for patient and provider decision-making, we are exploring the manner in which non–cancer chronic illnesses and geriatric syndromes affect the care and outcomes of older patients with colorectal cancer. We are using a large population-based cohort of patients with cancer derived from administrative data, and in a separate study, COPPER is participating in a prospective cohort study of older patients with cancer as part of the Cancer in Aging Research Group (CARG: http://www.mycarg.org/home).
Chronic Disease; Epidemiology; Health Policy; Internal Medicine; Ethics, Research