Center for Applied Cancer Health Policy
The Center for Applied Cancer Health Policy — affiliated with Duke Cancer Institute's Cancer Control & Population Sciences Research Program and directed by Yousuf Zafar, MD, MHS, FASCO — focuses on research at the interface of policy and the cancer patient experience. Broad topics of investigation include affordability of care, treatment decision-making, and the role of behavioral science in cost and value. Our research focuses on affordability, treatment decision-making and behavioral science among other topics.
- Affordability We are examining whether oral chemotherapy parity laws reduce out-of-pocket costs for cancer patients; if value-based insurance design impacts clinical decision-making for providers and patients; how manufacturer financial assistance programs impact patient costs, and how the affordability of cancer care impacts cancer outcomes.
- Treatment decision-making We are asking if informing providers about patients’ financial burden changes treatment decision-making; if all-payer claims databases can inform treatment choices, thereby reducing patient costs; how patients facing catastrophic illness make decisions regarding insurance plan selection; and if sharing affordability and cost data impact patient decision-making.
- Behavioral science Our research also looks at how out-of-pocket costs might be reduced for patients using a behavioral science approach; how cancer patients define value in cancer care; how we can we help patients understand value in cancer care; and how to educate physicians about the cultural change needed to address care affordability.
Select Recent Publications
- Chino F, Peppercorn JM, Rushing C, Kamal AH, Altomare I, Samsa G, Zafar SY. Out-of-pocket costs, financial distress, and underinsurance in cancer care. JAMA Onc 2017;3:1582-1584.
- Hunter, W, Zafar SY, Hesson A, David JK, Kirby C, Barnett JA, Ubel PA. Discussing Healthcare Expenses in the Oncology Clinic: Analysis of Cost Conversations in 677 Outpatient Encounters. J Oncol Pract 2017;13:e944-e956.
- Zullig LL, Vlastelica L, Shankaran V, Wolf S, Zafar SY. The role of patient financial assistance programs (PAPs) in reducing costs for cancer patients. J Manage Care Specialty Pharm 2016 [In press]
- Greenup RA, Obeng-Gyasi S, Thomas, Houck K, Lane WO, Blitzblau RB, Hyslop T, Hwang ES. The Effect of Hospital Volume on Breast Cancer Mortality. Annals of Surgery 2016 [epub ahead of print]
- Lathan CS, Cronin A, Tucker-Seeley R, Zafar SY, Ayanian J, Schrag D. The association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. J Clin Oncol 2016 [epub ahead of print]
- Nipp RD, Zullig LL, Samsa G, Peppercorn JM, Schrag D, Taylor DH, Abernethy AP, Zafar SY. Identifying cancer patients who alter care or lifestyle due to treatment-related financial distress. Psycho-Oncol 2015; doi: 10.1002/pon.3911. [Epub ahead of print]
- Zafar SY, Chino F, Ubel PA, Rushing C, Samsa G, Altomare I, Schrag D, Tulsky JA, Abernethy AP, Peppercorn JP. The utility of cost discussions between cancer patients and oncologists. Am J Manage Care 2015;21:607-615
- Altomare I, Irwin B, Houck K, Zafar SY, Maloney B, Greenup R, Peppercorn J. Physician experience and attitudes toward addressing the cost of cancer care. J Onc Pract 2016 Mar;12(3):247-8
- Zafar SY, McNeil RB, Thomas CM, Lathan CS, Ayanian JZ, Provenzale D. Population-based assessment of cancer survivors' financial burden and quality of life: a prospective cohort study. J Oncol Pract. 2015;11;145-150.
Commentaries and Reviews
- Zafar SY, Newcomer LN, McCarthy J, Fuld Nasso S, Saltz LB. How should we intervene on the financial toxicity of cancer care? One shot, four perspectives. Am Soc Clin Oncol Educ Book. 2017;37:35-39.
- Zafar SY, Peppercorn JM. Patient financial assistance programs: A path to affordability or a barrier to accessible cancer care? J Clin Oncol 2017; 35:2113-2116.
- Tina Shih YC, Fuld Nasso S, Zafar SY. Price transparency for whom? In search of out-of-pocket cost estimates to facilitate cost communication. Pharmacoeconomics 2018 [Epub ahead of print]
- Tran G, Zafar SY. Price of cancer care and its tax on quality of life. J Oncol Pract 2018 [Epub ahead of print]
- Wollins D, Zafar SY. A touchy subject: Can physicians improve value by discussing costs and clinical benefits with patients? Oncologist 2016. [In press]
- Zafar SY. Financial toxicity of cancer care: It's time to intervene. J Nat Cancer Inst; 2016; [epub ahead of print]
- Zafar SY, Ubel PA, Tuslky JA, Pollak KI. Cost-related health literacy: A key component of high quality cancer care. J Oncol Pract 2015;11:171-173.
- Zafar SY, Tulsky JA, Abernethy AP. It’s time to have “the talk”: cost communication and patient-centered care. Oncology 2014;28:479-480.
- Ubel PA, Abernethy AP, Zafar SY. Full Disclosure — Out-of-Pocket Costs as Side Effects. New Eng J Med 2013;369:1484-1486.
In the News
- Widowed Early, A Cancer Doctor Writes About The Harm Of Medical Debt National Public Radio
- Obamacare's guaranteed health coverage changes lives in first year. LA Times
- Tackling the financial toll of cancer, one patient at a time. Washington Post
- For working-age cancer survivors, debt and bankruptcy are common. Reuters
- Addressing the Costs of Cancer Care DCI Blog