Harvey Cohen

Overview:

Dr. Cohen's research program includes clinical research relating to aspects of the pathways to functional decline and reilience with aging, geriatric assessment, and cancer and anemia in the elderly.

Pathways to functional decline are being explored through the NIA funded Claude Pepper Older Americans Independence Center, and includes studies of the contributions of age related physiologic change, in particular changes in inflammatory parameters, comorbid diseases and conditions, environment, genetics, and the interactionas among them. Data are derived from several current studies as well as previously collected data sets from the Established Populations for Epidemiologic Studies of the Elderly (EPESE), National Long Term Care Survey, and the Chinese Longevity Study (with Dr. Zeng Yi). Previous work has demonstrated the important contributions of age related inflammation and coagulation activation to functional status. He is Co-PI of the Pepper Center Physical Performance Across the LifeSpan (PALS) study, which is a longitudinal cohort study of community dwelling adults from age 30-90+and includes functional measures and biomarkers on inflammation and metabolism.
 
Geriatric assessment approaches have been studied in a number of randomized and controlled studies and work is now concentrating on the application of Comprehensive Geriatric Assessment tools to the evaluation and treatment of elderly patients with cancer. This is an extension and continuation of a long standing interest in geriatric oncology. Previous studies have elucidated age-related patterns of disease presentation, treatment approaches, clinical trials, survivorship, quality of life, impact of comrobidities and functional outcomes. Dr. Cohen was co-chair, and now member of the Cancer in the Older Adult Committee of the Alliance for Clinical Trials in Oncology (ALLIANCE). A number of active studies and ongoing data bases aree being utilized to address these questions.


Anemia in the older adult is being addressed through an NIA funded U01 consortium (Dr. Cohen Co-PI). the current main study is an observational study followed by a pragmatic treatment trial for anemia in older adults with CHF, in collaboration with the Cardiovascular Research Network (CVRN) of the Health services research network (HSRN) 

Positions:

Professor of Medicine

Medicine, Geriatrics
School of Medicine

Walter Kempner Distinguished Professor of Medicine, in the School of Medicine

Medicine, Geriatrics
School of Medicine

Emeritus Director, Center for the Study of Aging & Human Development

Center for the Study of Aging and Human Development
School of Medicine

Faculty Research Scholar of DuPRI's Center for Population Health & Aging

Center for Population Health & Aging
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1965

State University of New York, Brooklyn

Grants:

Quantifying the genomic consequences of chronic social stress for accelerated aging

Administered By
Institutes and Provost's Academic Units
Awarded By
National Institutes of Health
Role
Advisor
Start Date
End Date

IPA-Rick Sloane

Administered By
Center for the Study of Aging and Human Development
Awarded By
Durham Veterans Affairs Medical Center
Role
Principal Investigator
Start Date
End Date

Mentoring Intervention Development in Fall and Fracture Prevention

Administered By
Medicine, Geriatrics
Awarded By
National Institutes of Health
Role
Advisor
Start Date
End Date

Cognitive Changes and Brain Connectivity in Age-Related Macular Degeneration

Administered By
Center for the Study of Aging and Human Development
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

PACTTE-Partnership for Anemia: Clinical and Translational Trials in the Elderly

Administered By
Duke Clinical Research Institute
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Publications:

Early-pregnancy prediction of risk for pre-eclampsia using maternal blood leptin/ceramide ratio: discovery and confirmation.

OBJECTIVE: This study aimed to develop a blood test for the prediction of pre-eclampsia (PE) early in gestation. We hypothesised that the longitudinal measurements of circulating adipokines and sphingolipids in maternal serum over the course of pregnancy could identify novel prognostic biomarkers that are predictive of impending event of PE early in gestation. STUDY DESIGN: Retrospective discovery and longitudinal confirmation. SETTING: Maternity units from two US hospitals. PARTICIPANTS: Six previously published studies of placental tissue (78 PE and 95 non-PE) were compiled for genomic discovery, maternal sera from 15 women (7 non-PE and 8 PE) enrolled at ProMedDx were used for sphingolipidomic discovery, and maternal sera from 40 women (20 non-PE and 20 PE) enrolled at Stanford University were used for longitudinal observation. OUTCOME MEASURES: Biomarker candidates from discovery were longitudinally confirmed and compared in parallel to the ratio of placental growth factor (PlGF) and soluble fms-like tyrosine kinase (sFlt-1) using the same cohort. The datasets were generated by enzyme-linked immunosorbent and liquid chromatography-tandem mass spectrometric assays. RESULTS: Our discovery integrating genomic and sphingolipidomic analysis identified leptin (Lep) and ceramide (Cer) (d18:1/25:0) as novel biomarkers for early gestational assessment of PE. Our longitudinal observation revealed a marked elevation of Lep/Cer (d18:1/25:0) ratio in maternal serum at a median of 23 weeks' gestation among women with impending PE as compared with women with uncomplicated pregnancy. The Lep/Cer (d18:1/25:0) ratio significantly outperformed the established sFlt-1/PlGF ratio in predicting impending event of PE with superior sensitivity (85% vs 20%) and area under curve (0.92 vs 0.52) from 5 to 25 weeks of gestation. CONCLUSIONS: Our study demonstrated the longitudinal measurement of maternal Lep/Cer (d18:1/25:0) ratio allows the non-invasive assessment of PE to identify pregnancy at high risk in early gestation, outperforming the established sFlt-1/PlGF ratio test.
Authors
Huang, Q; Hao, S; You, J; Yao, X; Li, Z; Schilling, J; Thyparambil, S; Liao, W-L; Zhou, X; Mo, L; Ladella, S; Davies-Balch, SR; Zhao, H; Fan, D; Whitin, JC; Cohen, HJ; McElhinney, DB; Wong, RJ; Shaw, GM; Stevenson, DK; Sylvester, KG; Ling, XB
MLA Citation
Huang, Qianyang, et al. “Early-pregnancy prediction of risk for pre-eclampsia using maternal blood leptin/ceramide ratio: discovery and confirmation.Bmj Open, vol. 11, no. 11, Nov. 2021, p. e050963. Pubmed, doi:10.1136/bmjopen-2021-050963.
URI
https://scholars.duke.edu/individual/pub1504326
PMID
34824115
Source
pubmed
Published In
Bmj Open
Volume
11
Published Date
Start Page
e050963
DOI
10.1136/bmjopen-2021-050963

Perceptions of specialty palliative care and its role in pediatric stem cell transplant: A multidisciplinary qualitative study.

BACKGROUND: Consultation of specialty palliative care remains uncommon in pediatric stem cell transplant (SCT) despite growing evidence that early integration of palliative care improves outcomes in patients with advanced cancers or undergoing SCT. Little is known about how multidisciplinary pediatric SCT teams perceive palliative care and its role in SCT. PROCEDURE: We conducted semistructured interviews of members of a multi-disciplinary SCT team to understand their perceptions of palliative care, how specialty palliative care is integrated into SCT, and to identify barriers to increased integration. Eligible participants included physicians, nurses, inpatient nurse practitioners, social workers, and child life specialists. Data were analyzed using thematic analysis. RESULTS: Four major themes were identified. First, SCT team members held a favorable perception of the palliative care team. Second, participants desired increased palliative care integration in SCT. Third, participants believed that the palliative care team had insufficient resources to care for the large number of SCT patients, which led to the SCT team limiting palliative care consultation. And, finally, the lack of a standardized palliative care consultation process prevented greater integration of palliative care in SCT. CONCLUSIONS: SCT team members held a favorable perception of palliative care and saw a role for greater palliative care integration throughout the SCT course. We identified modifiable barriers to greater palliative care integration. SCT teams who desire greater palliative care integration may adapt and implement an existing model of palliative care integration in order to improve standardization and increase integration of specialty palliative care in SCT.
Authors
Collins, GS; Beaman, H; Ho, AM; Hermiston, ML; Cohen, HJ; Dzeng, EW
MLA Citation
Collins, Griffin S., et al. “Perceptions of specialty palliative care and its role in pediatric stem cell transplant: A multidisciplinary qualitative study.Pediatr Blood Cancer, vol. 69, no. 1, Jan. 2022, p. e29424. Pubmed, doi:10.1002/pbc.29424.
URI
https://scholars.duke.edu/individual/pub1501040
PMID
34705322
Source
pubmed
Published In
Pediatr Blood Cancer
Volume
69
Published Date
Start Page
e29424
DOI
10.1002/pbc.29424

Response to Dekker, Stege, and Versteeg.

Authors
Mandelblatt, JS; Zhou, X; Small, BJ; Ahn, J; Zhai, W; Ahles, T; Extermann, M; Graham, D; Jacobsen, PB; Jim, H; McDonald, BC; Patel, SK; Root, JC; Saykin, AJ; Cohen, HJ; Carroll, JE
MLA Citation
Mandelblatt, Jeanne S., et al. “Response to Dekker, Stege, and Versteeg.J Natl Cancer Inst, vol. 113, no. 10, Oct. 2021, pp. 1436–37. Pubmed, doi:10.1093/jnci/djab060.
URI
https://scholars.duke.edu/individual/pub1478112
PMID
33823011
Source
pubmed
Published In
J Natl Cancer Inst
Volume
113
Published Date
Start Page
1436
End Page
1437
DOI
10.1093/jnci/djab060

Predictors of Unplanned Hospitalizations Among Older Adults Receiving Cancer Chemotherapy.

PURPOSE: Hospitalizations during cancer treatment are costly, can impair quality of life, and negatively affect therapy completion. Our objective was to identify risk factors for unplanned hospitalization among older adults receiving chemotherapy. METHODS: This is a secondary analysis of a multisite cohort study (N = 750) of patients ≥ 65 years of age evaluated with a geriatric assessment (GA) to predict chemotherapy toxicity. The primary outcome of this analysis was unplanned hospitalizations during treatment; the secondary outcome was length of stay (LOS) of the first hospitalization. Independent variables included pretreatment GA measures, laboratory values, cancer type and stage, and treatment intensity characteristics. We used logistic regression to estimate the odds of hospitalization and generalized linear models for LOS in multivariable analyses. RESULTS: The sample median age was 72 years (range, 65-94 years); 59% had stage IV disease. At least one unplanned hospitalization occurred in 193 patients (25.7%) during receipt of chemotherapy. In multivariable analyses controlling for cancer type, the following baseline characteristics were significantly associated with increased odds of hospitalization: needing help bathing or dressing (odds ratio [OR], 1.8; 95% CI, 1.0 to 3.1), polypharmacy (≥ 5 meds) (OR, 1.6; 95% CI, 1.1 to 2.4), more comorbid conditions (OR, 1.1; 95% CI, 1.0 to 1.3), availability of someone to take them to the doctor (OR, 2.0; 95% CI, 1.0 to 4.1), CrCl < 60 mL/min (OR, 1.7; 95% CI, 1.1 to 2.4), and albumin < 3.5 g/dL (OR, 1.8; 95% CI, 1.2 to 2.8). In multivariable analyses, older age, self-reported presence of liver or kidney disease, living alone and depressive symptoms were associated with longer LOS. CONCLUSION: Readily available GA variables and laboratory data, but not age, were associated with unplanned hospitalizations among older adults receiving chemotherapy. If validated, these data can inform prediction models and the design of interventions to decrease unplanned hospitalizations.
Authors
Klepin, HD; Sun, C-L; Smith, DD; Elias, R; Trevino, KM; Bryant, AL; Li, D; Nelson, C; Tew, WP; Mohile, SG; Gajra, A; Owusu, C; Gross, C; Lichtman, SM; Katheria, VV; Muss, HB; Chapman, AE; Cohen, HJ; Hurria, A; Dale, W
MLA Citation
Klepin, Heidi D., et al. “Predictors of Unplanned Hospitalizations Among Older Adults Receiving Cancer Chemotherapy.Jco Oncol Pract, vol. 17, no. 6, June 2021, pp. e740–52. Pubmed, doi:10.1200/OP.20.00681.
URI
https://scholars.duke.edu/individual/pub1480306
PMID
33881905
Source
pubmed
Published In
Jco Oncol Pract
Volume
17
Published Date
Start Page
e740
End Page
e752
DOI
10.1200/OP.20.00681

Electronic Geriatric Assessment: Is It Feasible in a Multi-Institutional Study That Included a Notable Proportion of Older African American Patients? (Alliance A171603).

PURPOSE: This study determined whether an electronic version of the geriatric assessment is feasible in a multi-institutional, diverse setting. METHODS: Ten sites within the Alliance for Clinical Trials in Oncology participated. Patients who had active cancer or a history of cancer and were 65 years of age or older were eligible. The geriatric assessment was completed with an electronic data capture system that had been loaded onto iPads. Feasibility was defined a priori as completion in at least 70% of patients either with or without help. To enhance racial diversity, the original sample size was later changed and augmented by 50% with the intention of increasing enrollment of older minority patients. RESULTS: A total of one hundred fifty-four patients were registered with a median age of 72 years (range, 65-91 years). Forty-three (28%) identified themselves as African American or Black. One hundred forty-one patients (92%) completed the electronic geriatric assessment. Feasibility was observed across all subgroups, regardless of race, education, performance status, comorbidities, and cognition; 124 patients (81%) completed the geriatric assessment without help. Reasons for not completing the geriatric assessment are as follows: clinic visit did not occur (n = 6), no iPad connection to the Internet (n = 3), patient declined (n = 2), prolonged hospitalization (n = 1), and patient died (n = 1). Reasons for needing help, as reported by study personnel, were as follows: the patient preferred that research personnel ask the questions (n = 9), vision problem (n = 3), lack of comfort with the iPad (n = 2), questions were not clear (n = 1), less proficient in English (n = 1), and challenge in pressing the green button to go to the next question (n = 1). CONCLUSION: The electronic geriatric assessment is feasible in a multi-institutional setting that includes a notable proportion of African American or Black patients.
Authors
Guerard, E; Dodge, AB; Le-Rademacher, JG; Kemeny, MM; Ojelabi, M; Sedrak, MS; Hopkins, J; Shahrokni, A; Harlos, E; Muss, H; Cohen, HJ; Lafky, J; Sloan, J; Jatoi, A; Hurria, A
MLA Citation
Guerard, Emily, et al. “Electronic Geriatric Assessment: Is It Feasible in a Multi-Institutional Study That Included a Notable Proportion of Older African American Patients? (Alliance A171603).Jco Clin Cancer Inform, vol. 5, Apr. 2021, pp. 435–41. Pubmed, doi:10.1200/CCI.20.00163.
URI
https://scholars.duke.edu/individual/pub1480307
PMID
33852323
Source
pubmed
Published In
Jco Clinical Cancer Informatics
Volume
5
Published Date
Start Page
435
End Page
441
DOI
10.1200/CCI.20.00163