Walter Lee

Overview:

Global Health, Virtue-Based Professional Development and Leadership, Device Development for Cancer Detection

Positions:

Professor of Head and Neck Surgery & Communication Sciences

Head and Neck Surgery & Communication Sciences
School of Medicine

Professor in Radiation Oncology

Radiation Oncology
School of Medicine

Affiliate, Duke Global Health Institute

Duke Global Health Institute
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1999

The George Washington University

M.H.S. 2015

Duke University

Grants:

Clinical Evaluation of the OncAlert® RAPID in Subjects Presenting for Evaluation and/or Initial Biopsy

Administered By
Head and Neck Surgery & Communication Sciences
Awarded By
Vigilant Biosciences
Role
Principal Investigator
Start Date
End Date

A Quantitative Optical Sensor to Monitor Tumor Vascular Physiology

Administered By
Radiation Oncology
Awarded By
Zenalux Biomedical, Inc.
Role
Investigator
Start Date
End Date

TERT promoter mutation frequency in subsets of oral tongue cancer patients

Administered By
Head and Neck Surgery & Communication Sciences
Awarded By
American Medical Association Foundation
Role
Principal Investigator
Start Date
End Date

CHECKPOINT Head & Neck Nerve Stimulator/Locator Product Validation Study (9394-CSP-000-B)

Administered By
Head and Neck Surgery & Communication Sciences
Awarded By
Checkpoint Surgical
Role
Principal Investigator
Start Date
End Date

A Virtue Based on-line Leadership Curriculum: A Nationwide Resource for Professional Development

Administered By
Head and Neck Surgery & Communication Sciences
Awarded By
Society of University Otolaryngologists
Role
Principal Investigator
Start Date
End Date

Publications:

Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study.

BACKGROUND: Cognitive dysfunction after surgery is a major issue in older adults. Here, we determined the effect of APOE4 on perioperative neurocognitive function in older patients. METHODS: We enrolled 140 English-speaking patients ≥60 yr old scheduled for noncardiac surgery under general anaesthesia in an observational cohort study, of whom 52 underwent neuroimaging. We measured cognition; Aβ, tau, p-tau levels in CSF; and resting-state intrinsic functional connectivity in six Alzheimer's disease-risk regions before and 6 weeks after surgery. RESULTS: There were no significant APOE4-related differences in cognition or CSF biomarkers, except APOE4 carriers had lower CSF Aβ levels than non-carriers (preoperative median CSF Aβ [median absolute deviation], APOE4 305 pg ml-1 [65] vs 378 pg ml-1 [38], respectively; P=0.001). Controlling for age, APOE4 carriers had significantly greater preoperative functional connectivity than non-carriers between several brain regions implicated in Alzheimer's disease, including between the left posterior cingulate cortex and left angular gyrus (β [95% confidence interval, CI], 0.218 [0.137-0.230]; PFWE=0.016). APOE4 carriers, but not non-carriers, experienced significant connectivity decreases from before to 6 weeks after surgery between several brain regions including between the left posterior cingulate cortex and left angular gyrus (β [95% CI], -0.196 [-0.256 to -0.136]; PFWE=0.001). Most preoperative and postoperative functional connectivity differences did not change after controlling for preoperative CSF Aβ levels. CONCLUSIONS: Postoperative change trajectories for cognition and CSF Aβ, tau or p-tau levels did not differ between community dwelling older APOE4 carriers and non-carriers. APOE4 carriers showed greater preoperative functional connectivity and greater postoperative decreases in functional connectivity in key Alzheimer's disease-risk regions, which occur via Aβ-independent mechanisms.
Authors
Browndyke, JN; Wright, MC; Yang, R; Syed, A; Park, J; Hall, A; Martucci, K; Devinney, MJ; Moretti, EW; Whitson, HE; Cohen, HJ; Mathew, JP; Berger, M; MADCO-PC Investigators,
MLA Citation
URI
https://scholars.duke.edu/individual/pub1496919
PMID
34535274
Source
pubmed
Published In
Bja: British Journal of Anaesthesia
Published Date
DOI
10.1016/j.bja.2021.08.012

Incidence and Risk of Suicide Among Patients With Head and Neck Cancer in Rural, Urban, and Metropolitan Areas.

Importance: Patients with head and neck cancer (HNC) are known to be at increased risk of suicide compared with the general population, but there has been insufficient research on whether this risk differs based on patients' rural, urban, or metropolitan residence status. Objective: To evaluate whether the risk of suicide among patients with HNC differs by rural vs urban or metropolitan residence status. Design, Setting, and Participants: This cross-sectional study uses data from the Surveillance, Epidemiology, and End Results database on patients aged 18 to 74 years who received a diagnosis of HNC from January 1, 2000, to December 31, 2016. Statistical analysis was conducted from November 27, 2020, to June 3, 2021. Exposures: Residence status, assessed using 2013 Rural Urban Continuum Codes. Main Outcomes and Measures: Death due to suicide was assessed by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes (U03, X60-X84, and Y87.0) and the cause of death recode (50220). Standardized mortality ratios (SMRs) of suicide, assessing the suicide risk among patients with HNC compared with the general population, were calculated. Suicide risk by residence status was compared using Fine-Gray proportional hazards regression models. Results: Data from 134 510 patients with HNC (101 142 men [75.2%]; mean [SE] age, 57.7 [10.3] years) were analyzed, and 405 suicides were identified. Metropolitan residents composed 86.6% of the sample, urban residents composed 11.7%, and rural residents composed 1.7%. The mortality rate of suicide was 59.2 per 100 000 person-years in metropolitan counties, 64.0 per 100 000 person-years in urban counties, and 126.7 per 100 000 person-years in rural counties. Compared with the general population, the risk of suicide was markedly higher among patients with HNC in metropolitan (SMR, 2.78; 95% CI, 2.49-3.09), urban (SMR, 2.84; 95% CI, 2.13-3.71), and rural (SMR, 5.47; 95% CI, 3.06-9.02) areas. In Fine-Gray competing-risk analyses that adjusted for other covariates, there was no meaningful difference in suicide risk among urban vs metropolitan residents. However, compared with rural residents, residents of urban (subdistribution hazard ratio, 0.52; 95% CI, 0.29-0.94) and metropolitan counties (subdistribution hazard ratio, 0.55; 95% CI, 0.32-0.94) had greatly lower risk of suicide. Conclusions and Relevance: The findings of this cross-sectional study suggest that suicide risk is elevated in general among patients with HNC but is significantly higher for patients residing in rural areas. Effective suicide prevention strategies in the population of patients with HNC need to account for rural health owing to the high risk of suicide among residents with HNC in rural areas.
Authors
Osazuwa-Peters, N; Barnes, JM; Okafor, SI; Taylor, DB; Hussaini, AS; Adjei Boakye, E; Simpson, MC; Graboyes, EM; Lee, WT
MLA Citation
Osazuwa-Peters, Nosayaba, et al. “Incidence and Risk of Suicide Among Patients With Head and Neck Cancer in Rural, Urban, and Metropolitan Areas.Jama Otolaryngol Head Neck Surg, July 2021. Pubmed, doi:10.1001/jamaoto.2021.1728.
URI
https://scholars.duke.edu/individual/pub1489727
PMID
34297790
Source
pubmed
Published In
Jama Otolaryngol Head Neck Surg
Published Date
DOI
10.1001/jamaoto.2021.1728

Cerebrospinal Fluid Proteome Changes in Older Non-Cardiac Surgical Patients with Postoperative Cognitive Dysfunction.

BACKGROUND: Postoperative cognitive dysfunction (POCD), a syndrome of cognitive deficits occurring 1-12 months after surgery primarily in older patients, is associated with poor postoperative outcomes. POCD is hypothesized to result from neuroinflammation; however, the pathways involved remain unclear. Unbiased proteomic analyses have been used to identify neuroinflammatory pathways in multiple neurologic diseases and syndromes but have not yet been applied to POCD. OBJECTIVE: To utilize unbiased mass spectrometry-based proteomics to identify potential neuroinflammatory pathways underlying POCD. METHODS: Unbiased LC-MS/MS proteomics was performed on immunodepleted cerebrospinal fluid (CSF) samples obtained before, 24 hours after, and 6 weeks after major non-cardiac surgery in older adults who did (n = 8) or did not develop POCD (n = 6). Linear mixed models were used to select peptides and proteins with intensity differences for pathway analysis. RESULTS: Mass spectrometry quantified 8,258 peptides from 1,222 proteins in > 50%of patient samples at all three time points. Twelve peptides from 11 proteins showed differences in expression over time between patients with versus withoutPOCD (q < 0.05), including proteins previously implicated in neurodegenerative disease pathophysiology. Additionally, 283 peptides from 182 proteins were identified with trend-level differences (q < 0.25) in expression over time between these groups. Among these, pathway analysis revealed that 50 were from 17 proteins mapping to complement and coagulation pathways (q = 2.44*10-13). CONCLUSION: These data demonstrate the feasibility of performing unbiased mass spectrometry on perioperative CSF samples to identify pathways associated with POCD. Additionally, they provide hypothesis-generating evidence for CSF complement and coagulation pathway changes in patients with POCD.
Authors
VanDusen, KW; Li, Y-J; Cai, V; Hall, A; Hiles, S; Thompson, JW; Moseley, MA; Cooter, M; Acker, L; Levy, JH; Ghadimi, K; Quiñones, QJ; Devinney, MJ; Chung, S; Terrando, N; Moretti, EW; Browndyke, JN; Mathew, JP; Berger, M; MADCO-PC Investigators,
MLA Citation
VanDusen, Keith W., et al. “Cerebrospinal Fluid Proteome Changes in Older Non-Cardiac Surgical Patients with Postoperative Cognitive Dysfunction.J Alzheimers Dis, vol. 80, no. 3, 2021, pp. 1281–97. Pubmed, doi:10.3233/JAD-201544.
URI
https://scholars.duke.edu/individual/pub1475476
PMID
33682719
Source
pubmed
Published In
J Alzheimers Dis
Volume
80
Published Date
Start Page
1281
End Page
1297
DOI
10.3233/JAD-201544

Analysis of Self- and 360-Evaluation Scores of the Professionalism Intelligence Model Within an Academic Otolaryngology-Head and Neck Surgery Department.

Purpose: To analyze self and 360-evaluation scores of the professionalism intelligence model domains within an academic Otolaryngology-Head and Neck Surgery Department. Methods: A leadership course was introduced within the Department of Head and Neck Surgery & Communication Sciences at Duke University Medical Center. A 360 evaluation assessing domains of the professional intelligence model was recorded for all participants. Participant demographics included gender (male vs female), generation group (generation Y vs older generations) and physician status of participants (physician vs non-physician). Differences in mean self-scores were modeled using linear regression. When analyzing the evaluator scores, gaps were defined as self-score minus evaluator-score for each member of a participant's evaluator groupings (supervisor, peer, and direct report). Two types of linear mixed models were fit with a random intercept to account for the correlated gaps in the same participant. Results: Scores of 50 participants and 394 evaluators were analyzed. The average age was 40.6 (standard deviation 9.3) years, and 50% (N=25) of participants were females. Physicians accounted for 36% (N=18) of the cohort, and 61% (N=11) of physicians were residents. Physicians scored themselves lower than non-physicians when assessing leadership intelligence, interpersonal relations, empathy, and focused thinking. On average, participants under-rated themselves compared to their evaluators with direct reports giving higher scores than managers and peers. When compared with generation Y, older generations tended to rate themselves lower than their peers and managers in cognitive intelligence. No significant association was observed between gender and any scores. Conclusion: Participants rate themselves lower on average than their evaluators. This work is important in understanding how perceived leadership qualities are assessed and developed within an academic surgical department. Finally, the results presented could serve as a model to address the gap between self- and other-perceptions of defined leadership virtues in future leadership development activities.
Authors
Issa, K; Abi Hachem, R; Gordee, A; Truong, T; Pfohl, R; Doublestein, B; Lee, W
MLA Citation
Issa, Khalil, et al. “Analysis of Self- and 360-Evaluation Scores of the Professionalism Intelligence Model Within an Academic Otolaryngology-Head and Neck Surgery Department.J Healthc Leadersh, vol. 13, 2021, pp. 129–36. Pubmed, doi:10.2147/JHL.S296501.
URI
https://scholars.duke.edu/individual/pub1481823
PMID
34007234
Source
pubmed
Published In
Journal of Healthcare Leadership
Volume
13
Published Date
Start Page
129
End Page
136
DOI
10.2147/JHL.S296501

Value Signposts in MedTech Development: An Experience from the Field

Medical technology (MedTech) is traditionally seen as enabling the delivery of health in a better, innovative fashion. For example, the Da Vinci robot enables robotic surgeries, and Ardian enables surgical treatment of refractory hypertension. More recently, there has been a profound shift in emphasis on technologies that can provide cost-saving values to the payers. To this end, value signposts are fundamental in identifying and addressing clinical needs on a global scale. These value signposts include the potential to keep patients out of the hospital, change location of care to less expensive venues, and diagnose a condition earlier to reduce complications and/or slow disease progression. These presentations will review the key value signposts for translating health science technology and apply them to two case studies. Case 1: Even with readily available Emergency Medical Service and well equipped tertiary medical centres dotted across Singapore, the rate of patients with ischemic stroke receiving thrombolysis is low at 6.3%. Patients missing the window for thrombolysis have worse clinical outcome and require expensive rehabilitation. Our Singapore Stanford Biodesign team developed an app to identify the three most common symptoms of stroke and automatically activate medical response. Case 2: Our team of physicians from Singapore and the United States identified a scarcity of nasoendoscope in Vietnam. Only 45% of central and regional hospitals have nasoendoscopes whereas no community or district hospitals have such capacity. The team developed an affordable, LED-based, cord-free, AAA-battery-powered nasoendoscope system with data acquisition and transmission circuitry. This device can potentially add significant value to the delivery of ENT care in Vietnam and beyond. The objective is to demonstrate how innovations with strong focus on reducing the costs to healthcare systems have global appeal.
Authors
Nguyen, KT; Lee, PP; Yock, PG; Tan, NC; Tan, HK; Lee, WT
MLA Citation
Nguyen, K. T., et al. “Value Signposts in MedTech Development: An Experience from the Field.” Ifmbe Proceedings, vol. 69, 2020, pp. 571–75. Scopus, doi:10.1007/978-981-13-5859-3_98.
URI
https://scholars.duke.edu/individual/pub1394161
Source
scopus
Published In
Ifmbe Proceedings
Volume
69
Published Date
Start Page
571
End Page
575
DOI
10.1007/978-981-13-5859-3_98

Research Areas:

Academic Medical Centers
Adjuvants, Immunologic
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Alcohol Drinking
Algorithms
Ambulatory Care
Anastomosis, Surgical
Animals
Antigen Presentation
Antigens
Antigens, Neoplasm
Attitude of Health Personnel
Attitude to Health
Breast Neoplasms
Cancer Vaccines
Carcinoma, Squamous Cell
Career Choice
Caregivers
Cation Transport Proteins
Cell Differentiation
Cell Fusion
Cell Movement
Cell Separation
Cell Transplantation
Cells, Cultured
Chemotherapy, Adjuvant
Chi-Square Distribution
Child
Clinical Competence
Clinical Trials as Topic
Clinical trials
Cohort Studies
Combined Modality Therapy
Computer Simulation
Conflict of Interest
Constriction, Pathologic
Cranial Nerve Neoplasms
Critical Care
Cross-Sectional Studies
Curriculum
Cysts
Cytoskeletal Proteins
DNA Methylation
Data Interpretation, Statistical
Database
Debridement
Dendritic Cells
Diagnosis, Differential
Disease Models, Animal
Disease-Free Survival
Dose-Response Relationship, Drug
Drug Evaluation, Preclinical
Drug Therapy, Combination
Early Detection of Cancer
Edema
Education, Medical, Graduate
Electric Stimulation
Electrofusion
Electrophoresis
Emergency Treatment
Endoscopy
Enzyme-Linked Immunosorbent Assay
Esophageal Stenosis
Ethics
Evidence-Based Medicine
False Negative Reactions
Female
Fractures, Bone
GTP-Binding Proteins
Genes, Tumor Suppressor
Goiter
Head and Neck Neoplasms
Health Care Surveys
Health Priorities
Heart Defects, Congenital
Hemoglobins
Hernia
Herniorrhaphy
Hoarseness
Homeodomain Proteins
Hospitalization
Human papillomavirus 16
Humans
Hybrid Cells
Hypopharynx
Immunotherapy
Industry
Infant
Interferon-gamma
Interleukin-10
Interleukin-12
Internet
Internship and Residency
Intubation
Intubation, Intratracheal
Inventions
Laryngeal Diseases
Laryngeal Neoplasms
Laryngectomy
Laryngoplasty
Laryngoscopy
Laryngostenosis
Larynx
Laser Therapy
Leadership
Lung Neoplasms
Lymph Nodes
Lymphatic Metastasis
Lymphocyte Activation
Male
Mandibular Diseases
Melanoma
Melanoma, Experimental
Metals
Mice
Mice, Inbred BALB C
Mice, Inbred C57BL
Microsurgery
Microtubule-Associated Proteins
Middle Aged
Military Personnel
Monocytes
Monte Carlo Method
Moral Development
Mouth Neoplasms
Neck Dissection
Neoplasm Metastasis
Neoplasm Recurrence, Local
Neoplasm Staging
Neoplasm Transplantation
Neoplasms
Neoplastic Stem Cells
Nerve Tissue Proteins
Nerve Transfer
Nose
Nose Neoplasms
Organ Sparing Treatments
Organophosphorus Compounds
Osteoradionecrosis
Otolaryngology
Otorhinolaryngologic Diseases
Oxygen
Oxygen Consumption
Pain
Palliative Care
Papillomavirus Infections
Personnel Selection
Phantoms, Imaging
Physicians
Pilot Projects
Politics
Postoperative Care
Postoperative Complications
Prejudice
Preoperative Care
Professional Competence
Prognosis
Program Development
Program Evaluation
Promoter Regions, Genetic
Proto-Oncogene Proteins
Publication Bias
Questionnaires
Radiation Injuries
Radiometry
Radiotherapy
Radiotherapy, Adjuvant
Randomized Controlled Trials as Topic
Recombinant Fusion Proteins
Reconstructive Surgical Procedures
Recovery of Function
Reference Values
Registries
Resource Allocation
Respiratory Tract Neoplasms
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Sentinel Lymph Node Biopsy
Septins
Sex Factors
Signal Transduction
Skin Neoplasms
Smoking
Software
Specialties, Surgical
Specific Pathogen-Free Organisms
Spectrum Analysis
Statistics, Nonparametric
Surgical Procedures, Operative
Surveys and Questionnaires
Survival Analysis
Survival Rate
Suture Techniques
T-Lymphocytes
Tensile Strength
Terminally Ill
Thyroid Nodule
Time Factors
Toll-Like Receptors
Tongue
Tongue Diseases
Tongue Neoplasms
Tonsillar Neoplasms
Trachea
Tracheal Diseases
Tracheostomy
Tracheotomy
Transcription Factors
Treatment Outcome
Tumor Cells, Cultured
Tumor Markers, Biological
United States
Vaccines
Vaccines, Synthetic
Ventilators, Mechanical
Vestibulocochlear Nerve Diseases
Video Recording
Virtues
Vocal Cord Paralysis
Voice Disorders
Wounds, Nonpenetrating
Young Adult