Paul Mosca

Overview:

My research focuses on three areas. One is the development of more effective and entirely novel treatments for melanoma. I have a special interest in immunotherapy, novel targeted molecular therapies, and regional chemotherapy for advanced melanoma of the arm or leg. Another area of interest is palliative surgery for cancer with an emphasis on understanding the optimal role and application of this type of surgery in the care of advanced malignancy. A third area of interest is quality and patient safety with an emphasis on communication and work culture.

Positions:

Associate Professor of Surgery

Surgical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 1994

University of Virginia

M.D. 1995

University of Virginia

M.B.A. 2011

Desales University

Intern, Surgery

Duke University

Junior Assistant Resident, Surgery

Duke University

Senior Assistant Resident, Surgery

Duke University

Surgical Research Fellow, Surgery

Duke University

2nd Year SAR, Surgery

Duke University

Chief Resident, Surgery

Duke University

Assistant Professor, Surgery

Duke University School of Medicine

Assistant Professor, Surgery

Lehigh Valley Health Network

Grants:

Dendritic Cell Immunotherapy For Breast Cancer

Awarded By
National Institutes of Health
Role
PI-Fellow
Start Date
End Date

Publications:

The Legacy of Joseph A. Moylan, M.D.: "it's about Everyone Else"

The history of modern American surgery is marked by larger-than-life pioneers who have made transformative contributions to our field. These extraordinary individuals have been known primarily for their technical and clinical mastery, development of novel surgical procedures and techniques, extraordinary abilities in the education and training of surgeons, and/or innovative discoveries in biomedical science. While mastery in clinical surgery, education, and research have come to characterize the consummate academic surgeon, challenging social inequities of today now demand deeper engagement in another vital arena. This historical account is the story of a truly exceptional surgeon and visionary who spent much of his life leading that very charge. Early in his career, Dr. Joseph Moylan recognized and embraced this obligation to go beyond the walls of the hospital and out into the community to combat social factors leading to adverse outcomes for at-risk young men. His legacy itself represents a vehicle for empowering youth confronted with barriers to educational opportunities and experiences. Furthermore, recounting Joe's journey conveys the over-arching thesis that surgeons have the opportunity - and, indeed, are well positioned - to engage more deeply with their communities, to lead efforts to address social determinants at their roots and to create a pipeline of bright young scholars and potential future surgeons.
Authors
Mosca, PJ; Zani, S; Haglund, MM; Collins, BH; Wasiolek, S; Pappas, TN; Kirk, AD; Cendales, LC
MLA Citation
Mosca, P. J., et al. “The Legacy of Joseph A. Moylan, M.D.: "it's about Everyone Else".” Annals of Surgery, Jan. 2021. Scopus, doi:10.1097/AS9.0000000000000051.
URI
https://scholars.duke.edu/individual/pub1482748
Source
scopus
Published In
Annals of Surgery
Published Date
DOI
10.1097/AS9.0000000000000051

Relationship Between HCAHPS Scores and Survey Response Rate Is Linked to Hospital Size.

Patient experience is an important dimension of health care quality and is assessed using the standard Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for inpatients. The HCAHPS scores may vary based on survey response rate and hospital size. The objective of this study was to describe the association between survey response rate and HCAHPS scores and examine whether the relationship varies based on hospital size. Medicare's Hospital Compare publicly reported HCAHPS data were used. Pearson correlation, controlling for number of staffed beds, and linear regression models were used for the analysis. Hospitals were grouped into quartiles based on number of staffed beds to delineate the effect of increasing hospital size on the relationship between survey response rate and HCAHPS scores. A significant association between HCAHPS survey response rate and all examined HCAHPS domain scores was observed. The effect size across HCAHPS domains varied based on hospital size. The relationship between HCAHPS score and survey response rate differed significantly between hospitals in the smallest and largest size quartiles for discharge information, nurse communication, and hospital quietness. While a causal relationship cannot be inferred from this study, the response rate could be a direct and/or indirect driver of HCAHPS scores. Future research should be aimed to further explore the basis of this relationship and to determine how it may inform the interpretation of HCAHPS results.
Authors
Rodriguez-Homs, LG; Hammill, BG; Ryser, MD; Phillips, HR; Mosca, PJ
MLA Citation
Rodriguez-Homs, Larissa G., et al. “Relationship Between HCAHPS Scores and Survey Response Rate Is Linked to Hospital Size.J Patient Exp, vol. 7, no. 6, Dec. 2020, pp. 1543–48. Pubmed, doi:10.1177/2374373520932458.
URI
https://scholars.duke.edu/individual/pub1472628
PMID
33457612
Source
pubmed
Published In
J Patient Exp
Volume
7
Published Date
Start Page
1543
End Page
1548
DOI
10.1177/2374373520932458

Gratitude at Work: Prospective Cohort Study of a Web-Based, Single-Exposure Well-Being Intervention for Health Care Workers (Preprint)

<sec> <title>BACKGROUND</title> <p>Emotional exhaustion (EE) in health care workers is common and consequentially linked to lower quality of care. Effective interventions to address EE are urgently needed.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This randomized single-exposure trial examined the efficacy of a gratitude letter–writing intervention for improving health care workers’ well-being.</p> </sec> <sec> <title>METHODS</title> <p>A total of 1575 health care workers were randomly assigned to one of two gratitude letter–writing prompts (self- vs other focused) to assess differential efficacy. Assessments of EE, subjective happiness, work-life balance, and tool engagement were collected at baseline and 1-week post intervention. Participants received their EE score at baseline and quartile benchmarking scores. Paired-samples &lt;i&gt;t&lt;/i&gt; tests, independent &lt;i&gt;t&lt;/i&gt; tests, and correlations explored the efficacy of the intervention. Linguistic Inquiry and Word Count software assessed the linguistic content of the gratitude letters and associations with well-being.</p> </sec> <sec> <title>RESULTS</title> <p>Participants in both conditions showed significant improvements in EE, happiness, and work-life balance between the intervention and 1-week follow-up (&lt;i&gt;P&lt;/i&gt;&amp;lt;.001). The self-focused (vs other) instruction conditions did not differentially predict improvement in any of the measures (&lt;i&gt;P&lt;/i&gt;=.91). Tool engagement was high, and participants reporting higher motivation to improve their EE had higher EE at baseline (&lt;i&gt;P&lt;/i&gt;&amp;lt;.001) and were more likely to improve EE a week later (&lt;i&gt;P&lt;/i&gt;=.03). Linguistic analyses revealed that participants high on EE at baseline used more negative emotion words in their letters (&lt;i&gt;P&lt;/i&gt;=.005). Reduction in EE at the 1-week follow-up was predicted at the level of a trend by using fewer first-person (&lt;i&gt;P&lt;/i&gt;=.06) and positive emotion words (&lt;i&gt;P&lt;/i&gt;=.09). No baseline differences were found between those who completed the follow-up assessment and those who did not (&lt;i&gt;P&lt;/i&gt;s&amp;gt;.05).</p> </sec> <sec> <title>CONCLUSIONS</title> <p>This single-exposure gratitude letter–writing intervention appears to be a promising low-cost, brief, and meaningful tool to improve the well-being of health care workers.</p> </sec>
Authors
Adair, KC; Rodriguez-Homs, LG; Masoud, S; Mosca, PJ; Sexton, JB
MLA Citation
URI
https://scholars.duke.edu/individual/pub1441218
Source
crossref
DOI
10.2196/preprints.15562

Characterization of Sentinel Lymph Node Immune Signatures and Implications for Risk Stratification for Adjuvant Therapy in Melanoma.

BACKGROUND: Although sentinel lymph node (SLN) biopsy is a standard procedure used to identify patients at risk for melanoma recurrence, it fails to risk-stratify certain patients accurately. Because processes in SLNs regulate anti-tumor immune responses, the authors hypothesized that SLN gene expression may be used for risk stratification. METHODS: The Nanostring nCounter PanCancer Immune Profiling Panel was used to quantify expression of 730 immune-related genes in 60 SLN specimens (31 positive [pSLNs], 29 negative [nSLNs]) from a retrospective melanoma cohort. A multivariate prediction model for recurrence-free survival (RFS) was created by applying stepwise variable selection to Cox regression models. Risk scores calculated on the basis of the model were used to stratify patients into low- and high-risk groups. The predictive power of the model was assessed using the Kaplan-Meier and log-rank tests. RESULTS: During a median follow-up period of 6.3 years, 20 patients (33.3%) experienced recurrence (pSLN, 45.2% [14/31] vs nSLN, 20.7% [6/29]; p = 0.0445). A fitted Cox regression model incorporating 12 genes accurately predicted RFS (C-index, 0.9919). Improved RFS was associated with increased expression of TIGIT (p = 0.0326), an immune checkpoint, and decreased expression of CXCL16 (p = 0.0273), a cytokine important in promoting dendritic and T cell interactions. Independent of SLN status, the model in this study was able to stratify patients into cohorts at high and low risk for recurrence (p < 0.001, log-rank). CONCLUSIONS: Expression profiles of the SLN gene are associated with melanoma recurrence and may be able to identify patients as high or low risk regardless of SLN status, potentially enhancing patient selection for adjuvant therapy.
Authors
Farrow, NE; Holl, EK; Jung, J; Gao, J; Jung, S-H; Al-Rohil, RN; Selim, MA; Mosca, PJ; Ollila, DW; Antonia, SJ; Tyler, DS; Nair, SK; Beasley, GM
MLA Citation
Farrow, Norma E., et al. “Characterization of Sentinel Lymph Node Immune Signatures and Implications for Risk Stratification for Adjuvant Therapy in Melanoma.Ann Surg Oncol, vol. 28, no. 7, July 2021, pp. 3501–10. Pubmed, doi:10.1245/s10434-020-09277-w.
URI
https://scholars.duke.edu/individual/pub1465295
PMID
33205334
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
28
Published Date
Start Page
3501
End Page
3510
DOI
10.1245/s10434-020-09277-w

Ipilimumab and Radiation in Patients with High-risk Resected or Regionally Advanced Melanoma.

PURPOSE: In this prospective trial, we sought to assess the feasibility of concurrent administration of ipilimumab and radiation as adjuvant, neoadjuvant, or definitive therapy in patients with regionally advanced melanoma. PATIENTS AND METHODS: Twenty-four patients in two cohorts were enrolled and received ipilimumab at 3 mg/kg every 3 weeks for four doses in conjunction with radiation; median dose was 4,000 cGy (interquartile range, 3,550-4,800 cGy). Patients in cohort 1 were treated adjuvantly; patients in cohort 2 were treated either neoadjuvantly or as definitive therapy. RESULTS: Adverse event profiles were consistent with those previously reported with checkpoint inhibition and radiation. For the neoadjuvant/definitive cohort, the objective response rate was 64% (80% confidence interval, 40%-83%), with 4 of 10 evaluable patients achieving a radiographic complete response. An additional 3 patients in this cohort had a partial response and went on to surgical resection. With 2 years of follow-up, the 6-, 12-, and 24-month relapse-free survival for the adjuvant cohort was 85%, 69%, and 62%, respectively. At 2 years, all patients in the neoadjuvant/definitive cohort and 10/13 patients in the adjuvant cohort were still alive. Correlative studies suggested that response in some patients were associated with specific CD4+ T-cell subsets. CONCLUSIONS: Overall, concurrent administration of ipilimumab and radiation was feasible, and resulted in a high response rate, converting some patients with unresectable disease into surgical candidates. Additional studies to investigate the combination of radiation and checkpoint inhibitor therapy are warranted.
Authors
Salama, AKS; Palta, M; Rushing, CN; Selim, MA; Linney, KN; Czito, BG; Yoo, DS; Hanks, BA; Beasley, GM; Mosca, PJ; Dumbauld, C; Steadman, KN; Yi, JS; Weinhold, KJ; Tyler, DS; Lee, WT; Brizel, DM
MLA Citation
Salama, April K. S., et al. “Ipilimumab and Radiation in Patients with High-risk Resected or Regionally Advanced Melanoma.Clin Cancer Res, vol. 27, no. 5, Mar. 2021, pp. 1287–95. Pubmed, doi:10.1158/1078-0432.CCR-20-2452.
URI
https://scholars.duke.edu/individual/pub1464016
PMID
33172894
Source
pubmed
Published In
Clinical Cancer Research
Volume
27
Published Date
Start Page
1287
End Page
1295
DOI
10.1158/1078-0432.CCR-20-2452

Research Areas:

Cancer Vaccines
Carcinoma, Merkel Cell
Immunity, Cellular
Immunotherapy
Lymph Node Excision
Melanoma
Sarcoma
Surgery
T-Lymphocytes