Haley Moss

Positions:

Assistant Professor of Obstetrics and Gynecology

Obstetrics and Gynecology, Gynecologic Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.B.A. 2012

University of Pennsylvania

M.D. 2012

University of Pennsylvania, School of Medicine

Residency in Obstetrics and Gynecology, Obstetrics And Gynecology

New York University School of Medicine

Fellowship in Gynecology Oncology, Obstetrics And Gynecology

Duke University

Grants:

Publications:

Cascade Testing for Hereditary Cancer Syndromes: Should We Move Toward Direct Relative Contact? A Systematic Review and Meta-Analysis.

<h4>Purpose</h4>Evidence-based guidelines recommend cascade genetic counseling and testing for hereditary cancer syndromes, providing relatives the opportunity for early detection and prevention of cancer. The current standard is for patients to contact and encourage relatives (patient-mediated contact) to undergo counseling and testing. Direct relative contact by the medical team or testing laboratory has shown promise but is complicated by privacy laws and lack of infrastructure. We sought to compare outcomes associated with patient-mediated and direct relative contact for hereditary cancer cascade genetic counseling and testing in the first meta-analysis on this topic.<h4>Materials and methods</h4>We conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO No.: CRD42020134276). We searched key electronic databases to identify studies evaluating hereditary cancer cascade testing. Eligible trials were subjected to meta-analysis.<h4>Results</h4>Eighty-seven studies met inclusion criteria. Among relatives included in the meta-analysis, 48% (95% CI, 38 to 58) underwent cascade genetic counseling and 41% (95% CI, 34 to 48) cascade genetic testing. Compared with the patient-mediated approach, direct relative contact resulted in significantly higher uptake of genetic counseling for all relatives (63% [95% CI, 49 to 75] <i>v</i> 35% [95% CI, 24 to 48]) and genetic testing for first-degree relatives (62% [95% CI, 49 to 73] <i>v</i> 40% [95% CI, 32 to 48]). Methods of direct contact included telephone calls, letters, and e-mails; respective rates of genetic testing completion were 61% (95% CI, 51 to 70), 48% (95% CI, 37 to 59), and 48% (95% CI, 45 to 50).<h4>Conclusion</h4>Most relatives at risk for hereditary cancer do not undergo cascade genetic counseling and testing, forgoing potentially life-saving medical interventions. Compared with patient-mediated contact, direct relative contact increased rates of cascade genetic counseling and testing, arguing for a shift in the care delivery paradigm, to be confirmed by randomized controlled trials.
Authors
Frey, MK; Ahsan, MD; Bergeron, H; Lin, J; Li, X; Fowlkes, RK; Narayan, P; Nitecki, R; Rauh-Hain, JA; Moss, HA; Baltich Nelson, B; Thomas, C; Christos, PJ; Hamilton, JG; Chapman-Davis, E; Cantillo, E; Holcomb, K; Kurian, AW; Lipkin, S; Offit, K; Sharaf, RN
MLA Citation
Frey, Melissa K., et al. “Cascade Testing for Hereditary Cancer Syndromes: Should We Move Toward Direct Relative Contact? A Systematic Review and Meta-Analysis.Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, Aug. 2022, p. JCO2200303. Epmc, doi:10.1200/jco.22.00303.
URI
https://scholars.duke.edu/individual/pub1532663
PMID
35960887
Source
epmc
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Published Date
Start Page
JCO2200303
DOI
10.1200/jco.22.00303

Impact of a Documentation Intervention on Health-Assessment Metrics on an Inpatient Gynecologic Oncology Service [24A]: Correction.

MLA Citation
Impact of a Documentation Intervention on Health-Assessment Metrics on an Inpatient Gynecologic Oncology Service [24A]: Correction.Obstet Gynecol, vol. 133, no. 4, Apr. 2019, p. 834. Pubmed, doi:10.1097/AOG.0000000000003248.
URI
https://scholars.duke.edu/individual/pub1507027
PMID
30913188
Source
pubmed
Published In
Obstet Gynecol
Volume
133
Published Date
Start Page
834
DOI
10.1097/AOG.0000000000003248

Associations of Healthcare Affordability, Availability, and Accessibility with Quality Treatment Metrics in Patients with Ovarian Cancer.

BACKGROUND: Differential access to quality care is associated with racial disparities in ovarian cancer survival. Few studies have examined the association of multiple healthcare access (HCA) dimensions with racial disparities in quality treatment metrics, that is, primary debulking surgery performed by a gynecologic oncologist and initiation of guideline-recommended systemic therapy. METHODS: We analyzed data for patients with ovarian cancer diagnosed from 2008 to 2015 in the Surveillance, Epidemiology, and End Results-Medicare database. We defined HCA dimensions as affordability, availability, and accessibility. Modified Poisson regressions with sandwich error estimation were used to estimate the relative risk (RR) for quality treatment. RESULTS: The study cohort was 7% NH-Black, 6% Hispanic, and 87% NH-White. Overall, 29% of patients received surgery and 68% initiated systemic therapy. After adjusting for clinical variables, NH-Black patients were less likely to receive surgery [RR, 0.83; 95% confidence interval (CI), 0.70-0.98]; the observed association was attenuated after adjusting for healthcare affordability, accessibility, and availability (RR, 0.91; 95% CI, 0.77-1.08). Dual enrollment in Medicaid and Medicare compared with Medicare only was associated with lower likelihood of receiving surgery (RR, 0.86; 95% CI, 0.76-0.97) and systemic therapy (RR, 0.94; 95% CI, 0.92-0.97). Receiving treatment at a facility in the highest quartile of ovarian cancer surgical volume was associated with higher likelihood of surgery (RR, 1.12; 95% CI, 1.04-1.21). CONCLUSIONS: Racial differences were observed in ovarian cancer treatment quality and were partly explained by multiple HCA dimensions. IMPACT: Strategies to mitigate racial disparities in ovarian cancer treatment quality must focus on multiple HCA dimensions. Additional dimensions, acceptability and accommodation, may also be key to addressing disparities.
Authors
Akinyemiju, TF; Wilson, LE; Diaz, N; Gupta, A; Huang, B; Pisu, M; Deveaux, A; Liang, M; Previs, RA; Moss, HA; Joshi, A; Ward, KC; Schymura, MJ; Berchuck, A; Potosky, AL
MLA Citation
Akinyemiju, Tomi F., et al. “Associations of Healthcare Affordability, Availability, and Accessibility with Quality Treatment Metrics in Patients with Ovarian Cancer.Cancer Epidemiol Biomarkers Prev, vol. 31, no. 7, July 2022, pp. 1383–93. Pubmed, doi:10.1158/1055-9965.EPI-21-1227.
URI
https://scholars.duke.edu/individual/pub1519396
PMID
35477150
Source
pubmed
Published In
Cancer Epidemiol Biomarkers Prev
Volume
31
Published Date
Start Page
1383
End Page
1393
DOI
10.1158/1055-9965.EPI-21-1227

Malnutrition as a risk factor for post-operative morbidity in gynecologic cancer: Analysis using a national surgical outcomes database.

OBJECTIVE: To assess, using a national surgical outcomes database, the association of various malnutrition definitions with post-operative morbidity in three gynecologic malignancies. METHODS: Patients undergoing resection of ovarian, uterine, or cervical cancer between 2005 and 2019 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Patients were classified based on specific, pre-defined malnutrition criteria: severe malnutrition (Body Mass Index (BMI) <18.5 + 10% weight loss), European Society for Clinical Nutrition and Metabolism ((ESPEN1); BMI 18.5-22 + 10% weight loss), ESPEN2 (BMI < 18.5), American Cancer Society ((ACS); normal/overweight BMI + 10% weight loss), mild malnutrition (BMI 18.5-22), or albumin (<3.5 g/dL). Outcomes included 30-day major complications, readmission, reoperation. Modified Poisson regression estimated associations between definitions and outcomes. RESULTS: Of 76,290 total patients undergoing surgery, those meeting malnutrition definitions were: severe-98 (0.1%), ESPEN1-148 (0.2%), ESPEN2-877 (1.1%), ACS-1028 (1.3%), mild-2853 (3.7%), and albumin (11.1%). Complication rates were: unplanned readmission-5.5%, reoperation-1.7%, major complications-13.5%. For ovarian cancer, ESPEN2 malnutrition was associated with higher readmissions (risk ratio 1.69; 95% confidence interval 1.29-2.20), reoperations (2.53; 1.70-3.77), and complications (1.36; 1.20-1.54). For uterine cancer, ACS malnutrition was associated with readmissions (2.74; 2.09-3.59), reoperations (3.61; 2.29-5.71) and complications (3.92; 3.40-4.53). For cervical cancer, albumin<3.5 g/dL was associated with readmissions (1.48; 1.01-2.19), reoperations (2.25; 1.17-4.34), and complications (2.59; 2.11-3.17). Albumin<3.5 was associated with adverse outcomes in ovarian and uterine cancer. CONCLUSIONS: Preoperative risk assessments might be tailored using cancer-specific malnutrition criteria. Major complications, readmissions, and reoperations are all associated with the ESPEN2 definition for ovarian cancer, the ACS definition for uterine cancer, and with albumin<3.5 for all cancers.
Authors
MLA Citation
Goins, Emily C., et al. “Malnutrition as a risk factor for post-operative morbidity in gynecologic cancer: Analysis using a national surgical outcomes database.Gynecol Oncol, vol. 165, no. 2, May 2022, pp. 309–16. Pubmed, doi:10.1016/j.ygyno.2022.01.030.
URI
https://scholars.duke.edu/individual/pub1512098
PMID
35241292
Source
pubmed
Published In
Gynecol Oncol
Volume
165
Published Date
Start Page
309
End Page
316
DOI
10.1016/j.ygyno.2022.01.030

Catastrophic Health Expenditures With Pregnancy and Delivery in the United States.

OBJECTIVE: To describe prevalence, trends, and risk factors for catastrophic health expenditures in the year of delivery among birth parents (delivering people). METHODS: We conducted a retrospective, cross-sectional study of the Medical Expenditure Panel Survey from 2008-2016. We identified newborn birth parents and a 2:1 nearest-neighbor propensity-matched control cohort of nonpregnant reproductive-aged individuals, then assessed for catastrophic health expenditures (spending greater than 10% of family income) in the delivery year. We applied survey weights to extrapolate to the noninstitutionalized U.S. population and used the adjusted Wald test for significance testing. We compared risk of catastrophic health expenditures between birth parents and the control cohort and described time trends and risk factors for catastrophic spending with subgroup comparisons. RESULTS: We analyzed 4,056 birth parents and 7,996 reproductive-aged females without pregnancy in a given year. Birth parents reported higher rates of unemployment (52.6% vs 46.6%, P<.001), and high rates of gaining (22.4%) and losing (25.6%) Medicaid in the delivery year. Birth parents were at higher risk of catastrophic health expenditures (excluding premiums: 9.2% vs 6.8%, odds ratio [OR] 1.95, 95% CI 1.61-2.34; including premiums: 21.3% vs 18.4%, OR 1.53, 95% CI 1.32-1.82). Birth parents living on low incomes had the highest risk of catastrophic health expenditures (18.8% vs 0.7% excluding premiums for 138% or less vs greater than 400% of the federal poverty level, relative risk [RR] 26.9; 29.8% vs 5.9% including premiums, RR 5.1). For birth parents living at low incomes, public insurance was associated with lower risks of catastrophic health expenditures than private insurance, particularly when including premium spending (incomes 138% of the federal poverty level or lower: 18.8% public vs 67.9% private, RR 0.28; incomes 139-250% of the federal poverty level: 6.5% public vs 41.1% private, RR 0.16). The risk of catastrophic spending for birth parents did not change significantly over time from before to after Affordable Care Act implementation. CONCLUSION: Pregnancy and delivery are associated with increased risk of catastrophic health expenditures in the delivery year. Medicaid and public coverage were more protective from high out-of-pocket costs than private insurance, particularly among low-income families.
Authors
Peterson, JA; Albright, BB; Moss, HA; Bianco, A
MLA Citation
Peterson, Jessica A., et al. “Catastrophic Health Expenditures With Pregnancy and Delivery in the United States.Obstet Gynecol, vol. 139, no. 4, Apr. 2022, pp. 509–20. Pubmed, doi:10.1097/AOG.0000000000004704.
URI
https://scholars.duke.edu/individual/pub1524549
PMID
35271537
Source
pubmed
Published In
Obstet Gynecol
Volume
139
Published Date
Start Page
509
End Page
520
DOI
10.1097/AOG.0000000000004704

Research Areas:

Cancer
Cancer Disparities
Cancer insurance
Cost effectiveness
Health Care Reform
Health Policy