Syed Zafar

Overview:

Dr. Zafar is a gastrointestinal medical oncologist and Associate Professor of Medicine, Public Policy, and Population Health Science at the Duke Cancer Institute and Duke-Margolis Center for Health Policy. He serves as Director of Healthcare Innovation at the Duke Cancer Institute. Dr. Zafar also serves as Clinical Associate Director of Duke Forge (Health Data Science Center). Dr. Zafar is considered an international expert in identifying and intervening upon the financial burden of cancer care. His research explores ways to improve cancer care delivery with a primary focus on improving the value of cancer treatment from both patient-focused and policy perspectives.

Dr. Zafar speaks internationally on his research and cancer care delivery. He has over 100 publications in top peer-reviewed journals including the New England Journal of Medicine, the Journal of Clinical Oncology, and JAMA Oncology. His research has been funded by the National Institutes of Health and the American Cancer Society, among others. His work has been covered by national media outlets including New York Times, Forbes, Wall Street Journal, NPR, and Washington Post. He is a Fellow of the American Society of Clinical Oncology.

Positions:

Associate Professor of Medicine

Medicine, Medical Oncology
School of Medicine

Associate Professor in the Sanford School of Public Policy

Sanford School of Public Policy
Sanford School of Public Policy

Associate Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Affiliate, Duke Global Health Institute

Duke Global Health Institute
Institutes and Provost's Academic Units

Core Faculty Member, Duke-Margolis Center for Health Policy

Duke - Margolis Center For Health Policy
Institutes and Provost's Academic Units

Associate of the Duke Initiative for Science & Society

Duke Science & Society
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Member in the Duke Clinical Research Institute

Duke Clinical Research Institute
School of Medicine

Education:

M.D. 2002

The University of Toledo

Resident, Medicine

University of Cincinnati

Fellow in Hematology-Oncology, Medicine

Duke University

Grants:

Couple Communication in Cancer: A Multi-method Examination

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine
Awarded By
Arizona State University
Role
Co Investigator
Start Date
End Date

Examining Best Practices for Factoring Out-Of-Pocket Expenses into Patients' Health Care Decisions

Administered By
Institutes and Provost's Academic Units
Awarded By
Patrick & Catherine Weldon Donaghue Medical Research Foundation
Role
Co Investigator
Start Date
End Date

Improving Advance Care Planning in Oncology: A Pragmatic, Cluster-Randomized Trial Integrating Patient Videos and Clinician Communication Training

Administered By
Duke Cancer Institute
Awarded By
Dana Farber Cancer Institute
Role
Co Investigator
Start Date
End Date

PAPNavigator STTR (Fast-Track)

Administered By
Duke Cancer Institute
Awarded By
Vivor, LLC
Role
Principal Investigator
Start Date
End Date

Using AACT - to answer Oncology landscape portfolio of open trials

Administered By
Duke Clinical Research Institute
Awarded By
American Cancer Society Cancer Action Network
Role
Principal Investigator
Start Date
End Date

Publications:

Developing, Implementing, and Validating a Social Toxicity Assessment Tool of Cancer.

PURPOSE: The social impact of cancer on patients and their family is well known. Yet, unlike with physical and financial toxicities, no validated tools are available to measure this impact. This study aimed at developing, validating, and implementing a novel social toxicity assessment tool for patients with cancer diagnosis (STAT-C). METHODS: Questions were generated through multiple steps including focus groups of patients, their families, and oncology care professionals. These steps along with relevant literature resulted in the development of an initial 20-item questionnaire. Content validity and relevance of the tool were assessed using Content Validity Index for individual items and Content Validity Index for the entire scale. Following expert examination, the constructed STAT-C tool consisted of 14 items grouped into three domains-social relations, social activities, and economic impact. Based on the total possible score for the survey in 150 patients for all the items, three levels of a socioeconomic toxicity were determined-severe social toxicity, mild social toxicity, and no social toxicity. RESULTS: The 14 items were marked as relevant, and the Content Validity Index for individual items ranged between 0.80 and 1.00. An overall average Content Validity Index for the entire scale of 0.87 showed high content validity of the constructed tool. Exploratory factor analysis revealed retention of 13 items of the constructed STAT-C Tool, which loaded across three factors that mapped groupings into measures of social relations, social activities, and economic impact domains. CONCLUSION: Our study revealed that STAT-C is a valid, reliable tool, and well captures and measures unique and pertinent social toxicity constructs for Arabic-speaking patients. The tool should enable oncology professionals to deliver better patient-centered care as a component of a comprehensive approach.
Authors
Jazieh, A-R; Jradi, H; Da'ar, OB; Alkaiyat, M; Zafar, Y; Alolayan, A
MLA Citation
Jazieh, Abdul-Rahman, et al. “Developing, Implementing, and Validating a Social Toxicity Assessment Tool of Cancer.Jco Glob Oncol, vol. 7, Sept. 2021, pp. 1522–28. Pubmed, doi:10.1200/GO.21.00170.
URI
https://scholars.duke.edu/individual/pub1500573
PMID
34726956
Source
pubmed
Published In
Jco Glob Oncol
Volume
7
Published Date
Start Page
1522
End Page
1528
DOI
10.1200/GO.21.00170

Financial burden, distress, and toxicity in cardiovascular disease.

Cardiovascular disease (CVD) is a major source of financial burden and distress, which has 3 main domains: (1) psychological distress; (2) cost-related care non-adherence or medical care deferral, and (3) tradeoffs with basic non-medical needs. We propose 4 ways to reduce financial distress in CVD: (1) policymakers can expand insurance coverage and curtail underinsurance; (2) health systems can limit expenditure on low-benefit, high-cost treatments while developing services for high-risk individuals; (3) physicians can engage in shared-decision-making for high-cost interventions, and (4) community-based initiatives can support patients with system navigation and financial coping. Avenues for research include (1) analysis of how healthcare policies affect financial burden; (2) comparative effectiveness studies examining high and low-cost strategies for CVD management; and (3) studying interventions to reduce financial burden, financial coaching, and community health worker integration.
Authors
Slavin, SD; Khera, R; Zafar, SY; Nasir, K; Warraich, HJ
MLA Citation
Slavin, Samuel D., et al. “Financial burden, distress, and toxicity in cardiovascular disease.Am Heart J, vol. 238, Aug. 2021, pp. 75–84. Pubmed, doi:10.1016/j.ahj.2021.04.011.
URI
https://scholars.duke.edu/individual/pub1482044
PMID
33961830
Source
pubmed
Published In
American Heart Journal
Volume
238
Published Date
Start Page
75
End Page
84
DOI
10.1016/j.ahj.2021.04.011

Mobile Application to Identify Cancer Treatment-Related Financial Assistance: Results of a Randomized Controlled Trial.

PURPOSE: Insured patients with cancer face high treatment-related, out-of-pocket (OOP) costs and often cannot access financial assistance. We conducted a randomized, controlled trial of Bridge, a patient-facing app designed to identify eligible financial resources for patients. We hypothesized that patients using Bridge would experience greater OOP cost reduction than controls. METHODS: We enrolled patients with cancer who had OOP expenses from January 2018 to March 2019. We randomly assigned patients 1:1 to intervention (Bridge) versus control (financial assistance educational websites). Primary and secondary outcomes were self-reported OOP costs and subjective financial distress 3 months postenrollment. In post hoc analyses, we analyzed application for and receipt of financial assistance at 3 months postenrollment. We used chi-square, Mann-Whitney tests, and logistic regression to compare study arms. RESULTS: We enrolled 200 patients. The median age was 57 years (IQR, 47.0-63.0). Most patients had private insurance (71%), and the median household income was $62,000 in US dollars (USD) (IQR, $36,000-$100,000 [USD]). Substantial missing data precluded assessment of primary and secondary outcomes. In post hoc analyses, patients in the Bridge arm were more likely than controls to both apply for and receive financial assistance. CONCLUSION: We were unable to test our primary outcome because of excessive missing follow-up survey data. In exploratory post hoc analyses, patients who received a financial assistance app were more likely to apply for and receive financial assistance. Ultimately, our study highlights challenges faced in identifying measurable outcomes and retaining participants in a randomized, controlled trial of a mobile app to alleviate financial toxicity.
Authors
Tarnasky, AM; Tran, GN; Nicolla, J; Friedman, FAP; Wolf, S; Troy, JD; Sung, AD; Shah, K; Oury, J; Thompson, JC; Gagosian, B; Pollak, KI; Manners, I; Zafar, SY
MLA Citation
Tarnasky, Aaron M., et al. “Mobile Application to Identify Cancer Treatment-Related Financial Assistance: Results of a Randomized Controlled Trial.Jco Oncol Pract, vol. 17, no. 10, Oct. 2021, pp. e1440–49. Pubmed, doi:10.1200/OP.20.00757.
URI
https://scholars.duke.edu/individual/pub1478310
PMID
33797952
Source
pubmed
Published In
Jco Oncol Pract
Volume
17
Published Date
Start Page
e1440
End Page
e1449
DOI
10.1200/OP.20.00757

Does Cancer Treatment-Related Financial Distress Worsen Over Time?

BACKGROUND Patients with cancer are at risk for both objective and subjective financial distress. Financial distress during treatment is adversely associated with physical and mental well-being. Little is known about whether patients' subjective financial distress changes during the course of their treatment.method This is a cross-sectional study of insured adults with solid tumors on anti-cancer therapy for ≥1 month, surveyed at a referral center and three rural oncology clinics. The goal was to investigate how financial distress varies depending on where patients are in the course of cancer therapy. Financial distress (FD) was assessed via a validated measure; out-of-pocket (OOP) costs were estimated and medical records were reviewed for disease/treatment data. Logistic regression was used to evaluate the potential association between treatment length and financial distress.RESULTS Among 300 participants (86% response rate), median age was 60 years (range 27-91), 52.3% were male, 78.3% had stage IV cancer or metastatic recurrence, 36.7% were retired, and 56% had private insurance. Median income was $60,000/year and median OOP costs including insurance premiums were $592/month. Median FD score (7.4/10, SD 2.5) corresponded to low FD with 16.3% reporting high/overwhelming distress. Treatment duration was not associated with the odds of experiencing high/overwhelming FD in single-predictor (OR = 1.01, CI [.93, 1.09], P = .86) or multiple predictor regression models (OR = .98, CI [.86, 1.12], P = .79). Treatment duration was not correlated with FD as a continuous variable (P = .92).LIMITATIONS This study is limited by its cross-sectional design and generalizability to patients with early-stage cancer and those being treated outside of a major referral center.CONCLUSION Severity of cancer treatment-related financial distress did not correlate with time on treatment, indicating that patients are at risk for FD throughout the treatment continuum. Screening for and addressing financial distress should occur throughout the course of cancer therapy.
Authors
Hussaini, SMQ; Chino, F; Rushing, C; Samsa, G; Altomare, I; Nicolla, J; Peppercorn, J; Zafar, SY
MLA Citation
Hussaini, SM Qasim, et al. “Does Cancer Treatment-Related Financial Distress Worsen Over Time?N C Med J, vol. 82, no. 1, Jan. 2021, pp. 14–20. Pubmed, doi:10.18043/ncm.82.1.14.
URI
https://scholars.duke.edu/individual/pub1470848
PMID
33397749
Source
pubmed
Published In
North Carolina Medical Journal
Volume
82
Published Date
Start Page
14
End Page
20
DOI
10.18043/ncm.82.1.14

BRAF-Mutated Metastatic Colon Cancers During COVID-19 Pandemic Reply

Authors
Lou, E; Beg, MS; Bergsland, E; Eng, C; Khorana, AA; Kopetz, S; Lubner, S; Saltz, L; Shankaran, V; Zafar, SY
MLA Citation
Lou, Emil, et al. “BRAF-Mutated Metastatic Colon Cancers During COVID-19 Pandemic Reply.” Jco Oncology Practice, vol. 16, no. 8, Aug. 2020, pp. 526-+.
URI
https://scholars.duke.edu/individual/pub1467618
Source
wos-lite
Published In
Jco Oncology Practice
Volume
16
Published Date
Start Page
526
End Page
+

Research Areas:

Academic Medical Centers
Adenocarcinoma
Adult
Africa
Age Factors
Aged
Aged, 80 and over
Ambulatory Care
Ampulla of Vater
Angiogenesis Inhibitors
Antibodies, Monoclonal
Antibodies, Monoclonal, Humanized
Antineoplastic Agents
Antineoplastic Combined Chemotherapy Protocols
Attitude of Health Personnel
Bevacizumab
Carcinoma, Non-Small-Cell Lung
Carcinoma, Squamous Cell
Cardiovascular Diseases
Caregivers
Chemoradiotherapy, Adjuvant
Clinical Trials as Topic
Cognition Disorders
Cohort Studies
Colorectal Neoplasms
Common Bile Duct Neoplasms
Communication
Comorbidity
Comparative Effectiveness Research
Comprehensive Health Care
Consensus
Continental Population Groups
Cooperative Behavior
Cost Control
Cost of Illness
Cost-Benefit Analysis
Data Collection
Decision Making
Decision Support Techniques
Delivery of Health Care
Delivery of Health Care, Integrated
Delphi Technique
Demography
Depression
Disclosure
Disease-Free Survival
Drug Administration Schedule
Drug Approval
Early Detection of Cancer
Epidemiologic Research Design
Evidence-Based Medicine
Evidence-Based Practice
Family
Fatigue
Fee-for-Service Plans
Female
Financial Support
Financing, Personal
Follow-Up Studies
Gastrointestinal Diseases
Gastrointestinal Neoplasms
Glutamates
Guanine
Guideline Adherence
Guilt
Health Care Costs
Health Care Rationing
Health Expenditures
Health Priorities
Health Services Accessibility
Health Services Needs and Demand
Health Services Research
Health Status
Hospitals, Veterans
Humans
Hydroxamic Acids
Hypocalcemia
Hypokalemia
Immunohistochemistry
Immunosuppressive Agents
Income
Injections, Intravenous
Insurance Carriers
Internal-External Control
Kaplan-Meier Estimate
Leukocytes, Mononuclear
Logistic Models
Long-Term Care
Male
Medical History Taking
Medical Oncology
Microsatellite Instability
Middle Aged
Motivation
Mutation
Neoplasm Grading
Neoplasm Metastasis
Neoplasm Proteins
Neoplasm Staging
Neoplasms
Organizational Innovation
Oxaliplatin
Pain
Pain Measurement
Palliative Care
Pancreaticoduodenectomy
Patient Preference
Patient Satisfaction
Patient-Centered Care
Patients
Perception
Personnel, Hospital
Physician's Practice Patterns
Pilot Projects
Practice Patterns, Physicians'
Prevalence
Prognosis
Program Development
Program Evaluation
Prospective Studies
Protein Kinase Inhibitors
Pyrimidines
Quality Assurance, Health Care
Quality Improvement
Quality Indicators, Health Care
Quality of Health Care
Quality of Life
Questionnaires
Randomized Controlled Trials as Topic
Reference Standards
Regional Health Planning
Registries
Regression Analysis
Reproducibility of Results
Research
Research Design
Retrospective Studies
Sarcoma, Kaposi
Self Concept
Sirolimus
Social Stigma
Socioeconomic Factors
Specialization
Stereotyping
Stress, Psychological
Surveys and Questionnaires
Survival Rate
Survivors
Terminology as Topic
Therapeutics
Thiazoles
Treatment Outcome
Tumor Markers, Biological
United States
United States Department of Veterans Affairs
Veterans
Veterans Health
Withholding Treatment
Young Adult