Syed Zafar


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.


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


M.D. 2002

The University of Toledo

Resident, Medicine

University of Cincinnati

Fellow in Hematology-Oncology, Medicine

Duke University


Couple Communication in Cancer: A Multi-method Examination

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

PAPNavigator STTR (Fast-Track)

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


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.
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, Apr. 2021, p. OP2000757. Pubmed, doi:10.1200/OP.20.00757.
Published In
Jco Oncol Pract
Published Date
Start Page

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.
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.
Published In
North Carolina Medical Journal
Published Date
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BRAF-Mutated Metastatic Colon Cancers During COVID-19 Pandemic Reply

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-+.
Published In
Jco Oncology Practice
Published Date
Start Page
End Page

Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer.

BACKGROUND: No adjuvant treatment has been established for patients who remain at high risk for recurrence after neoadjuvant chemoradiotherapy and surgery for esophageal or gastroesophageal junction cancer. METHODS: We conducted CheckMate 577, a global, randomized, double-blind, placebo-controlled phase 3 trial to evaluate a checkpoint inhibitor as adjuvant therapy in patients with esophageal or gastroesophageal junction cancer. Adults with resected (R0) stage II or III esophageal or gastroesophageal junction cancer who had received neoadjuvant chemoradiotherapy and had residual pathological disease were randomly assigned in a 2:1 ratio to receive nivolumab (at a dose of 240 mg every 2 weeks for 16 weeks, followed by nivolumab at a dose of 480 mg every 4 weeks) or matching placebo. The maximum duration of the trial intervention period was 1 year. The primary end point was disease-free survival. RESULTS: The median follow-up was 24.4 months. Among the 532 patients who received nivolumab, the median disease-free survival was 22.4 months (95% confidence interval [CI], 16.6 to 34.0), as compared with 11.0 months (95% CI, 8.3 to 14.3) among the 262 patients who received placebo (hazard ratio for disease recurrence or death, 0.69; 96.4% CI, 0.56 to 0.86; P<0.001). Disease-free survival favored nivolumab across multiple prespecified subgroups. Grade 3 or 4 adverse events that were considered by the investigators to be related to the active drug or placebo occurred in 71 of 532 patients (13%) in the nivolumab group and 15 of 260 patients (6%) in the placebo group. The trial regimen was discontinued because of adverse events related to the active drug or placebo in 9% of the patients in the nivolumab group and 3% of those in the placebo group. CONCLUSIONS: Among patients with resected esophageal or gastroesophageal junction cancer who had received neoadjuvant chemoradiotherapy, disease-free survival was significantly longer among those who received nivolumab adjuvant therapy than among those who received placebo. (Funded by Bristol Myers Squibb and Ono Pharmaceutical; CheckMate 577 number, NCT02743494.).
Kelly, RJ; Ajani, JA; Kuzdzal, J; Zander, T; Van Cutsem, E; Piessen, G; Mendez, G; Feliciano, J; Motoyama, S; Lièvre, A; Uronis, H; Elimova, E; Grootscholten, C; Geboes, K; Zafar, S; Snow, S; Ko, AH; Feeney, K; Schenker, M; Kocon, P; Zhang, J; Zhu, L; Lei, M; Singh, P; Kondo, K; Cleary, JM; Moehler, M; CheckMate 577 Investigators,
MLA Citation
Kelly, Ronan J., et al. “Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer.N Engl J Med, vol. 384, no. 13, Apr. 2021, pp. 1191–203. Pubmed, doi:10.1056/NEJMoa2032125.
Published In
The New England Journal of Medicine
Published Date
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Cabozantinib and Panitumumab for RAS Wild-Type Metastatic Colorectal Cancer.

TRIAL INFORMATION: Identifier: NCT02008383 Sponsor: Duke University Principal Investigator: John H. Strickler IRB Approved: Yes LESSONS LEARNED: Antitumor activity was observed in the study population. Dose modifications of cabozantinib improve long-term tolerability. Biomarkers are needed to identify patient populations most likely to benefit. Further study of cabozantinib with or without panitumumab in patients with metastatic colorectal cancer is warranted. BACKGROUND: The epidermal growth factor receptor (EGFR) antibody panitumumab is active in patients with RAS wild-type (WT) metastatic colorectal cancer (mCRC), but nearly all patients experience resistance. MET amplification is a driver of panitumumab resistance. Cabozantinib is an inhibitor of multiple kinases, including vascular endothelial growth factor receptor 2 (VEGFR2) and c-MET, and may delay or reverse anti-EGFR resistance. METHODS: In this phase Ib clinical trial, we established the maximum tolerated dose (MTD) and recommended phase II dose (RP2D) of cabozantinib and panitumumab. We then treated an expansion cohort to further describe the tolerability and clinical activity of the RP2D. Eligibility included patients with KRAS WT mCRC (later amended to include only RAS WT mCRC) who had received prior treatment with a fluoropyrimidine, oxaliplatin, irinotecan, and bevacizumab. RESULTS: Twenty-five patients were enrolled and treated. The MTD/RP2D was cabozantinib 60 mg p.o. daily and panitumumab 6 mg/kg I.V. every 2 weeks. The objective response rate (ORR) was 16%. Median progression free survival (PFS) was 3.7 months (90% confidence interval [CI], 2.3-7.1). Median overall survival (OS) was 12.1 months (90% CI, 7.5-14.3). Five patients (20%) discontinued treatment due to toxicity, and 18 patients (72%) required a dose reduction of cabozantinib. CONCLUSION: The combination of cabozantinib and panitumumab has activity. Dose reductions of cabozantinib improve tolerability.
Strickler, JH; Rushing, CN; Uronis, HE; Morse, MA; Niedzwiecki, D; Blobe, GC; Moyer, AN; Bolch, E; Webb, R; Haley, S; Hatch, AJ; Altomare, IP; Sherrill, GB; Chang, DZ; Wells, JL; Hsu, SD; Jia, J; Zafar, SY; Nixon, AB; Hurwitz, HI
MLA Citation
Strickler, John H., et al. “Cabozantinib and Panitumumab for RAS Wild-Type Metastatic Colorectal Cancer.Oncologist, Jan. 2021. Pubmed, doi:10.1002/onco.13678.
Published In
Published Date

Research Areas:

Academic Medical Centers
Age Factors
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
Carcinoma, Non-Small-Cell Lung
Carcinoma, Squamous Cell
Cardiovascular Diseases
Chemoradiotherapy, Adjuvant
Clinical Trials as Topic
Cognition Disorders
Cohort Studies
Colorectal Neoplasms
Common Bile Duct Neoplasms
Comparative Effectiveness Research
Comprehensive Health Care
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
Disease-Free Survival
Drug Administration Schedule
Drug Approval
Early Detection of Cancer
Epidemiologic Research Design
Evidence-Based Medicine
Evidence-Based Practice
Fee-for-Service Plans
Financial Support
Financing, Personal
Follow-Up Studies
Gastrointestinal Diseases
Gastrointestinal Neoplasms
Guideline Adherence
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
Hydroxamic Acids
Immunosuppressive Agents
Injections, Intravenous
Insurance Carriers
Internal-External Control
Kaplan-Meier Estimate
Leukocytes, Mononuclear
Logistic Models
Long-Term Care
Medical History Taking
Medical Oncology
Microsatellite Instability
Middle Aged
Neoplasm Grading
Neoplasm Metastasis
Neoplasm Proteins
Neoplasm Staging
Organizational Innovation
Pain Measurement
Palliative Care
Patient Preference
Patient Satisfaction
Patient-Centered Care
Personnel, Hospital
Physician's Practice Patterns
Pilot Projects
Practice Patterns, Physicians'
Program Development
Program Evaluation
Prospective Studies
Protein Kinase Inhibitors
Quality Assurance, Health Care
Quality Improvement
Quality Indicators, Health Care
Quality of Health Care
Quality of Life
Randomized Controlled Trials as Topic
Reference Standards
Regional Health Planning
Regression Analysis
Reproducibility of Results
Research Design
Retrospective Studies
Sarcoma, Kaposi
Self Concept
Social Stigma
Socioeconomic Factors
Stress, Psychological
Surveys and Questionnaires
Survival Rate
Terminology as Topic
Treatment Outcome
Tumor Markers, Biological
United States
United States Department of Veterans Affairs
Veterans Health
Withholding Treatment
Young Adult