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:

Facilitated cascade testing (FaCT): a randomized controlled trial.

BACKGROUND: Identifying mutation-carrying relatives of patients with hereditary cancer syndromes via cascade testing is an underused first step in primary cancer prevention. A feasibility study of facilitated genetic testing of at-risk relatives of patients with a known pathogenic mutation demonstrated encouraging uptake of cascade testing. PRIMARY OBJECTIVE: Our primary objective is to compare the proportion of genetic testing of identified first-degree relatives of probands with a confirmed BRCA1/2 mutation randomized to a facilitated cascade testing strategy versus standard of care, proband-mediated, information sharing. STUDY HYPOTHESIS: We hypothesize that facilitated cascade testing will drive significantly higher uptake of genetic testing than the standard of care. TRIAL DESIGN: The FaCT (Facilitated Cascade Testing) trial is a prospective multi-institutional randomized study comparing the efficacy of a multicomponent facilitated cascade testing intervention with the standard of care. Patients with a known BRCA1/2 mutation (probands) cared for at participating sites will be randomized. Probands randomized to the standard of care group will be instructed to share a family letter with their first-degree relatives and encourage them to complete genetic testing. First-degree relatives of probands randomized to the intervention arm will receive engagement strategies with a patient navigator, an educational video, and accessible genetic testing services. MAJOR INCLUSION/EXCLUSION CRITERIA: Adult participants who are first-degree relatives of a patient with a BRCA1/2 mutation and have not had prior genetic testing will be included. PRIMARY ENDPOINT: Analyses will assess the proportion of first-degree relatives identified by the proband who complete genetic testing by 6 months in the intervention arm versus the control arm. SAMPLE SIZE: One hundred and fifty probands with a BRCA1/2 mutation will be randomized. Each proband is expected to provide an average of 3 relatives, for an expected 450 participants. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: January 2024. TRIAL REGISTRATION: NCT04613440.
Authors
Nitecki, R; Moss, HA; Watson, CH; Urbauer, DL; Melamed, A; Lu, KH; Lipkin, SM; Offit, K; Rauh-Hain, JA; Frey, MK
MLA Citation
Nitecki, Roni, et al. “Facilitated cascade testing (FaCT): a randomized controlled trial.Int J Gynecol Cancer, vol. 31, no. 5, May 2021, pp. 779–83. Pubmed, doi:10.1136/ijgc-2020-002118.
URI
https://scholars.duke.edu/individual/pub1471219
PMID
33443030
Source
pubmed
Published In
Int J Gynecol Cancer
Volume
31
Published Date
Start Page
779
End Page
783
DOI
10.1136/ijgc-2020-002118

Voter Registration Among People With HIV in North Carolina

<jats:title>Abstract</jats:title> <jats:p>Persons with HIV (PWH) represent a socially and medically vulnerable population who often depend on public resources. We examined voter registration among PWH in North Carolina. Sixty-four percent were registered to vote. Registration was lower among PWH who were young, Hispanic, publicly insured or uninsured, and who had poor HIV health status.</jats:p>
Authors
Schranz, AJ; Belenky, N; Moss, HA; Napravnik, S; Rosen, DL
MLA Citation
Schranz, Asher J., et al. “Voter Registration Among People With HIV in North Carolina.” Open Forum Infectious Diseases, vol. 8, no. 2, Oxford University Press (OUP), Feb. 2021. Crossref, doi:10.1093/ofid/ofab037.
URI
https://scholars.duke.edu/individual/pub1477895
Source
crossref
Published In
Open Forum Infectious Diseases
Volume
8
Published Date
DOI
10.1093/ofid/ofab037

Impact of Medicaid expansion on women with gynecologic cancer: a difference-in-difference analysis.

BACKGROUND: Women with gynecologic cancer face socioeconomic disparities in care that affect survival outcomes. The Affordable Care Act offered states the option to expand Medicaid enrollment eligibility criteria as a means of improving timely and affordable access to care for the most vulnerable. The variable uptake of expansion by states created a natural experiment, allowing for quasi-experimental methods that offer more unbiased estimates of treatment effects from retrospective data than the traditional regression adjustment. OBJECTIVE: To use a quasi-experimental, difference-in-difference framework to create unbiased estimates of impact of Medicaid expansion on women with gynecologic cancer. STUDY DESIGN: We performed a quasi-experimental retrospective cohort study from the National Cancer Database files for women with invasive cancers of the uterus, ovary and fallopian tube, cervix, vagina, and vulva diagnosed from 2008 to 2016. Using a marker for state Medicaid expansion status, we created difference-in-difference models to assess the impact of Medicaid expansion on the outcomes of access to and timeliness of care. We excluded women aged <40 years owing to the suppression of the state Medicaid expansions status in the data and women aged ≥65 years owing to the universal Medicare coverage availability. Our primary outcome was the rate of uninsurance at diagnosis. Secondary outcomes included Medicaid coverage, early-stage diagnosis, treatment at an academic facility, and any treatment or surgery within 30 days of diagnosis. Models were run within multiple subgroups and on a propensity-matched cohort to assess the robustness of the treatment estimates. The assumption of parallel trends was assessed with event study time plots. RESULTS: Our sample included 335,063 women. Among this cohort, 121,449 were from nonexpansion states and 213,614 were from expansion states, with 79,886 posttreatment cases diagnosed after the expansion took full effect in expansion states. The groups had minor differences in demographics, and we found occasional preperiod event study coefficients diverging from the mean, but the outcome trends were generally similar between the expansion and nonexpansion states in the preperiod, satisfying the necessary assumption for the difference-in-difference analysis. In a basic difference-in-difference model, the Medicaid expansion in January 2014 was associated with significant increases in insurance at diagnosis, treatment at an academic facility, and treatment within 30 days of diagnosis (P<.001 for all). In an adjusted model including all states and accounting for variable expansion implementation time, there was a significant treatment effect of Medicaid expansion on the reduction in uninsurance at diagnosis (-2.00%; 95% confidence interval, -2.3 to -1.7; P<.001), increases in early-stage diagnosis (0.80%; 95% confidence interval, 0.2-1.4; P=.02), treatment at an academic facility (0.83%; 95% confidence interval, 0.1-1.5; P=.02), treatment within 30 days (1.62%; 95% confidence interval, 1.0-2.3; P<.001), and surgery within 30 days (1.54%; 95% confidence interval, 0.8-2.3; P<.001). In particular, large gains were estimated for women living in low-income zip codes, Hispanic women, and women with cervical cancer. Estimates from the subgroup and propensity-matched cohorts were generally consistent for all outcomes besides early-stage diagnosis and treatment within 30 days. CONCLUSION: Medicaid expansion was significantly associated with gains in the access and timeliness of treatment for nonelderly women with gynecologic cancer. The implementation of Medicaid expansion could greatly benefit women in nonexpansion states. Gynecologists and gynecologic oncologists should advocate for Medicaid expansion as a means of improving outcomes and reducing socioeconomic and racial disparities.
Authors
Albright, BB; Nasioudis, D; Craig, S; Moss, HA; Latif, NA; Ko, EM; Haggerty, AF
MLA Citation
Albright, Benjamin B., et al. “Impact of Medicaid expansion on women with gynecologic cancer: a difference-in-difference analysis.Am J Obstet Gynecol, vol. 224, no. 2, Feb. 2021, pp. 195.e1-195.e17. Pubmed, doi:10.1016/j.ajog.2020.08.007.
URI
https://scholars.duke.edu/individual/pub1461288
PMID
32777264
Source
pubmed
Published In
American Journal of Obstetrics and Gynecology
Volume
224
Published Date
Start Page
195.e1
End Page
195.e17
DOI
10.1016/j.ajog.2020.08.007

Cost-effectiveness analysis comparing "PARP inhibitors-for-all" to the biomarker-directed use of PARP inhibitor maintenance therapy for newly diagnosed advanced stage ovarian cancer.

OBJECTIVES: Clinical trials evaluating universal PARP inhibitor (PARPi) frontline maintenance therapy for advanced stage ovarian cancer have reported progression-free survival (PFS) benefit. It is unclear whether PARPi maintenance therapy will universally enhance value (clinical benefits relative to cost of delivery). We compared a "PARPi-for-all" to a biomarker-directed frontline maintenance therapy approach as a value-based care strategy. METHODS: The cost of two frontline PARPi maintenance strategies, PARPi-for-all and biomarker-directed maintenance, was compared using modified Markov decision models simulating the study designs of the PRIMA, VELIA, and, PAOLA-1 trials. Outcomes of interest included overall costs and incremental cost-effectiveness ratios (ICERs) reported in US dollars per quality adjusted progression-free life-year (QA-PFY) gained. RESULTS: PARPi-for-all was more costly and provided greater PFS benefit than a biomarker-directed strategy for each trial. The mean cost per patient for the PARPi-for-all strategy was $166,269, $286,715, and $366,506 for the PRIMA, VELIA, and PAOLA-1 models, respectively. For the biomarker-directed strategy, the mean cost per patient was $98,188, $167,334, and $260,671 for the PRIMA, VELIA, and PAOLA-1 models. ICERs of PARPi-for-all compared to biomarker-directed maintenance were: $593,250/QA-PFY (PRIMA), $1,512,495/QA-PFY (VELIA), and $3,347,915/QA-PFY (PAOLA-1). At current drug pricing, there is no PFS improvement in a biomarker negative cohort that would make PARPi-for-all cost-effective compared to biomarker-directed maintenance. CONCLUSIONS: This study highlights the high costs of universal PARPi maintenance treatment, compared with a biomarker-directed PARPi strategy. Maintenance therapy in the front-line setting should be reserved for those with germline or somatic HRD mutations until the cost of therapy is significantly reduced.
Authors
MLA Citation
Gonzalez, Rafael, et al. “Cost-effectiveness analysis comparing "PARP inhibitors-for-all" to the biomarker-directed use of PARP inhibitor maintenance therapy for newly diagnosed advanced stage ovarian cancer.Gynecol Oncol, vol. 159, no. 2, Nov. 2020, pp. 483–90. Pubmed, doi:10.1016/j.ygyno.2020.08.003.
URI
https://scholars.duke.edu/individual/pub1459500
PMID
32863036
Source
pubmed
Published In
Gynecol Oncol
Volume
159
Published Date
Start Page
483
End Page
490
DOI
10.1016/j.ygyno.2020.08.003

Declines in health insurance among cancer survivors since the 2016 US elections.

Authors
Moss, HA; Han, X; Yabroff, KR; Chino, J; Chino, F
MLA Citation
Moss, Haley A., et al. “Declines in health insurance among cancer survivors since the 2016 US elections.Lancet Oncol, vol. 21, no. 11, Nov. 2020, p. e517. Pubmed, doi:10.1016/S1470-2045(20)30623-9.
URI
https://scholars.duke.edu/individual/pub1464081
PMID
33069279
Source
pubmed
Published In
Lancet Oncol
Volume
21
Published Date
Start Page
e517
DOI
10.1016/S1470-2045(20)30623-9

Research Areas:

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