Betty Tong

Positions:

Associate Professor of Surgery

Surgery, Cardiovascular and Thoracic Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.S. 1995

Georgia Institute of Technology

M.D. 1999

Duke University

M.H.S. 2009

Johns Hopkins University

Grants:

Access to screening facilities for U.S. populations at risk for lung cancer: A geospatial analysis of access to CT facilities for individuals eligible for lung cancer screening

Administered By
Radiology, Cardiothoracic Imaging
Awarded By
Ge-Aur Radiology Research
Role
Mentor
Start Date
End Date

Publications:

The Effect of Timing of Adjuvant Therapy on Survival After Esophagectomy.

BACKGROUND: Adjuvant chemotherapy (AC) after esophagectomy improves survival in esophageal cancer when induction therapy is not given; however, the optimal timing for initiation of AC is poorly characterized. We aimed to determine the impact of timing of AC on survival after esophagectomy. METHODS: The National Cancer Database was queried for patients with pT1-4aNxM0 esophageal cancer receiving AC with or without radiation from 2004 to 2015. The median and interquartile range of time to AC were determined. Patients were stratified by initiation of AC into 4 cohorts based on quartiles. Kaplan-Meier curves were generated and factors associated with survival were identified by Cox proportional hazards modeling. A separate analysis was performed with time to AC as a continuous variable. RESULTS: A total of 1634 patients received AC after esophagectomy. Median time to receipt of AC was 59 (interquartile range, 45-78) days. There was no significant difference in overall survival at 5 years (P = .86) between groups. Median survival was 29 months in those receiving AC within 45 days and was 28 months in those receiving AC at other time points. On multivariable analysis, delay in receipt of AC beyond 45 days was not associated with inferior survival. This was preserved when time to AC was analyzed as a continuous variable (hazard ratio, 1.0; 95% confidence interval, 1.0-1.0). CONCLUSIONS: Timing of initiation of AC after esophagectomy does not appear to impact survival. Given the highly variable postoperative course after esophagectomy, the decision to start AC should involve multidisciplinary discussion and be made on a patient-by-patient basis.
Authors
Rhodin, KE; Raman, V; Jawitz, OK; Tong, BC; Harpole, DH; D'Amico, TA
MLA Citation
Rhodin, Kristen E., et al. “The Effect of Timing of Adjuvant Therapy on Survival After Esophagectomy.Ann Thorac Surg, Apr. 2020. Pubmed, doi:10.1016/j.athoracsur.2020.03.040.
URI
https://scholars.duke.edu/individual/pub1438062
PMID
32330471
Source
pubmed
Published In
The Annals of Thoracic Surgery
Published Date
DOI
10.1016/j.athoracsur.2020.03.040

The Impact of Adjuvant Therapy on Survival After Esophagectomy for Node-negative Esophageal Adenocarcinoma.

OBJECTIVE: Determine whether adjuvant chemotherapy is associated with a survival benefit in high risk T2-4a, pathologically node-negative distal esophageal adenocarcinoma. SUMMARY OF BACKGROUND DATA: There is minimal literature to substantiate the NCCN guidelines recommending adjuvant therapy for patients with distal esophageal adenocarcinoma and no pathologic evidence of nodal disease. METHODS: The National Cancer Database was used to identify adult patients with pT2-4aN0M0 esophageal adenocarcinoma who underwent definitive surgery (2004-2015) and had characteristics considered high risk by the NCCN. Patients were stratified by receipt of adjuvant chemotherapy with or without radiation. The primary outcome was overall survival, which was evaluated using Kaplan-Meier and multivariable Cox Proportional Hazards models. A 1:1 propensity score-matched analysis was also performed to compare survival between the groups. RESULTS: Four hundred three patients met study criteria: 313 (78%) without adjuvant therapy and 90 who received adjuvant chemotherapy with or without radiation (22%). In both unadjusted and multivariable analysis, adjuvant chemotherapy with or without radiation was not associated with a significant survival benefit compared to no adjuvant therapy. In a subgroup analysis of 335 patients without high risk features by NCCN criteria, adjuvant chemotherapy was not independently associated with a survival benefit. CONCLUSION: In this analysis, adjuvant chemotherapy with or without radiation was not associated with a significant survival benefit in completely resected, pathologically node-negative distal esophageal adenocarcinoma, independent of presence of high risk characteristics. The risks and benefits of adjuvant therapy should be weighed before offering it to patients with completely resected pT2-4aN0M0 esophageal adenocarcinoma.
Authors
Rucker, AJ; Raman, V; Jawitz, OK; Voigt, SL; Harpole, DH; D'Amico, TA; Tong, BC
MLA Citation
Rucker, A. Justin, et al. “The Impact of Adjuvant Therapy on Survival After Esophagectomy for Node-negative Esophageal Adenocarcinoma.Ann Surg, Mar. 2020. Pubmed, doi:10.1097/SLA.0000000000003886.
URI
https://scholars.duke.edu/individual/pub1435752
PMID
32209899
Source
pubmed
Published In
Ann Surg
Published Date
DOI
10.1097/SLA.0000000000003886

Risk for non-home discharge following surgery for ischemic mitral valve disease.

OBJECTIVES: To determine the frequency and risk factors for non-home discharge (NHD) and its association with clinical outcomes and quality of life (QOL) at 1 year following cardiac surgery in patients with ischemic mitral regurgitation (IMR). METHODS: Discharge disposition was evaluated in 552 patients enrolled in trials of severe or moderate IMR. Patient and in-hospital factors associated with NHD were identified using logistic regression. Subsequently, association of NHD with 1-year mortality, serious adverse events (SAEs), and QOL was assessed. RESULTS: NHD was observed in 30% (154/522) with 25% (n = 71/289) in moderate and 36% (n = 83/233) in patients with severe IMR (unadjusted P = .006), a difference not significant after including age (5-year change: adjusted odds ratio [adjOR], 1.52; 95% confidence interval [CI], 1.35-1.72; P < .001), diabetes (adjOR, 1.94; 95% CI, 1.27-2.94; P = .002), and previous heart failure (adjOR, 1.64; 95% CI, 1.06-2.52; P = .03). Odds of NHD were increased for patients with postoperative SAEs (adjOR, 1.85; 95% CI, 1.19-2.86; P = .01) but not based on type of cardiac surgery. Greater rates of death and SAEs were observed in NHD patients at 1 year: adjusted hazard ratio, 4.29 (95% CI, 2.14-8.59; P < .001) and adjusted rate ratio, 1.45 (95% CI, 1.03-2.02; P = .03), respectively. QOL did not differ significantly between groups. CONCLUSIONS: NHD is common following surgery for IMR, influenced by older age, diabetes, previous heart failure, and postoperative SAEs. These patients may be at greater risk of death and subsequent SAEs after discharge. Discussion of NHD with patients may have important implications for decision-making and guiding expectations following cardiac surgery.
Authors
Lala, A; Chang, HL; Liu, X; Charles, EJ; Yerokun, BA; Bowdish, ME; Thourani, VH; Mack, MJ; Miller, MA; O'Gara, PT; Blackstone, EH; Moskowitz, AJ; Gelijns, AC; Mullen, JC; Stevenson, LW; Cardiothoracic Surgical Trials Network (CTSN) Working Group,
MLA Citation
Lala, Anuradha, et al. “Risk for non-home discharge following surgery for ischemic mitral valve disease.J Thorac Cardiovasc Surg, Mar. 2020. Pubmed, doi:10.1016/j.jtcvs.2020.02.084.
URI
https://scholars.duke.edu/individual/pub1437807
PMID
32307181
Source
pubmed
Published In
The Journal of Thoracic and Cardiovascular Surgery
Published Date
DOI
10.1016/j.jtcvs.2020.02.084

Equivalent survival between lobectomy and segmentectomy for clinical stage IA lung cancer.

BACKGROUND: The oncologic efficacy of segmentectomy is controversial. We compared long- term survival in clinical stage IA (T1N0) patients undergoing lobectomy and segmentectomy in Medicare patients in the STS database. METHODS: The Society of Thoracic Surgeons General Thoracic Surgery Database (STS- GTSD) was linked to Medicare data in 14,286 lung cancer patients who underwent segmentectomy (n=1654) or lobectomy (n=12,632) for clinical stage IA disease from 2002-15. Cox regression was used to create a long-term survival model. Patients were then propensity matched on demographic and clinical variables to derive matched pairs. RESULTS: In Cox modeling, segmentectomy is associated with survival similar to lobectomy in the entire cohort [HR 1.04, 95%CI (0.89,1.20), P=0.64] and in the matched subcohort. A subanalysis restricted to the 2009-15 population (n=11,811), when T1a tumors were specified and PET scan results and mediastinal staging procedures were accurately recorded in the database, also showed that segmentectomy and lobectomy continue to have similar survival [HR 1.00, 95% CI (0.87,1.16)]. Subanalysis of the pathologic N0 patients demonstrated the same results. CONCLUSIONS: Lobectomy and segmentectomy for early stage lung cancer are equally effective treatments with similar survival. STS surgeons appear to be selecting patients appropriately for sublobar procedures.
Authors
Onaitis, MW; Furnary, AP; Kosinski, AS; Feng, L; Boffa, D; Tong, BC; Cowper, P; Jacobs, JP; Wright, CD; Habib, R; Putnam, JB; Fernandez, FG
MLA Citation
Onaitis, Mark W., et al. “Equivalent survival between lobectomy and segmentectomy for clinical stage IA lung cancer.Ann Thorac Surg, Feb. 2020. Pubmed, doi:10.1016/j.athoracsur.2020.01.020.
URI
https://scholars.duke.edu/individual/pub1434078
PMID
32119855
Source
pubmed
Published In
The Annals of Thoracic Surgery
Published Date
DOI
10.1016/j.athoracsur.2020.01.020

Use of Lung Cancer Screening in the Medicare Fee-for-Service Population.

BACKGROUND: A number of organizations, including the US Preventive Services Task Force (USPSTF), recommend lung cancer screening (LCS) by low-dose CT (LDCT) imaging for high-risk current and former smokers. In 2015, Medicare issued a decision to cover LCS as a preventive health benefit; however, use by the Medicare population has not been thoroughly examined. RESEARCH QUESTION: Our objective was to evaluate the early use of LCS in the Medicare fee-for-service (FFS) population and determine the relationship(s) among beneficiary sociodemographic characteristics, geographic location, and use. STUDY DESIGN AND METHODS: This cross-sectional observational study used 100% Medicare FFS claims files for Medicare beneficiaries receiving LCS between January 1, 2016 and December 31, 2016. We estimated the LCS-eligible Medicare population using population and smoking data from the US Census Bureau and Centers for Disease Control and Prevention. We assessed variation in LCS rates by beneficiary characteristics and geography, using univariate and multivariate regression, the latter also including how interactions between geographic location and race/ethnicity influence screening. RESULTS: A total of 103,892 Medicare FFS beneficiaries received LCS in 2016, comprising 4.1% (95% CI, 3.9%-4.3%) of the estimated LCS-eligible Medicare population. Accounting for the interactions between race/ethnicity and US region, nonwhite (black, Hispanic) beneficiaries in all US regions were screened with lower frequency than white beneficiaries (P < .001). Screening rates in the Northeast were significantly higher than in other regions (adjusted rate ratio [95% CI] of Northeast relative to South: 1.83 [1.36-2.46]). INTERPRETATION: The early adoption of LCS among Medicare beneficiaries was low. Our results suggest geographic and racial disparities in screening use, with populations in the South and those of nonwhite race/ethnicity being screened with lower frequency. Further work is needed to improve LCS uptake and ensure consistent use by all at-risk populations.
Authors
Tailor, TD; Tong, BC; Gao, MJ; Henderson, LM; Choudhury, KR; Rubin, GD
MLA Citation
Tailor, Tina D., et al. “Use of Lung Cancer Screening in the Medicare Fee-for-Service Population.Chest, June 2020. Pubmed, doi:10.1016/j.chest.2020.05.592.
URI
https://scholars.duke.edu/individual/pub1448127
PMID
32562612
Source
pubmed
Published In
Chest
Published Date
DOI
10.1016/j.chest.2020.05.592

Research Areas:

Esophagus--Cancer--Surgery
Lungs--Cancer--Patients
Lungs--Cancer--Surgery
Mesothelioma
Small cell lung cancer