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
Role
Mentor
Start Date
End Date

Publications:

Implementation of a Surgical Oncology Disparities Curriculum for Preclinical Medical Students.

BACKGROUND: Underinsured and uninsured surgical-oncology patients are at higher risk of perioperative morbidity and mortality. Curricular innovation is needed to train medical students to work with this vulnerable population. We describe the implementation of and early educational outcomes from a student-initiated pilot program aimed at improving medical student insight into health disparities in surgery. MATERIALS/METHODS: First-year medical students participated in a dual didactic and perioperative-liaison experience over a 10-month period. Didactic sessions included surgical-skills training and faculty-led lectures on financial toxicity and management of surgical-oncology patients. Students were partnered with uninsured and Medicaid patients receiving surgical-oncology care and worked with these patients by providing appointment reminders, clarifying perioperative instructions, and accompanying patients to surgery and clinic appointments. Students' interest in surgery and self-reported comfort in 15 Association of American Medical Colleges core competencies were assessed with preparticipation and postparticipation surveys using a 5-point Likert scale. RESULTS: Twenty-four first-year students were paired with 14 surgical-oncology patients during the 2017-2018 academic year. Sixteen students (66.7%) completed both preprogram and postprogram surveys. Five students (31.3%) became "More Interested" in surgery, whereas 11 (68.8%) reported "Similar Interest or No Change." Half of the students (n = 8) felt more prepared for their surgery clerkship after participating. Median self-reported comfort improved in 7/15 competencies including Oral Communication and Ethical Responsibility. All students reported being "Somewhat" or "Extremely Satisfied" with the program. CONCLUSIONS: We demonstrate that an innovative program to expose preclinical medical students to challenges faced by financially and socially vulnerable surgical-oncology patients is feasible and may increase students' clinical preparedness and interest in surgery.
Authors
Rhodin, KE; Hong, CS; Olivere, LA; Howell, EP; Giri, VK; Mehta, KA; Oyekunle, T; Scheri, RP; Tong, BC; Sosa, JA; Fayanju, OM
MLA Citation
Rhodin, Kristen E., et al. “Implementation of a Surgical Oncology Disparities Curriculum for Preclinical Medical Students.J Surg Res, vol. 253, May 2020, pp. 214–23. Pubmed, doi:10.1016/j.jss.2020.03.058.
URI
https://scholars.duke.edu/individual/pub1440399
PMID
32380347
Source
pubmed
Published In
J Surg Res
Volume
253
Published Date
Start Page
214
End Page
223
DOI
10.1016/j.jss.2020.03.058

ACR Appropriateness Criteria® Occupational Lung Diseases.

Ordering the appropriate diagnostic imaging for occupational lung disease requires a firm understanding of the relationship between occupational exposure and expected lower respiratory track manifestation. Where particular inorganic dust exposures typically lead to nodular and interstitial lung disease, other occupational exposures may lead to isolated small airway obstruction. Certain workplace exposures, like asbestos, increase the risk of malignancy, but also produce pulmonary findings that mimic malignancy. This publication aims to delineate the common and special considerations associated with occupational lung disease to assist the ordering physician in selecting the most appropriate imaging study, while still stressing the importance of a multidisciplinary approach. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Authors
Expert Panel on Thoracic Imaging,; Cox, CW; Chung, JH; Ackman, JB; Berry, MF; Carter, BW; de Groot, PM; Hobbs, SB; Johnson, GB; Maldonado, F; McComb, BL; Tong, BC; Walker, CM; Kanne, JP
MLA Citation
Expert Panel on Thoracic Imaging, Jeffrey P., et al. “ACR Appropriateness Criteria® Occupational Lung Diseases.J Am Coll Radiol, vol. 17, no. 5S, May 2020, pp. S188–97. Pubmed, doi:10.1016/j.jacr.2020.01.022.
URI
https://scholars.duke.edu/individual/pub1438521
PMID
32370962
Source
pubmed
Published In
Journal of the American College of Radiology : Jacr
Volume
17
Published Date
Start Page
S188
End Page
S197
DOI
10.1016/j.jacr.2020.01.022

The effect of extent of resection on outcomes in patients with limited stage small cell lung cancer.

BACKGROUND: There is poor understanding of the comparative effectiveness of lobar and sublobar resections for limited-stage small cell lung cancer (SCLC). We analyzed the National Cancer Database to examine the outcomes of patients undergoing wedge resection (WR), segmentectomy (SR), and lobectomy (LB) for limited-stage SCLC. METHODS: Patients with cT1-2N0M0 SCLC (2004-2015) who underwent definitive surgery were identified and stratified by extent of resection: WR, SR, or LB. The primary outcome was overall survival (OS) and secondary outcomes were margin-positive resection (>R0) and pathologic nodal upstaging. RESULTS: A total 1948 patients met study criteria: 619 (32%) underwent WR, 96 (5%) SR, and 1233 (63%) LB. Patients receiving LB were more likely to be younger, have fewer comorbidities, and be privately insured. The unadjusted 5-year OS of WR, SR, and LB patients was 31% (95% confidence interval [CI], 27-35), 35% (95% CI, 25-49), and 45% (95% CI, 42-49), respectively. In a multivariable Cox model, WR was associated with worse OS (hazard ratio, 1.53; 95% CI, 1.31-1.79) and SR similar OS (hazard ratio, 1.20; 95% CI, 0.87-1.67) compared with LB. SR was associated with similar survival compared with LB in a propensity score-matched multivariable analysis as well. WR was also associated with greater odds of >R0 resection compared with LB. CONCLUSIONS: In this study, patients with limited-stage SCLC undergoing WR experienced worse survival compared with those undergoing LB; survival was similar between segmentectomy and LB.
Authors
Raman, V; Jawitz, OK; Yang, C-FJ; Voigt, SL; D'Amico, TA; Harpole, DH; Tong, BC
MLA Citation
Raman, Vignesh, et al. “The effect of extent of resection on outcomes in patients with limited stage small cell lung cancer.J Thorac Cardiovasc Surg, 2020. Pubmed, doi:10.1016/j.jtcvs.2020.02.135.
URI
https://scholars.duke.edu/individual/pub1437870
PMID
32327184
Source
pubmed
Published In
The Journal of Thoracic and Cardiovascular Surgery
Published Date
DOI
10.1016/j.jtcvs.2020.02.135

A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.

OBJECTIVE: Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort studies who underwent LPs using a standardized protocol and 25 g needle. METHODS: Eight hundred and nine LPs performed in 262 patients age ≥ 60 years in the MADCO-PC and INTUIT studies were analyzed. Medical records were monitored for LP-related adverse events, and patients were queried about subjective complaints. We analyzed adverse event rates, including headaches and pain scores. RESULTS: There were 22 adverse events among 809 LPs performed, a rate of 2.72% (95% CI 1.71-4.09%). Patient hospital stay did not increase due to adverse events. Four patients (0.49%) developed a post-lumbar puncture headache (PLPH). Twelve patients (1.48%) developed nausea, vasovagal responses, or headaches that did not meet PLPH criteria. Six patients (0.74%) reported lower back pain at the LP site not associated with muscular weakness or paresthesia. The median pain score was 1 [0, 3]; the mode was 0 out of 10. CONCLUSIONS: The LP protocol described herein may reduce adverse event rates and improve patient comfort in future studies.
Authors
Nobuhara, CK; Bullock, WM; Bunning, T; Colin, B; Cooter, M; Devinney, MJ; Ferrandino, MN; Gadsden, J; Garrigues, G; Habib, AS; Moretti, E; Moul, J; Ohlendorf, B; Sandler, A; Scheri, R; Sharma, B; Thomas, JP; Young, C; Mathew, JP; Berger, M; MADCO-PC and INTUIT Investigators Teams,
MLA Citation
Nobuhara, Chloe K., et al. “A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.J Neurol, Mar. 2020. Pubmed, doi:10.1007/s00415-020-09797-1.
URI
https://scholars.duke.edu/individual/pub1434663
PMID
32198714
Source
pubmed
Published In
J Neurol
Published Date
DOI
10.1007/s00415-020-09797-1

ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompromised Patients.

The immunocompromised patient with an acute respiratory illness (ARI) may present with fever, chills, weight loss, cough, shortness of breath, or chest pain. The number of immunocompromised patients continues to rise with medical advances including solid organ and stem cell transplantation, chemotherapy, and immunomodulatory therapy, along with the continued presence of human immunodeficiency virus and acquired immunodeficiency syndrome. Given the myriad of pathogens that can infect immunocompromised individuals, identifying the specific organism or organisms causing the lung disease can be elusive. Moreover, immunocompromised patients often receive prophylactic or empiric antimicrobial therapy, further complicating diagnostic evaluation. Noninfectious causes for ARI should also be considered, including pulmonary edema, drug-induced lung disease, atelectasis, malignancy, radiation-induced lung disease, pulmonary hemorrhage, diffuse alveolar damage, organizing pneumonia, lung transplant rejection, and pulmonary thromboembolic disease. As many immunocompromised patients with ARI progress along a rapid and potentially fatal course, timely selection of appropriate imaging is of great importance in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking, or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Authors
Expert Panel on Thoracic Imaging,; Lee, C; Colletti, PM; Chung, JH; Ackman, JB; Berry, MF; Carter, BW; de Groot, PM; Hobbs, SB; Johnson, GB; Maldonado, F; McComb, BL; Tong, BC; Walker, CM; Kanne, JP
MLA Citation
Expert Panel on Thoracic Imaging, Jeffrey P., et al. “ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompromised Patients.J Am Coll Radiol, vol. 16, no. 11S, Nov. 2019, pp. S331–39. Pubmed, doi:10.1016/j.jacr.2019.05.019.
URI
https://scholars.duke.edu/individual/pub1417926
PMID
31685101
Source
pubmed
Published In
Journal of the American College of Radiology : Jacr
Volume
16
Published Date
Start Page
S331
End Page
S339
DOI
10.1016/j.jacr.2019.05.019

Research Areas:

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