Syed Zafar

Overview:

Dr. Zafar is a health services researcher with a focus in improving care delivery for patients with advanced cancer. He has obtained advanced training in health services research and has participated in single-institution, multi-institution and national studies focusing on access to care, cost of care, and comparative effectiveness of care delivery between health systems. His primary area of interest is in the cost of cancer care. He has conducted institutional and national studies on how treatment-related costs impact cancer patients' experience. His current work in this arena is focused on patient preferences regarding cost-related communication and decision-making.

A second field of interest is palliative care. Dr. Zafar has collaborated with national and international palliative care leaders to improve the design and delivery of palliative care in cancer clinical trials. Methodologically, this work has centered around systematic literature reviews, iterative surveys, and prospective clinical trials.

Dr. Zafar is a member of the American Society of Clinical Oncology’s Health Disparities and Clinical Practice Guideline Committees. He is a member of the Alliance for Clinical Trials in Oncology's Health Disparities and Health Outcomes Committees. Dr. Zafar's work has been funded by the American Cancer Society, the HealthWell Foundation, the Duke Cancer Prevention and Control Program, the Duke Clinical Research Institute, and the CALGB Foundation.

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

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

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
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
Role
Principal Investigator
Start Date
End Date

Using AACT - to answer Oncology landscape portfolio of open trials

Administered By
Duke Clinical Research Institute
Role
Principal Investigator
Start Date
End Date

Publications:

A phase Ib study of capecitabine and ziv-aflibercept followed by a phase II single-arm expansion cohort in chemotherapy refractory metastatic colorectal cancer.

BACKGROUND: Patients with chemotherapy refractory metastatic colorectal cancer (CRC) have a poor prognosis and limited therapeutic options. In this phase Ib/II clinical trial, we established the maximum tolerated dose (MTD) and recommended phase II dose (RPTD) for the combination of capecitabine and ziv-aflibercept, and then we evaluated the efficacy of the combination in patients with chemotherapy refractory metastatic CRC. METHODS: All patients were required to have a Karnofsky Performance Status > 70% and adequate organ function. The phase Ib dose escalation cohort included patients with advanced solid tumors who had progressed on all standard therapies. Using a standard 3 + 3 design, we identified the MTD and RPTD for the combination. Fifty patients with metastatic CRC who had progressed on or were intolerant of a fluoropyrimidine, oxaliplatin, irinotecan, and bevacizumab were then enrolled in a single-arm phase II expansion cohort, and were treated at the RPTD. Prior EGFR antibody therapy was required for subjects with RAS wildtype tumors. The primary endpoint for the expansion cohort was progression-free survival (PFS) at two months. Secondary endpoints included objective response rate (ORR) and overall survival (OS). RESULTS: A total of 63 patients were enrolled and evaluable for toxicity (13 dose escalation; 50 expansion). The MTD and RPTD were: capecitabine 850 mg/m2, P.O. bid, days 1-14, and ziv-aflibercept 6 mg/kg I.V., day 1, of each 21-day cycle. In the expansion cohort, 72% of patients were progression-free at two months (95% confidence interval [CI], 60-84%). Median PFS and OS were 3.9 months (95% CI, 2.3-4.5) and 7.1 months (95% CI: 5.8-10.0), respectively. Among all patients evaluable for toxicity, the most common treatment related adverse events (all grade [%]; grade ≥ 3 [%]) included palmar-plantar erythrodysesthesia (41%; 6%), hypertension (33%; 22%), and mucositis (19%; 5%). RNA was isolated from archived tumor specimens and gene expression analyses revealed no association between angiogenic biomarkers and clinical outcomes. CONCLUSION: The combination of capecitabine and ziv-aflibercept at the RPTD demonstrated acceptable safety and tolerability. PFS at 2 months in patients with chemotherapy refractory metastatic CRC was significantly greater than that in historical controls, indicating that this combination warrants further study. TRIAL REGISTRATION: This clinical trial was registered in the www.clinicaltrials.gov system as NCT01661972 on July 31, 2012.
Authors
Strickler, JH; Rushing, CN; Niedzwiecki, D; McLeod, A; Altomare, I; Uronis, HE; Hsu, SD; Zafar, SY; Morse, MA; Chang, DZ; Wells, JL; Blackwell, KL; Marcom, PK; Arrowood, C; Bolch, E; Haley, S; Rangwala, FA; Hatch, AJ; Nixon, AB; Hurwitz, HI
MLA Citation
Strickler, John H., et al. “A phase Ib study of capecitabine and ziv-aflibercept followed by a phase II single-arm expansion cohort in chemotherapy refractory metastatic colorectal cancer..” Bmc Cancer, vol. 19, no. 1, Nov. 2019. Pubmed, doi:10.1186/s12885-019-6234-8.
URI
https://scholars.duke.edu/individual/pub1417915
PMID
31675952
Source
pubmed
Published In
Bmc Cancer
Volume
19
Published Date
Start Page
1032
DOI
10.1186/s12885-019-6234-8

Financial Costs and Burden Related to Decisions for Breast Cancer Surgery.

PURPOSE: Financial toxicity is a well-recognized adverse effect of cancer care, yet little is known about how women consider treatment costs when facing preference-sensitive decisions for breast cancer surgery or how surgical treatment choice affects financial harm. We sought to determine how financial costs and burden relate to decisions for breast cancer surgery. METHODS: Women (≥ 18 years old) with a history of breast cancer were recruited from the Army of Women and Sisters Network to complete an 88-item electronic survey. Descriptive statistics and regression analysis were used to evaluate the impact of costs on surgical decisions and financial harm after breast cancer surgery. RESULTS: A total of 607 women with stage 0 to III breast cancer were included. Most were white (90%), were insured privately (70%) or by Medicare (25%), were college educated (78%), and reported household incomes of more than $74,000 (56%). Forty-three percent underwent breast-conserving surgery, 25% underwent mastectomy, 32% underwent bilateral mastectomy, and 36% underwent breast reconstruction. Twenty-eight percent reported that costs of treatment influenced their surgical decisions, and at incomes of $45,000 per year, costs were prioritized over breast preservation or appearance. Overall, 35% reported financial burden as a result of their cancer treatment, and 78% never discussed costs with their cancer team. When compared with breast-conserving surgery, bilateral mastectomy with or without reconstruction was significantly associated with higher incurred debt, significant to catastrophic financial burden, treatment-related financial hardship, and altered employment. Among the highest incomes, 65% of women were fiscally unprepared, reporting higher-than-expected (26%) treatment costs. CONCLUSION: Cancer treatment costs influenced decisions for breast cancer surgery, and comparably effective surgical treatments differed significantly in their risk of patient-reported financial burden, debt, and impact on employment. Cost transparency may inform preference-sensitive surgical decisions and improve patient-centered care.
Authors
Greenup, RA; Rushing, C; Fish, L; Campbell, BM; Tolnitch, L; Hyslop, T; Peppercorn, J; Wheeler, SB; Zafar, SY; Myers, ER; Hwang, ES
MLA Citation
Greenup, Rachel A., et al. “Financial Costs and Burden Related to Decisions for Breast Cancer Surgery..” J Oncol Pract, vol. 15, no. 8, Aug. 2019, pp. e666–76. Pubmed, doi:10.1200/JOP.18.00796.
URI
https://scholars.duke.edu/individual/pub1402269
PMID
31356147
Source
pubmed
Published In
J Oncol Pract
Volume
15
Published Date
Start Page
e666
End Page
e676
DOI
10.1200/JOP.18.00796

A phase Ib study of the combination regorafenib with PF-03446962 in patients with refractory metastatic colorectal cancer (REGAL-1 trial).

PURPOSE: This study aimed to evaluate the maximum tolerated dose (MTD) and recommended phase II dose (RPTD), as well as the safety and tolerability of PF-03446962, a monoclonal antibody targeting activin receptor like kinase 1 (ALK-1), in combination with regorafenib in patients with refractory metastatic colorectal cancer. METHODS: The first stage of this study was a standard "3 + 3" open-label dose-escalation scheme. Cohorts of 3-6 subjects were started with 120 mg of regorafenib given PO daily for 3 weeks of a 4 week cycle, plus 4.5 mg/kg of PF-03446962 given IV every 2 weeks. Doses of both drugs were adjusted according to dose-limiting toxicities (DLT). Plasma was collected for multiplexed ELISA analysis of factors related to tumor growth and angiogenesis. RESULTS: Seventeen subjects were enrolled, of whom 11 were deemed evaluable. Seven subjects were enrolled at dose level 1, and four were enrolled at level - 1. Overall, three DLTs were observed during the dose-escalation phase: two in level 1 and one in level - 1. A planned dose-expansion cohort was not started due to early termination of the clinical trial. Common adverse events were infusion-related reaction, fatigue, palmar-plantar erythrodysesthesia syndrome, abdominal pain, dehydration, nausea, back pain, anorexia, and diarrhea. One subject achieved stable disease for 5.5 months, but discontinued treatment due to adverse events. CONCLUSIONS: The regimen of regorafenib and PF-03446962 was associated with unacceptable toxicity and did not demonstrate notable clinical activity in patients with refractory metastatic colorectal cancer.
Authors
Clarke, JM; Blobe, GC; Strickler, JH; Uronis, HE; Zafar, SY; Morse, M; Dropkin, E; Howard, L; O'Neill, M; Rushing, CN; Niedzwiecki, D; Watson, H; Bolch, E; Arrowood, C; Liu, Y; Nixon, AB; Hurwitz, HI
MLA Citation
Clarke, Jeffrey Melson, et al. “A phase Ib study of the combination regorafenib with PF-03446962 in patients with refractory metastatic colorectal cancer (REGAL-1 trial)..” Cancer Chemother Pharmacol, vol. 84, no. 4, Oct. 2019, pp. 909–17. Pubmed, doi:10.1007/s00280-019-03916-0.
URI
https://scholars.duke.edu/individual/pub1405169
PMID
31444620
Source
pubmed
Published In
Cancer Chemother Pharmacol
Volume
84
Published Date
Start Page
909
End Page
917
DOI
10.1007/s00280-019-03916-0

Defining Value of Cancer Therapeutics-A Health System Perspective.

Because of the rising costs of cancer care and ongoing challenges in ensuring access to quality care, there is an increasing need to prioritize spending and define the benefits of therapy in proportion to costs. The term "value" has gained favor as means to define the relative utility of a medical intervention in terms of benefits, risks, and financial costs, which in turn can help clinicians, patients, and policy makers prioritize "high-value" care. While numerous value concepts have been proposed, a comprehensive discussion of value initiatives along the care continuum is missing. In this Commentary, we propose a health system taxonomy of value initiatives in cancer care to discuss what the field needs to progress.
Authors
Leopold, C; Peppercorn, JM; Zafar, SY; Wagner, AK
MLA Citation
Leopold, Christine, et al. “Defining Value of Cancer Therapeutics-A Health System Perspective..” J Natl Cancer Inst, vol. 110, no. 7, July 2018, pp. 699–703. Pubmed, doi:10.1093/jnci/djy079.
URI
https://scholars.duke.edu/individual/pub1319617
PMID
29788313
Source
pubmed
Published In
J Natl Cancer Inst
Volume
110
Published Date
Start Page
699
End Page
703
DOI
10.1093/jnci/djy079

Patient Financial Assistance Programs: A Path to Affordability or a Barrier to Accessible Cancer Care?

Authors
Zafar, SY; Peppercorn, JM
MLA Citation
Zafar, S. Yousuf, and Jeffrey M. Peppercorn. “Patient Financial Assistance Programs: A Path to Affordability or a Barrier to Accessible Cancer Care?.” J Clin Oncol, vol. 35, no. 19, July 2017, pp. 2113–16. Pubmed, doi:10.1200/JCO.2016.71.7280.
URI
https://scholars.duke.edu/individual/pub1252817
PMID
28459612
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
35
Published Date
Start Page
2113
End Page
2116
DOI
10.1200/JCO.2016.71.7280

Research Areas:

Academic Medical Centers
Adenocarcinoma
Administration, Oral
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
DNA Methylation
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
Odds Ratio
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