Syed Zafar

Overview:

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.

Positions:

Adjunct Professor in the Department of Medicine

Medicine, Medical Oncology
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

Education:

M.D. 2002

The 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
Awarded By
Patrick & Catherine Weldon Donaghue Medical Research Foundation
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
Awarded By
Vivor, LLC
Role
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
Role
Principal Investigator
Start Date
End Date

Publications:

Time to add screening for financial hardship as a quality measure?

Cancer treatment is associated with financial hardship for many patients and families. Screening for financial hardship and referrals to appropriate resources for mitigation are not currently part of most clinical practices. In fact, discussions regarding the cost of treatment occur infrequently in clinical practice. As the cost of cancer treatment continues to rise, the need to mitigate adverse consequences of financial hardship grows more urgent. The introduction of quality measurement and reporting has been successful in establishing standards of care, reducing disparities in receipt of care, and improving other aspects of cancer care outcomes within and across providers. The authors propose the development and adoption of financial hardship screening and management as an additional quality metric for oncology practices. They suggest relevant stakeholders, conveners, and approaches for developing, testing, and implementing a screening and management tool and advocate for endorsement by organizations such as the National Quality Forum and professional societies for oncology care clinicians. The confluence of increasingly high-cost care and widening disparities in ability to pay because of underinsurance and lack of health insurance coverage makes a strong argument to take steps to mitigate the financial consequences of cancer.
Authors
Bradley, CJ; Yabroff, KR; Zafar, SY; Shih, Y-CT
MLA Citation
Bradley, Cathy J., et al. “Time to add screening for financial hardship as a quality measure?Ca Cancer J Clin, vol. 71, no. 2, Mar. 2021, pp. 100–06. Pubmed, doi:10.3322/caac.21653.
URI
https://scholars.duke.edu/individual/pub1465443
PMID
33226648
Source
pubmed
Published In
Ca: a Cancer Journal for Clinicians
Volume
71
Published Date
Start Page
100
End Page
106
DOI
10.3322/caac.21653

Modifiable patient-reported factors associated with cancer-screening knowledge and participation in a community-based health assessment.

BACKGROUND: We sought to identify modifiable factors associated with cancer screening in a community-based health assessment. METHODS: 24 organizations at 47 community events in central North Carolina distributed a 91-item survey from April-December 2017. Responses about (1) interest in disease prevention, (2) lifestyle choices (e.g., diet, tobacco), and (3) perceptions of primary care access/quality were abstracted to examine their association with self-reported screening participation and knowledge about breast, prostate, and colorectal cancer. RESULTS: 2135/2315 participants (92%; 38.5% White, 38% Black, 9.9% Asian) completed screening questions. >70% of screen-eligible respondents reported guideline-concordant screening. Healthy dietary habits were associated with greater knowledge about breast and colorectal cancer screening; reporting negative attitudes about and barriers to healthcare were associated with less breast, prostate, and colorectal cancer screening. Having a place to seek medical care (a proxy for primary care access) was independently associated with being ∼5 times as likely to undergo colorectal screening (OR 4.66, 95% CI 1.58-13.79, all p < 0.05). CONCLUSIONS: In this diverse, community-based sample, modifiable factors were associated with screening engagement, highlighting opportunities for behavioral intervention.
Authors
MLA Citation
Fayanju, Oluwadamilola M., et al. “Modifiable patient-reported factors associated with cancer-screening knowledge and participation in a community-based health assessment.Am J Surg, vol. 225, no. 4, Apr. 2023, pp. 617–29. Pubmed, doi:10.1016/j.amjsurg.2022.10.059.
URI
https://scholars.duke.edu/individual/pub1555407
PMID
36411107
Source
pubmed
Published In
Am J Surg
Volume
225
Published Date
Start Page
617
End Page
629
DOI
10.1016/j.amjsurg.2022.10.059

Crowdfunded Cancer Care-A Reflection on Health Care Delivery in the US.

Authors
MLA Citation
Zafar, S. Yousuf. “Crowdfunded Cancer Care-A Reflection on Health Care Delivery in the US.Jama Netw Open, vol. 3, no. 12, Dec. 2020, p. e2027191. Pubmed, doi:10.1001/jamanetworkopen.2020.27191.
URI
https://scholars.duke.edu/individual/pub1467534
PMID
33270118
Source
pubmed
Published In
Jama Network Open
Volume
3
Published Date
Start Page
e2027191
DOI
10.1001/jamanetworkopen.2020.27191

Evaluating a couple communication skills training (CCST) intervention for advanced cancer: study protocol for a randomized controlled trial.

BACKGROUND: For patients and their intimate partners, advanced cancer poses significant challenges that can negatively impact both individuals and their relationship. Prior studies have found evidence that couple-based communication skills interventions can to be beneficial for patients and partners. However, these studies have been limited by reliance on in-person treatment delivery and have not targeted couples at high risk for poor outcomes. This study tests the efficacy of a Couples Communication Skills Training (CCST) intervention delivered via videoconference for couples reporting high levels of holding back from discussing cancer-related concerns, a variable associated with poorer psychological and relationship functioning. METHODS: This RCT is designed to evaluate the efficacy of CCST in improving patient and partner relationship functioning (primary outcome). Secondary outcomes include patient and partner psychological functioning and patient symptoms and health care use. We also examine the role of objective and self-reported communication behaviors as mediators of treatment effects. Two hundred thirty patients with advanced lung, gastrointestinal, genitourinary, and breast cancer and their partners will be randomized to CCST or an education control intervention. Participants in both conditions complete self-reported outcome measures at baseline, mid-treatment, post-treatment, and 3 months post-treatment. Objective measures of communication are derived from video-recorded couple conversations collected at baseline and post-treatment. An implementation-related process evaluation (assessing implementation outcomes and potential barriers to/facilitators of implementation) will be conducted to inform future efforts to implement CCST in real-world settings. DISCUSSION: This trial can yield important new knowledge about effective ways to improve patient and partner adjustment to advanced cancer. TRIAL REGISTRATION: This study trial is registered at clinicaltrials.gov (Trial # NCT04590885); registration date: October 19, 2020.
Authors
Porter, LS; Ramos, K; Baucom, DH; Steinhauser, K; Erkanli, A; Strauman, TJ; Zafar, SY; Check, DK; Leo, K; Liu, E; Keefe, FJ
MLA Citation
Porter, Laura S., et al. “Evaluating a couple communication skills training (CCST) intervention for advanced cancer: study protocol for a randomized controlled trial.Trials, vol. 23, no. 1, Aug. 2022, p. 712. Pubmed, doi:10.1186/s13063-022-06656-4.
URI
https://scholars.duke.edu/individual/pub1533589
PMID
36028908
Source
pubmed
Published In
Trials
Volume
23
Published Date
Start Page
712
DOI
10.1186/s13063-022-06656-4

Low-touch, team-based care for co-morbidity management in cancer patients: the ONE TEAM randomized controlled trial.

BACKGROUND: As treatments for cancer have improved, more people are surviving cancer. However, compared to people without a history of cancer, cancer survivors are more likely to die of cardiovascular disease (CVD). Increased risk for CVD-related mortality among cancer survivors is partially due to lack of medication adherence and problems that exist in care coordination between cancer specialists, primary care physicians, and cardiologists. METHODS/DESIGN: The Onco-primary care networking to support TEAM-based care (ONE TEAM) study is an 18-month cluster-randomized controlled trial with clustering at the primary care clinic level. ONE TEAM compares the provision of the iGuide intervention to patients and primary care providers versus an education-only control. For phase 1, at the patient level, the intervention includes video vignettes and a live webinar; provider-level interventions include electronic health records-based communication and case-based webinars. Participants will be enrolled from across North Carolina one of their first visits with a cancer specialist (e.g., surgeon, radiation or medical oncologist). We use a sequential multiple assignment randomized trial (SMART) design. Outcomes (measured at the patient level) will include Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of management of three CVD comorbidities using laboratory testing (glycated hemoglobin [A1c], lipid profile) and blood pressure measurements; (2) medication adherence assessed pharmacy refill data using Proportion of Days Covered (PDC); and (3) patient-provider communication (Patient-Centered Communication in Cancer Care, PCC-Ca-36). Primary care clinics in the intervention arm will be considered non-responders if 90% or more of their participating patients do not meet the modified HEDIS quality metrics at the 6-month measurement, assessed once the first enrollee from each practice reaches the 12-month mark. Non-responders will be re-randomized to either continue to receive the iGuide 1 intervention, or to receive the iGuide 2 intervention, which includes tailored videos for participants and specialist consults with primary care providers. DISCUSSION: As the population of cancer survivors grows, ONE TEAM will contribute to closing the CVD outcomes gap among cancer survivors by optimizing and integrating cancer care and primary care teams. ONE TEAM is designed so that it will be possible for others to emulate and implement at scale. TRIAL REGISTRATION: This study (NCT04258813) was registered in clinicaltrals.gov on February 6, 2020.
Authors
Zullig, LL; Shahsahebi, M; Neely, B; Hyslop, T; Avecilla, RAV; Griffin, BM; Clayton-Stiglbauer, K; Coles, T; Owen, L; Reeve, BB; Shah, K; Shelby, RA; Sutton, L; Dinan, MA; Zafar, SY; Shah, NP; Dent, S; Oeffinger, KC
MLA Citation
Zullig, Leah L., et al. “Low-touch, team-based care for co-morbidity management in cancer patients: the ONE TEAM randomized controlled trial.Bmc Fam Pract, vol. 22, no. 1, Nov. 2021, p. 234. Pubmed, doi:10.1186/s12875-021-01569-8.
URI
https://scholars.duke.edu/individual/pub1501851
PMID
34794388
Source
pubmed
Published In
Bmc Family Practice
Volume
22
Published Date
Start Page
234
DOI
10.1186/s12875-021-01569-8

Research Areas:

Academic Medical Centers
Adenocarcinoma
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
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
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