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:

Price of Cancer Care and Its Tax on Quality of Life.

Authors
Tran, G; Zafar, SY
MLA Citation
Tran, George, and S. Yousuf Zafar. “Price of Cancer Care and Its Tax on Quality of Life..” J Oncol Pract, vol. 14, no. 2, Feb. 2018, pp. 69–71. Pubmed, doi:10.1200/JOP.2017.028498.
URI
https://scholars.duke.edu/individual/pub1300353
PMID
29381412
Source
pubmed
Published In
J Oncol Pract
Volume
14
Published Date
Start Page
69
End Page
71
DOI
10.1200/JOP.2017.028498

Validation and Quality Assessment of the Kilimanjaro Cancer Registry.

PURPOSE: Global cancer burden has increasingly shifted to low- and middle-income countries and is particularly pronounced in Africa. There remains a lack of comprehensive cancer information as a result of limited cancer registry development. In Moshi, Tanzania, a regional cancer registry exists at Kilimanjaro Christian Medical Center. Data quality is unknown. Our objective was to evaluate the completeness and quality of the Kilimanjaro Cancer Registry (KCR). METHODS: In October 2015, we conducted a retrospective review of KCR by validating the internal consistency of registry records with medical and pathology records. We randomly sampled approximately 100 total registry cases. Four reviewers not associated with the KCR manually collected data elements from medical records and compared them with KCR data. RESULTS: All 100 reviewed registry cases had complete cancer site and morphology included in the registry. Six had a recorded stage. For the majority (n = 92), the basis of diagnosis was pathology. Pathology reports were found in the medical record for 40% of patients; for the remainder, these were stored separately in the pathology department. Of sampled registry cases, the KCR and medical records were 98% and 94% concordant for primary cancer site and morphology, respectively. For 28%, recorded diagnosis dates were within 14 days of what was found in the medical record, and for 32%, they were within 30 days. CONCLUSION: The KCR has a high level of concordance for classification and coding when data are retrieved for validation. This parameter is one of the most important for measuring data quality in a regional cancer registry.
Authors
Zullig, LL; Schroeder, K; Nyindo, P; Namwai, T; Silayo, E; Msomba, A; Munishi, MO; Karia, F; Muiruri, C; Bartlett, J; Maro, V; Zafar, SY
MLA Citation
Zullig, Leah L., et al. “Validation and Quality Assessment of the Kilimanjaro Cancer Registry..” J Glob Oncol, vol. 2, no. 6, Dec. 2016, pp. 381–86. Pubmed, doi:10.1200/JGO.2015.002873.
URI
https://scholars.duke.edu/individual/pub1266075
PMID
28717724
Source
pubmed
Published In
Journal of Global Oncology
Volume
2
Published Date
Start Page
381
End Page
386
DOI
10.1200/JGO.2015.002873

Best supportive care in clinical trials: review of the inconsistency in control arm design.

BACKGROUND: Best supportive care (BSC) as a control arm in clinical trials is poorly defined. We conducted a review to evaluate clinical trials' concordance with published, consensus-based framework for BSC delivery in trials. METHODS: A consensus-based Delphi panel previously identified four key domains of BSC delivery in trials: multidisciplinary care; supportive care documentation; symptom assessment; and symptom management. We reviewed trials including BSC control arms from 2002 to 2014 to assess concordance to BSC standards and to selected items from the CONSORT 2010 guidelines. RESULTS: Of 408 articles retrieved, we retained 18 after applying exclusion criteria. Overall, trials conformed to the CONSORT guidelines better than the BSC standards (28% vs 16%). One-third of articles offered a detailed description of BSC, 61% reported regular symptom assessment, and 44% reported using validated symptom assessment measures. One-third reported symptom assessment at identical intervals in both arms. None documented evidence-based symptom management. No studies reported educating patients about symptom management or goals of therapy. No studies reported offering access to palliative care specialists. CONCLUSIONS: Reporting of BSC in trials is incomplete, resulting in uncertain internal and external validity. Such studies risk systematically over-estimating the net clinical effect of the comparator arms.
Authors
Nipp, RD; Currow, DC; Cherny, NI; Strasser, F; Abernethy, AP; Zafar, SY
MLA Citation
Nipp, R. D., et al. “Best supportive care in clinical trials: review of the inconsistency in control arm design..” Br J Cancer, vol. 113, no. 1, June 2015, pp. 6–11. Pubmed, doi:10.1038/bjc.2015.192.
URI
https://scholars.duke.edu/individual/pub1074518
PMID
26068397
Source
pubmed
Published In
Br J Cancer
Volume
113
Published Date
Start Page
6
End Page
11
DOI
10.1038/bjc.2015.192

Phase I study of dasatinib in combination with capecitabine, oxaliplatin and bevacizumab followed by an expanded cohort in previously untreated metastatic colorectal cancer.

PURPOSE: Dasatinib inhibits src family kinases and has anti-angiogenic properties. We conducted a phase I study of dasatinib, capecitabine, oxaliplatin, and bevacizumab (CapeOx/bevacizumab), with an expansion cohort in metastatic colorectal cancer (CRC). METHODS: Patients were enrolled in a dose escalation cohort to establish the maximum tolerated dose (MTD) and the recommended phase II dose (RP2D). Using a "3 + 3" design, twelve patients with advanced solid tumors received dasatinib (50 mg twice daily or 70 mg daily), capecitabine (850 mg/m(2) twice daily, days 1-14), oxaliplatin (130 mg/m(2) on day 1) and bevacizumab (7.5 mg/kg on day1), every 3 weeks. Ten patients with previously untreated metastatic CRC were then enrolled in an expansion cohort. Activated src (src(act)) expression was measured by immunohistochemistry, using an antibody that selectively recognizes the active conformation of src (clone 28). RESULTS: Twenty-two patients were enrolled between June 2009 and May 2011. Two DLTs were observed in the 50 mg bid dasatinib cohort, and one DLT was observed in the 70 mg daily dasatinib cohort. The MTD and RP2D for dasatinib was 70 mg daily. The most common treatment-related adverse events were fatigue (20; 91 %) and diarrhea (18; 82 %). Biomarker analysis of src(act) expression demonstrated that the overall response rate (ORR) was 75 % (6/8) for patients with high src(act) expression (IHC ≥ 2), compared to 0 % (0/8) for patients with low srcact expression (IHC 0 or 1); (p = 0.007). CONCLUSIONS: The RP2D of dasatinib is 70 mg daily in combination with CapeOx/bevacizumab. High levels of srcact expression may predict those patients most likely to benefit from dasatinib.
Authors
Strickler, JH; McCall, S; Nixon, AB; Brady, JC; Pang, H; Rushing, C; Cohn, A; Starodub, A; Arrowood, C; Haley, S; Meadows, KL; Morse, MA; Uronis, HE; Blobe, GC; Hsu, SD; Zafar, SY; Hurwitz, HI
MLA Citation
Strickler, John H., et al. “Phase I study of dasatinib in combination with capecitabine, oxaliplatin and bevacizumab followed by an expanded cohort in previously untreated metastatic colorectal cancer..” Invest New Drugs, vol. 32, no. 2, Apr. 2014, pp. 330–39. Pubmed, doi:10.1007/s10637-013-0042-9.
URI
https://scholars.duke.edu/individual/pub967259
PMID
24173967
Source
pubmed
Published In
Invest New Drugs
Volume
32
Published Date
Start Page
330
End Page
339
DOI
10.1007/s10637-013-0042-9

Financial toxicity, Part II: how can we help with the burden of treatment-related costs?

Authors
Zafar, SY; Abernethy, AP
MLA Citation
Zafar, S. Y., and A. P. Abernethy. “Financial toxicity, Part II: how can we help with the burden of treatment-related costs?.” Oncology (Williston Park, N.Y.), vol. 27, no. 4, Jan. 2013.
URI
https://scholars.duke.edu/individual/pub961862
Source
scopus
Published In
Oncology (Williston Park, N.Y.)
Volume
27
Published Date

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