Chronic Disease; Epidemiology; Health Policy; Internal Medicine; Ethics, Research
Internal Medicine: Center for Outcomes Research & Evaluation (CORE) | General Internal Medicine | Robert Wood Johnson Foundation Clinical Scholars Program: National Clinician Scholars Program
The over-arching theme of my work is the disconnect between evidence generated from clinical research and the needs of members of patients in the "real-world" setting, outside of clinical trials. Ongoing investigations focus on the comparative effectiveness of different approaches to cancer screening and treatment, the complex interplay of factors affecting the value of cancer care, and the abandonment of low-value approaches to cancer care. Bioethics and research integrity are also a major interest; my work has focused on the scope and impact of financial conflicts, as well as identifying and overcoming barriers to sharing research data as part of the YODA project at Yale (http://yoda.yale.edu/ )
Specialized Terms: Cancer policy; Health policy; Comparative effectiveness; Cancer outcomes; Research ethics and integrity
Extensive Research Description
I am the Director of the COPPER Center at Yale, which aims to improve cancer care and to decrease the burden of cancer on individual patients and society, and to increase equity and patient-centeredness in cancer care. The Center is comprised of researchers and clinicians from across the Yale Schools of Medicine (General Medicine, Geriatrics, Oncology, Radiation Oncology, Dermatology, and Pediatrics), Public Health, and Nursing. We also provide training and mentorship to the next generation of cancer policy and outcomes researchers. Please see the COPPER website for a full description of the team and our work ((http://copper.yale.edu/).
I have received NIH-funding from 2002 through the present time, with grants supporting the investigation of barriers to clinical trial enrollment, the impact of non-cancer illnesses on older persons with cancer, and the dissemination of new approaches to cancer screening and treatment into clinical practice.Currently, my collaborators and I are recipients of an NCI Provocative Questions grant, which aims to apply the concept of “social contagion” to cancer practice, shedding new light on the role of physicians and physician patient-sharing networks in the adoption of unproven technologies and the abandonment of proven ineffective treatments in cancer care.
Our recent grant through the American Cancer Society will examine patterns of Gene Expression Profile (GEP) use among women diagnosed with breast cancer at the population level. We will specifically look at the adoption of the Oncotype Dx test, and other tests coming into the market during the study period. Through this grant we will assess independent patient and hospital factors associated with adoption, if these newer technologies are contributing to disparities in breast cancer care, and if GEP testing follows current guideline recommendations.
I am particularly interested in cancer in older persons. Cancer is an aging-related disease, and elderly cancer patients tend to have worse outcomes than their younger counterparts. This is likely due, at least in part, to the myriad of non–cancer problems that tend to accrue with age. To provide greater clarity for patient and provider decision-making, we are exploring the manner in which non–cancer chronic illnesses and geriatric syndromes affect the care and outcomes of older patients with colorectal cancer. We are using a large population-based cohort of patients with cancer derived from administrative data, and in a separate study, COPPER is participating in a prospective cohort study of older patients with cancer as part of the Cancer in Aging Research Group (CARG: http://www.mycarg.org/home).
The Cost of Breast Cancer Screening in the Medicare Population
Gross CP, Long JB, Ross JS, Abu-Khalaf MM, Wang R, Killelea BK, Gold HT, Chagpar AB, Ma X. The Cost of Breast Cancer Screening in the Medicare Population. JAMA Internal Med. 2013 11;173(3):220-6.
Exploring Standards for Online Professionalism: A national study of state medical board propensity to investigate reported violations
Greysen SR, Johnson D, Kind T, Chretien KC, Gross CP, Young A, Chaudhry HJ. Exploring Standards for Online Professionalism: A national study of state medical board propensity to investigate reported violations. Ann Internal Med. 2013;158(2):124-30.
Proton versus Intensity Modulated Radiotherapy for Prostate Cancer: Patterns of Care and Early Toxicity
Yu JB, Soulos PR, Herrin J, Cramer LD, Potosky AL, Roberts KB, Gross CP. Proton versus Intensity Modulated Radiotherapy for Prostate Cancer: Patterns of Care and Early Toxicity. J Natl Cancer Inst. 2013;105 (1):25-32.
Use of hospital-based acute care among patients recently discharged from the hospital
Vashi AA, Fox JP, Carr BG, D'Onofrio G, Pines JM, Ross JS, Gross CP. Use of hospital-based acute care among patients recently discharged from the hospital. JAMA 2013;309(4):364-71
Assessing the impact of a cooperative group trial on breast cancer care in the Medicare population
Soulos PR, Yu JB, Roberts KB, Raldow AC, Herrin J, Long JB, Gross CP. Assessing the impact of a cooperative group trial on breast cancer care in the Medicare population. J Clin Oncol. 2012, 30:1601-7
Appropriate And Inappropriate Imaging Rates For Prostate Cancer Go Hand In Hand By Region, As If Set By Thermostat
Makarov DV, Desai R, Yu JB, Sharma R, Abraham N, Albertsen P, Krumholz HM, Penson D, and Gross CP. Appropriate And Inappropriate Imaging Rates For Prostate Cancer Go Hand In Hand By Region, As If Set By Thermostat. Health Affairs. 2012, 31: 730-740
The relationship between clinical benefit and receipt of curative therapy for prostate cancer
Raldow AC, Presley CJ, Yu JB, Sharma R, Cramer LD, Soulos PR, Long JB, Makarov DV, Gross CP. The relationship between clinical benefit and receipt of curative therapy for prostate cancer. Arch Intern Med. 2012, 172:362-3.
The Relation between Medicare Screening Reimbursement and Stage at Diagnosis for Older Patients with Colon Cancer
Gross CP, Andersen MS, Krumholz HM, McAvay GJ, Proctor D, Tinetti ME. The Relation between Medicare Screening Reimbursement and Stage at Diagnosis for Older Patients with Colon Cancer. JAMA 2006 296:2815-2822.
The effect of age and chronic illness on life expectancy after a diagnosis of colorectal cancer: Implications for screening
Gross CP, McAvay GJ, Krumholz HM, Paltiel AD, Bhasin D, Tinetti ME. The effect of age and chronic illness on life expectancy after a diagnosis of colorectal cancer: Implications for screening. Annals of Internal Medicine 2006 145:646-653.
Effectiveness of radiation therapy in older women with ductal carcinoma in situ
Smith BD, Haffty BG, Buchholz TA, Smith GL, Galusha DH, Bekelman JE, Gross CP. Effectiveness of radiation therapy in older women with ductal carcinoma in situ. Journal of the National Cancer Institute 2006 98:1302-1310.
Access to Experimental Drugs for Terminally Ill Patients
Falit BP, Gross CP. Access to Experimental Drugs for Terminally Ill Patients. JAMA 2008;300:2793-2795 (Commentary).
Killelea BK, Long JB, Chagpar AB, Ma X, Wang R, Ross JS, Gross CP. Evolution of breast cancer screening in the Medicare population: clinical and economic implications.
J Natl Cancer Inst. 2014 Jul 16;106(8)
Makarov DV, Soulos PR, Gold HT, Yu JB, Sen S, Ross JS, Gross CP. Regional-Level Correlations in Inappropriate Imaging Rates for Prostate and Breast Cancers: Potential Implications for the Choosing Wisely Campaign.
JAMA Oncol. 2015 May 1;1(2):185-94.
Diagnosis of cancer as an emergency: a critical review of current evidence
Zhou Y, Abel GA, Hamilton W, Pritchard-Jones K, Gross CP, Walter FM, Renzi C, Johnson S, McPhail S, Elliss-Brookes L, Lyratzopoulos G. Diagnosis of cancer as an emergency: a critical review of current evidence. Nat Rev Clin Oncol. 2016
Howard DH, Soulos PR, Chagpar AB, Mougalian S, Killelea B, Gross CP. Contrary To Conventional Wisdom, Physicians Abandoned A Breast Cancer Treatment After A Trial Concluded It Was Ineffective.
Health Aff (Millwood). 2016 Jul 1;35(7):1309-15. doi: 10.1377/hlthaff.2015.1490.