James B Yu

James B Yu
St. Francis Hospital

Doctor of Medicine

About

612
Publications
25,371
Reads
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12,453
Citations
Citations since 2017
256 Research Items
9492 Citations
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Additional affiliations
January 2008 - December 2012
January 2007 - December 2012
Yale University

Publications

Publications (612)
Article
Purpose/Objective(s) Despite the recognition that women with triple-negative (TNBC) and HER2+ breast cancer have a higher risk of developing brain metastases than other subtypes of breast cancer, the recently updated NCCN guidelines for breast cancer do not recommend MR imaging of the brain in women with either primary or metastatic breast cancer (...
Article
Purpose/Objective(s) The rising cost of health care is a major concern in the United States. Though radiation oncology was targeted for cost reductions based on expenditure growth, subsequent analyses suggested stabilization of radiation oncology charges. In 2019, the Centers for Medicare and Medicaid Services (CMS) proposed a new radiation oncolog...
Article
Objectives Distant metastases (DM) are the primary driver of mortality for patients with early stage non-small cell lung cancer (NSCLC) receiving stereotactic body radiation therapy (SBRT), yet patient-level risk is difficult to predict. We developed and validated a model to predict individualized risk of DM in this population. Methods We utilized...
Article
Introduction Our goal was to estimate a relative decreased rate of social connectedness to family and friends, increased rate of stress or anxiety during the 2020–2021 winter surge of the COVID-19 pandemic, and investigate the association between social connectedness and stress or anxiety among a nationally representative sample of older adults wit...
Article
Background Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma (CTCL). Although it often has an indolent course, it can progress to more aggressive CTCL forms. There is sparse data in current literature describing specific clinical factors associated with in-hospital mortality in mycosis fungoides patients. An understanding...
Article
Objective: Because of the aggressive nature of glioblastoma, patients with unresected disease are encouraged to begin radiotherapy within approximately 1 month after craniotomy. The aim of this study was to investigate the potential association between time interval from biopsy to radiotherapy with overall survival in patients with unresected glio...
Article
Health economics research, defined as research that evaluates how patients, health-care providers, and governments make health-care decisions using economic theory, models, and empirical techniques, requires broad domains of knowledge that are not fully encompassed by a single discipline. Collaboration between disciplines provides different perspec...
Article
The National Cancer Institute Division of Cancer Control and Population Science hosted a virtual conference on the Future of Cancer Health Economics Research and included a presentation from a workgroup that considered current challenges and future directions in health economics research centered on cancer treatment. The workgroup identified 3 broa...
Article
Brain metastases are a challenging manifestation of renal cell carcinoma. We have a limited understanding of brain metastasis tumor and immune biology, drivers of resistance to systemic treatment, and their overall poor prognosis. Current data support a multimodal treatment strategy with radiation treatment and/or surgery. Nonetheless, the optimal...
Article
TPS5115 Background: Roughly 20%-30% of prostate cancer patients experience biochemical recurrence (BCR), rising prostate-specific antigen (PSA) levels, after definitive therapy with radical prostatectomy (RP) or radiation therapy (RT). The optimal therapy and timing of treatment for BCR is unknown, however, for patients who are not eligible for sal...
Article
Full-text available
Purpose Whole brain radiation therapy (WBRT) is often used as an effective treatment for patients with brain metastasis, although it is also known to have deleterious cognitive effects. Multiple trials have identified strategies to help mitigate neurocognitive decline after WBRT, although there may be barriers to integrating these techniques into r...
Article
We sought to understand patient- and institution-level factors associated with use of locoregional therapy for newly diagnosed metastatic prostate cancer in the era before the availability of evidence supporting its efficacy. We queried the National Cancer Database to identify patients diagnosed with metastatic prostate adenocarcinoma (stage M1) be...
Article
Objectives: To elucidate the national burden of emergency department (ED) visits for radiation cystitis (RC), a known complication of radiation therapy to the pelvic area, among patients with a prostate cancer history, and identify those who are at increased risk of requiring invasive measures. Methods: This study queried the Nationwide Emergenc...
Article
Importance In April 2017, the US Preventive Services Task Force (USPSTF) published a draft guideline that reversed its 2012 guidance advising against prostate-specific antigen (PSA)–based screening for prostate cancer in all men (grade D), instead endorsing individual decision-making for men aged 55 to 69 years (grade C). Objective To evaluate cha...
Article
Purpose/Objective(s) Whole brain radiation therapy (WBRT) is often employed as an effective treatment to palliate symptoms, improve intracranial control, and potentially improve survival for patients with brain metastasis, although it is also known to have deleterious cognitive effects. Despite multiple trials having identified strategies to help m...
Article
Purpose/Objective(s) There is mounting evidence that curative-intent stereotactic body radiation therapy (SBRT) may improve overall survival (OS) in patients with oligometastatic disease. However, the optimal sequencing and timing of radiation in this setting remains unclear. Delaying SBRT in favor of upfront systemic therapy can reduce tumor burde...
Article
Purpose/Objective(s) Studies have suggested that prior radiation dose to normal lung tissue is associated with poor COVID-19 outcomes. However, radiation dose to the heart may be an equally important consideration, given the impact of COVID-19 on cardiovascular/thrombotic complications, and of cardiac dose on overall mortality after breast and lung...
Article
Background: The current distribution of radiation therapy (RT) facilities in the US is not well established. A comprehensive inventory of US RT facilities was last assessed in 2005, based on data from state regulatory agencies and dosimetric quality assurance bodies. We updated this database to characterize population-level measures of geographic a...
Article
The progression of cancer is an evolutionary process that is challenging to monitor between sampling timepoints. However, investigation of cancer evolution over specific time periods is crucial to the elucidation of key events such as the acquisition of therapeutic resistance and subsequent fatal metastatic spread of therapy-resistant cell populati...
Article
Full-text available
Importance: The clinical decisions that arise from prostate magnetic resonance imaging (MRI) and genomic testing in patients with prostate cancer are not well understood. Objective: To evaluate the association between regional uptake of prostate MRI and genomic testing and observation vs treatment for prostate cancer. Design, setting, and parti...
Article
Full-text available
Introduction The study aimed to describe the brain metastases (BM) incidence, at diagnosis and follow-up, in patients initially presenting with stage III or IV melanoma and characterize their metastatic brain lesions. We also sought to describe the association of common genetic mutations and immunotherapy with BM development in advanced melanoma.Me...
Article
Objectives: Post-operative radiation therapy (PORT) in locally advanced non-small cell lung cancer (LA-NSCLC) has historically been associated with toxicity. Conformal techniques like intensity modulated radiation therapy (IMRT) have the potential to reduce acute and long-term toxicity from radiation therapy. Among patients receiving PORT for LA-N...
Article
Objective: The impact of immunotherapy and stereotactic radiosurgery (SRS) in treatment of brain metastases (BM) from renal cell carcinoma (RCC) has not been well investigated. Materials and methods: Forty-eight patients with 372 RCC BM were treated with SRS and divided into those ever treated with immunotherapy versus those who never received i...
Article
Full-text available
Comparative effectiveness research (CER) using national registries influences cancer clinical trial design, treatment guidelines, and patient management. However, the extent to which treatment selection bias (TSB) affects overall survival (OS) in cancer CER remains poorly defined. We sought to quantify the TSB effect on OS in the setting of low-ris...
Article
Background: There exists wide practice variability in palliative treatment schedules for bone metastases. In an effort to reduce variation and promote high-quality, cost-conscious care, the National Quality Forum (NQF) endorsed measure 1822 in 2012. This measure recommends the use of 30 Gy in 10 fractions, 24 Gy in 6 fractions, 20 Gy in 5 fraction...
Article
Purpose: Ductal carcinoma in situ (DCIS) accounts for 20% of breast cancer cases in the United States and is potentially overtreated, leading to high expenditures and low-value care. We conducted a cost-effectiveness analysis evaluating all adjuvant treatment strategies for DCIS. Methods: A Markov model was created with six competing treatment s...
Article
e20550 Background: Soon after the publication of the PACIFIC trial, the Food and Drug Administration (FDA) approved durvalumab following definitive chemoradiation in patients with unresectable stage III non-small cell lung cancer (NSCLC). However, patterns of durvalumab adoption within the United States are currently unknown. We investigated the pa...
Preprint
Full-text available
The progression of cancer—including the acquisition of therapeutic resistance and the fatal metastatic spread of therapy-resistant cell populations—is an evolutionary process that is challenging to monitor between sampling timepoints. Here we apply mutational signature analysis to clinically correlated cancer chronograms to detect and describe the...
Article
Full-text available
PurposeTo evaluate practice patterns of planned post-operative radiation therapy (RT) among men with positive surgical margins (PSM) at radical prostatectomy.Methods We identified 43,806 men within the National Cancer Database with pathologic node-negative prostate cancer diagnosed in 2010 through 2014 with PSM. The primary endpoint was receipt of...
Article
INTRODUCTION Radiation therapy (XRT) has been investigated as a possible treatment for high-risk non-muscle invasive bladder cancer (NMIBC) with the goal of bladder preservation, especially with the ongoing Bacillus Calmette-Guerin (BCG) shortage. Yet, little is known about the clinical efficacy and the quality of evidence supporting XRT for NMIBC....
Chapter
Testicular cancer is a common genitourinary malignancy among men which can be treated successfully with excellent survival outcomes. Reviewing new studies and national guidelines, we provide an overview of radiotherapy management for seminoma and nonseminoma germ cell tumors. Modern radiotherapy employs volume and dose reduction strategies to bette...
Article
Importance Cancer registries are important real-world data sources consisting of data abstraction from the medical record; however, patients with unknown or missing data are underrepresented in studies that use such data sources. Objective To assess the prevalence of missing data and its association with overall survival among patients with cancer...
Article
205 Background: Commonly used tools for predicting the risk of pelvic lymph node involvement (LNI) in prostate cancer often do not incorporate information on the percentage of positive biopsy cores (PPB). To better inform the use of elective nodal irradiation in the definitive treatment of prostate cancer, we examined the association between PPB an...
Article
Full-text available
Introduction Patients with early-stage non-small cell lung cancer (NSCLC) commonly must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many cancer patients have competing mortality risks unrelated to cancer, we investigated whether an established model of predicting l...
Article
Full-text available
Importance Prostate radiation therapy (PRT) is a treatment option in men with low-volume metastatic prostate cancer based on the results of the Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy Arm H (STAMPEDE-H) trial. However, the cost-effectiveness of this treatment remains unaddressed. Objective To assess...
Article
Text Purpose/Objective(s) In 2019, the Centers for Medicare and Medicaid Services proposed a new radiation oncology alternative payment model aimed at reducing expenditures. We examined changes in aggregate physician Medicare charges allowed per specialty to provide contemporary context to proposed changes and hypothesize that radiation oncology c...
Article
Full-text available
Background: Presently, educational programming is not standardized across radiation oncology (RO) training programs. Specifically, there are limited materials through national organizations or structured practice exams for residents preparing for the American Board of Radiology (ABR) oral board examination. We present our 2019 experience implement...
Article
Firearm injuries are a significant public health problem. Prior studies have analyzed firearm death data or adult firearm injury data, but few studies have analyzed firearm injury data specifically among youth. To inform the current debate surrounding gun policy in the United States, this study aims to provide an estimate of the immense burden of y...
Article
PURPOSE Deep learning survival models show promise for outcome prediction by leveraging the ability to model non-linear relationships between pixel-level imaging predictors and survival data. We hypothesized that a deep learning survival model derived from quantitative imaging predictors would be more effective than traditional models of survival i...
Preprint
Background There has been increased enthusiasm regarding the use of real-world data (RWD) for clinical evidence generation. Cancer registries are important RWD sources that rely on data abstraction from the medical record, however, patients with unknown or missing data elements are under-represented in studies that use such data sources. Therefore,...
Article
Full-text available
Purpose Management options for localized prostate cancer include definitive radiation therapy (RT) or radical prostatectomy, with a subset of surgical patients requiring adjuvant or salvage RT after prostatectomy. The use of a peri-rectal hydrogel spacer in patients receiving definitive RT has been shown to reduce rectal doses and toxicity. However...
Article
Full-text available
Purpose: During a global pandemic, the benefit of routine visits and treatment of patients with cancer must be weighed against the risks to patients, staff, and society. Prostate cancer is one of the most common cancers radiation oncology departments treat, and efficient resource utilization is essential in the setting of a pandemic. Herein, we ai...
Article
Objective: To examine variation in trajectories of abandoning conventionally fractionated whole-breast irradiation (CF-WBI) for adjuvant breast radiotherapy among physician peer groups and the associated cost implications. Data sources: Medicare claims data were obtained from the Chronic Conditions Data Warehouse for fee-for-service beneficiarie...
Article
Full-text available
Importance Prescription opioids are frequently prescribed to treat cancer-related pain. However, limited information exists regarding rates of prescription opioid use and misuse in populations with cancer. Objectives To estimate the prevalence and likelihood of prescription opioid use and misuse in adult cancer survivors compared with respondents...
Article
Background: In the wake of the United States opioid epidemic, there have been efforts to curb opioid prescribing. However, it is unknown whether these efforts have affected prescribing among oncologists, whose patients often require opioids for symptom management. We investigated temporal patterns in opioid prescribing for Medicare beneficiaries a...
Article
Objectives: Pathologic fractures from bone metastases can significantly affect quality-of-life, although it is unclear which patients may be at high risk of this outcome. We aim to determine risk factors for pathologic fracture among patients admitted with bone metastases and to evaluate the association of pathologic fracture with clinical and eco...
Article
Full-text available
Abstract Brain metastases can contribute to a decreased quality of life for patients with cancer, often leading to malaise, neurologic dysfunction, or death. Intracerebral hemorrhage (ICH) is an especially feared complication in patients with brain metastases given the potential for significant morbidity and mortality. We aim to characterize patien...
Article
Full-text available
The Monte Carlo (MC) method is widely used to solve various problems in radiotherapy. There has been an impetus to accelerate MC simulation on GPUs whereas thread divergence remains a major issue for MC codes based on acceptance-rejection sampling. Inverse transform sampling has the potential to eliminate thread divergence but it is only implemente...
Article
Importance Although stereotactic radiosurgery (SRS) is preferred for limited brain metastases from most histologies, whole-brain radiotherapy (WBRT) has remained the standard of care for patients with small cell lung cancer. Data on SRS are limited. Objective To characterize and compare first-line SRS outcomes (without prior WBRT or prophylactic c...
Article
Objectives Although survival after a cancer diagnosis has improved considerably over the past 20 years, little is known about trends in health-related quality-of-life (HRQOL) for older prostate, breast, and lung cancer survivors. Methods Using a population-based registry with longitudinal patient reported outcomes (the National Cancer Institute Su...
Article
12022 Background: In the wake of the United States (U.S.) opioid epidemic, there have been significant governmental and societal efforts to curb opioid prescribing. However, it is unknown whether these efforts have affected prescribing among oncologists, whose patient population often requires narcotics for symptom management. We investigated tempo...
Article
TPS5601 Background: Salvage radiotherapy (SRT) is an important intervention for men with prostate cancer (PCa) who experience biochemical recurrence (BCR) after radical prostatectomy (RP). These patients are in need of cure or else they will develop metastatic disease. NRG/RTOG 9601 (WU Shipley, N Eng J Med 2017) identified a survival benefit from...
Article
e19309 Background: Prophylactic cranial irradiation (PCI) use is controversial in extensive-stage small cell lung cancer (ES-SCLC). In addition to lack of survival benefit of PCI compared to close MRI surveillance in a 2017 published trial, the role of PCI is being further challenged in the modern immune-oncology (IO) era. The IMpower133 trial repo...
Article
e19308 Background: There is emerging evidence for using clinical genomic classifiers for prognostication and to guide treatment choice in metastatic prostate cancer (mPC). While clinical-grade next generation sequencing (NGS) tests are increasingly available, how NGS has impacted systemic therapy selection for mPC is unclear. Methods: We performed...
Article
Purpose On June 13-14, 2019, the American Society for Radiation Oncology (ASTRO) and the Radiological Society of North America (RSNA) convened a workshop on the Treatment of Oligometastatic Disease in Washington, DC. The workshop was initiated because of several reasons. First, oligometastatic (OM) disease is of increasing academic and community in...
Article
Full-text available
Purpose During a global pandemic the benefit of routine visits and treatment of cancer patients must be weighed against the risks to patients, staff, and society. Prostate cancer is one of the most common cancers Radiation Oncology departments treat, and efficient resource utilization is essential in the setting of a pandemic. Herein, we aim to est...
Article
Background We did a phase 2 trial of pembrolizumab in patients with non-small-cell lung cancer (NSCLC) or melanoma with untreated brain metastases to determine the activity of PD-1 blockade in the CNS. Interim results were previously published, and we now report an updated analysis of the full NSCLC cohort. Methods This was an open-label, phase 2...
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Full-text available
Background Recognizing the rapidly increasing interest and evidence in using metastasis-directed radiotherapy (MDRT) for oligometastatic disease (OMD), ESTRO and ASTRO convened a committee to establish consensus regarding definitions of OMD and define gaps in current evidence. Methods A systematic literature review focused on curative intent MDRT...