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Introduction
Current institution
Additional affiliations
May 2015 - present
September 2010 - May 2015
January 2010 - May 2015
Publications
Publications (697)
Background: Since tobacco smoking represents the most established risk factor for bladder cancer, we sought to assess the ecological association between tobacco smoking prevalence and bladder cancer incidence and to contrast it with lung cancer. Methods: The annual overall tobacco smoking prevalence rates were extracted from the Report of the Surge...
e14592
Background: Ipilimumab is a CTLA-4 inhibitor widely used to treat advanced melanoma. While ipilimumab-induced cardiac immune-related adverse events (irAE) have been reported, there is a paucity of data from large cohorts. We investigated the risk and predictors of ipilimumab-associated cardiac irAE in a national cohort of patients with cutan...
Objective:
The objective of this study was to examine the risk of immune-related adverse events (irAEs) in patients with a preexisting autoimmune disease (pAID) presenting with a cutaneous melanoma receiving an immune checkpoint inhibitor (ICI) therapy.
Methods:
Data from the Surveillance, Epidemiology, and End Results cancer registries and link...
Introduction
Designing adjuvant trials is challenging because of uncertainties of prevalence and outcome of high-risk Renal Cell Cancer(RCC) despite use of validated risk scores. Our objective is to investigate how differences in eligibility criteria may impact on potential study results in RCC adjuvant trials.
Patients and Methods
RECUR is a mult...
Background
Prostate cancer ranks among the top 5 cancers in contribution to national expenditures. Previous reports have identified that 5% of the population accounts for 50% of the nation's annual health care spending. To date, the assessment of the top 5% resource-patients among men diagnosed with prostate cancer (PCa) has never been performed. W...
Evidence for androgen deprivation therapy (ADT) and risk of dementia is both limited and mixed. We aimed to assess the association between ADT and risk of dementia among men with localized and locally advanced prostate cancer (PCa).
We conducted a retrospective cohort study using SEER-Medicare-linked data among 100,414 men aged ≥ 66 years and diagn...
Background
Androgen deprivation therapy (ADT) increases the risk of metabolic adverse effects among patients with prostate cancer. The transformative impact of mobile health (mHealth) apps may benefit men managing activity and nutrition at home.
Objective
This study aimed to evaluate the usability and patient experience of a newly developed mHealt...
BACKGROUND
Androgen deprivation therapy (ADT) increases the risk of metabolic adverse effects among patients with prostate cancer. The transformative impact of mobile health (mHealth) apps may benefit men managing activity and nutrition at home.
OBJECTIVE
This study aimed to evaluate the usability and patient experience of a newly developed mHealt...
Induction of hypogonadism is standard‐of‐care for advanced prostate cancer. Gonadotropic releasing hormone (GnRH) agonists and antagonists lower testosterone with similar efficacy but may be associated with increased cardiovascular risk. In small randomized controlled trials (RCTs) comparing the two, one found no difference, whereas another and a n...
To assess whether Medicare expenditures for men with incident prostate cancer, treated in Accountable Care Organizations (ACOs) differ from those of men treated in non-ACOs.
Using the 20% Medicare sample, total charges for 1 year following an initial diagnosis of prostate cancer were abstracted from Medicare claims. Prostate cancer expenditures wer...
Objectives:
Early surgical resection remains the recommended treatment option for most small renal mass (≤4 cm). We examined the long-term overall survival (OS) of patients managed with delayed and immediate nephrectomy of cT1a renal cancer.
Patient and methods:
We utilized the National Cancer Database (2005-2010) to identify 14,677 patients (im...
Background:
We aim to understand how Medicaid expansion under the ACA has affected utilization of surgical services.
Methods:
The State Inpatient Databases were used to compare utilization of a broad array of surgical procedures among nonelderly adults (aged 19-64 years) in a multistate population that experienced ACA-related Medicaid expansion...
Background:
Previous studies have found an association between androgen deprivation therapy (ADT) and an increased risk of dementia and depression in elderly men. This association remains controversial, and little is known about the effects of ADT in younger men.
Objective:
To examine the association between the receipt of ADT and these outcomes...
Background:
Insurance coverage is associated with better cancer outcomes; however, the relative importance of insurance coverage may differ between cancers. This study compared the association between insurance coverage at diagnosis and cancer-specific mortality (CSM; insurance sensitivity) in 6 cancers.
Patients and methods:
Using the SEER canc...
Purpose:
Accountable care organizations (ACOs) are a delivery and payment model designed to encourage integrated, high-value care. We designed a study to test the association between ACOs and two recommended cancer screening tests, colonoscopy for colorectal cancer and mammography for breast cancer.
Methods:
Using the random 20% sample of Medica...
Background:
Racial differences in prostate cancer (PCa) outcomes in the United States may be due to differences in tumor biology and race-based differences in access and treatment. We designed a study to estimate the relative contribution of these factors on Black/White disparities in overall survival (OS) in advanced PCa.
Methods:
We identified...
Background:
Despite randomized data demonstrating better overall survival favoring radical nephrectomy, partial nephrectomy continues to be the treatment of choice for low-stage renal cell carcinoma.
Methods:
We utilized the National Cancer Database to identify patients younger than 50 years diagnosed with low-stage renal cell carcinoma (cT1) tr...
Background
There are race‐based differences in bladder cancer survival. To better understand this phenomenon, this study was designed to assess the statistical contributions of tumor, treatment, and access variables to race‐based differences in survival.
Methods
Data were extracted from the National Cancer Data Base on black and white adults with...
Purpose
In this study, we sought to describe the contemporary trends in utilization of neoadjuvant androgen deprivation therapy (ADT). As a secondary endpoint, we assessed the community-level effect of neoadjuvant ADT on positive surgical margins after radical prostatectomy (RP).
Methods
Using the National Cancer Database (2004–2014), we identifie...
IntroductionMuscle-invasive bladder cancer (MIBC) is an aggressive disease for which treatment strategies are continuously evolving. We characterized trends in treatment modalities for MIBC from 2004 to 2013 (the “pre-immunotherapy era”) and identified predictors of receiving the current standard of care treatment: neoadjuvant chemotherapy (NAC) fo...
Purpose:
We investigated the quality of care at minority serving hospitals compared to other institutions for men with localized intermediate and high risk prostate cancer.
Materials and methods:
Using the National Cancer Database we identified 536,539 men 40 years old or older who presented with localized intermediate and high risk prostate can...
Introduction:
Accountable care organizations are designed to financially incentivize efficiency and reduce low value care. To determine if accountable care organizations have impacted prostate cancer screening patterns, we analyzed trends in prostate specific antigen screening and prostate biopsies by accountable care organization and nonaccountab...
Background
Hospitals are increasingly being held responsible for their readmissions rates. The contribution of hospital versus patient factors (eg, case mix) to hospital readmissions is unknown.
Objective
To estimate the relative contribution of hospital and patient factors to readmissions after radical cystectomy (RC) for bladder cancer.
Design,...
Purpose:
Data revealed the benefit of high-volume care in many complex disease processes. Among patients undergoing nephrectomy, those receiving cytoreductive nephrectomy (CN) for metastatic renal cell cancer (mRCC) constitute a unique subset. They often have a greater medical and surgical complexity. Against this backdrop, we sought to investigat...
Introduction:
We aimed to assess the contemporary knowledge of human papillomavirus (HPV) and its association with penile cancer in a nationwide cohort from the US.
Methods:
We used the Health Information National Trends Survey (HINTS), a cross-sectional telephone survey performed in the U.S. initiated by the National Cancer Institute. The most...
Introduction:
Metastasectomy (MSX) is considered a treatment option in patients with metastatic renal cell carcinoma (mRCC) at diagnosis, but its role in the targeted therapy era is unclear. We sought to describe the utilization trends of MSX and survival outcomes in a large US cohort.
Materials and methods:
Using the National Cancer Database, w...
Context:
Contradictory data exist with regard to adjuvant vascular endothelial growth factor receptor (VEGFR)-targeted therapy in surgically managed patients for localized renal cell carcinoma (RCC).
Objective:
To systematically evaluate the current evidence regarding the therapeutic benefit (disease-free survival [DFS] and overall survival [OS]...
Purpose:
Androgen deprivation therapy is associated with development of diabetes and metabolic syndrome. Its effect on developing non-alcoholic fatty liver disease, a condition frequently co-occuring with metabolic syndrome, and other subsequent liver conditions (liver cirrhosis, hepatic necrosis, any liver disease) has not been investigated.
MATE...
492
Background: Healthcare for racial minorities is densely concentrated at a small subset of hospitals in the United States. Understanding long-term outcomes at these minority-serving hospitals is highly relevant to elucidating the sources of racial disparities in cancer care. We investigated the impact of treatment at a minority-serving hospital...
The ethical and economic discussions regarding the extreme costs of many new cancer therapies are familiar. The authors have long held that changes in cancer care delivery also are an important strategy, yielding large benefits at potentially far lower costs. To put this into context, the authors performed an analysis to compare the overall surviva...
Purpose:
Use of androgen deprivation therapy (ADT) may increase risk of cognitive impairment in men with prostate cancer. We performed a systematic review of the risk of overall cognitive impairment as an outcome in men receiving ADT for prostate cancer.
Materials and methods:
Studies were identified through PubMed Medline, PsycINFO, Cochrane Li...
Objectives:
Healthcare for racial minorities is densely concentrated at a small subset of hospitals in the United States. Understanding long-term outcomes at these minority-serving hospitals is highly relevant to elucidating the sources of racial disparities in cancer care. We investigated the effect of treatment at a minority-serving hospital on...
Objectives:
To assess the association of TRT with thromboembolism, cardiovascular disease (stroke, coronary artery disease, and heart failure) and obstructive sleep apnea (OSA).
Methods:
A cohort of 3,422 male United States military service members, retirees and their dependents, aged 40-64 was identified, who were prescribed TRT between 2006-20...
Background:
The incidence of brain metastases (BM) in patients with renal cell carcinoma (RCC) is hypothesized to have increased in the last 2 decades.
Objective:
To define incidence trends according to patient and clinical characteristics, to identify risk factors, and to describe outcomes of patients with BM for RCC.
Design, setting, and part...
Objectives:
Over the past decade, robot-assisted radical cystectomy (RARC) has gained traction as an alternative to the conventional open approach open radical cystectomy (ORC). However, the benefits of RARC over ORC remain unclear. Our objective was to conduct a comparative effectiveness analysis between RARC and ORC using data from the National...
The 2010 Patient Protection and Affordable Care Act (ACA) emphasizes preventive care. In addition to expanding insurance coverage, the ACA eliminates cost sharing for services graded “A” or “B” by the US Preventive Services Task Force (USPSTF). Although these policies have improved preventive care generally, their impact on cancer screening specifi...
Purpose:
An adequate pelvic lymph node dissection (LND) during radical cystectomy (RC) for muscle-invasive bladder cancer (BCa) has been shown to provide a survival benefit. We designed a study to assess the effect of adequate LND on overall survival (OS) according to cT stage and receipt of neoadjuvant chemotherapy (NAC).
Material and methods:...
Background:
This study assessed the use of active surveillance in men with low-risk prostate cancer and evaluated institutional factors associated with the receipt of active surveillance.
Methods:
A retrospective, hospital-based cohort of 115,208 men with low-risk prostate cancer diagnosed between 2010 and 2014 was used. Multivariate and mixed e...
Purpose
Monopolar transurethral resection is the conventional surgical standard of care for bladder outlet obstruction due to benign prostatic enlargement. Bipolar resection and Greenlight photovaporization have emerged as options with favorable safety profiles. Literature comparing these modalities is limited by sample size and absence of cost dat...
Importance:
Despite existing evidence of a benefit associated with cisplatin-based adjuvant chemotherapy (AC) after radical cystectomy (RC) for chemotherapy-naive patients with pT3/T4 and/or pN+ urothelial carcinoma of the bladder (UCB), to our knowledge, no studies have addressed the effectiveness of AC in those who received neoadjuvant chemother...
Background:
The gap in prostate cancer (PCa) survival between Blacks and Whites has widened over the past decade. Investigators hypothesize that this disparity may be partially attributable to differences in rates of definitive therapy between races.
Objective:
To examine facility level variation in the use of definitive therapy among Black and...
Background:
Radical cystectomy (RC) for muscle-invasive bladder cancer (BCa) has potential for serious complications, prolonged length of stay and readmissions-all of which may increase costs. Although variations in outcomes are well described, less is known about determinants driving variation in costs.
Objective:
To assess surgeon- and hospita...
Introduction:
Knowledge of the comparative oncologic outcomes of histologic variants after radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) relies on small case series. We compared the effect of pure squamous cell carcinoma, adenocarcinoma, and neuroendocrine carcinoma compared with pure urothelial carcinoma (PUC) on overall survi...
Background:
Neoadjuvant chemotherapy in pure urothelial bladder cancer provides a significant survival benefit. However, to the authors' knowledge, it is unknown whether this benefit persists in histological variants. The objective of the current study was to assess the effect of neoadjuvant chemotherapy on the probability of non-organ-confined di...
Purpose
Fee for service (FFS) reimbursement incentives may affect care. We sought to compare odds of PSA screening among former and active duty United States (US) military service members based on receipt of primary care from integrated military health facilities versus community providers reimbursed via FFS.
Materials and Methods
We performed a r...
Background:
A critical appraisal of the benefits of minimally invasive surgery (MIS) is needed, but is lacking. This study examined the associations between MIS and 30-day postoperative outcomes including complications graded according to the Clavien-Dindo classification, unplanned readmissions, hospital stay and mortality for five common surgical...
The incidence of localized renal cell carcinoma (RCC) has been steadily increasing, in large part because of the increased use of imaging. Optimizing the management of localized RCC has become one of the leading priorities and foremost challenges within the urologic-oncologic community. Adequate risk stratification of patients following the diagnos...
e16506
Background: Use of androgen deprivation therapy (ADT) may confer a higher risk of cognitive impairment. Published results are variable and lack consensus. Our objective was to perform meta-analysis of the risk of overall cognitive impairment in men receiving ADT for prostate cancer. Methods: Relevant studies were identified through the searc...
e18308
Background: Accountable Care Organizations (ACOs) were established under the Affordable Care Act as a new payment model intended to impose greater responsibility on all stakeholders for cost control and quality improvement. Preventive services are an ideal target to monitor the effectiveness of new health care delivery models. We sought to e...
Studies have noted contrasting findings with regard to the contemporary incidence of metastatic prostate cancer (PCa) in the USA, especially in light of the United States Preventive Services Task Force (USPSTF) recommendations against prostate-specific antigen (PSA) screening in recent years. We used data from the 18 population- based tumor registr...
Cancer preventive services, when used appropriately, result in improved health, better quality of life and decreased costs. For these reasons, cancer preventive services represent important priorities within the Affordable Care Act (ACA). Among the many provisions to improve access to preventive services the ACA introduced Accountable Care Organiza...
Purpose
The management of locally advanced prostate cancer (PCa) remains controversial. We sought to compare the effect of primary external beam radiation therapy (EBRT) vs. radical prostatectomy (RP) for locally advanced PCa.
Materials and Methods
Retrospective analysis of 2,935 elderly (≥65 years) men in the Surveillance, Epidemiology, and End R...
Given the lack of randomized evidence comparing trimodal therapy (TMT) to radical cystectomy (RC) for muscle-invasive urothelial carcinoma of the bladder (UCB), we performed an observational cohort study to examine the comparative effectiveness of these two definitive treatments. Within the National Cancer Data Base (2004–2011),we identified 1257 (...
Metastasectomy has long been considered a valid treatment option for patients with oligometastatic renal cell carcinoma (oligo-mRCC). However, the literature on complications in this setting is scarce. Our objective was to describe in-hospital complications after metastasectomy in a contemporary cohort of patients with mRCC. Using the National Inpa...
529Background: The incidence of brain metastases (BM) in patients with renal cell carcinoma (RCC) is hypothesized to have increased in the last two decades.Our objective was to provide an overview of recent incidence trends in patients with primary renal cell carcinoma (RCC) and BM at diagnosis using a nationally representative cancer cohort origin...
150
Background: Nearly 50% of men diagnosed with prostate cancer may receive treatment with some form of androgen deprivation therapy (ADT). While some side effects of ADT are well acknowledged, the specific impact of ADT on cognitive function is uncertain. Our objective was to perform a systematic review and meta-analysis assessing the impact of A...
