Our expert answers 3 Questions
My areas of interest within health services research and health policy are understanding the patterns of care for advanced prostate cancer, specifically the overuse, underuse, and misuse of available drugs, as well as the outcomes and effects of the treatment of advanced prostate cancer on pre-existing co-morbid conditions.
My research interests include minimizing the harm done to patients with cancer-directed therapies and understanding the factors that guide treatment decisions. Currently, I am studying the variation in care of patients with castration-resistant prostate cancer, the lethal form of prostate cancer that has become more aggressive by developing resistance to first-line hormone therapies. I believe the variation in treatment is widespread due to a number of factors: the field of prostate cancer care is becoming increasingly complex, the list of drugs available for treatment is rapidly expanding while drug costs continue to rise, and little guidance exists for the optimal sequencing of therapies. My goals are to define the landscape of the existing patterns of care for men with castration-resistant prostate cancer, including non-evidence-based use of therapies, and to investigate the clinical and nonclinical factors that guide treatment decisions. I believe the root causes of unwarranted variation are likely to driven by nonclinical factors such as the knowledge, beliefs, and attitudes of the physicians treating castration-resistant disease.
Identifying potentially modifiable opportunities for improvement, such as characterizing non-evidence-based use and unnecessary variation from nonclinical factors, will have immediate and important implications for patients, providers, and policymakers, ultimately laying the foundation for the implementation of policy-relevant strategies toward better treatment for men with metastatic castration-resistant prostate cancer.