Nrupen Bhavsar, PhD, is the subject of this week’s faculty spotlight. In this interview, Bhavsar talks about understanding and improving chronic disease at the population level, his work in the QDACT team, and a recent Cancer article that examined how a major clinical trial actually affected treatment for elderly women with breast cancer.
You’re one of the newest members of the division, having just joined in April. What led you to join the division?
It was the people within the Division. I appreciate the vision set forth by our chief, Ebony Boulware, and really value the work being conducted by researchers within the division, some of whom I knew prior to joining. It also seemed like a natural fit for me given my own research interests.
What are your responsibilities within the division? What does a typical day for you look like?
Oddly enough I became interested in science at an early age because I thought it would mean I would have to read and write less (I really enjoyed my math and science classes). As an epidemiologist and health outcomes researcher I spend much of my time reading articles, writing manuscripts and grants, and analyzing data. No two days are alike so the amount of reading, writing, and data analysis varies but I enjoy all three (now). On some days, as an epidemiologist, I offer methodological support to colleagues to help design and analyze their studies. One of the great aspects of my job is that I get to interact and collaborate with outstanding faculty and staff every day.
Your areas of expertise are renal disease, cardiovascular disease, oncology and palliative care, with a focus on health outcomes and population level research. Can you tell me more about your research in this area?
Broadly speaking, I’m interested in using large, observational datasets to understand how best to prevent and treat individuals with chronic disease. The topical areas include using biomarkers to predict incidence of renal and cardiovascular disease, understanding best therapies for patients with metastatic cancer that increase survival and improve quality of life, examining clinician practices in discontinuing unnecessary medications in patients with life limiting illness, and using electronic health records coupled with neighborhood level data to understand factors that may impact the health of a population.
What do you see as the biggest challenges and opportunities in this area over the next decade?
Over the next decade, the opportunities and challenges at the intersection of chronic disease and population health will come from the same source – making sense of the volume and velocity of data coming from electronic health records, mobile applications, and wearable sensors. These tools are important to collect data on the health of individuals and/or populations in “real-time.” The true challenge and potential opportunity involves understanding the validity and accuracy of the data and translating that information to predict health events/outcomes, response to treatment, and/or change behavior.
You’re part of the QDACT team, a multidisciplinary team that combines clinical content expertise with information technology, data security, data architecture, and data visualization knowledge. How did you get involved, and what is your role in the team?
Prior to joining GIM, I was a member of the Center for Learning Healthcare (CLHC) within the DCRI. I was introduced to QDACT (a web-based data collection tool used to track quality and outcomes in palliative care) soon after I joined the CLHC. On the team, I leveraged my background in epidemiology, comparative effectiveness research, and data analysis to provide guidance on how best to collect and analyze the data they were interested in.
You're also the co-author of a recent article in Cancer that examined how a large phase-3 trial changed treatment for elderly women with breast cancer. What were the major findings of your article? What do they indicate for the future treatment of elderly women with breast cancer?
In 2004, the CALGB 9343 trial reported a minimal absolute difference in the recurrence rate of cancer in older women with breast cancer that received surgery plus chemotherapy as compared to surgery, radiation therapy, and chemotherapy. Our study, led by my colleagues, found there was a small but significant decrease in the use of adjuvant radiotherapy in older women with breast cancer after the release of findings from the CALGB 9343 trial. However, the use of adjuvant radiotherapy remained high (>60%).
The clinical benefit of adjuvant radiotherapy in older women with early-stage breast cancer is rather small, especially when the negative consequences of such treatment, including acute and late toxicities of radiotherapy, the inconvenience of the treatment to patients, and the overall healthcare costs associated with it are considered. Broadly speaking, treatment decisions should be evidence-based. This study offers support to the notion that it may be harder for clinicians to incorporate the results of a clinical trial into practice when it involves holding back a procedure/treatment as compared to adding a procedure/treatment.
What passions or hobbies do you have outside of the division?
We are relatively new to the area so my fiancé and I enjoy exploring everything that the Chapel Hill/Durham/Raleigh area has to offer. We try to spend as much time outside as possible on the weekends and that usually means we’re running or biking in the area. We are self-identified foodies so we enjoy trying new restaurants and we’re always on the hunt for good pizza. I’m a lifelong Duke basketball fan (long before I started working here) so the last few months have been exciting. I look forward to getting to the beach as much as possible this summer to practice my new hobby, surfing.
Have you recently read any books, articles, blog posts or other material that would be of interest to the division?
My reading list lately has been filled with journal articles and children’s books (my fiancé and I watch her two young nieces often). I have a lot of recommendations for children’s books if anyone is interested.