Center for Surgery and Public Health


In cancer care, patients are paying more and getting less. Spending for oncology services is increasing by over 15% annually, faster than the background growth in overall expenditures. Next-generation “precision-therapies” carry the promise of identifying and targeting specific molecular alterations in cancer cells, but many also carry extremely high price tags – some reaching six- and even seven-figures. Expensive technologies like robot-assisted surgery have become ubiquitous, alongside molecular diagnostic tests and advanced imaging modalities. Despite this influx of resources and expensive new technological advances, the death rate from the most common cancers has only slightly declined. This has led some researchers to state that we face a “value crisis” in oncology.

This program aims to improve the value and effectiveness of cancer care by identifying drivers of high and low-value care. We focus on policy and health systems-based changes to better understand how to improve access to high-quality cancer care that makes a difference, including: screening, vaccinations, tobacco cessation, appropriate genetic testing and more, while protecting patients against high cost-sharing requirements.


 The goals of this study are to conduct a county-level spatiotemporal analysis to assess the relationship between clinical, sociodemographic, and geographic characteristics and likelihood of undergoing surgical treatment of colorectal liver metastasis in the United States between 2010 and 2018 and to develop an institutional database to identify clinical and sociodemographic characteristics associated with surgical treatment of colorectal liver metastasis at Dana-Farber/Brigham and Women’s Cancer Hospital between 2010 and 2020.

PI: George Molina

Funding Source: Harvard Catalyst | The Harvard Clinical and Translational Science Center (NCATS, NIH) [KL2]

The objectives of this project are to 1) determine factors associated with physician-level and regional variation in the receipt of de-escalated locoregional treatment of older adults with early-stage HR+ breast cancer and 2) to detail how geriatric-specific concerns (e.g. frailty, life expectancy, functional status, and competing risks) are currently integrated into treatment conversations.

PI: Christina Minami

Funding Source: NIA GEMSSTAR

The objective of “Evaluation of a Low-Value Care Practice in Breast Cancer: Physician-level Variation in Sentinel-Lymph Node Biopsy Use in the Elderly by Age, Comorbidities, and Frailty Status” is to determine trends in and factors associated with locoregional therapy type in women 70 years and older with early-stage HR+ breast cancer and ductal carcinoma in situ.

PI: Christina Minami

Funding Source: Conquer Cancer ASCO Young Investigator Award in Geriatric Oncology

Preliminary research by our team has identified significant racial disparities in receipt of definitive therapy for men in Massachusetts who are diagnosed with intermediate and high risk localized prostate cancer. We will use a comparative case study approach to identify factors, processes, programs, and practices associated with receipt of definitive therapy and develop recommendations to inform equitable care for Black men with prostate cancer.

PI(s): Quoc-Dien Trinh, MD & Alexander P. Cole, MD

Funding: American Cancer Society and Pfizer Inc. 

  • Assessing outcomes of colorectal, appendiceal, and peritoneal malignancies utilizing large national database quantitative analysis.
  • Decisional and educational support for locally advanced rectal cancer patients. Assessing patient perspectives and care experiences to improve patient-centered care and shared-decision making in rectal cancer, utilizing mixed methods approaches.
  • Studying colorectal cancer screening capacity and outcomes in Ukraine, utilizing Markov Modeling and cost-effective analysis, to inform the implementation of a national colorectal cancer screening program in Ukraine.
  • The Global Medical Knowledge Alliance (GMKA) – a non-profit open access centralized source of evidence-based medical information on oncologic care for both patients and providers that seeks to improve accessibility to information and quality of care for cancer patients in Ukraine and worldwide.


PI: Nelya Melnitchouk, MD, MSc