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Coming Full Circle

CTRI KL2 Awardee Murphy Studies Head-and-Neck Cancer Outcomes and Mentors the Next Generation

February 17, 2015  |  Patti Wieser

James Murphy, MD

James Murphy, MD, is conducting a study about head-and-neck cancer outcomes with support from CTRI through a KL2 award.

When James Murphy, MD, was completing his residency in radiation oncology, head-and-neck cancer patients who lived far away often asked if it would be better to receive radiation treatment at a specialized treatment center or at home through their community provider.

"We really had no idea," said Murphy, now an assistant professor in the Department of Radiation Medicine and Applied Sciences at UC San Diego where he serves as the Clinical Chief of Gastrointestinal and Palliative Radiation Oncology. "A lot of patients and physicians believe specialists in head-and-neck cancer have better patient outcomes, but there was no data to support that belief."

One of the first things he did after joining UC San Diego was apply for a Clinical and Translational Research Institute (CTRI) KL2 grant to study the question. In 2013, Murphy received the grant for his project: Impact of Provider and Hospital Experience in Head-and-Neck Cancer. The CTRI KL2 is an award for junior faculty that offers training and mentored research experience for up to three years. 

"We are addressing our question with a retrospective population-based longitudinal cohort study using Surveillance, Epidemiology, and End Results (SEER) registry data linked to Medicare claims data." The study population includes thousands of Medicare patients with head-and-neck cancer; Murphy tracked physicians delivering radiation through their Medicare physician ID number. "We can look across the country at radiation oncologists with a lot of experience, and those who do not see as many head-and-neck cancers. We can track patient outcomes, and determine if provider experience influences these outcomes," he said. Medicare serves people 65 and older – an age group that makes up the majority of head-and-neck cancer patients.

Radiation therapy plays a primary role in the treatment of head-and-neck cancer, but the complex anatomy and high radiation doses required for cure leave little room for error, Murphy said. Suboptimal radiation therapy in the head-and-neck can lead to decreased survival or substantial long-term toxicity. "The treatment for head-and-neck cancer with radiation is very complicated," he said. "The tumors are sensitive to radiation; however, the normal tissues next to the tumor receive collateral radiation which can lead to toxicity."

Murphy has completed the first phase of his multi-year KL2 project, which included exploring the data, as well as constructing and validating covariates and endpoints. "The primary covariate of interest – provider volume – has no standardized definition. We have devoted substantial effort to creating and validating a definition," Murphy said. "The main study endpoints we are looking at include the risk of toxicity from radiation treatment, and the risk of cancer recurrence." For both the first phase and subsequent phases of his project, Murphy is analyzing computational data using competing risk models and mixed-effect multinomial logistic regression models. He said the competing risk models help determine whether physician or treatment center experience has an impact on outcomes while accounting for competing events.

Murphy's background in epidemiology and experience in statistical programming enables him to perform most of the data analysis himself. He received a bachelor's degree in applied mathematics from Columbia University, a medical degree from the University of Michigan, and completed his residency in radiation oncology at Stanford University, where he also received a master's degree in epidemiology. CTRI's Biostatistics Unit provides additional support with statistics and analysis.

"CTRI has been absolutely fantastic. I am extremely grateful for the protected time the KL2 award offers for research, education, and professional development. I'm also grateful for the support from CTRI's biostatistics and education units," said Murphy, who has a research interest in many types of cancer. "The KL2 also was the seed that started a whole line of research. Now we have several projects with SEER-Medicare data involving patient-specific health outcomes. We have projects looking at a wide range of topics including racial disparities, patient-specific prediction models, as well as health economics."

The mentee is now assuming the mantle of mentor, with a line that often connects to CTRI. His KL2 mentor, Loren Mell, MD, is a past KL2 awardee, and Murphy is now mentoring a medical student, Isabel Boero, who is CTRI-supported through the TL1 training program, with plans to take a second TL1 student under his wing next year. The KL2 also helped him recruit young investigators for his research team. "One of the most enjoyable parts of my job is the opportunity to work with young, bright, super-motivated people," he said.

Mell described Murphy as "an exceptionally gifted young academician" and lauded Murphy's skills as a mentor. "Dr. Murphy's command of scientific methods is impressive, and he has already exhibited an ability to mentor others, serving as senior author on a recent publication in the Journal of the National Cancer Institute by one of our residents, a nice early indication of his talent and likelihood for future success," Mell said.

Murphy, who spends about 70 percent of his time doing research and 30 percent in clinic, said much of his research is inspired by issues that arise during clinic.

"I love the blend of seeing patients and doing research," Murphy said. "The issues that our patients face directly feed into my research. It's like a translational project in reverse, and then we hope that our research findings translate back to the clinic someday."

About UC San Diego Altman Clinical and Translational Research Institute:

UC San Diego Altman Clinical and Translational Research Institute (ACTRI) is part of a national Clinical and Translational Science Award consortium, led by the National Institutes of Health National Center for Advancing Translational Science. Established in 2010, ACTRI provides infrastructure and support for basic, translational and clinical research throughout the San Diego region to bring discoveries from the laboratory to the bedside, and facilitates training and education of the next generation of researchers. ACTRI carries out its activities in collaboration with institutional and corporate partners and currently has more than 1,500 members.