Research Summary

Dr. Walter is Chief of the Division of Geriatrics at UCSF and the San Francisco VA Health Care System (SFVAHCS) and a clinician-researcher who is an international leader in evaluating the real-world risks and benefits of cancer screening and surveillance in older adults. Dr. Walter received her MD from Stanford University in 1995. She completed a residency in internal medicine and a fellowship in Geriatrics at UCSF and joined the UCSF faculty in July 2001. She is a geriatrician at the SFVAHCS Geriatrics Clinic, Interim Director of the UCSF Clinical & Translational Science Institute (CTSI) Career Development (K Scholars) Program, a faculty leader for the Mentoring and Career Development Core of the NIH-funded Clinician Scientists Transdisciplinary Aging Research (Clin-STAR) Program, and Director of Geriatrics Health Services Research & Development at SFVAHCS.

Dr. Walter has transformed our approach to cancer screening in older adults. She has developed novel methodology demonstrating the fundamental importance of life expectancy rather than age in determining benefits and risks of screening. Virtually every cancer screening guideline cites her research. Further, in 2014, Dr. Walter’s JAMA article, “Cancer Screening in Elderly Patients: A Framework for Individualized Decision Making,” was selected in a national survey of geriatricians as one of the 27 landmark articles that have advanced the field of Geriatrics. In 2012, Dr. Walter was elected into the American Society for Clinical Investigation (ASCI).

In addition, Dr. Walter led a series of seminal studies demonstrating decisions to screen older adults for cancer are often dictated more by age than health such that many patients in poor health continue to undergo screening while many healthy older patients fail to get screened. Also, she discovered that cancer screening frequently leads to significant harms without benefit in patients in poor health and developed a taxonomy and quantification of screening harms. This quantification of downstream harms has also been applied to study outcomes of other procedures performed in frail older adults in poor health, such as tight glycemic control, chemotherapy and surgery.

Dr. Walter is Principal Investigator of Tideswell at UCSF, a center to mentor and develop future leaders in aging. Dr. Walter views mentoring as one of her most important academic activities. In 2010, nomination letters from her mentees led to her receipt of the UCSF Academic Senate Distinction in Mentoring Award, one of the highest awards at UCSF given annually to one faculty member in recognition of “exceptional mentoring to fellows and faculty. Dr. Walter also serves as the Core Director of the UCSF Claude D. Pepper Older Americans Independence Center’s Career Development (REC) Core.

Research Funding

  • September 30, 2011 - May 31, 2019 - Midcareer Mentoring Award for Patient-Oriented Research in Aging , Principal Investigator . Sponsor: NIH, Sponsor Award ID: K24AG041180
  • July 1, 2009 - April 30, 2015 - Prostate-Specific Antigen Practices and Outcomes in the Elderly , Principal Investigator . Sponsor: NIH, Sponsor Award ID: R01CA134425

Education

Stanford University, Stanford, CA, B.S., 1990, Biology
Stanford University School of Medicine, Stanford, CA, M.D., 1995, Internal Medicine
University of California, San Francisco (Advanced Training in Clinical Research Program), Certificate, 1999, Clinical Epidemiology

Honors & Awards

  • 2007
    Outstanding Junior Investigator of the Year by the Society of General Internal Medicine
  • 2007
    Accepted into the UCSF Mentor Development Program
  • 2009
    Outstanding Scientific Achievement for Clinical Investigation Award by the American Geriatrics Society
  • 2009
    Elected to Fellowship in the American College of Physicians (FACP)
  • 2010
    UCSF Academic Senate Distinction in Faculty Mentoring Award
  • 2012
    Elected into American Society for Clinical Investigation (ASCI)
  • 2013
    Outstanding Research Mentor of the Year by the Society of General Internal Medicine
  • 2014
    My 2001 JAMA article “Cancer Screening in Older Adults” was selected as 1 of 27 landmark articles that have advanced the field of Geriatrics (J Am Geriatr Soc. 62:2159-2162)
  • 2016
    Elected into Alpha Omega Alpha Honor Medical Society by UCSF Medical Student Class of 2016
  • 2019
    Selected into Executive Leadership in Academic Medicine (ELAM)

Selected Publications

  1. Pravosud V, Lum E, Vali M, Cohen BE, Hoggatt KJ, Byers AL, Austin PC, Walter LC, Hasin D, Zaman T, Keyhani S. Cannabis Use Among Older Adults. JAMA Netw Open. 2025 May 01; 8(5):e2510173.  View on PubMed
  2. Chawla SA, Harrison KL, Walter LC, Yank V, Wang L, Suskind AM. Specialist Practices for Managing Persons Living with Dementia and Urinary Incontinence. Int Urogynecol J. 2025 Apr 29.  View on PubMed
  3. Cham S, Kumar A, Walter LC, Lichtman S, Tew WP. Understanding frailty and the role of patient-centered care for older adults with gynecologic cancer. Gynecol Oncol. 2025 Apr 02; 196:42-53.  View on PubMed
  4. Avelino-Silva TJ, Lee SJ, Covinsky KE, Walter LC, Deardorff WJ, Boscardin J, Campora F, Szlejf C, Suemoto CK, Smith AK. External Validation of the Walter Index for Posthospitalization Mortality Prediction in Older Adults. JAMA Netw Open. 2025 Jan 02; 8(1):e2455475.  View on PubMed
  5. Schoenborn NL, Walter LC. Do Not Wait to Consider Life Expectancy Until After a Prostate Cancer Diagnosis. JAMA Intern Med. 2025 Jan 01; 185(1):36-37.  View on PubMed
  6. Lee HJ, Boscardin J, Walter LC, Smith AK, Cohen HJ, Giri S, Williams GR, Presley CJ, Singhal S, Huang LW, Velazquez AI, Gubens MA, Blakely CM, Mulvey CK, Cheng ML, Sakoda LC, Kushi LH, Quesenberry C, Liu R, Fleszar-Pavlovic S, Eskandar C, Cutler E, Mercurio AM, Wong ML. Associations of frailty with survival, hospitalization, functional decline, and toxicity among older adults with advanced non-small cell lung cancer. Oncologist. 2024 Dec 09.  View on PubMed
  7. Nguyen T, Tang B, Harrison KL, Stadler S, Walter LC, Hoepke K, Aronson L, Allison TA. Age Self Care, a program to improve aging in place through group learning and incremental behavior change: Preliminary data. J Am Geriatr Soc. 2025 Mar; 73(3):920-929.  View on PubMed
  8. Singhal S, Walter LC, Smith AK, Boscardin WJ, Shi Y, Cohen HJ, Presley CJ, Kushi LH, Giri S, Magnuson A, Williams GR, Velazquez AI, Lee HJ, Sakoda LC, Quesenberry CP, Falvey JR, Van Dyk KM, Wong ML. Function, cognition, and quality of life among older adults with lung cancer who live alone: A prospective cohort study. J Geriatr Oncol. 2024 11; 15(8):102068.  View on PubMed
  9. Gutierrez RD, Smith EJT, Matthay ZA, Gasper WJ, Hiramoto JS, Conte MS, Finlayson E, Walter LC, Iannuzzi JC. Risk factors and associated outcomes of postoperative delirium after open abdominal aortic aneurysm repair. J Vasc Surg. 2024 Apr; 79(4):793-800.  View on PubMed
  10. Shaw NM, Breyer BN, Walter LC, Sudore RL, Suskind AM, Baussan C, Quanstrom K, Allen IE, Cooperberg MR, Dohan D, Hampson LA. How older men live with stress urinary incontinence: Patient experience and navigation to treatment. Neurourol Urodyn. 2024 Jan; 43(1):11-21.  View on PubMed
  11. Wolf AMD, Oeffinger KC, Shih TY, Walter LC, Church TR, Fontham ETH, Elkin EB, Etzioni RD, Guerra CE, Perkins RB, Kondo KK, Kratzer TB, Manassaram-Baptiste D, Dahut WL, Smith RA. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin. 2024 Jan-Feb; 74(1):50-81.  View on PubMed
  12. Neumann AV, Gonzalez A, Walter LC, Rivera J. Improving older adults' telehealth through a novel community-academic partnership: Preliminary data. J Am Geriatr Soc. 2023 12; 71(12):3886-3895.  View on PubMed
  13. Schifferdecker KE, Ramesh NP, Walter LC, Calderwood AH. Multi-level Factors Influencing Decisions About Stopping Surveillance Colonoscopy in Older Adults: a Qualitative Study. J Gen Intern Med. 2023 09; 38(12):2761-2767.  View on PubMed
  14. Calderwood AH, Tosteson TD, Wang Q, Onega T, Walter LC. Association of Life Expectancy With Surveillance Colonoscopy Findings and Follow-up Recommendations in Older Adults. JAMA Intern Med. 2023 05 01; 183(5):426-434.  View on PubMed
  15. Huang AJ, Walter LC, Yaffe K, Vittinghoff E, Kornblith E, Schembri M, Chang A, Subak LL. TReating Incontinence for Underlying Mental and Physical Health (TRIUMPH): a study protocol for a multicenter, double-blinded, randomized, 3-arm trial to evaluate the multisystem effects of pharmacologic treatment strategies for urgency-predominant urinary incontinence in ambulatory older women. Trials. 2023 Apr 21; 24(1):287.  View on PubMed
  16. Hampson LA, Shaw NM, Breyer BN, Walter LC, Sudore RL, Cooperberg MR, Baussan C, Quanstrom K, Elaine Allen I, Dohan D. Patient-identified Treatment Attributes Among Older Men With Stress Urinary Incontinence: A Qualitative Look at What Matters to Patients Making Treatment Decisions. Urology. 2023 07; 177:189-196.  View on PubMed
  17. Jones CP, Shaw NM, Mena J, Breyer BN, Walter LC, Baussan C, Quanstrom K, Allen IE, Dohan D, Hampson LA. The relationship between frailty, incontinence severity, and treatment decisions for men with post-prostatectomy stress urinary incontinence: a mixed methods analysis. Transl Androl Urol. 2023 May 31; 12(5):840-848.  View on PubMed
  18. Shaw NM, Nik-Ahd F, Jones C, Breyer BN, Walter LC, Sudore R, Cooperberg MR, Baussan C, Quanstrom K, Allen IE, Hampson LA. Patient decision-making for surgical treatment of post-prostatectomy stress urinary incontinence: a mixed-methods exploratory pilot study. Transl Androl Urol. 2023 May 31; 12(5):849-858.  View on PubMed
  19. Smith EJT, Gasper WJ, Schneider PA, Finlayson E, Walter LC, Covinsky KE, Conte MS, Iannuzzi JC. Cognitive Impairment is Common in a Veterans Affairs Population with Peripheral Arterial Disease. Ann Vasc Surg. 2023 Apr; 91:210-217.  View on PubMed
  20. Tsang M, Gan S, Boscardin WJ, Wong ML, Walter LC, Smith AK. The epidemiology of preexisting geriatric and palliative conditions in older adults with poor prognosis cancers. J Am Geriatr Soc. 2022 12; 70(12):3402-3412.  View on PubMed

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