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. Wong ML, Nicosia FM, Smith AK, Walter LC, Lam V, Cohen HJ, Loh KP, Mohile SG, Ursem CJ, Schwarze ML. "You have to be sure that the patient has the full picture": Adaptation of the Best Case/Worst Case communication tool for geriatric oncology. J Geriatr Oncol. 2022 Feb 02.  View on PubMed
  2. Advani S, Abraham L, Buist DSM, Kerlikowske K, Miglioretti DL, Sprague BL, Henderson LM, Onega T, Schousboe JT, Demb J, Zhang D, Walter LC, Lee CI, Braithwaite D, O'Meara ES, Breast Cancer Surveillance Consortium. Breast biopsy patterns and findings among older women undergoing screening mammography: The role of age and comorbidity. J Geriatr Oncol. 2022 03; 13(2):161-169.  View on PubMed
  3. Calderwood AH, Tosteson TD, Walter LC, Hua P, Onega T. Colonoscopy utilization and outcomes in older adults: Data from the New Hampshire Colonoscopy Registry. J Am Geriatr Soc. 2022 03; 70(3):801-811.  View on PubMed
  4. Hampson LA, Suskind AM, Breyer BN, Cooperberg MR, Sudore RL, Keyhani S, Allen IE, Walter LC. Predictors of Regret among Older Men after Stress Urinary Incontinence Treatment Decisions. J Urol. 2022 04; 207(4):885-892.  View on PubMed
  5. Zhang D, Abraham L, Sprague BL, Onega T, Advani S, Demb J, Miglioretti DL, Henderson LM, Wernli KJ, Walter LC, Kerlikowske K, Schousboe JT, Chrischilles E, Braithwaite D, O'Meara ES, Breast Cancer Surveillance Consortium. Mammography adherence in relation to function-related indicators in older women. Prev Med. 2022 01; 154:106869.  View on PubMed
  6. Bauer SR, Walter LC, Ensrud KE, Suskind AM, Newman JC, Ricke WA, Liu TT, McVary KT, Covinsky K. Assessment of Frailty and Association With Progression of Benign Prostatic Hyperplasia Symptoms and Serious Adverse Events Among Men Using Drug Therapy. JAMA Netw Open. 2021 11 01; 4(11):e2134427.  View on PubMed
  7. Wong ML, Shi Y, Smith AK, Miaskowski C, Boscardin WJ, Cohen HJ, Lam V, Mazor M, Metzger L, Presley CJ, Williams GR, Loh KP, Ursem CJ, Friedlander TW, Blakely CM, Gubens MA, Allen G, Shumay D, Walter LC. Changes in older adults' life space during lung cancer treatment: A mixed methods cohort study. J Am Geriatr Soc. 2022 01; 70(1):136-149.  View on PubMed
  8. Dotan E, Walter LC, Browner IS, Clifton K, Cohen HJ, Extermann M, Gross C, Gupta S, Hollis G, Hubbard J, Jagsi R, Keating NL, Kessler E, Koll T, Korc-Grodzicki B, McKoy JM, Misra S, Moon D, O'Connor T, Owusu C, Rosko A, Russell M, Sedrak M, Siddiqui F, Stella A, Stirewalt DL, Subbiah IM, Tew WP, Williams GR, Hollinger L, George GV, Sundar H. NCCN Guidelines® Insights: Older Adult Oncology, Version 1.2021. J Natl Compr Canc Netw. 2021 09 20; 19(9):1006-1019.  View on PubMed
  9. Wray CM, Vali M, Walter LC, Christensen L, Chapman W, Austin PC, Byers AL, Keyhani S. Examining the association of social risk with heart failure readmission in the Veterans Health Administration. BMC Health Serv Res. 2021 Aug 26; 21(1):874.  View on PubMed
  10. Advani SM, Zhu W, Demb J, Sprague BL, Onega T, Henderson LM, Buist DSM, Zhang D, Schousboe JT, Walter LC, Kerlikowske K, Miglioretti DL, Braithwaite D, Breast Cancer Surveillance Consortium. Association of Breast Density With Breast Cancer Risk Among Women Aged 65 Years or Older by Age Group and Body Mass Index. JAMA Netw Open. 2021 08 02; 4(8):e2122810.  View on PubMed
  11. Zhang D, Abraham L, Demb J, Miglioretti DL, Advani S, Sprague BL, Henderson LM, Onega T, Wernli KJ, Walter LC, Kerlikowske K, Schousboe JT, O'Meara ES, Braithwaite D, Breast Cancer Surveillance Consortium. Function-related Indicators and Outcomes of Screening Mammography in Older Women: Evidence from the Breast Cancer Surveillance Consortium Cohort. Cancer Epidemiol Biomarkers Prev. 2021 08; 30(8):1582-1590.  View on PubMed
  12. Hampson LA, Suskind AM, Breyer BN, Lai L, Cooperberg MR, Sudore RL, Keyhani S, Allen IE, Walter LC. Understanding the Health Characteristics and Treatment Choices of Older Men with Stress Urinary Incontinence. Urology. 2021 08; 154:281-287.  View on PubMed
  13. Loh KP, Lam V, Webber K, Padam S, Sedrak MS, Musinipally V, Grogan M, Presley CJ, Grandi J, Sanapala C, Castillo DA, DiGiovanni G, Mohile SG, Walter LC, Wong ML. Characteristics Associated With Functional Changes During Systemic Cancer Treatments: A Systematic Review Focused on Older Adults. J Natl Compr Canc Netw. 2021 04 15; 19(9):1055-1062.  View on PubMed
  14. Chang A, Schwartz BS, Harleman E, Johnson M, Walter LC, Fernandez A. Guiding Academic Clinician Educators at Research-Intensive Institutions: a Framework for Chairs, Chiefs, and Mentors. J Gen Intern Med. 2021 10; 36(10):3113-3121.  View on PubMed
  15. Freedman RA, Minami CA, Winer EP, Morrow M, Smith AK, Walter LC, Sedrak MS, Gagnon H, Perilla-Glen A, Wildiers H, Wildes TM, Lichtman SM, Loh KP, Brain EGC, Ganschow PS, Hunt KK, Mayer DK, Ruddy KJ, Jagsi R, Lin NU, Canin B, LeStage BK, Revette AC, Schonberg MA, Keating NL. Individualizing Surveillance Mammography for Older Patients After Treatment for Early-Stage Breast Cancer: Multidisciplinary Expert Panel and International Society of Geriatric Oncology Consensus Statement. JAMA Oncol. 2021 Apr 01; 7(4):609-615.  View on PubMed
  16. Wray CM, Vali M, Walter LC, Christensen L, Abdelrahman S, Chapman W, Keyhani S. Examining the Interfacility Variation of Social Determinants of Health in the Veterans Health Administration. Fed Pract. 2021 Jan; 38(1):15-19.  View on PubMed
  17. Wong ML, Gao J, Thanarajasingam G, Sloan JA, Dueck AC, Novotny PJ, Jatoi A, Hurria A, Walter LC, Miaskowski C, Cohen HJ, Wood WA, Feliciano JL, Stinchcombe TE, Wang X. Expanding Beyond Maximum Grade: Chemotherapy Toxicity over Time by Age and Performance Status in Advanced Non-Small Cell Lung Cancer in CALGB 9730 (Alliance A151729). Oncologist. 2021 03; 26(3):e435-e444.  View on PubMed
  18. Kotwal AA, Walter LC. Cancer Screening in Older Adults: Individualized Decision-Making and Communication Strategies. Med Clin North Am. 2020 Nov; 104(6):989-1006.  View on PubMed
  19. Kotwal AA, Walter LC. Cancer Screening Among Older Adults: a Geriatrician's Perspective on Breast, Cervical, Colon, Prostate, and Lung Cancer Screening. Curr Oncol Rep. 2020 08 15; 22(11):108.  View on PubMed
  20. Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A, Guerra CE, Oeffinger KC, Shih YT, Walter LC, Kim JJ, Andrews KS, DeSantis CE, Fedewa SA, Manassaram-Baptiste D, Saslow D, Wender RC, Smith RA. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020 09; 70(5):321-346.  View on PubMed

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