About

Robert S. Krouse, MD, MS, is a Professor of Surgery and the Chief of Surgical Services at the Cpl. Michael J. Crescenz Veterans Affairs Medical Center of Philadelphia. He is also a Senior Fellow at the Leonard Davis Institute of Health Economics and a Staff Surgeon at the same VA Medical Center. Dr. Krouse's educational background includes a B.A. in Fine Arts and Biology from Syracuse University, an M.S. in Human Nutrition from Columbia University, and an M.D. from Hahnemann University School of Medicine. His professional focus is in the field of surgery, with a particular emphasis on patient care and surgical services at the VA Medical Center.

Research topics

• Medicine
• Gerontology
• Internal medicine
• Surgery
• General surgery

Selected publications

• S2408: A randomized phase III blinded trial of lanreotide for the prevention of postoperative pancreatic fistula.

  Journal of Clinical Oncology · 2026-01-10

  articleSenior author

  TPS790 Background: Postoperative pancreatic fistula (POPF) remains the defining complication of pancreatectomy, leading to significant morbidity, mortality, and increased healthcare costs. Multiple trialed interventions have failed to meaningfully reduce the incidence of POPF. Since the early 1990s, studies have explored the role of perioperative somatostatin analogs (SSAs) for POPF prophylaxis. Earlier trials focused on octreotide and reported mixed results. A randomized trial of perioperative pasireotide reported a reduced incidence of POPF, but faced criticism due to its single-center design, inconvenient dosing regimen, and pasireotide’s high rate of dose-limiting side effects. Lanreotide is a more recently developed SSA with a simpler dosing regimen due to its depot formulation and a favorable side-effects profile that has been proposed for POPF prophylaxis. In a single-arm phase II trial, a single dose of preoperative lanreotide was associated with low POPF rates of 11% and 3% in patients undergoing pancreaticoduodenectomy (PD) and distal pancreatectomy (DP), respectively. Methods: SWOG 2408 is a multicenter, phase III randomized controlled trial sponsored by the National Cancer Institute Division of Cancer Prevention comparing the incidence of POPF in participants receiving a single dose of preoperative lanreotide (120 mg subcutaneous) versus saline placebo immediately prior to DP for suspected or biopsy-proven pancreatic malignancy. Planned enrollment of 274 participants will take place at academic and community hospitals in North America. The primary objective is to compare the incidence of POPF between treatment groups within 60 days after surgery. Secondary objectives include comparing the incidences of other postoperative sequelae (biochemical leak, delayed gastric emptying, post-pancreatectomy hemorrhage) within 60 days of surgery, postoperative length of hospital stay, and changes from baseline in cancer-specific quality of life between treatment groups. Blood, pancreas fluid, and tissue specimens will be banked for future correlative studies. Clinical trial information: NCT06807437 .

  PublisherDOI

• A Community Based Participatory Research Approach to Evaluate Barriers and Facilitators for Behavioral Weight Loss Intervention Implementation in a Predominantly Black Community

  Supportive Care in Cancer · 2025-09-16

  preprintOpen access

  PURPOSE: Breast cancer survivors with overweight or obesity have worse breast cancer specific survival and outcomes as compared to those with average weight by Yung and Ligibel (Clin Adv Hematol Oncol 14:790-797, 2016) and Druesne-Pecollo et al. (Breast Cancer Res Treat 135:647-654, 2012). Our pilot Group-basEd Telehealth behavioral Weight Los (GET-WEL) Program showed that fewer Black breast cancer survivors (BBCS) enrolled and lost less weight than White breast cancer survivors by Allison et al. (Obesity Science and Practice 10:e70023, 2024). This study is aimed at using a community-based participatory research approach to assess barriers and facilitators of implementing a behavioral weight loss intervention among BBCS. METHODS: Eight BBCS from a predominantly Black community were invited to participate in semi-structured interviews that were voice recorded, transcribed, coded, and analyzed via comparative thematic analysis. RESULTS: Thematic analyses revealed multiple barriers within participants. These included lack of affordable healthy food access, safety concerns with regards to outdoor activities, lack of affordable fitness center memberships, time constraints related to competing work/life obligations, and steep learning curves with technology use. Most BBCS preferred an integrated community-based coach to guide their weight loss interventions via a combination of both virtual and in-person sessions. CONCLUSION: Our results indicate that a multimodal approach including nutrition education, reducing physical activity barriers, limiting time constraints by implementing both in-person and virtual platforms, and assisting with technology courses, is necessary to improve the equitable implementation of weight loss interventions. BBCS recommended utilizing established community facilities and leveraging known community members such as nutrition counselors and physical trainers to increase successful implementation.

  PublisherOA PDFDOI

• Intake and Nutritional Adequacy in Patients with Cancer Diagnosed with Malignant Bowel Obstruction: A secondary analysis of a randomized trial

  UNC Libraries · 2025-11-26

  articleOpen access
  PublisherDOI

• Impact of Ostomy Self‐Management Telehealth training for rural cancer survivors on health care utilization and economic outcomes in the United States

  The Journal of Rural Health · 2025-09-01

  articleOpen accessSenior author

  PURPOSE: To assess the impact of a structured educational curriculum Ostomy Self-Management Telehealth (OSMT) treatment among cancer survivors residing in rural areas of the United States on selected measures of health care utilization, cost, and employment status. METHODS: This was a multi-site randomized controlled trial comparing OSMT treatment group against a control group receiving usual care (UC) in rural populations. OSMT treatment consisted of virtual group sessions led by trained peer ostomates delivered once a week over a 5-week period via video conferencing platforms. Surveys related to health care utilization were administered up to four times: baseline, post-session, 3-month and 6-month follow-up. RESULTS: Compared to the UC group, the OSMT group was associated with lower frequencies of in-person nurse (-57.2%; p = 0.015) and physician (-76.1%; p = 0.024) visits in the post-session follow-up survey; no significant differences were observed in the subsequent follow-up surveys. Moreover, the OSMT treatment group was also associated with lower ostomy-related emergency department visits (-88.3%; p = 0.119), lower direct out-of-pocket health care (-25.8%; p = 0.405) and travel costs (-47.7%; p = 0.105), as well as higher probability of full-time employment (18.9% vs. 12.3%; p = 0.179) and lower probability of claiming disability (14.3% vs. 18.9%; p = 0.459) in the 6-month follow-up; these differences, however, were not statistically significant. CONCLUSION: While not all statistically significant, the OSMT treatment was associated with some notable changes in the patterns of health care utilization and selected economic outcomes among ostomates residing in rural communities. This suggests that the OSMT treatment likely contributes to more efficient and cost-effective care in the target population. SYNOPSIS: Ostomy Self-Management Telehealth (OSMT) program seeks to reduce barriers to care and improve self-management skills especially among ostomates residing in rural communities. This study reports that OSMT was associated with lower in-person health care provider visits, suggesting OSMT may lead to more efficient and cost-effective care.

  PublisherOA PDFDOI

• A Bootstrap Method to Estimate Cost of Behavioral Intervention Implementation: A Proof of Concept

  Health Services Research · 2025-03-20

  articleOpen accessSenior authorCorresponding

  OBJECTIVE: To develop a bootstrapping method to augment time-driven activity-based costing (TDABC) analysis intended to allow more realistic cost estimates. DATA SOURCES: Secondary data from a multisite clinical trial conducted from 2016 to 2018 on an ostomy self-management telehealth intervention for cancer survivors. STUDY DESIGN: The intervention cost was newly estimated by incorporating expected patient participation rates calculated via bootstrapping. This cost was compared against the cost estimate obtained via traditional TDABC. DATA COLLECTION: Study personnel self-reported the time spent on each activity associated with the intervention. We also utilized patient participation data collected from the trial. PRINCIPAL FINDINGS: The total cost of the telehealth intervention estimated via the bootstrapping method was $210,052.62 (95% CI: 208,652.13, 211,402.51), with an average cost per participant of $1981.63 (95% CI: 1968.42, 1994.36). Traditional TDABC analysis yielded $186,363 or $1758 per participant. Further adjusting assumptions about the cost of the postintervention monitoring phase, our approach yielded an alternative estimate of $176,362.56 (95% CI: 174,962.07, 177,712.45) and an average cost per participant of $1663.80 (95% CI: 1650.59, 1676.53) suggesting both methods yielded similar bottom-line results. CONCLUSIONS: Incorporating bootstrapping into traditional TDABC methodology is feasible and is likely to capture variance in clinical trial data.

  PublisherOA PDFDOI

• The impact of opioid use associated with curative‐intent cancer surgery on safe opioid prescribing practice among veterans: An observational study

  Cancer · 2025-09-08 · 1 citations

  articleOpen access

  BACKGROUND: Opioid exposure during cancer therapy may increase long-term unsafe opioid prescribing. This study sought to determine the rates of coprescription of benzodiazepine and opioid medications and new persistent opioid use after surgical treatment of early-stage cancer. METHODS: A retrospective cohort study was conducted among a US veteran population via the Veterans Affairs Corporate Data Warehouse database. Participants were opioid-naive persons aged ≥21 years with a new diagnosis of stage 0-III cancer between January 1, 2015, and December 31, 2016. Outcomes were days of coprescription of benzodiazepines and opioids in the 13 months posttreatment and new persistent opioid use. The exposure was total morphine milligram equivalents (MMEs) attributed to treatment and prescribed from 30 days before through 14 days after the index surgical procedure. RESULTS: Among 9213 veterans, coprescription of benzodiazepines and opioids occurred in 366 patients (4.0%) and new persistent opioid use in 981 patients (10.6%). In a linear model adjusting for patient, clinical, and geographic factors, persons in the highest quartile compared to no opioid exposure had increased days with coprescription of benzodiazepines and opioids (mean difference, 1.0; 95% CI, 0.3-1.7). In a discrete time survival analysis, persons in the highest quartile of MME exposure compared to none had a greater risk of new persistent opioid use (hazard ratio, 1.6; 95% CI, 1.3-1.9). CONCLUSIONS: More than one of 10 opioid-naive veterans undergoing curative-intent surgical treatment for cancer developed new persistent opioid use. Optimizing cancer treatment pain management strategies to mitigate long-term opioid-related health risks is crucial.

  PublisherOA PDFDOI

• Optimizing Palliative Cancer Surgery Trial Completion: Lessons Learned From Qualitative Content Analysis of S1316 – Comparative Effectiveness Trial for Malignant Bowel Obstruction

  American Journal of Hospice and Palliative Medicine® · 2025-10-29

  articleOpen accessSenior author

  BackgroundMalignant bowel obstruction (MBO) is a complex clinical entity and there remains a relative lack of high-quality comparative trials on surgical management, in part due to a heterogeneous patient population and different treatment modalities which contribute to challenges in trial design and completion. SWOG S1316 is the only prospective randomized trial evaluating surgical vs non-surgical management of MBO and involved a trial framework in which patients were recruited for a randomization pathway as well as a patient choice pathway. Importantly, successful completion of S1316 required numerous amendment modifications to the trial during its course. We aimed to highlight aspects of S1316 trial design, execution, and modification that potentially contributed to trial completion.MethodsIterative qualitative content analysis of trial modification amendments through the course of the trial from 2015 to 2020.Results133 unique amendments were made to S1316 from 2015 to 2020. We found four dominant domains for the amendments: Accrual Barriers, Study Design Changes, Data Collection Issues, and Clarifications. Accrual amendments were essential to completing the trial and included increasing participating sites from six to 30 (including international sites) and the inclusion of Spanish-speaking participants (11% of final study population).ConclusionsContent analysis of S1316 trial amendments highlighted that Accrual amendments were important in trial completion. Future investigators may benefit from better anticipating trial modifications as they design their studies. It is likely that rapid initiation of trial amendments can lead to improved accrual and study completion.

  PublisherDOI

• Depression in patients with advanced prostate cancer in SWOG advanced cancer clinical trials.

  Journal of Clinical Oncology · 2025-05-28 · 1 citations

  article1st authorCorresponding

  12090 Background: Depression is common in patients with advanced cancer, but its prevalence has not been well documented. Moreover, depression is likely associated with other patient factors, including sociodemographic and clinical variables. We examined depression at enrollment in clinical trials for patients with advanced prostate cancer. Methods: We pooled clinical trial data from the SWOG Cancer Research Network. We identified phase III treatment trials of advanced prostate cancer patients with baseline mental health symptom measurements. Baseline depression was derived from emotional functioning items from the FACT-G, the SF-36, and the EORTC QLQ-C30 instruments. Using Likert scale distributions, depression was categorized as none, mild or moderate, and severe. We evaluated the prevalence of depression and its association with other baseline variables including age, race, ethnicity, insurance, rural/urban locale, the Area Deprivation Index, measurable disease, and prognostic risk. Generalized estimating equations with binomial logistic regression were used to assess the association of baseline variables with the odds of any depression and severe depression, with study as the clustering variable. A composite risk model was developed by summing the number of baseline risk factors adversely associated with depression. Results: Overall, N = 4,103 patients from four phase III trials were examined, including 69.8% aged 65 or older, 17.5% Black, 3.4% Hispanic, 18.4% rural, and nearly half (46.4%) from socioeconomically deprived areas (ADI score above the national median). At baseline, 50.4% of patients had depression (mild/moderate, 38.3%; severe, 12.1%). Depression was associated with age < 65 years, non-Black race, Hispanic ethnicity, having Medicaid or no insurance, and worse disease clinical characteristics. Patients with >3 risk factors (high risk) vs. 0-2 risk factors (low risk) were more likely to experience depression (54.3% vs. 43.2%, p < .0001) and severe depression (21.0% vs. 9.7%, p < .0001), corresponding to a 50% (OR = 1.50; 95% CI: 1.34-1.67; P < .0001) and 135% (OR = 2.35; 95% CI: 1.84-3.02; P < .0001) increase in risk, respectively. Quartile (Q) level proportions of any depression were 32.8% (Q1), 44.4% (Q2), 53.1% (Q3), and 72.0% (Q4), respectively, with a fivefold higher risk for those in the highest vs. lowest quartiles (Q4 vs. Q1, OR = 4.97; 95% CI, 2.86-8.64, p < .0001). Similar findings were seen with severe depression. Conclusions: Evidence of depression at baseline was reported by one-half of patients with advanced prostate cancer in clinical trials. Moreover, we showed that the number of adverse socioeconomic and clinical variables could strongly predict the prevalence of depression. Screening for depression in patients with cancer could help guide patients to appropriate mitigation resources. Interventions to help screen and treat patients with advanced cancer are warranted.

  PublisherDOI

• The bowel function instrument for rectal cancer survivors with anastomosis and ostomy

  Journal of Psychosomatic Research · 2024-09-14 · 1 citations

  articleSenior author
  PublisherDOI

• Intake and Nutritional Adequacy in Patients With Cancer Diagnosed With Malignant Bowel Obstruction: A Secondary Analysis of a Randomized Trial

  Journal of the Academy of Nutrition and Dietetics · 2024-11-26

  articleOpen accessSenior author
  PublisherOA PDFDOI

Recent grants

• HRQOL-enhancing ostomy self-management intervention for CRC survivors

  NIH · $294k · 2009–2014

• Prospective Comparative Effectiveness Trial for Malignant Bowel Obstruction

  NIH · $1.1M · 2013–2020

• NIH Grant R13CA110771

  NIH · $20k · 2005

• HR-QOL in Colorectal Cancer Survivors with Stomas

  NIH · $3.4M · 2004–2015

Frequent coauthors

• Marcia Grant

  City of Hope

  493 shared

• Christopher S. Wendel

  356 shared

• Susan M. Rawl

  Indiana University – Purdue University Indianapolis

  280 shared

• Carol M. Baldwin

  222 shared

• Clifford Y. Ko

  University of California, Los Angeles

  220 shared

• Mark C. Hornbrook

  206 shared

• Lisa J. Herrinton

  Kaiser Permanente

  154 shared

• Carmit K. McMullen

  144 shared