Steven Doerstling

All Publications

• Impact of Medical Conditions and Area Deprivation on Fundraising Success in Online Crowdfunding: Cross-Sectional Study. Journal of medical Internet research Doerstling, S. S., Engelhard, M. M., Akrobetu, D., Sloan, C. E., Campagna, A., Nguyen, T. V., Madanay, F., Chen, F., Ubel, P. A. 2025; 27: e72475

  Abstract

  Web-based crowdfunding is commonly used to defray medical expenses, but it is not fully known which factors determine fundraising success. Previous studies have usually focused on a single disease category at a time or a small number of mutually exclusive diseases, even though a given campaign may seek funding for multiple conditions. In addition, differences in fundraising exist according to socioeconomic status, but whether this association applies across different diseases is unclear. Thus, questions remain about how certain medical conditions and the socioeconomic context of a campaign's location interact to influence fundraising success.This study aimed to determine the impact of specific medical conditions on crowdfunding success and to evaluate if the socioeconomic environment of a campaign's location has a distinct effect on earnings. Last, we sought to understand the effect of these features on donation behavior in terms of number of donations and donation amount.Web scraping was used to collect medical crowdfunding campaigns on GoFundMe that were based in the United States and created between 2010 and 2020. Using a previously validated disease identification algorithm based on natural language processing, we identified the presence or absence of 11 broad disease categories in each campaign description. An Area Deprivation Index was calculated to represent a composite view of the socioeconomic status of each campaign's county of origin. Generalized linear models were constructed to estimate the impact of mentioning specific disease categories and the campaign's area deprivation on the amount of money raised.This study analyzed 89,645 crowdfunding campaigns. We identified at least one medical condition in 82.6% (n=74,016) of campaigns. A quarter of campaigns (n=25,026, 27.9%) mentioned more than one disease category. Neoplasms were the most common condition among medical crowdfunding campaigns by a large margin (n=38,221, 43.7% of campaigns), followed by injuries and external causes (n=18,087, 20.7% of campaigns). In multivariable analysis, mentioning neoplasms, injuries and external causes, respiratory system diseases, nervous system diseases, or infections in the campaign was associated with higher total fundraising amounts. On the other hand, mentioning genitourinary, mental health, or endocrine diseases was associated with lower total fundraising amounts. Campaigns originating from less-deprived counties raised more money than those from more-deprived counties, and this effect was independent of the diseases mentioned in the campaign. The success of campaigns for higher-earning conditions and from less-deprived areas was typically due to a larger number of donations, rather than a higher donation amount.The medical conditions mentioned in crowdfunding campaigns matter for the fundraising success of the campaign. Importantly, certain diseases tended to receive lower total fundraising amounts. Regardless of the specific diseases mentioned in the campaign, the socioeconomic backdrop of a campaign's location had a significant impact on fundraising.

  View details for DOI 10.2196/72475

  View details for PubMedID 40729621

• Striking a balance: strategies for addressing single-use surgical equipment in infection prevention. Antimicrobial stewardship & healthcare epidemiology : ASHE Doerstling, S. S., Fox, P. M., Salinas, J. L., Sampson, M. M. 2025; 5 (1): e132

  Abstract

  Single-use surgical equipment is a standard strategy to reduce the risk of pathogen transmission in the operative room. However, this practice is associated with a great environmental impact. Reusable surgical tools represent an opportunity to reduce this impact, with many studies showing a 50% or greater reduction in carbon emissions by switching to reusable alternatives. While the safety of reusable equipment depends on strict sterilization protocols, the risk of infection is minimal when guidelines are followed. To advance sustainability in healthcare, we must balance infection prevention priorities, operational challenges, and the environmental considerations.

  View details for DOI 10.1017/ash.2025.186

  View details for PubMedID 40567397

  View details for PubMedCentralID PMC12188274

• Classification of Patients' Judgments of Their Physicians in Web-Based Written Reviews Using Natural Language Processing: Algorithm Development and Validation. Journal of medical Internet research Madanay, F., Tu, K., Campagna, A., Davis, J. K., Doerstling, S. S., Chen, F., Ubel, P. A. 2024; 26: e50236

  Abstract

  Patients increasingly rely on web-based physician reviews to choose a physician and share their experiences. However, the unstructured text of these written reviews presents a challenge for researchers seeking to make inferences about patients' judgments. Methods previously used to identify patient judgments within reviews, such as hand-coding and dictionary-based approaches, have posed limitations to sample size and classification accuracy. Advanced natural language processing methods can help overcome these limitations and promote further analysis of physician reviews on these popular platforms.This study aims to train, test, and validate an advanced natural language processing algorithm for classifying the presence and valence of 2 dimensions of patient judgments in web-based physician reviews: interpersonal manner and technical competence.We sampled 345,053 reviews for 167,150 physicians across the United States from Healthgrades.com, a commercial web-based physician rating and review website. We hand-coded 2000 written reviews and used those reviews to train and test a transformer classification algorithm called the Robustly Optimized BERT (Bidirectional Encoder Representations from Transformers) Pretraining Approach (RoBERTa). The 2 fine-tuned models coded the reviews for the presence and positive or negative valence of patients' interpersonal manner or technical competence judgments of their physicians. We evaluated the performance of the 2 models against 200 hand-coded reviews and validated the models using the full sample of 345,053 RoBERTa-coded reviews.The interpersonal manner model was 90% accurate with precision of 0.89, recall of 0.90, and weighted F1-score of 0.89. The technical competence model was 90% accurate with precision of 0.91, recall of 0.90, and weighted F1-score of 0.90. Positive-valence judgments were associated with higher review star ratings whereas negative-valence judgments were associated with lower star ratings. Analysis of the data by review rating and physician gender corresponded with findings in prior literature.Our 2 classification models coded interpersonal manner and technical competence judgments with high precision, recall, and accuracy. These models were validated using review star ratings and results from previous research. RoBERTa can accurately classify unstructured, web-based review text at scale. Future work could explore the use of this algorithm with other textual data, such as social media posts and electronic health records.

  View details for DOI 10.2196/50236

  View details for PubMedID 39088259

• Calorie restriction outperforms bariatric surgery in a murine model of obesity and triple-negative breast cancer. JCI insight Camp, K. K., Coleman, M. F., McFarlane, T. L., Doerstling, S. S., Khatib, S. A., Rezeli, E. T., Lewis, A. G., Pfeil, A. J., Smith, L. A., Bowers, L. W., Fouladi, F., Gong, W., Glenny, E. M., Parker, J. S., Milne, G. L., Carroll, I. M., Fodor, A. A., Seeley, R. J., Hursting, S. D. 2023; 8 (19)

  Abstract

  Obesity promotes triple-negative breast cancer (TNBC), and effective interventions are urgently needed to break the obesity-TNBC link. Epidemiologic studies indicate that bariatric surgery reduces TNBC risk, while evidence is limited or conflicted for weight loss via low-fat diet (LFD) or calorie restriction (CR). Using a murine model of obesity-driven TNBC, we compared the antitumor effects of vertical sleeve gastrectomy (VSG) with LFD, chronic CR, and intermittent CR. Each intervention generated weight and fat loss and suppressed tumor growth relative to obese mice (greatest suppression with CR). VSG and CR regimens exerted both similar and unique effects, as assessed using multiomics approaches, in reversing obesity-associated transcript, epigenetics, secretome, and microbiota changes and restoring antitumor immunity. Thus, in a murine model of TNBC, bariatric surgery and CR each reverse obesity-driven tumor growth via shared and distinct antitumor mechanisms, and CR is superior to VSG in reversing obesity's procancer effects.

  View details for DOI 10.1172/jci.insight.172868

  View details for PubMedID 37698918

  View details for PubMedCentralID PMC10629811

• Online Crowdfunding Campaigns for Diabetes-Related Expenses. Annals of internal medicine Sloan, C. E., Campagna, A., Tu, K., Doerstling, S., Davis, J. K., Ubel, P. A. 2023

  View details for DOI 10.7326/M23-0540

  View details for PubMedID 37307582

• Mutational profiles of head and neck squamous cell carcinomas based upon human papillomavirus status in the Veterans Affairs National Precision Oncology Program. Journal of cancer research and clinical oncology Doerstling, S., Winski, D., Katsoulakis, E., Agarwal, P., Poonnen, P. J., Snowdon, J. L., Jackson, G. P., Weeraratne, D., Kelley, M. J., Vashistha, V. 2023; 149 (1): 69-77

  Abstract

  Patients with advanced head and neck squamous cell carcinoma (HNSCC) associated with human papillomavirus (HPV) demonstrate favorable clinical outcomes compared to patients bearing HPV-negative HNSCC. We sought to characterize the association between HPV status and mutational profiles among patients served by the Veterans Health Administration (VHA).We performed a retrospective analysis of all Veterans with primary HNSCC tumors who underwent next-generation sequencing (NGS) through the VHA's National Precision Oncology Program between July 2016 and February 2019. HPV status was determined by clinical pathology reports of p16 immunohistochemical staining; gene variant pathogenicity was classified using OncoKB, an online precision oncology knowledge database, and mutation frequencies were compared using Fisher's exact test.A total of 79 patients met inclusion criteria, of which 48 (60.8%) had p16-positive tumors. Patients with p16-negative HNSCC were more likely to have mutations in TP53 (p < 0.0001), and a trend towards increased mutation frequency was observed within NOTCH1 (p = 0.032) and within the composite CDK/Rb pathway (p = 0.065). Mutations in KRAS, NRAS, HRAS, and FBXW7 were exclusively identified within p16-positive tumors, and a trend towards increased frequency was observed within the PI3K pathway (p = 0.051). No difference in overall mutational burden was observed between the two groups.In accordance with the previous studies, no clear molecular basis for improved prognosis among patients harboring HPV-positive disease has been elucidated. Though no targeted therapies are approved based upon HPV-status, current efforts to trial PI3K inhibitors and mTOR inhibitors across patients with HPV-positive disease bear genomic rationale based upon the current findings.

  View details for DOI 10.1007/s00432-022-04358-7

  View details for PubMedID 36117189

• Reversing the Genomic, Epigenetic, and Triple-Negative Breast Cancer-Enhancing Effects of Obesity. Cancer prevention research (Philadelphia, Pa.) Bowers, L. W., Doerstling, S. S., Shamsunder, M. G., Lineberger, C. G., Rossi, E. L., Montgomery, S. A., Coleman, M. F., Gong, W., Parker, J. S., Howell, A., Harvie, M., Hursting, S. D. 2022; 15 (9): 581-594

  Abstract

  The reversibility of the procancer effects of obesity was interrogated in formerly obese C57BL/6 mice that lost weight via a nonrestricted low-fat diet (LFD) or 3 distinct calorie-restricted (CR) regimens (low-fat CR, Mediterranean-style CR, or intermittent CR). These mice, along with continuously obese mice and lean control mice, were orthotopically injected with E0771 cells, a mouse model of triple-negative breast cancer. Tumor weight, systemic cytokines, and incidence of lung metastases were elevated in the continuously obese and nonrestricted LFD mice relative to the 3 CR groups. Gene expression differed between the obese and all CR groups, but not the nonrestricted LFD group, for numerous tumoral genes associated with epithelial-to-mesenchymal transition as well as several genes in the normal mammary tissue associated with hypoxia, reactive oxygen species production, and p53 signaling. A high degree of concordance existed between differentially expressed mammary tissue genes from obese versus all CR mice and a microarray dataset from overweight/obese women randomized to either no intervention or a CR diet. Assessment of differentially methylated regions in mouse mammary tissues revealed that obesity, relative to the 4 weight loss groups, was associated with significant DNA hypermethylation. However, the anticancer effects of the CR interventions were independent of their ability to reverse obesity-associated mammary epigenetic reprogramming. Taken together, these preclinical data showing that the procancer effects of obesity are reversible by various forms of CR diets strongly support translational exploration of restricted dietary patterns for reducing the burden of obesity-associated cancers.Obesity is an established risk and progression factor for triple-negative breast cancer (TNBC). Given rising global rates of obesity and TNBC, strategies to reduce the burden of obesity-driven TNBC are urgently needed. We report the genomic, epigenetic, and procancer effects of obesity are reversible by various calorie restriction regimens.

  View details for DOI 10.1158/1940-6207.CAPR-22-0113

  View details for PubMedID 35696725

  View details for PubMedCentralID PMC9444913

• A Disease Identification Algorithm for Medical Crowdfunding Campaigns: Validation Study. Journal of medical Internet research Doerstling, S. S., Akrobetu, D., Engelhard, M. M., Chen, F., Ubel, P. A. 2022; 24 (6): e32867

  Abstract

  Web-based crowdfunding has become a popular method to raise money for medical expenses, and there is growing research interest in this topic. However, crowdfunding data are largely composed of unstructured text, thereby posing many challenges for researchers hoping to answer questions about specific medical conditions. Previous studies have used methods that either failed to address major challenges or were poorly scalable to large sample sizes. To enable further research on this emerging funding mechanism in health care, better methods are needed.We sought to validate an algorithm for identifying 11 disease categories in web-based medical crowdfunding campaigns. We hypothesized that a disease identification algorithm combining a named entity recognition (NER) model and word search approach could identify disease categories with high precision and accuracy. Such an algorithm would facilitate further research using these data.Web scraping was used to collect data on medical crowdfunding campaigns from GoFundMe (GoFundMe Inc). Using pretrained NER and entity resolution models from Spark NLP for Healthcare in combination with targeted keyword searches, we constructed an algorithm to identify conditions in the campaign descriptions, translate conditions to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes, and predict the presence or absence of 11 disease categories in the campaigns. The classification performance of the algorithm was evaluated against 400 manually labeled campaigns.We collected data on 89,645 crowdfunding campaigns through web scraping. The interrater reliability for detecting the presence of broad disease categories in the campaign descriptions was high (Cohen κ: range 0.69-0.96). The NER and entity resolution models identified 6594 unique (276,020 total) ICD-10-CM codes among all of the crowdfunding campaigns in our sample. Through our word search, we identified 3261 additional campaigns for which a medical condition was not otherwise detected with the NER model. When averaged across all disease categories and weighted by the number of campaigns that mentioned each disease category, the algorithm demonstrated an overall precision of 0.83 (range 0.48-0.97), a recall of 0.77 (range 0.42-0.98), an F1 score of 0.78 (range 0.56-0.96), and an accuracy of 95% (range 90%-98%).A disease identification algorithm combining pretrained natural language processing models and ICD-10-CM code-based disease categorization was able to detect 11 disease categories in medical crowdfunding campaigns with high precision and accuracy.

  View details for DOI 10.2196/32867

  View details for PubMedID 35727610

  View details for PubMedCentralID PMC9257615

• Growth differentiation factor 15 in a community-based sample: age-dependent reference limits and prognostic impact. Upsala journal of medical sciences Doerstling, S., Hedberg, P., Öhrvik, J., Leppert, J., Henriksen, E. 2018; 123 (2): 86-93

  Abstract

  Despite the growing body of evidence on growth differentiation factor 15 (GDF-15) reference values for patients with existing cardiovascular disease, limited investigation has been dedicated to characterizing the distribution and prognostic impact of GDF-15 in predominantly healthy populations. Furthermore, current cutoff values for GDF-15 fail to account for the well-documented age-dependence of circulating GDF-15.From 810 community-dwelling older adults, we selected a group of apparently healthy participants (n = 268). From this sample, circulating GDF-15 was modeled using the generalized additive models for location scale and shape (GAMLSS) to develop age-dependent centile values. Unadjusted and adjusted Cox proportional hazards models were used to assess the association between the derived GDF-15 reference values (expressed as centiles) and all-cause mortality.Smoothed centile curves showed increasing GDF-15 with age in the apparently healthy participants. An approximately three-fold difference was observed between the 95th and 5th GDF-15 centiles across ages. In a median 8.0 years of follow-up, 97 all-cause deaths were observed in 806 participants with eligible values. In unadjusted Cox regression analyses, the hazard ratio (95% CI) for all-cause mortality per 25-unit increase in GDF-15 centile was 1.80 (1.48-2.20) and dichotomized at the 95th centile, ≥95th versus <95th, was 3.04 (1.99-4.65). Age-dependent GDF-15 centiles remained a significant predictor of all-cause mortality in all subsequent adjusted models.Age-dependent GDF-15 centile values developed from a population of apparently healthy older adults are independently predictive of all-cause mortality. Therefore, GDF-15 reference values could be a useful tool for risk-stratification in a clinical setting. ClinicalTrials.gov Identifier: NCT01452178.

  View details for DOI 10.1080/03009734.2018.1460427

  View details for PubMedID 29714603

  View details for PubMedCentralID PMC6055745

• Leptin Signaling Mediates Obesity-Associated CSC Enrichment and EMT in Preclinical TNBC Models. Molecular cancer research : MCR Bowers, L. W., Rossi, E. L., McDonell, S. B., Doerstling, S. S., Khatib, S. A., Lineberger, C. G., Albright, J. E., Tang, X., deGraffenried, L. A., Hursting, S. D. 2018; 16 (5): 869-879

  Abstract

  Obesity is associated with poor prognosis in triple-negative breast cancer (TNBC). Preclinical models of TNBC were used to test the hypothesis that increased leptin signaling drives obesity-associated TNBC development by promoting cancer stem cell (CSC) enrichment and/or epithelial-to-mesenchymal transition (EMT). MMTV-Wnt-1 transgenic mice, which develop spontaneous basal-like, triple-negative mammary tumors, received either a control diet (10% kcal from fat) or a diet-induced obesity regimen (DIO, 60% kcal from fat) for up to 42 weeks (n = 15/group). Mice were monitored for tumor development and euthanized when tumor diameter reached 1.5 cm. Tumoral gene expression was assessed via RNA sequencing (RNA-seq). DIO mice had greater body weight and percent body fat at termination than controls. DIO mice, versus controls, demonstrated reduced survival, increased systemic metabolic and inflammatory perturbations, upregulated tumoral CSC/EMT gene signature, elevated tumoral aldehyde dehydrogenase activity (a CSC marker), and greater leptin signaling. In cell culture experiments using TNBC cells (murine: E-Wnt and M-Wnt; human: MDA-MB-231), leptin enhanced mammosphere formation, and media supplemented with serum from DIO versus control mice increased cell viability, migration, invasion, and CSC- and EMT-related gene expression, including Foxc2, Twist2, Vim, Akt3, and Sox2 In E-Wnt cells, knockdown of leptin receptor ablated these procancer effects induced by DIO mouse serum. These findings indicate that increased leptin signaling is causally linked to obesity-associated TNBC development by promoting CSC enrichment and EMT.Implications: Leptin-associated signals impacting CSC and EMT may provide new targets and intervention strategies for decreasing TNBC burden in obese women. Mol Cancer Res; 16(5); 869-79. ©2018 AACR.

  View details for DOI 10.1158/1541-7786.MCR-17-0508

  View details for PubMedID 29453319

  View details for PubMedCentralID PMC5967653

• Resveratrol inhibits obesity-associated adipose tissue dysfunction and tumor growth in a mouse model of postmenopausal claudin-low breast cancer. Molecular carcinogenesis Rossi, E. L., Khatib, S. A., Doerstling, S. S., Bowers, L. W., Pruski, M., Ford, N. A., Glickman, R. D., Niu, M., Yang, P., Cui, Z., DiGiovanni, J., Hursting, S. D. 2018; 57 (3): 393-407

  Abstract

  Adipose tissue dysregulation, a hallmark of obesity, contributes to a chronic state of low-grade inflammation and is associated with increased risk and progression of several breast cancer subtypes, including claudin-low breast tumors. Unfortunately, mechanistic targets for breaking the links between obesity-associated adipose tissue dysfunction, inflammation, and claudin-low breast cancer growth have not been elucidated. Ovariectomized female C57BL/6 mice were randomized (n = 15/group) to receive a control diet, a diet-induced obesity (DIO) diet, or a DIO + resveratrol (0.5% wt/wt) diet. Mice consumed these diets ad libitum throughout study and after 6 weeks were orthotopically injected with M-Wnt murine mammary tumor cells, a model of estrogen receptor (ER)-negative claudin-low breast cancer. Compared with controls, DIO mice displayed adipose dysregulation and metabolic perturbations including increased mammary adipocyte size, cyclooxygenase-2 (COX-2) expression, inflammatory eicosanoid levels, macrophage infiltration, and prevalence of crown-like structures (CLS). DIO mice (relative to controls) also had increased systemic inflammatory cytokines and decreased adipocyte expression of peroxisome proliferator-activated receptor gamma (PPARγ) and other adipogenesis-regulating genes. Supplementing the DIO diet with resveratrol prevented obesity-associated increases in mammary tumor growth, mammary adipocyte hypertrophy, COX-2 expression, macrophage infiltration, CLS prevalence, and serum cytokines. Resveratrol also offset the obesity-associated downregulation of adipocyte PPARγ and other adipogenesis genes in DIO mice. Our findings suggest that resveratrol may inhibit obesity-associated inflammation and claudin-low breast cancer growth by inhibiting adipocyte hypertrophy and associated adipose tissue dysregulation that typically accompanies obesity.

  View details for DOI 10.1002/mc.22763

  View details for PubMedID 29197120

  View details for PubMedCentralID PMC6053655

• Obesity and Cancer Metabolism: A Perspective on Interacting Tumor-Intrinsic and Extrinsic Factors. Frontiers in oncology Doerstling, S. S., O'Flanagan, C. H., Hursting, S. D. 2017; 7: 216

  Abstract

  Obesity is associated with increased risk and poor prognosis of many types of cancers. Several obesity-related host factors involved in systemic metabolism can influence tumor initiation, progression, and/or response to therapy, and these have been implicated as key contributors to the complex effects of obesity on cancer incidence and outcomes. Such host factors include systemic metabolic regulators including insulin, insulin-like growth factor 1, adipokines, inflammation-related molecules, and steroid hormones, as well as the cellular and structural components of the tumor microenvironment, particularly adipose tissue. These secreted and structural host factors are extrinsic to, and interact with, the intrinsic metabolic characteristics of cancer cells to influence their growth and spread. This review will focus on the interplay of these tumor cell-intrinsic and extrinsic factors in the context of energy balance, with the objective of identifying new intervention targets for preventing obesity-associated cancer.

  View details for DOI 10.3389/fonc.2017.00216

  View details for PubMedID 28959684

  View details for PubMedCentralID PMC5604081

• Energy Balance Modulation Impacts Epigenetic Reprogramming, ERα and ERβ Expression, and Mammary Tumor Development in MMTV-neu Transgenic Mice. Cancer research Rossi, E. L., Dunlap, S. M., Bowers, L. W., Khatib, S. A., Doerstling, S. S., Smith, L. A., Ford, N. A., Holley, D., Brown, P. H., Estecio, M. R., Kusewitt, D. F., deGraffenried, L. A., Bultman, S. J., Hursting, S. D. 2017; 77 (9): 2500-2511

  Abstract

  The association between obesity and breast cancer risk and prognosis is well established in estrogen receptor (ER)-positive disease but less clear in HER2-positive disease. Here, we report preclinical evidence suggesting weight maintenance through calorie restriction (CR) may limit risk of HER2-positive breast cancer. In female MMTV-HER2/neu transgenic mice, we found that ERα and ERβ expression, mammary tumorigenesis, and survival are energy balance dependent in association with epigenetic reprogramming. Mice were randomized to receive a CR, overweight-inducing, or diet-induced obesity regimen (n = 27/group). Subsets of mice (n = 4/group/time point) were euthanized after 1, 3, and 5 months to characterize diet-dependent metabolic, transcriptional, and epigenetic perturbations. Remaining mice were followed up to 22 months. Relative to the overweight and diet-induced obesity regimens, CR decreased body weight, adiposity, and serum metabolic hormones as expected and also elicited an increase in mammary ERα and ERβ expression. Increased DNA methylation accompanied this pattern, particularly at CpG dinucleotides located within binding or flanking regions for the transcriptional regulator CCCTC-binding factor of ESR1 and ESR2, consistent with sustained transcriptional activation of ERα and ERβ. Mammary expression of the DNA methylation enzyme DNMT1 was stable in CR mice but increased over time in overweight and diet-induced obesity mice, suggesting CR obviates epigenetic alterations concurrent with chronic excess energy intake. In the survival study, CR elicited a significant suppression in spontaneous mammary tumorigenesis. Overall, our findings suggest a mechanistic rationale to prevent or reverse excess body weight as a strategy to reduce HER2-positive breast cancer risk. Cancer Res; 77(9); 2500-11. ©2017 AACR.

  View details for DOI 10.1158/0008-5472.CAN-16-2795

  View details for PubMedID 28373182

  View details for PubMedCentralID PMC5964334