The Phyllis F. Cantor Center for Research in Nursing & Patient Care Services
Current Research
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Ongoing Studies
Mindfulness in Autologous/Stem cell Transplantation to Enhance Resiliency (MASTER)
Principal Investigator: Susan Bauer-Wu, PhD, RN
Co-Investigators: Ann S. LaCasce, MD (Medical Oncology)
This multi-site, randomized clinical trial (RCT) is aimed at examining the bio-behavioral effects of mindfulness meditation (MM) in cancer patients undergoing stem cell/autologous bone marrow transplantation (SCI/ABMT). A total of 270 patients will be randomized to one of three groups (1. mindfulness instruction by trained registered nurses; 2. nurse education/attention control; 3. standard care), and will be followed throughout SC/ABMT and until six months after discharge from the hospital. Outcomes include psychological and physical symptoms, quality of life, cardiovascular arousal, neuro-endocrine function, and transplant-related immune outcomes. Recruitment and data collection are underway.
Expressive Writing for Young Women with Newly Diagnosed Breast Cancer
Principal Investigator: Susan Bauer-Wu, PhD, RN
Co-Investigators: Ann Partridge, MD, and Anne Elperin, MS, NP (Women's Cancers); Lidia Schapira, MD, and Mary Artery, MS, NP (Massachusetts General Hospital [MGH])
Funded by the CALGB Foundation, this two-site (Dana-Farber and Massachusetts General Hospital [MGH]) pilot study prospectively evaluates the feasibility and estimated effect size of participation in a four-month expressive writing intervention (Web based or handwritten) in young women who are receiving systemic adjuvant therapy for breast cancer (N=90). Recruitment and data collection are complete, and data analysis is underway.
The Experience of Living with Advanced Breast Cancer
Principal Investigator: Susan Bauer-Wu, PhD, RN
Co-Investigators: Marsha Fonteyn, PhD, RN, Ulrika Kreicbergs, PhD, RN, Carolyn Hayes, PhD, RN (DFCI & Brigham and Women's Hospital [BWH]), Anne-Marie Barron, PhD, RN, CS (Simmons College)
The study team is analyzing the expressive writing narratives using a codebook of concepts and their descriptors. This secondary analysis of expressive writing texts of women with metastatic breast cancer follows the parent study, a randomization trial of expressive writing funded by the Susan G. Komen Breast Cancer Foundation. Four days of texts written by women with advanced breast cancer (n=89) are being analyzed by the team using content analysis and NVIVO qualitative software to manage the data. The women wrote about difficulties and stressors associated with having advanced cancer and thoughts and feelings about dying, relationships and other personal issues.
Prevalence and Correlates of Smoking Behaviors in Adults with Cancer
Principal Investigator: Mary E. Cooley, PhD, RN
Co-Investigators: Karen Emmons, PhD (Population Sciences), Arthur Garvey, PhD (Harvard School of Dental Medicine), Bruce Johnson, MD (Thoracic Oncology), Jean Lukanich, MD (Thoracic Surgery, Brigham and Women's Hospital), Robert Haddad, MD (Head and Neck Oncology), Marshall Posner, MD (Head and Neck Oncology)
The objectives of the current study are to identify point prevalence and continued abstinence rates among adult smokers with lung and head and neck cancers, and identify factors related to relapse among smokers with cancer. The results from this research will provide information needed to develop interventions and to target those who need more intensive smoking cessation interventions. Recruitment and data collection are underway for this study.
Mentoring Studies
Evaluation of the Clinical Trials Video on the Patient's Experience of the Informed Consent Process
Principal Investigator: Susan Hitchcock-Bryan, RN, MPH (Medical Oncology)
Co-Investigators: Susan Bauer-Wu, PhD, RN, Steven Joffe, MD, MPH (Pediatric Oncology), Christina Parker, MD (Office of Research), Andrew Wolanski, NP (Medical Oncology), Mark Powell (Biostatistics & Computational Biology)
The study evaluates the audiovisual program - "Entering a Clinical Trial: Is it Right for You?" - to determine whether the program dispels patients' misconceptions about clinical trials. This study assesses the impact of viewing the video on patients' understanding of clinical trials and how that understanding contributes to the informed consent process. Recruitment and data collection are ongoing with completion in August 2006. Dr. Bauer-Wu is mentoring clinician co-PI Suzanne Hitchcock-Bryan, RN.
A Feasibility Study Comparing Two Methods of Port-a-Cath Access in the Pediatric Oncology Patient
Principal Investigator: Ann Deady, MS, RN, NP (Jimmy Fund Clinic)
Co-Investigators: Susan Bauer-Wu, PhD, RN, Martha Healey, MSN, FNP, Deb Yokoe, MD (Infectious Disease), Kristen Graham, RN, BSN (Jimmy Fund Clinic)
The objectives of this pilot study are to access feasibility and to compare outcomes of two implantable venous access techniques, sterile versus clean, in a small sample (N=42) of pediatric oncology patients undergoing active treatment. Outcome measures will be infection rate, time and cost. Dr. Bauer-Wu is serving as a co-investigator and mentor to Jimmy Fund Clinic Nurse Ann Deady in this exploratory study funded by the Friends of DFCI. Data collection is complete and analysis is underway.
Lymphoma Patients End of Treatment Transition
Principal Investigator: Kristin Roper, MSN, ONC, RN (Radiation Oncology) Co-Investigators: Kecia Boyd, BSN, RN, OCN (Dana 1 Infusion), Christine Coakley, MPH, RN (Dana 1 Infusion), Kathleen McDermott, BSN, RN, OCN (Hematologic Malignancies), Mary Cooley, PhD, RN, and Jacqueline Fawcett, PhD, FAAN (UMass Boston)
In this study, Kristen Roper, RN, MSN, OCN, Christine Coakley, RN, MPH, Kathleen McDermott, RN, and Keisha Boyd, BSN, RN, OCN, are examining the adaptation of patients with Hodgkin's disease (HD) following treatment. This descriptive, longitudinal study focuses on the adaptation of HD patients by describing individual physical symptoms, emotional distress, intimate relationships, and functional status during, at the end of, and after cancer treatment. Another specific aim of this exploratory study includes the identification of the types of supportive care services used by this patient population. Such a study is central to developing effective clinical interventions to enhance HD patients' adaptation after treatment. During the course of this research a review of studies examining the QOL of both younger and older adults with HD was presented as a podium presentation at the 8th annual Conference on Cancer Nursing Research in 2004. This abstract has also been accepted as a poster presentation at the Annual Boston Area Cancer Survivorship Research Meeting in October 2006, as well as an abstract entitled "Lessons Learned in the Recruitment and Retention of Young Adult Cancer Survivors in a Longitudinal Clinical Trial." Dissemination of the findings of this study will begin the summer of 2007. This research team of clinical nurses has been closely mentored by Dr. Cooley and Jacqueline Fawcet, PhD, RN, FAAN (Cantor Center associate clinical scientist), which has enabled them to secure funding from the national Oncology Nursing Society and the Friends of Dana-Farber.
Completed Studies
Activities of Daily Living in Women with Metastatic Breast Cancer
Dr. Bauer-Wu, Susan DeSanto-Madeya, PhD, RN, of the University of Massachusetts Boston, and Abigail Gross, BA, of the Cantor Center, conducted a secondary analysis of activity logs written by women with metastatic breast cancer. These activity logs were kept over four days per participant (n=90) as the control writing for the parent study described previously. This data analysis provides insight into the level and extent of activities done by women living with advanced breast cancer. The study was presented at the Oncology Nursing Society Congress in May 2006, and a manuscript is in review.
Symptoms in Post-Surgical Lung Cancer Patients
Dr. Cooley, together with Linda Sarna, RN, PhD, from the University of California, Los Angeles, and Jeanne Lukanich, MD, Raphael Bueno, MD, and Michael Jaklitsch, MD, of the Division of Thoracic Surgery at Brigham and Women's Hospital are collaborating on this multi-site study. The overall goal of this project is to determine the profile and characteristics of symptoms of patients who have had surgery for non-small cell lung cancer. The specific aims for this study are to
- Determine the prevalence and trajectory of symptoms and symptom clusters experienced during recovery from treatment,
- Determine demographic, health status, and disease/treatment predictors of the symptom recovery experience,
- Determine the relationship of the symptom experience trajectory to perceptions of quality of life,
- Describe the linkage between types of self-care management strategies for individual symptoms and for symptom clusters, and
- Compare the symptom profile and self-care management strategies used by men and women.
Recruitment and data collection have been completed and data analysis is underway.
Tobacco Use in Women with Lung Cancer
Dr. Mary E. Cooley, together with Linda Sarna PhD, RN, from University of California, Los Angeles Jean Brown PhD, RN from University at Buffalo, State University of New York, Cynthia Chernecky PhD, RN, from Medical College of Georgia, and Roma Williams PhD, RN, formerly from University of Alabama, Birmingham, conducted a secondary analysis using data from 230 women with lung cancer. The purposes of this analysis were to determine smoking prevalence, describe patterns of smoking, identify readiness to quit and cessation strategies, identify factors associated with continued smoking among women with lung cancer, and determine smoking prevalence among household members. The mean age of the sample was 65 years, 84% were Caucasian, 11% were African American, and 81% had early stage disease. The mean time since diagnosis was 2 years. Data were collected through reliable and valid standardized questionnaires and interviews, medical record review, and anthropometrics. Current smoking was determined through self-report and biochemical verification with urinary cotinine. Descriptive statistics, chi-square and t-tests were used for analyses.
Results from this study revealed that 87% of women reported ever smoking and 37% reported smoking at the time of their diagnosis. Ten percent of women were smoking at entry to the study, 13% were smoking at 3 months and 11% at 6 months. Fifty-five percent of smokers planned a quit attempt within the next month. One-third of smokers received cessation assistance at diagnosis, and pharmacotherapy was the most common strategy. Significant factors associated with continued smoking included younger age, depression, and household member smoking. Continued smoking among household members was 21%. Twelve percent of household members changed their smoking behavior; 77% quit smoking but 13% started smoking. These findings suggest that the diagnosis of cancer is a strong motivator for behavioral change and some patients need additional support in order to quit smoking. Family members should also be targeted for cessation interventions. The results of this study are currently in press.
Gender Differences in Smoking Relapse
Dr. Mary E. Cooley, Dr. Arthur Garvey and colleagues Mark Powell, Emily Blood and Randy Hoskinson have completed a secondary analysis using data from 608 participants. The purposes of this study were to examine whether pre-cessation and post-quit-day-1 (D1) biopsychosocial and behavioral factors associated with smoking relapse differed among men and women, and to examine potential differences in self-reported reasons for SR. Salivary cotinine was used to confirm smoking abstinence. Descriptive statistics, chi-square, and time-to-event analysis were performed. Controlling for nicotine replacement gum dose, pre-cessation factors associated with time-to-relapse among men were higher social stress and partner smoking, whereas women with higher financial stress and higher temptation to smoke in positive affect situations were at greater risk for smoking relapse. In a combined model, only the effect of being tempted to smoke in positive affect situations appeared to be different in time-to-relapse among men and women. Controlling for nicotine gum dose, the only D1 factor associated with time-to-relapse in men was having a higher temptation to smoke in negative affect situations. For women, having lower motivation, lower temptation to smoke in negative-affect situations, and higher temptation to smoke in habitual-craving situations were associated with greater risk of smoking relapse. In a combined model, the effects of being tempted to smoke in negative-affect and habitual-craving situations appeared to be significantly different among men and women. Analysis of self-reported reasons for early smoking relapse showed 24% of women and 37% of men identified smoking out of habit as the reason for smoking relapse. Another 24% of women identified negative affect as the reason for smoking relapse as compared to 14% of men. Results suggest that factors associated with smoking relapse may differ among men and women. An important finding is that women may underestimate the effect of negative affect on their risk of smoking relapse. Thus, interventions that focus on helping women to anticipate and deal with negative affect situations during smoking cessation attempts may help increase long-term abstinence rates. Results from this study were presented at national conferences and a manuscript is underway.
Age-related Differences in Smoking Relapse among Women
Dr. Mary E. Cooley, Dr. Arthur Garvey and colleagues Mark Powell, Emily Blood and Randy Hoskinson have completed another secondary analysis using data from a community-based sample. This study examined whether pre-cessation and post-quit-day-1 (D1) factors associated with smoking relapse differed among younger (< 40) and older (> 40) women, and examined differences in self-reported reasons for smoking relapse. The biobehavioral model of nicotine addiction was used to guide this study. Data were collected from 312 women using standardized reliable and valid questionnaires. Salivary cotinine was used to confirm smoking abstinence. Chi-square and multivariate time-to-event analyses were performed. Controlling for nicotine gum dose, pre-cessation factors significantly associated with time-to-relapse were increased depression among younger women and lower motivation and among older women. There was a significant age interaction with depression, and motivation but not dose suggesting that depression and motivation affect time-to-relapse differently in younger versus older women. D1 factors associated with time-to-relapse were increased craving and lower temptation to smoke in negative affect situations among younger women and lower motivation among older women. There was a significant age interaction with craving, temptation to smoke in negative affect situations, and motivation indicating that time-to-relapse differs among younger and older women. Twenty-one percent of younger women as compared to 10% of older women identified use of alcohol as the reason for early smoking relapse. Another 13% of younger women as compared to 24% of older women identified craving tobacco as the reason for early smoking relapse. Results from this study suggest that factors associated with smoking relapse differ by age. It appears that behavioral treatments targeting enhanced coping in negative affect situations may be beneficial among younger women, whereas behavioral treatments that increase motivation to quit smoking are needed among older women. Results from this study were presented at a national conference and a draft manuscript is underway.
Disclosure: Effects on Women With Metastatic Breast Cancer
Principal Investigator: Susan Bauer-Wu, PhD, RN
Co-Investigator: Eric Winer, MD (Women's Cancers)
The overall goal of this study was to examine the effects of an easy to implement and low-cost psycho-behavioral intervention, expressive writing, on the way women with metastatic breast cancer feel and function. This randomized trial, funded by the Susan G. Komen Breast Cancer Foundation, had a final sample of 178 patients recruited from DFCI, MGH, Dartmouth-Hitchcock Medical Center, and the University of Massachusetts Memorial Medical Center. The most significant results were differences in healthcare utilization, particularly with visits to psychiatric providers and telephone calls to oncology providers, between the expressive writing group and the usual care control group. The expressive writing group had a decrease in psychiatric visits and calls to oncology providers over three and six months, compared to the control group that had an increase in these measures. The results have been presented at the Cancer Nursing Research Conference and the Eastern Nursing Research Society conference. A manuscript is in preparation.
Music Therapy for Women With Metastatic Breast Cancer
Co-Principal Investigators: Susan Bauer-Wu, PhD, RN and Suzanne Hanser, EdD, MT-BC (Cantor Center Associate, Berklee College of Music and the Zakim Center for Integrated Therapies)
Co-Investigator: Craig Bunnell, MD (Women's Cancers)
This randomized, two-group study was aimed at improving quality of life and stress-related outcomes in women with metastatic breast cancer through the use of music therapy. The music therapy program consisted of three individual 45-minute sessions with a music therapist and listening to music every day over the course of the nine weeks. During the sessions participants learned simple techniques to enhance mood and relaxation through music. Findings from this study, which were published in the Journal of the Society for Integrative Oncology (Vol. 4, Number 3, Summer 2006), revealed significant improvements on immediate measures of anxiety, mood, and comfort as well as lowered heart rate after that music therapy sessions, although no statistically significant differences between the music therapy and control groups on the over-time measures. Qualitative data strongly demonstrates the value of music therapy for some of the participants. A manuscript based on these findings is in preparation.
