Survivorship and Cancer Care Delivery Research and Clinical Trials

An Adapted Dialectical Behavioral Therapy Skills Training Protocol for Patients Living with Metastatic Lung Cancer

LiveWell Study: NIH Reporter
LiveWell Study: ClinicalTrials.gov
PIs: Kelly Hyland, Ph.D. 

Patients with metastatic lung cancer are living longer, but experience high rates of psychological distress (i.e., depression, anxiety), persistent symptom burden, and decrements in psychological well-being and overall quality of life. Given that existing psychosocial intervention paradigms are not designed to help patients navigate the emotional turbulence of living with life-limiting illness, SCOR researchers developed LiveWell, an 8-session telehealth-delivered adapted Dialectical Behavioral Therapy Skills Training protocol that teaches patients transdiagnostic skills (e.g., mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) to live as well as possible, with metastatic lung cancer.

This NCI-funded randomized clinical trial will evaluate the feasibility, acceptability, and preliminary efficacy of LiveWell to reduce psychological distress in people living with metastatic lung cancer compared to usual care (N=80). Results may support LiveWell’s ability to reduce psychological distress and improve quality of life in this population, thereby providing a promising psychosocial intervention paradigm for patients living with advanced cancer and other chronic illnesses.

Optimizing Treatment for Human Papillomavirus-Associated Oropharyngeal Cancer in Older Adults

Geriatric Oncology
SOLACE Trial: NIH Reporter
PIs: Ashish Deshmukh, Ph.D., MPH, and Evan Graboyes, M.D., MPH

Human papillomavirus-associated oropharyngeal cancer (OPC) is one of the fastest rising causes of cancer incidence in the US, particularly among older adults. To date, ongoing de-intensification clinical trials have not considered the evolving OPC epidemiology and the unique considerations of treating older adults with cancer.

To address these gaps, SCOR researchers launched the SOLACE study. This NCI-funded study will leverage disease simulation modeling to generate in-silico trials to compare harms vs benefits of different treatment paradigms over the patient’s lifetime in the context of aging and multimorbidity. Study findings could transform clinical decision-making for OPC, maximize benefits and reduce harms, and inform evidence-based, patient-centered, and preference-concordant decision-making for this rapidly growing patient population.

Optimizing Care for Cancer Survivors with Depression

The OASIS Program
PI: Evan Graboyes, M.D., MPH and Jen Dahne, Ph.D.

Cancer survivors have a 2- to 5-fold higher risk of depression than the general population with downstream negative health consequences including lower adherence to cancer treatment, decreased physical and social functioning, impaired immunity, and increased mortality. Unfortunately, barriers to screening, referral, and treatment prevent the growing population of cancer survivors with depression from receiving the mental health care they need.

In the Hollings Cancer Center-funded OASIS study, SCOR researchers will conduct a multi-project program comprised of three highly synergistic and integrated projects related to depression screening, referral, and treatment supported by four shared cores (behavioral immunology, administrative, implementation science and economic evaluation, data science) organized around a central theme of developing a scalable, technology-based care delivery model for the growing population of cancer survivors with depression.

Addressing Unmet Psychosocial Needs of Individuals Living with Advanced and Metastatic Cancer

IMPACT Trial: NIH Reporter
IMPACT Trial: ClinicalTrials.gov
PIs: Jennifer Dahne, Ph.D., and Evan Graboyes, M.D., MPH

Individuals living with advanced and metastatic cancer that is likely incurable cancer are a growing subpopulation of cancer survivors with unique care needs. Although depression is one of the most critical issues for these patients, current approaches for delivering care are limited and strategies for scalable identification of these patients are unknown.

To address these gaps, SCOR researchers launched the IMPACT trial. This NCI-funded randomized clinical trial will evaluate the effectiveness and implementation of a proactive identification plus digital mental health intervention approach to treating depression among 279 people living with likely incurable cancer. The study will also aim to develop an electronic health record-derived phenotype of likely incurable cancer to enhance efficient identification of these individuals for referral to a range of supportive care services and clinical trials. Results from this research have the potential to expand evidence-based psychosocial treatment access in a manner that is scalable across oncology settings for individuals living with likely incurable cancer.

Pathology and Otoprotective Mechanisms in the Cochlea

Hearing Loss Prevention
PI: Brent A. Wilkerson, Ph.D.

Many cancer survivors experience hearing loss and tinnitus associated with cisplatin chemotherapy. Hearing loss has implications for language, education and social development in young people as well as employment and mental well-being throughout life. Sodium thiosulfate therapy offers some protection against cisplatin-induced hearing loss in eligible patients, but can counteract the anti-tumor activity of cisplatin. Safer, targeted otoprotective strategies are needed.

As a step toward this goal, our research seeks to better define the therapeutic window and cellular targets for otoprotective therapies in the cochlea. Our approach studies the relationship between DNA damage, cochlear pathology and hearing loss following cisplatin exposure in model systems. Our hope is that understanding the effects of cisplatin on the ear could inform new targeted therapeutic approaches.

Reducing Delays in Starting Radiation Therapy after Head and Neck Cancer Surgery

ENDURE Trial: NIH Reporter
ENDURE Trial: ClinicalTrials.gov
PI: Evan Graboyes, M.D., MPH

For patients with locally advanced head and neck cancer, clinical practice guidelines recommend initiating adjuvant radiation therapy within six weeks of surgery. Despite its oncologic importance, delays starting adjuvant therapy are common, disproportionately burden non-majority populations, and contribute to poor survival and disparities in mortality.

To improve the delivery of timely adjuvant therapy for all patient groups, SCOR researchers launched the ENDURE (Enhanced Navigation for Disparities and Untimely Radiation thErapy) trial. This NCI-funded multisite hybrid effectiveness-implementation clinical trial will evaluate an enhanced patient navigation intervention versus usual care for decreasing delays and disparities starting adjuvant therapy among patients with head and neck cancer. Results may help improve survival and decrease disparities in mortality for patients with head and neck cancer while improving our understanding of the delivery of effective interprofessional team-based cancer care.

Development and Implementation of a Novel Shared Decision-Making Tool to Support Cancer Care Delivery Concordant with Patient Treatment Preferences

Shared Decision-Making
PI: Kathryn Engelhardt, M.D.

Shared decision-making (SDM) is a critical component to determining the optimal treatment of lung cancer. However, most interventions to enhance SDM target the provider. As a result, SDM-based interventions often shift decision-making responsibility to the overwhelmed patient.

This project aims to evaluate the implementation of a previously developed decision grid in the thoracic oncology clinics of Hollings Cancer Center and to engage patients and family members to understand what information patients want to share and how we can support transfer of this knowledge from patients to providers. Study findings will enhance the dissemination and implementation of SDM tools into clinical care for patients with lung cancer.

Survivorship Needs Assessment and Planning

SNAP Trial: NIH Reporter
SNAP Trial: ClinicalTrials.gov
PI: Katherine Sterba, Ph.D., MPH

Cancer caregivers face unique and overwhelming burdens as they care for survivors with life-altering changes in physical and social functioning, devastating late and long-term treatment effects and extremely demanding follow-up care. There is a significant gap in knowledge about effective care transition interventions to address caregiver burden and survivor toxicities and improve supportive care and health care utilization (HCU).

SCOR researchers are leading a study to improve post-treatment recovery outcomes in head and neck cancer survivors and their caregivers through the delivery of a tablet-based, dyadic survivorship needs assessment planning (SNAP) tool implemented into clinic workflow at the end of treatment. Results from this NCI-funded randomized clinical trial of 176 cancer survivor-caregiver dyads may provide critical evidence supporting this sustainable, technology-enabled care planning system.

Body Image-Related Distress Among Head and Neck Cancer Survivors

BRIGHT Trial: NIH Reporter
BRIGHT Multi-Site Trial: ClinicalTrials.gov
PI: Evan Graboyes, M.D., MPH

Head and neck cancer survivors suffer high rates of body image-related distress which results in significant psychosocial morbidity and decreased quality of life. However, effective therapies to manage this disorder among head and neck cancer survivors are lacking.

To address this gap, SCOR researchers launched the BRIGHT (Building a Renewed ImaGe after Head and neck cancer Treatment) trial. This NCI-funded multisite randomized clinical trial will randomize head and neck cancer survivors (N=180) to a brief tele-cognitive behavioral therapy intervention or a dose- and delivery-matched tele-survivorship education control condition. Results could provide evidence supporting the first effective treatment in this population, thereby minimizing psychosocial morbidity, improving quality of life and developing new standards of clinical care.

Implementation of Palliative Care in Low-Resource Settings

Palliative Care Implementation
PI: Suparna Qanungo, Ph.D.

The extremely limited use of palliative care in low resource settings exacerbates suffering in patients with life-limiting illnesses such as cancer. This is particularly a problem for patients living in rural areas where barriers to care are even more pronounced.

The goal of this NCI-funded pragmatic clinical trial is to test and evaluate a home-based palliative care intervention for utilizing community health workers to facilitate the delivery of palliative care to cancer patients in rural India. Results from this trial may enhance the implementation of palliative care for patients with cancer in low-resource settings, thereby minimizing symptom burden and enhancing quality of life for cancer survivors.

Yogic Breathing Video App for Breast Cancer Survivors

Pranayama Trial
PI: Sundar Balasubramanian, Ph.D.

Cancer survivorship is associated with many long-term chronic health issues that arise as a result of cancer treatment protocols. Non-pharmacological lifestyle and mind-body interventions have been shown to be effective and critical components of a total-health strategy for cancer survivors.

In this NCI-funded Small Business Technology Transfer (STTR) Grant, PranaScience Institute seeks to develop and test a novel group video app for home-based delivery of a yogic breathing intervention that reduces symptoms of cancer treatment survival and supports total-health. Results could provide a scalable platform for a mind-body intervention to manage chronic health concerns among cancer survivors.

For more information about SCOR,
please contact:
Willie Schaub
Administrative Coordinator
Survivorship and Cancer Outcomes Research
schaub@musc.edu

For direct inquiries about research or scientific opportunities, please contact:
Evan Graboyes, M.D., MPH, FACS
Director
Survivorship and Cancer Outcomes Research
graboyes@musc.edu