Survivorship and Cancer Care Delivery Research and Clinical Trials

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

Depression Management
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.

An Equity Focused Intervention to Improve Utilization in Guideline Concordant Extended Venous Thromboembolism Prophylaxis After Major Cancer Surgery

Blood Clot Prevention
PI: Thomas Curran, M.D., MPH

Blood clots after major cancer surgery are common and harmful to patients. Preventative dose blood thinners after major cancer surgery decrease the risk of blood clots and are recommended by professional societies. However, utilization of these medications is limited. Moreover, racial disparities exist for cancer associated outcomes including blood clots and mortality.

Through this NCI-funded career development award, we will identify barriers and facilitators to guideline concordant blood thinner utilization after cancer surgeries. Subsequently, we will conduct a stepped wedge cluster randomized trial to test the effect of a multi-faceted educational intervention including an electronic health record-based clinical decision support system on increasing guideline concordant usage of preventive dose blood thinners in a diverse oncology population.

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

ENDURE Trial
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 racial and ethnic minority populations, and contribute to poor survival and disparities in mortality.

To improve the delivery of timely, equitable adjuvant therapy, 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 racial disparities starting adjuvant therapy among patients with head and neck cancer. Results may help improve survival and decrease racial 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
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
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