Promoting Psychological Adjustment and Pelvic Health Among Female Cancer Survivors (2021-2022)

Background 

In 2020, more than 156,000 new cases of gynecologic, bladder, rectal and anal cancers were diagnosed among women in the U.S. Rates of survivorship have improved in recent decades, yet women frequently experience devastating and long-lasting side effects of treatment. Pelvic radiation, surgery and hormone depletion cause vaginal changes (e.g., scarring, vaginal shortening) that require genitally invasive follow-up care, such as vaginal dilators, pelvic floor physical therapy and frequent pelvic exams. Women report these procedures are distressing and painful, which can negatively impact their engagement in care. Difficulties with procedures in the genito-pelvic region can be compounded by past experiences of gender-based violence or discrimination, which are experienced by one in three women in the U.S. and 50-75 percent of people of color.

Few treatments exist to help this patient population cope with genito-pelvic changes and reduce distress and pain during follow-up procedures. One novel approach is to develop interventions grounded in the biopsychosocial model of pain, which is based on research that highlights the associations between emotional distress, cognitions (e.g., catastrophizing) and pain processing in the brain. Integrated psychological and medical interventions that target physiologic arousal and cognitions may fill this gap to reduce distress and procedural pain among women needing invasive surveillance and rehabilitation procedures.

Project Description 

This project team will conduct two intervention development studies grounded in the biopsychosocial model. 

Study 1 will investigate a telemedicine coping skills intervention to reduce anxiety during surveillance pelvic examinations following cancer treatment. The team will refine the intervention based on patient and provider interviews and expert feedback on the intervention manual. Subsequently, team members will conduct a proof of concept pilot study with 16 participants undergoing pelvic examinations at the Duke Cancer Institute to assess the feasibility and acceptability of the intervention and study procedures. 

Study 2 will develop an integrated pelvic floor physical therapy and coping skills training intervention based on qualitative data from interviews with cancer survivors, oncology providers and pelvic health physical therapists. The team will collect and analyze qualitative patient data to inform the development of medical provider interview guides. Team members will conduct interviews with pelvic heath physical therapists and oncology providers who treat pelvic radiation patients to obtain information regarding treatment needs, best practices and intervention strategies. Using information obtained from patient and provider interviews, the team will develop the intervention.

A phased research approach will allow findings from the pelvic examination study to inform the integrated physical therapy and coping skills study, as rehabilitation for sexual side effects requires more frequent engagement with highly invasive physical therapy and home exercises. The team will collaborate to integrate findings from the first study to inform the development of the second. Team members will participate in intervention development during all stages – assessment, development, refinement, piloting, process evaluation, data analysis and write-up.

Learn more about this project team by viewing the team's video.

Anticipated Outputs

Two novel interventions that can promote health and well-being of cancer survivors with written manuals and protocols to be tested in future studies; data for future research and grants; reports for Duke Cancer Institute leadership

Student Opportunities

Ideally, this project team will be comprised of 4 graduate students and 4 undergraduate students. The ideal composition of the team will include faculty, medical/physical therapy fellows or residents, and graduate and undergraduate students. The team would benefit from students studying the following: clinical psychology, nursing, neuroscience, biology (pre-med), global health, gender, sexuality and feminist studies and visual studies/graphic design/animation. 

Students will learn about women’s health and symptom management from the interdisciplinary team. Undergraduates will gain training in research methods (e.g., qualitative data analysis, interview shadowing to learn how interview guides are implemented). They will learn about translating research findings into intervention content (e.g., session role plays, developing patient materials) and will collaborate on manuscript writing and discussing reports with healthcare leadership. This project offers a significant learning opportunity for Ph.D. student project leaders, who will be mentored by Dr. Shelby and faculty collaborators. Additional graduate student opportunities include conducting interviews, intervention development and delivery, and leading data collection and analysis. 

There will be a weekly full team meeting for collaboration across studies. In Summer and Fall 2021, this meeting will be on Wednesdays from 4:00-5:00 p.m. All team members will be involved in this translational intervention research. To promote learning and shared knowledge, team members at all levels will deliver didactic instruction. Topics will include medical and physical therapy treatments for this population, the biopsychosocial model, cognitive behavioral approaches, and trauma-informed principles. 

One Ph.D. student will be the project manager for each study and will meet weekly with undergraduates on their subteam for supervision and collaboration. Undergraduates will be assigned to a study and will code qualitative data, assist with writing manuscripts and reports and create patient materials. 

The optional summer component will take place over 9 weeks in Summer 2021. Six students will be selected to participate for approximately 6 hours/week.

Jessica Coleman will serve as project manager.

Timing

Summer 2021 – Spring 2022 

  • Summer 2021: Study 1: Refine intervention based on stakeholder and expert feedback; begin proof of concept pilot study; Study 2: Analyze qualitative patient stakeholder data; submit conference abstract
  • Fall 2021: Study 1: Complete proof of concept pilot study; analyze data; submit conference abstract; Study 2: Create provider interview guide; conduct provider interviews; analyze data
  • Spring 2022: Study 1: Write manuscript for publication; disseminate findings; present at conference; Study2: Complete provider interviews and data analysis; draft intervention content; write manuscript for publication; present at conference

Crediting 

Academic credit available for fall and spring semesters; summer funding available

 

Image: Pelvis, Wikimedia Commons, licensed under CC BY 3.0

Pelvis.

Team Leaders

  • Jessica Coleman, Trinity–Department of Psychology and Neuroscience–Ph.D. Student
  • Rebecca Shelby, School of Medicine-Psychiatry and Behavioral Sciences

/graduate Team Members

  • Sarah Arthur, Psychology-AM, Psychology-PHD

/undergraduate Team Members

  • Alexandra Bennion
  • Michelle Huang, Neuroscience (BS), Global Health (AB2)
  • Shernice Martin, Neuroscience (BS)
  • Zadaiah Roye, Gender Sexuality & Fem St(AB)
  • Sophie Smith
  • Ruhama Tereda, Public Policy Studies (AB)

/yfaculty/staff Team Members

  • Brittany Davidson, School of Medicine-Obstetrics and Gynecology
  • Carol Figuers, School of Medicine-Family Medicine and Community Health: Doctor of Physical Therapy
  • Bridget Koontz, School of Medicine-Radiation Oncology
  • Lisa Massa, Physical Therapy
  • Niharika Mettu, School of Medicine-Medicine: Medical Oncology
  • Noga Zerubavel, School of Medicine-Psychiatry and Behavioral Sciences

/zcommunity Team Members

  • Duke Cancer Institute