Enhancing Survival

INSPIRE: Internet Program for a Randomized Controlled Trial (RCT) on Fatigue and Distress
for Long Term Cancer Survivors
Principal Investigator: Karen Syrjala, PhD

This NCI-funded R01 project's goals are to develop and test internet and phone-based treatment and assessment in an RCT to determine the efficacy of internet alone vs. internet plus problem-solving treatment by phone to improve long term fatigue/physical dysfunction, depression/distress, and health behaviors in adult 5-15 year hematopoietic stem cell transplantation survivors compared with survivors randomized to a delayed treatment control.

Muscle Joint Bone: Musculoskeletal Health in Long Term Transplant Survivors Study
Principal Investigator: Karen Syrjala, PhD

This NCI-funded project's goals are to determine late effects that contribute to determining musculoskeletal dysfunction in 5 to 20-year survivors of hematopoietic stem cell transplantation (HSCT), possibly indicating an "accelerated aging" late effect. We are bringing local survivors to our Center for a day of testing including bone density scans, treadmill testing and multiple lab tests.

Specifically we are examining:

1. The relationship between objective behavioral measures of muscle weakness (grip strength), physical inactivity and subjective complaints of muscle weakness and fatigue.
2. The relationship of inflammatory cytokines and muscle-related growth factor to reports of muscle weakness, leg cramps and joint or muscle stiffness and pain.
3. Whether cancer survivors with objective muscle weakness or inactivity have muscle mitochondrial energy coupling ratios more similar to the elderly than to age-matched norms, providing preliminary evidence of increased levels of mitochondrial uncoupling in muscles of these survivors.

Spouses/Partners Expressing their Thoughts after Transplant: A Randomized Controlled Trial
Principal Investigator: Shelby Langer, PhD

This NCI-funded project's goals are:

1. To determine, via experimental manipulation, whether or not caregivers of stem-cell transplant patients engage in protective buffering, a coping mechanism whereby partners shield patients from illness-related concerns or worries.
2. To examine synchrony or lack thereof, desynchrony, among subjective, expressive and biologic indicators of emotion among spousal caregivers.
3. To test the feasibility and implementation of an emotional expression exercise designed to enhance psychological and immune functioning among spousal caregivers.

Focus Forward: Enhancing Recovery from Blood and Bone Marrow Transplantation (BMT)
Principal Investigator: Karen Syrjala, PhD

This NCI-funded R01 project's goal is to test a resource conserving behavioral and interdisciplinary triage intervention team for stem cell and marrow transplantation survivors that could be disseminated to any transplant recipient. The intervention follows a psycho educational treatment model which includes: specific activities to reduce the impact of common long-term post transplant limitations, teaching of cognitive-behavioral active coping skills to manage any additional stresses or limitations, and a triage team intervention to activate additional resources for those with higher levels of need.

Long-term survivors of hematopoietic stem cell transplantation (HSCT—previously called BMT) face many problems and limitations after treatment. Through previous research studies, we have identified a set of problems that occur most frequently in HSCT survivors. The most frequently reported problems include:

1. Limits in stamina and cognition that affect daily functioning abilities.
2. Fluctuations in patient limitations, family roles, stress and emotional changes for all family members.
3. Changes in endocrine function and reproductive organs that directly effect menopausal symptoms and sexual functioning in women.

Using these common problems as guidelines for recovery, we are comparing two groups of randomly assigned HSCT survivors and their primary family caregivers. The treatment group receives the intervention as described above, with the control group receiving Standard Recovery Preparation as provided by their transplant center.

By designing a preventive intervention aimed at reducing the impact of these long-term effects, while recognizing the possible limits in cognitive function and attention of HSCT patients, we hope to minimize maladaptive patterns, thereby facilitating more rapid recovery for survivors and their families.

Enhancing Long-Term Survival after BMT
Principal Investigator: Karen Syrjala, PhD

This NCI-funded R01 multiple-cohort study's purpose is to identify factors that require intervention to improve long-term survival in HSCT patients. We have continued to follow one cohort of survivors from before transplant to 10 years post-transplant. In addition, a healthy matched control subject was evaluated to determine the relative quality of life of the HSCT survivors when compared to a healthy population.

The second cohort of HSCT recipients participated in a randomized clinical trial to enhance recovery. In addition, a spouse or partner was evaluated to examine the impact of the patients' recovery on their primary caregiver/partner. These patients completed 5 year post-transplant follow-up, with a case-matched control, examining medical, psychosocial and neuropsychological factors.

Specifically, we have evaluated outcomes and risk factors for:

1. The functional capabilities of adult HSCT survivors, and their spouse/partner where relevant, in relation to work, stamina, cognitive and psychomotor abilities, family adaptations, emotional fluctuations, infertility concerns, and for women, menopausal symptoms and sexual function.
2. The interaction of medical and psychological late effects in 10-year survivors as compared with their own status at 5 years and pre-transplant.
3. Prospective, long-term neuro-psychological function and its impact.

By identifying which effects remain over a long-term basis for specific subsets of survivors, we will be able to design cost-effective interventions targeted to reducing these effects for survivors at risk and facilitating full adaptation for survivors and their families. This research also provides a foundation for our research into biomarkers and behavioral mechanisms for musculoskeletal and other physical complications in long-term survivors.

Survivorship Center of Excellence Grant
Director: Scott Baker, MD MSc
Co-Director, Principal Investigator: Karen Syrjala, PhD
Medical Co-Director: Stephanie Lee, MD
Medical Co-Director: Julie Gralow, MD
Program Manager: Emily Jo Rajotte, MPH

This Lance Armstrong Foundation grant creates a comprehensive survivorship program, with outreach to all cancer survivors throughout the lifespan. With community-based centers, we are developing stronger community resources, targeting underserved populations. We will be establish and evaluate unique models of care, which are designated to overcome some of the barriers to optimal health services and access to research for survivors. This survivorship program provides a foundation for research defining survivorship barriers, needs and treatments to optimize survivor long-term care.

	Enhancing Survival
	Neurotoxicity
	Pain Management
	Collaboration