This K23 career development award will position the candidate to become an independent clinical researcher with expertise in refining and testing mind-body interventions for managing fears of illness recurrence and associated healthcare engagement among medical patients. BACKGROUND. Fear of recurrence (FOR) is a common, highly distressing difficulty faced by individuals with a history of chronic and/or life-threatening illness. For example, cancer survivors, a growing population, report clinically-elevated FOR as a chief psychological concern. Notably, FOR may lead to worsened clinical outcomes, due to maladaptive healthcare engagement (e.g., avoidance or overuse of follow-up screenings). It is critical to develop evidence-based FOR interventions. Relaxation skills, mindfulness meditation, cognitive-behavioral skills, and positive psychology techniques are promising for reducing FOR in cancer survivors, yet trials have been limited by testing these skills in isolation and among homogenous samples (e.g., breast cancer only).
SPECIFIC AIMS. The proposed studies employ mixed methods designs to: (1) refine a multimodal, mind-body intervention (Relaxation Response Resiliency Program) to target FOR among cancer survivors via tiered feedback from focus groups, individual interviews, and an interdisciplinary expert panel, (2) evaluate, in a pilot RCT, its feasibility and acceptability among cancer survivors with elevated FOR, and (3) explore within-group, longitudinal patterns of FOR, healthcare engagement, and their covariance across multiple timepoints. TRAINING. The candidate will achieve short- term goals through a resource-rich institutional environment and a cohesive training plan in (1) clinical trial design, (2) mixed methods and longitudinal data collection and analysis, and (3) evaluation of healthcare engagement. In addition to ongoing mentorship meetings and experiential training through the research plan, the candidate will complete targeted coursework, didactic trainings, and shadowing, present at local and national conferences, and publish in peer-reviewed journals. MENTORSHIP. The candidate will be supported by a stellar mentoring team: Elyse R. Park, PhD, MPD (primary mentor), Gloria Y. Yeh, MD, MPH (co-mentor), Conall O?Cleirigh, PhD (co-mentor), John Denninger, MD, PhD (consultant), Hang Lee, PhD (consultant), Jeffrey Peppercorn, MD, MPH (consultant), and Lynne Wagner, PhD (consultant). IMPACT. In line with NCCIH funding priorities, the proposed research will answer critical questions about (1) the feasibility and acceptability of mind-body approaches for hard-to-manage symptoms and (2) potential mechanisms underlying resiliency. While initial studies will focus on cancer survivors, it is anticipated that the candidate?s training and research will have broad applications to a variety of medical populations struggling with uncertainty about illness recurrence. Through this K23 award, the candidate will gain the training and preliminary data needed to apply for a larger NCCIH clinical trial (e.g., R01 or U01) to determine the optimal integration and dosage of mind- body skills for managing FOR and potential downstream effects on healthcare engagement.

Public Health Relevance

Fear of recurrence (FOR) is a common, highly distressing difficulty after diagnosis of a chronic and/or life- threatening illness that may increase risk for poorer clinical outcomes by influencing healthcare engagement (e.g., frequency of follow-up screening). Among cancer survivors, a population growing in prevalence, clinically-impairing FOR is pervasive and can persist for years. Using qualitative and quantitative methods, this project will assess the feasibility and acceptability of an adapted mind-body intervention targeting FOR among cancer survivors and will inform the science of managing these fears and their clinical consequences among medical populations more broadly.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZAT1)
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Mudd, Lanay Marie
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Massachusetts General Hospital
United States
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