The statistics on sexual abuse (SA) are staggering: 1 in 4 women and 1 in 6 men have experienced abusive sexual experiences before the age of 18. Healthcare procedures, even those that may seem minor or routine, share similarities with childhood sexual abuse (e.g., insertion of objects into the body, exposure, vulnerability, pain, powerlessness). Due to these similarities, SA survivors can feel retraumatized by healthcare procedures. Not surprisingly, to avoid this retraumatization, SA survivors may avoid healthcare (e.g., delay or cancel treatment). Despite the often invasive/intimate medical procedures involved in cancer treatment, and the serious consequences of cancer treatment avoidance, there has been no empirical study to date of the relationship between cancer treatment retraumatization and cancer treatment avoidance in sexually abused cancer (SACA) patients. Objectives: The overall goal of the project is to develop a greater understanding of SACA patients experiences of cancer treatment, how this suffering relates to treatment avoidance, and which SACA patients are most at risk for cancer treatment retraumatization and avoidance.
Specific Aims are to: 1) test the hypothesis that increased cancer treatment retraumatization will be associated with increased cancer treatment avoidance in SACA individuals;2) test the hypotheses that increased cancer treatment retraumatization and avoidance will be associated with: a) SA severity (e.g., duration, force), b) exposure to other types of childhood abuse, and c) exposure to pre-cancer traumatic life events;and, 3) explore the influence of gender and cancer characteristics on study outcomes. Methodology: The study is guided by the Healthcare Retraumatization Avoidance (HRA) model.
Aims 1 -3 will be accomplished through an online survey administered to 600 SACA patients (300 men, 300 women) recruited from SA survivor support websites, a cancer support website, and a crowdsourcing website (Amazon Mechanical Turk). The online approach will improve patient experience by providing anonymity, and will improve the generalizability of the project by allowing for nationwide recruitment. Path analysis will be used for study analyses. Long-term goals: The proposed study is a critical first step toward improving quality of care and quality of life of SACA patients undergoing cancer treatment. The project will advance scientific knowledge and will aid the cancer care community in understanding the difficulties SACA patients experience during cancer treatment. Results will serve as a foundation for a program of research including the development of interventions and assessment tools to reduce cancer treatment retraumatization and avoidance in this vulnerable population. Connection to NIH/NCI mission: This project is consistent with the Healthy People 2020 goal of improving quality of life of cancer patients and survivors.

Public Health Relevance

Adult survivors of childhood sexual abuse represent a large, vulnerable, and underserved population of cancer patients and survivors, whose retraumatization through cancer and its treatment has been largely overlooked. At the conclusion of this project, we will have filled the critical public health need for greater knowlede about, and an empirically supported model of, cancer treatment retraumatization and cancer treatment avoidance in childhood sexual abuse survivors. Results of the proposed exploratory study will inform the development of new interventions to reduce cancer treatment retraumatization and avoidance in survivors of childhood sexual abuse, and to improve their quality of life as they undergo cancer treatment.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZCA1-SRLB-B (O1))
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Nelson, Wendy
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Icahn School of Medicine at Mount Sinai
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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