This award will provide a translational and multidisciplinary research training experience for Annalynn Williams, M.S., a doctoral candidate in epidemiology at University of Rochester School of Medicine and Dentistry. Ms. Williams intends to pursue a career in cancer survivorship research that addresses questions of direct clinical relevance using an innovative research paradigm that combines public health, clinical, and basic science approaches. This is of emerging importance as the number of cancer survivors is expected to reach 18 million by 2022 . Cancer-related cognitive impairment (CRCI) and other psychosocial symptoms (e.g. anxiety, depression, fatigue, etc) are frequently reported by cancer survivors, and cytotoxic treatments are believed to be an important contributor. However, it is not yet known what factors and mechanisms increase survivors? susceptibility to CRCI and other sequelae. The National Cancer Institute has recognized the need for further research dedicated to this issue and has established it as a priority. Up to 10 million cancer survivors will experience CRCI before, during, or years after treatment for their disease. Some evidence suggests that CRCI may occur through various pro-inflammatory neurotoxic pathways but the relative contribution of cancer-related pathology and cancer treatment to CRCI and inflammation is currently unknown. The overall goal of this proposal is for Ms. Williams to enter the field of cancer survivorship research (Aim 1) by addressing a research question targeted at treatment, inflammation, and cognition using a feasible approach that takes advantage of a well-established clinical research infrastructure (Aim 2). She will subsequently pursue a postdoctoral fellowship that will provide further training to study the biological and clinical consequences of cancer and its treatment (Aim 3) preparing her for a career as an independent investigator in translational cancer survivorship research. This dissertation research project will examine whether cancer biology is related to CRCI prior to treatment and whether treatment exacerbates this effect, and to examine the role of inflammation in the relationship between cancer and CRCI. We will recruit a population of chronic lymphocytic leukemia (CLL) survivors. This population was chosen because of its indolent disease course and pro-inflammatory microenvironment, which will allow us to better examine the role of inflammation and cancer pathology in CRCI before and after cancer treatment. Ms. Williams has worked closely with her co-sponsors to develop a predoctoral training plan which includes didactic and mentored training in immunology, cancer biology, neuropsychological assessment, and laboratory methods. This plan will ensure the feasibility and quality of the research, and will provide an excellent foundation for a postdoctoral fellowship that will focus on studying the biological mechanisms of additional cancer-related neuropsychological and psychosocial sequelae in adolescent and young adult survivors. These study aims provide a feasible, focused and targeted plan for Ms. Williams to achieve her long-term career goal of becoming an independent researcher in cancer survivorship.
Over 10 million cancer survivors will experience cancer-related morbidities that will lessen their quality of life, inhibiting their ability to work and altering their lifestyles. Psychosocial challenges, including cancer-related cognitive impairment are commonly reported shortly after treatment but we do not yet know whether symptoms are due to cancer itself, treatment, or a combination of both. A better understanding of their respective roles will guide new approaches to manage such symptoms. Studying cognitive impairment and the role of inflammation in chronic lymphocytic leukemia survivors will serve as a model to examine the biological basis for other psychosocial morbidities in cancer survivors.