Jenny J. Lin, MD, is a general internist at the Mount Sinai School of Medicine. The candidate's long-term goal is to become an independent clinician-investigator working at the intersection between cancer survivorship and chronic disease management. More specifically, the candidate is interested in understanding the cognitive and emotional factors that affect cancer survivors' self-management of chronic comorbid diseases and to use this knowledge to develop, test, and disseminate behavioral interventions that can improve cancer survivors' management of comorbid illnesses. The candidate became involved in this area as she transitioned from being an established clinician-educator to a clinician-investigator and started to examine barriers to and facilitators of medication adherence to hormonal therapies in breast cancer survivors. The proposed career development plan combines a closely-mentored cancer control and behavioral sciences project with multidisciplinary, didactic training in health psychology (including behavior change and health beliefs), survey design, and complex data outcomes analysis. Diabetes is one of the most common comorbid illnesses affecting cancer survivors. This chronic disease and its complications are associated with considerable morbidity and mortality in cancer survivors. Additionally, diabetes may also impact cancer risk and prognosis. However, little is known about the impact of a new cancer diagnosis on patient self-management behaviors for cancer survivors with diabetes and of the impact that cancer has on diabetes control. Under the mentorship of cancer researchers, Juan Wisnivesky, MD, DrPH; Nina Bickell, MD, MPH; and Michael Diefenbach, PhD, the candidate will study the short- and longer-term impact of a new diagnosis of early-stage breast or prostate cancer on diabetes management and outcomes. The goals of the research component will be (1) to assess the relationship between new cancer diagnosis and diabetes control; (2) to evaluate the impact of cancer diagnosis on diabetes self-management behaviors, such as medication adherence, glucose self-monitoring, diet control and exercise; and (3) to elucidate the cognitive and emotional factors (such as health beliefs, depression, anxiety and stress) that mediate the association of cancer with poorer diabetes self-management behaviors and control. To achieve these goals, the candidate will prospectively assess diabetes control via hemoglobin A1c levels and monitor adherence to oral diabetes medications in a cohort of 200 diabetic patients with newly diagnosed early-stage breast or prostate cancer and 150 age- and gender-matched control diabetic patients without cancer. Adherence will be measured with electronic monitoring caps and via patient self-report using a standardized survey instrument. Self-management behaviors will be assessed using standardized survey measures, and validated survey instruments will be used to assess symptoms of depression, stress and anxiety, health beliefs and mental models of disease. Patients will be surveyed at enrollment and at 3, 6 and 12 months. We will use multivariate methods and structural equation modeling to test the proposed aims.
The impact of a new diagnosis of breast or prostate cancer on outcomes and self-management behaviors for other chronic diseases is still not clear. Understanding the factors that are associated with risks for poor diabetes control and self management in both the acute and chronic phase of cancer survivorship may help physicians better identify those who are at risk for poor self-management and to develop interventions to help cancer survivors manage their multiple comorbidities.
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