Self-management and survivorship

The proportion of people surviving cancer and living with chronic conditions is increasing. As a consequence, there is greater demand for self-management interventions that enable survivors to manage long-term side-effects and outcomes of treatments and to cope with the challenges of long-term conditions and survivorship. The group have undertaken work in supporting cancer patients back to work, managing late effects of treatments (such as hot flushes and night sweats) and examining the impact of hormonal treatments (such as androgen deprivation therapy) on cognitive function. As primary treatments improved for cancer and chronic conditions then there will be an increased demand for improved knowledge regarding the psychosocial and cognitive impact of surviving and a need for interventions to support patients, such as those implemented by BRiC.

WorkPlan project

Supporting return to work following cancer diagnosis and treatment

While the number of cancer survivors in the UK is increasing, evidence suggests that those who have survived cancer are less likely to return to work, or more likely to leave work at an earlier age than those who have not received a cancer diagnosed. However, returning to work after being treated for cancer is important for many reasons, with financial security being just one of them. Furthermore, not returning to work is known to have a negative impact on an individual’s psychological and physical wellbeing.

The WorkPlan intervention targets known psychological factors and practical barriers to returning to the workplace to improve the working lives of cancer survivors. The intervention is workbook-based, and the workbook sessions are structured to provide guidance and support to patients.

This theory-based intervention has been examined in a feasibility study of a randomised controlled trial with a 12 month follow-up. 65 cancer patients were randomly assigned to one of two arms of the trial (a guided intervention or usual care). The intervention was found to be acceptable and useful in supporting return to work.

WorkPlan is currently being developed in an interactive app which we plan to trial over the coming months working with people who have received a diagnosis of cancer but not yet returned to work.

For further information about this project contact Beth Grunfeld (e.grunfeld@bbk.ac.uk)

Grunfeld EA, Schumacher L, Armaou M, Woods PL, Rolf P, Sutton AJ, Zarkar A, Sadhra SS. Feasibility randomised controlled trial of a guided workbook intervention to support work-related goals among cancer survivors in the UK. BMJ Open. 2019;9(1):e022746. doi: 10.1136/bmjopen-2018-022746

Armaou M, Schumacher L, Grunfeld EA. Cancer Survivors’ Social Context in the Return to Work Process: Narrative Accounts of Social Support and Social Comparison Information. J Occup Rehabil. 2017. doi:10.1007/s10926-017-9735-9

Schumacher L, Armaou M, Rolf P, Sadhra S, Sutton AJ, Zarkar A, Grunfeld EA. Usefulness and engagement with a guided workbook intervention (WorkPlan) to support work related goals among cancer survivors. BMC Psychol. 2017 4;5(1):34. doi: 10.1186/s40359-017-0203-2

CogCan project

Prostate cancer survivors receiving long-term androgen deprivation therapy (ADT) sometimes experience debilitating side-effects, including changes in cognitive function.  The project will identify which cognitive domains (thinking skills) are affected by androgen deprivation therapy and whether some people are more at risk of decline in thinking skills performance. This is an innovative project combining: (1) cognitive testing (tests of thinking skills such as memory), (2) psychosocial measures (e.g. mood, fatigue), (3) brain imaging and (4) blood biomarkers (to assess testosterone levels and genetic risk of cognitive decline).

The study will allow us to record potential risk factors prior to starting ADT to identify baseline factors that predict performance on tasks at follow-up.

Currently, we do not have a clear understanding of the factors that might make patients receiving ADT more at risk to changes in thinking skills (for example, age-related brain changes), or whether there are protective factors that might make a person more resilient to these changes (for example, good psychosocial status). By providing this information, our study would offer men and their prescribing doctors evidence-based information to support decision-making. It would also allow us to develop specific, focused interventions to mitigate the impact of changes in thinking skills on everyday functioning (for example, through strategies to improve memory or aid planning skills).

For further information about this project contact Beth Grunfeld (e.grunfeld@bbk.ac.uk)

Joshee P, Wood AG, Jones ER, Grunfeld EA. Cognitive functioning in patients following Renal Transplantation: a Systematic Review and Meta-analysis. Kidney International

Grunfeld EA, Halliday A, Martin P, Drudge-Coates L. Andropause syndrome in men treated for prostate cancer: a qualitative study of the impact of symptoms. Cancer Nurs. 2012. 35(1):63-9.

Lama: Life after mastectomy

There is a lack of research in the UK examining the needs, preferences and experiences of breast treatment and reconstruction among Black and minority ethnic women. Research in this area has the potential to play a key role in reducing the disparities in breast reconstruction uptake and improve outcomes among women in the UK. Existing support interventions are not tailored towards the needs, language requirements and decision-making style of Black and minority ethnic

women, who may involve family and community support to a greater degree than observed among White women. This means that the support interventions that have been developed to date are likely to lack relevance and usefulness for Black and minority ethnic women. Therefore, there is a need to develop an intervention to support decision making around breast reconstruction that is culturally sensitive to the needs and involvement not only of women themselves but also significant others who support or participate in the decision-making process. This will lead to improvement in the provision of breast reconstruction services to all women in the UK living with a diagnosis of breast cancer.

The LAMA project examines experiences of women following mastectomy for breast cancer. We are currently recruiting women to take part in interviews looking at their experiences of decision making regrading breast reconstruction (we are speaking with women who have chosen not to undergo breast reconstruction and who have undergone breast reconstruction). Please contact Gemma Hutton for further details

Matthews H, Carroll N, Renshaw D, Turner A, Park A, Skillman J, McCarthy K, Grunfeld EA. Predictors of satisfaction and quality of life following post-mastectomy breast reconstruction. Psychooncology. 2017;26(11):1860-1865

Matthews H, Grunfeld EA, Turner A. The efficacy of interventions to improve psychosocial outcomes following surgical treatment for breast cancer: a systematic review and meta-analysis. Psychooncology. 2017;26(5):593-607.