Combating Cancer from All Angles

Through wide-ranging studies, researchers aim to improve survivorship and quality of life for cancer patients and caregivers.

In treating cancer, nurses care for the entire patient. At Case Western Reserve University's Frances Payne Bolton School of Nursing, this same spirit informs how nurse scientists approach oncology-related research—from the pain patients experience to the stress their caregivers face.

“Cancer is broad, so our focus must be, too,” said Ronald L. Hickman Jr., PhD, RN, associate dean for research and the Ruth M. Anderson Professor. “The new knowledge we discover directly contributes to effective and equitable cancer care around the world.”

Many School of Nursing faculty conduct oncology-related research with funding from the National Institutes of Health (NIH) and the National Cancer Institute (NCI), continuing a legacy of discovery and knowledge creation that has been characteristic of the institution since its inception.

Caring about caregivers

As the Gertrude Perkins Oliva Professor in Oncology—one of the only dedicated oncology professorships at a nursing school in the U.S.—Sara L. Douglas, PhD, RN, understands the critical importance that caregivers, and their own wellbeing, can have in the treatment outcomes of cancer patients.

Douglas recently published findings from a four-year, $2.3 million National Institute of Nursing Research study that found ways to integrate distance caregivers into the treatment of their family members.

A combination of methods—including having caregivers attend oncology appointments by videoconference and receive one-on-one coaching sessions from health professionals—can reduce the stress and anxiety that stems from a lack of information about a patient’s diagnosis and treatment, Douglas’ research team found.

Caregivers are also at the center of research by Susan R. Mazanec, PhD, RN. The associate professor of nursing is testing ways to support family caregivers helping patients with multiple cancer-related symptoms during treatment.

In Mazanec’s ongoing NCI-funded study, caregivers—who often use a variety of devices and techniques to manage symptoms—receive a combination of support, education and technical skills training.

The aim is to strengthen the family caregivers' abilities and confidence, as well as improve their emotional and physical health—which may also provide better outcomes for patients.

“We rely a great deal on caregivers to assist in care of patients at home,” said Mazanec. “Family caregivers need their own forms of support because their work can be very complex and difficult.”

Now in its fourth year, the study received a NIH MERIT Award—a recognition given to exceptional early-stage investigators that provides funding for two additional years. The extension allows Mazanec to further explore how social and economic conditions influence the effectiveness of the intervention.

Collaboration in action

Mazanec’s team, which includes physicians, a biostatistician, a medical economist and others, is indicative of the collaborative nature of the nursing school's cancer-related studies. Research by Amy Y. Zhang, PhD, a faculty member at both CWRU's medical and nursing schools, is no exception.

In her recent work, Zhang looks at how biological and psychological factors affect patient mental well-being. Her studies have connected inflammation in cancer patients to the depression they experience. She has also identified how irritability in patients correlates with specific biomarkers—and developed a scale to measure the phenomenon. 

“Patient biological data can help predict how irritability can influence depression during different stages of treatment,” said Zhang. “This data may help us intervene earlier and more effectively.”

Along with Zhang and Douglas, Associate Professor Chao-Pin Hsiao, PhD, RN, is a member of the Case Comprehensive Cancer Center, a research consortium among Case Western Reserve, Cleveland Clinic and University Hospitals that is one of only 53 in the U.S. earning NCI designation.

Supported by an NIH award, Hsiao’s latest research investigates how chemotherapy impacts mitochondrial bioenergetics—key to multiple basic cellular processes—and cancer-related fatigue symptoms in breast cancer patients. 

“The results may enable us to discover biomarkers, identify therapeutic agents and support the design of nonpharmacological interventions,” said Hsiao. “We also may be able to initiate precision symptom management to improve cancer-related fatigue.”

New additions 

Even with all of this research, the portfolio of cancer-related research at Frances Payne Bolton School of Nursing is growing.

Recently appointed Assistant Professor Monica Wagner, PhD, has been awarded an NIH grant to explore how environmental and behavioral factors can affect genetic expressions in patients experiencing pain related to head and neck cancers. Looking for common genetic patterns, Wagner is seeking to establish characteristics of patients, or phenotypes, that could provide paths for treating those more likely to experience pain. 

“The biology behind pain is so vast,” said Wagner. “Pinpointing patient phenotypes could allow us to intervene to lessen or avoid its development.”

Postdoctoral fellow Maura McCall, PhD, RN, who joined the nursing school last summer, examines how environmental and biological factors influence how faithfully patients take medications known as aromatase inhibitors, a class of drugs treating breast cancer in postmenopausal women. 

By gleaning a fuller picture of patient health from inside and outside the body, McCall hopes to pinpoint interventions to improve medication adherence. 

“Nurses approach research questions in a unique way,” said McCall. “In search of answers, we’re trained to consider the social, biological, psychological and spiritual all together.

“We don’t just look at cells in a tumor,” she added. “We look at the tumor in the person who is in a family, in a community, in a city.”

This article appears in the Fall/Winter 2022 issue of Forefront Magazine.