Led by Jean-Philippe Laurenceau, Unidel A. Gilchrist Sparks III Chair in the Social Sciences and professor in the Department of Psychological and Brain Sciences,
the research team will focus on three main health behaviors that can be
influenced by recurrence fears but also can potentially protect
survivors against future recurrence. These behaviors include taking
therapeutic hormonal medicines, physical activity and quality sleep. The
team will study the physical activity and sleep quality of the
patient’s spouse or partner, too, since they also experience disruption
when a loved one has cancer.
According to Laurenceau, fear of recurrence is a top concern for
cancer patients and arguably the most commonly shared adverse
psychosocial effect of cancer and its treatment.
“It is not just physical symptoms they have to live with. Fear of
cancer recurrence is a psychological symptom that is a consequence of
having cancer and can persist for months or years,” said Laurenceau.
“If this symptom becomes chronic and interferes with an individual’s
ability to engage in recommended health behaviors that actually might
protect them, it will affect their long-term ability to reach their
treatment goals and to reduce their chance for recurrence. We’re
interested in understanding what breast cancer patients and their
spouses or partners are experiencing from the couple’s perspective, not
just the patient alone.”
Underscoring the need for this work is that cardiovascular and
metabolic disease have been directly linked to long-term outcomes of
recurrence in breast cancer patients, as well as morbidity and mortality
for both patients and spouses.
The work is a collaborative project with ChristianaCare’s Helen F. Graham Cancer Center and Research Institute.
“Cancer treatment extends beyond surgery, chemotherapy and radiation.
We know it's important to address the psychosocial needs for our
patients and their loved ones,” said Dr. Nicholas J. Petrelli, medical
director for the Graham Cancer Center and Research Institute. “This
important study, forged from a robust partnership between UD and the
Graham Cancer Center at ChristianaCare, has the strong potential to help
us improve the delivery of cancer care for our community and inform
best practices nationally."
Understanding the role of worry
Shortly after arriving at UD in 2005, Laurenceau began collaborating
with Scott Siegel, a clinical health psychologist who practices in the
cancer center and director of Population Health Research at
ChristianaCare’s Value Institute. Laurenceau and Siegel noticed that
fear of cancer recurrence was a common clinical problem reported by
This new NIH-funded project represents the culmination of several
peer-reviewed publications and other grant projects funded by the National Cancer Institute.
It builds on preliminary data from previous NIH-funded projects
suggesting that fear of cancer recurrence may be linked to greater
sedentary behavior and weight gain, less adherence to doctor-recommended
medication regimens, and increased sleep disruption.
In a recent study,
the research team further found that when patients — or their
significant others — felt they couldn’t share their fears of recurrence
with a partner, they typically experienced greater levels of fear, even
on a daily basis. The couples tended to feel a less intimate connection
on days when they felt more inhibited about disclosing cancer-related
“Human beings aren’t as rational as we like to think, and our
decisions are often dictated by our emotions,” Laurenceau said. “When
fear gets to a certain level and we can’t process it with our
significant others, we can’t think straight, so we’re going to do
What makes fear of cancer recurrence different from other fears is
that there is a possibility that the cancer actually may recur and lead
to death, even if the probability is small.
The research team plans to follow approximately 300 early-stage
breast cancer patients and their partners for two years following
surgery, to explore the couple’s everyday habits and reactions in terms
of fear of recurrence.
“We want to see if the fear of cancer recurrence gets better after
the first or second mammogram when results come back okay, which will be
the case for the vast majority of these patients,” said Laurenceau.
Both the patients and their partners will complete daily electronic
diaries of their activity, interactions and relevant thoughts, feelings
and behaviors, including any worries. The approach, developed by
Laurenceau and a colleague, leverages what Laurenceau calls “intensive
longitudinal methods,” to track patients rigorously over multiple weeks
to gain a sense of their everyday life and communications. The couples
also will wear research-grade continuous activity trackers, similar to
the common Fitbit, to allow the researchers to correlate the
participant’s diary entries with objective measures of sleep quality and
“People are not the best reporters of their own behavior,” said
Laurenceau. “For example, while you might have a general sense of how
many hours you slept last night, that doesn’t always map onto the data
that are recorded if you wore an activity tracker overnight.”
UD graduate students involved in the project will collect additional
health data, such as cholesterol, blood sugar levels and body
composition, all of which are considered indicators for long-term health
and wellness. In addition to research experience, students gain
valuable clinical training as psychotherapists alongside
psycho-oncologists at ChristianaCare and learn ways to help patients
relieve worry and stress to promote healing and recovery.
“Students are integral to this work. They are involved in everything
from helping design the study and collect the data to recruiting and
monitoring patients’ well-being to publishing study results,” Laurenceau
Adherence to oral hormonal medication, for example, is one of the
biggest predictors of longer life for breast cancer patients and lowers
the chances of actual cancer recurrence. Yet some survivors struggle
with taking their medication regularly, said Laurenceau. He suspects
there may be a number of reasons for this, from potential side effects
that the medicine may cause to the fact that the physical act of taking
medication is a constant reminder that a person has cancer.
Poor sleep is associated with greater risk of cardiometabolic disease
and shortened lifespan, even without a cancer diagnosis. Laurenceau
explained it is well-documented that breast cancer patients, in
particular, experience a lot of sleep disturbance, but his research team
also has preliminary evidence that sleep disturbance affects
Laurenceau said he hopes this research will produce a better
understanding of how this fear can help drive interventions to improve
health behaviors and increase well-being among patients and their
spouses. This aligns with the recent Cancer Moonshot Blue Ribbon Panel report, which calls for symptom management research related to cancer.
Research challenges during a pandemic
For scientists across the world, including Laurenceau, conducting
research during a global pandemic brings many new challenges. For
example, Laurenceau’s research team typically recruits patients to their
studies soon after surgery for early-stage breast cancer, but these
processes have been disrupted under current best practices during the
The UD research team does not expect to begin recruiting study
participants until the pandemic threat has passed. While disappointing,
Laurenceau is mindful of the greater toll to patients undergoing any
number of treatments.
“It’s amazing to me how this pandemic is affecting so many people
across all walks of life, many of whom are in the middle of managing
significant medical conditions,” said Laurenceau.
About the research team
Jean-Philippe (J-P) Laurenceau, who is the project’s principal
investigator, is the Unidel A. Gilchrist Sparks III Chair in the Social
Sciences and professor in the Department of Psychological and Brain Sciences, which is within the College of Arts and Sciences.
A clinical psychologist, Laurenceau has served on the editorial boards
of several industry journals and is a regular grant reviewer for the
NIH. He is co-author of over 100 publications, including a book on how
to conduct intensive longitudinal research using daily-diary and
experience sampling methods. He said he was inspired to conduct
cancer-related research by the memory of his father, who died from
UD collaborators on the project include faculty members Jillian Trabulsi and Michael Mackenzie from the College of Health Science’s Department of Behavioral Health and Nutrition,
and three doctoral students under the advisement of Laurenceau in the
Department of Psychological and Brain Sciences: Emily Soriano, Christine
Perndorfer, and Alyssa Fenech, who will join UD this summer.
Scott Siegel is a trained clinical health psychologist with a
specialty in psycho-oncology. He previously served as director of
psychosocial oncology and cancer survivorship in the Helen F. Graham
Cancer Center and Research Institute. He maintains a clinical practice
within the cancer center, while also coordinating ChristianaCare’s
systemwide research on population health. Siegel also is an adjunct
associate professor within UD’s Department of Psychological and Brain
The project also involves collaborator Michelle Eakin, faculty and
co-director of the Adherence Research Center at Johns Hopkins School of
Article by Karen B. Roberts; illustration by Jeffrey C. Chase
Published May 12, 2020