In a series of symptom intervention studies, we have been evaluating different approaches to alleviate distressing symptoms during the cancer experience. In a previous clinical, trial, we demonstrated that teaching individuals how to conserve energy during cancer treatment was effective in reducing cancer-related fatigue. Based on the idea that symptoms occur in clusters and that the presence of more than one symptom can increase the severity of other symptoms, we evaluated a cognitive behavioral intervention focused on reducing both fatigue and sleep disturbance during cancer chemotherapy. That intervention was not effective in alleviating either symptom possibly due to the intensity of cancer therapy or lack of sufficient time for development of behavioral skills needed to fully engage participants in the intervention. Our most recent study takes a closer look at women undergoing chemotherapy for breast cancer, the severity of four symptoms (fatigue, insomnia, pain and depression), the type and amount of intervention used, and its effectiveness in alleviating symptoms. New directions for this research include developing a personalized symptom intervention and examining the biological basis for cancer-related symptoms. 

As survival time lengthens, work outcomes have become increasingly important to colon or rectal cancer (CRC) survivors as a symbol of better quality of life and return to normalcy. Yet, a review of research on return to work after treatment shows that cancer survivors in the U.S. are 1.5 times more likely to be unemployed than European survivors; also, compared with other cancer diagnoses, CRC survivors are at increased risk of unemployment. Extending our interest in quality of life, we are studying work outcomes of colon and rectal cancer survivors; we are looking at whether or not they return to work, how long it takes to return to work, whether symptoms such as fatigue, sleep disturbance, neuropathy, cognitive changes, urinary or bowel symptoms, and emotional distress are likely to result in lower rates of return to work, longer time until return, more part-time hours, and lower satisfaction with work. Our goal is to identify modifiable risk factors for poor work outcomes and develop interventions to facilitate the transition back to the workplace. 

Research on survivorship has focused primarily on Caucasian women. Less is known about a large group of survivors-- African American women -- despite the possibility of more advanced disease at diagnosis and poorer overall prognosis. Because their survivor experience could be different from Caucasian women, we are taking a more in-depth look at the quality of life of African American breast cancer survivors (AABCS). We are using mixed methods including qualitative and quantitative approaches to evaluate the problems and resources of AABCS who completed primary treatment. A stress-coping model of quality of life is being used to guide the study. We are working in collaboration with a Community-Academic Advisory Board that includes health care professionals and community advocates who work with AABCS. The board advises us in planning each phase of the research, assists in recruitment of study participants, and helps us interpret the study findings and plan for future research. Board members and the community organizations they represent have the benefit of research-derived information about the problems and resources of AABCS. Our goal is to collaborate with the advisory board in developing educational and supportive care resources for AABCS and evaluating these resources in future research.