Faculty Summaries
Suzanne M. Miller, PhD
Suzanne M. Miller, PhD
Professor
  • Director, Psychosocial and Biobehavioral Medicine Program
  • Director, Behavioral Center of Excellence in Breast Cancer
  • Director, Intervention Development and Measurement Core of the Cancer Information Service Research Consortium
  • Professor, Cancer Prevention and Control Program
  • Director, Behavioral Research Facility
Suzanne.Miller@fccc.edu
Office Phone: 215-728-4069
Fax: 215-214-1651
Office: P4149
  • Counseling Intervention for High Risk Women

    Drs. Miller and Daly evaluated the impact of an enhanced counseling intervention among high-risk women undergoing BRCA1/2 genetic testing on knowledge about the heritability of breast and ovarian cancer and on psychological distress. Enhanced counseling involved structured role-play, in which women were helped to anticipate and plan for the disclosure of all possible testing outcomes. Compared to women in the control group, women in the intervention group exhibited greater knowledge about the heritability of breast and ovarian cancer one week after the intervention. One week after genetic test result disclosure, mutation carriers in the control group experienced high levels of intrusive ideation, whereas mutation carriers who had received the enhanced counseling intervention experienced low levels of intrusive ideation and significantly less cancer-related worry than carriers in the control group. A sub-sample of participants provided an audio-taped account of their thoughts and feelings about their familial cancer risk and their decisions regarding genetic testing. A qualitative analysis of these transcripts showed that unaffected women who received enhanced counseling demonstrated deeper processing of risk feedback than the control group. This unique data set combines qualitative and quantitative approaches to the understanding and analysis of how individuals process complex risk-related decisions. A publication is currently in press that is based on this study (Miller et al, Enhanced Genetic Counseling for Women Undergoing BRCA1/2 Testing: Impact on Knowledge and Psychological Distress - Results From a Randomized Clinical Trial. Psychology and Health).

  • Smoking Cessation for Low-Income Pregnant Women

    In an ACS-funded study, Dr. Miller compared the efficacy of a Cognitive-Behavioral Counseling smoking cessation intervention to a Best Practice control for reducing smoking among pregnant women. Analyses show that access to care was an important barrier to the decision to stop smoking. Further, perceived disadvantages of quitting, anxiety, anger, and fatalism were barriers to cessation at baseline; however, at the 2-6 week post-partum follow-up session, self-efficacy and perceived risk were more important decisional barriers. Additional analyses of data relating to predictors of attendance at smoking cessation intervention sessions show that greater pre-pregnancy smoking addition predicted non-attendance at prenatal intervention sessions; that high self-efficacy and low educational attainment predicted non-attendance at the postpartum sessions; that number of children predicted increased rescheduling during the postpartum period; and that a higher smoking rate at baseline predicted inability to complete the prenatal follow-up session. Dr. Miller is currently in the process of submitting a manuscript based on this study.

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  • Cancer Information Service Research Consortium (CISRC) Program Project Grant

    Dr. Miller plays an integral role in the recently NCI-funded multi-site program project, “Cancer Information Service Research Consortium”. She serves as the co-principal investigator of the Program Project, the co-principal investigator of Project 1, and the principal investigator of the Intervention Development and Measurement Core, which has ultimate responsibility for the development and pre-testing of the multi-media programs produced under this grant. Thus far, the project has completed development of three innovative, multi-media intervention programs that are designed to address the concerns and unmet needs of breast and prostate cancer patients during their treatment decision-making (projects 1 and 2, respectively) and of cancer survivors during the adaptation period following primary breast cancer treatment (project 3). These programs expand the usual CIS services by proactively providing decision making preparation, values clarification, and skills building in communication with providers and family. The evaluation of these programs is now underway via a set of randomized trials. Innovative cross-project exploratory analyses will be conducted for a core set of shared resources outcomes, analyses which will be the first of their kind across an extended segment of the cancer survivorship continuum. By collaborating with all regional call centers of the CIS, the CISRC has mobilized the premiere cancer information program in the nation to partner in the evaluation of the interventions that this project has produced, resulting in an unprecedented opportunity to conduct the three intervention trials simultaneously, with ample statistical power, and with significant potential for dissemination and incorporation into ongoing health systems of care.

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  • Navigating Pennsylvania Cancer Patients (NPCP) Program

    With funding from the Pennsylvania Department of Health, Dr. Miller and Linda Fleisher have completed a three year project whose aims were to develop, implement and evaluate a theory-guided patient navigator program. The program provides culturally and linguistically appropriate guidance and support to breast, cervical, colorectal, and prostate cancer patients with abnormal screening findings and/or cancer diagnoses. It also includes an interactive navigator training curriculum and integrated linkages to key cancer services and programs. The program evaluated favorably with respect to the target criteria of acceptability, feasibility, and impact within an urban minority and rural population in which cancer health disparities are evident. The project also resulted in important lessons learned from the perspectives of program management, the navigators themselves, and the site supervisors. The success of this demonstration project now warrants exploration of broader dissemination. A study within this project based on 72 participants enrolled in the program (~56% breast cancer patients)) found that patients reported high satisfaction with the service they received, especially in the areas of seeking cancer information, answering medical concerns, and scheduling recommended appointments. It also found that both affect and self-regulatory scores were significantly improved from baseline to the 4-week assessment, as were satisfaction scores from the 4-week to the 12 week assessments.

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  • Facilitating Follow-up Adherence for Abnormal Pap Smears

    Dr. Miller is conducting an NCI-funded randomized controlled trial that aims to evaluate a theory-guided, tailored counseling intervention, delivered through either a telephone or mail-home print channel. The intervention is designed to assess and address cognitive-affective barriers to adherence to medical recommendations among low-income African American and Latina women immediately after notification of an abnormal Pap test result. Outcome measures include adherence to initial colposcopy and to follow-up management recommendations and intervention cost-effectiveness. This study is being evaluated in a service-delivery setting, thereby allowing for a realistic test of feasibility, as well as an evaluation of a translational model for delivery. It will also serve as a highly transportable prototype for dissemination within communities of need, and as a result can be expected to contribute to the reduction of disparities in cervical cancer morbidity and mortality. Building on Dr. Miller’s years of experience and funded research in this area, and the synergy of this study with her growing portfolio of innovative theory-guided interventions, study findings will lay the groundwork for counseling protocols that can be readily disseminated into routine care to increase adherence to medical regimens in other disease contexts, particularly among underserved populations, with a view to ultimately reducing disease disparities more generally.

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  • Breast Cancer Risk Assessment and Screening Behavior Among the Underserved

    As part of Dr. Miller's DOD-funded Behavioral Center of Excellence in Breast Cancer Awareness, she has completed data collection on the study that aims to understand the unique psychological barriers to and facilitators of interest in and utilization of participation in breast cancer risk assessment programs for first-degree relatives of African-American women diagnosed with breast cancer. Focus groups with African-American first-degree relatives of breast cancer patients were conducted in the first phase of the study; data from these focus groups have been used to develop a questionnaire for the psychosocial assessment of barriers to and facilitators of participation in risk assessment programs and adherence to screening guidelines. In the current second phase of the study , the reliability and validity of this questionnaire are undergoing evaluation among African-American women at high risk for breast cancer. Preliminary data analysis indicates that almost one third of the sample reported that they do not understand genetic testing or family risk assessment for breast cancer, and over one third have minimal understanding of how to obtain genetic testing or a family risk assessment. Notably, cost of screening, health insurance, and time were not considered significant barriers to obtaining risk assessment. Findings of this study will be used to develop a culturally sensitive, tailored intervention designed to promote interest in breast cancer risk assessment and breast cancer screening adherence among African-American women at high risk for breast cancer.

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  • Facilitating Re-entry Following Adjuvant Treatment for Primary Breast Cancer

    As part of Dr. Miller's DOD-funded Behavioral Center of Excellence in Breast Cancer Awareness, she is conducting a study that aims to evaluate the efficacy of a tailored Cognitive-Affective Preparatory counseling intervention designed to address the individual's cognitive-affective barriers to adaptive adjustment from active treatment to follow-up care, referred to as "the re-entry phase." Results of three focus groups indicate that breast cancer survivors do not feel adequately informed about or prepared for the challenges they face during re-entry. The intervention provides strategies for dealing with continuing concerns, unmet needs, and practical barriers to coping with the re-entry phase. The adjustment of women receiving the barriers counseling protocol is being compared to the adjustment of women receiving standard care plus NCI's booklet-Facing Forward, “Life after Cancer Treatment,” which addresses major areas of concern during re-entry. The principles tested and the techniques developed in this study are relevant not only to the medical and psychosocial management of breast cancer survivorship, but also lay the groundwork for other cancer survivorship counseling protocols.

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  • Evaluation of Facing Forward Manual

    In a randomized trial being conducted through the network hospitals, Dr. Miller is evaluating the NCI's newly revised manual for cancer patients going through the re-entry phase, “Facing Forward: Life after Cancer Treatment.” The manual contains content representing the major documented domains of information needed by individuals who are in the re-entry phase. Specific behavioral recommendations are provided for each area of concern. The goal is to evaluate the manual's utility and feasibility for dissemination among patients who are completing treatment for four common cancers (i.e., breast, colorectal, prostate, and thoracic).

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  • Prostate Cancer Survivors with Rising PSA and their Spouses: Treatment Decision Making and Quality of Life

    Dr. Miller, in collaboration with Dr. Hudes, is exploring how clinical, cognitive, and affective factors influence prostate cancer survivors' and their partners' treatment decision making in the face of a rising PSA. Men who have a rising PSA and their partners are being recruited to assess quality of life before and after a treatment decision is made. These data will be used to develop an intervention to aid clinicians in presenting information to their patients and family members, to educate patients and families, and to facilitate treatment decision making and quality of life.

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  • Evaluation of a Culturally Targeted, Personalized Mail-Home Brochure Directed to Partners of At-Risk Men to Facilitate Prostate Cancer Risk Assessment

    Dr. Miller, in collaboration with Dr. Giri, is conducting a randomized controlled trial to evaluate the efficacy of a theoretically based intervention directed to the partners of men at-risk for prostate cancer to encourage them to participate in prostate cancer risk assessment. Participants are spouses/partners of at-risk men. Control participants will receive an informational brochure on prostate cancer; intervention participants will receive a psychoeducational brochure that includes the same information about prostate cancer as the informational brochure, but in addition describes structured communication strategies which the spouse/partner can use to address, in preventive fashion, the at-risk man’s pattern of potential cognitive-affective barriers to risk assessment. The intervention is designed to be easily transportable and readily disseminable, and to provide outreach to critical support persons of at-risk individuals.

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  • Addressing the Cost of Success: A Needs Assessment for Adult Cancer Survivors

    Dr. Miller is conducting a study funded by the Lance Armstrong Foundation that represents a collaborative partnership between Fox Chase Cancer Center, the American Cancer Society, and St. Christopher’s Hospital for Children. The overarching purpose of the study is to identify the specific needs of young adult cancer survivors. The first aim of the study is to establish a Community Partners Committee, comprising a network of community-based organizations and key community stakeholders that will identify medical and psychosocial needs, available resources, and current gaps in services among young adult cancer survivors in southeastern Pennsylvania. This aim has been met in the last year. The second aim is to conduct a Patient Needs Assessment of young adult cancer survivors through two focus groups. The focus group data will be analyzed to develop a quantitative survey that will be distributed to a sample of young adult cancer survivors. A third aim is to generate research and program planning recommendations based on integrated findings from the needs assessment. Work on these two aims is currently underway.

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  • Light Therapy: An Innovative Smoking Cessation Treatment

    Drs. Miller and Lazev are conducting a study that examines the potential role of light therapy in reducing negative affect and the symptoms of nicotine withdrawal among smokers with high negative affect. They hypothesize that reductions in these factors will increase the maintenance of smoking cessation during the critical first few weeks of abstinence when lapse/relapse is at its highest.

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  • Situational Smoking Among College Students: Trajectories & Barriers To Cessation

    Drs. Miller and Lazev are conducting a study to identify distinct smoking phenotypes (e.g., situational smoker, regular smoker) among the college student population, examine smoking trajectories among students fitting each phenotype, identify factors that predict who will quit smoking and who will become daily smokers, and provide information to aid in the development and evaluation of more targeted and tailored smoking cessation programs for this population segment. The study will employ a web-based survey that will be administered twice during the academic year.

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  • Life After Cancer: Examining Survivor Transitions from Specialist to Primary Care

    Using a combination of interviewing and survey research methodologies, Drs. Hudson and Miller are conducting a project that includes two studies that will build on each other to (1) explore early stage breast and prostate cancer survivors' attitudes toward primary care for follow-up cancer screening, and (2) develop and validate a survey to be implemented in a study that describes primary care usage and assesses cognitive-affective, patient support, and demographic factors that affect how survivors use specialists and primary care physicians for follow-up care.

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  • Center for Environment and Mammary Gland Development

    Drs. Miller and Fang are collaborating with Dr. Russo on his study of social and environmental influences on mammary gland development and pubertal timing among preadolescent girls. The potential association between stress (either in the family environment or individual) and pubertal timing is hypothesized to be driven by the physiological response to stress, which involves activation of the hypothalamic-pituitary-adrenal (HPA) axis and can result in increased secretion of various hormones. Higher levels of key steroid hormones may lead to earlier pubertal timing (as evidenced by breast development and menarche), which may be associated with increased breast cancer risk later in life. This study will allow us to examine the relationship between familial stress and pubertal timing among an ethnically diverse sample of preadolescent girls. Taken together, findings from these studies will contribute to our currently limited understanding of the developmental role that psychosocial and behavioral factors play in affecting pubertal onset and other biomarkers associated with breast cancer risk.

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  • Psychosocial Predictors of Cancer-Related Cognitive Change

    Dr. Shapiro is conducting a mixed-method longitudinal study which examines 1) individual differences and psychosocial factors that confer vulnerability to cancer-related cognitive impairment and 2) situational parameters that impact cognitive function at different points across the trajectory of patients’ early breast cancer experience. Early analyses of baseline pre-treatment data show that women who met criteria for clinically significant distress had slower processing speed scores on objective tests of neurocognitive function, and patients with moderate to severe levels of fatigue had slower response speeds on executive function tasks. Processing speed underlies how quickly a person can think, take in sensory information, or conduct complex cognitive processes such as comprehending language; executive function is the ability to organize information and direct attention to relevant information. Breast cancer patients often report feeling that their thinking is slow and these objective neurocognitive test results support that perception. Moreover, these results suggest that depressed affect and fatigue may underlie these pretreatment cognitive deficits. Although neurocognitive test scores were only slightly below population norms (.5 to 1 SD), such minor deficits may be very salient to patients and manifest in everyday activities that impact job performance, social interactions, and routine competencies like driving. Our patients’ daily diary reports of cognitive events are consistent with these findings. Under the mentorship of Dr. Miller, further analyses are being conducted within the framework of her Cognitive-Social Information Processing model to examine individual differences in cognitive-affective processing as predictors of cognitive vulnerability.

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