Karen L. Syrjala

My research has focused on defining long term and late complications of hematopoietic stem cell transplantation, clinical trials to improve outcomes during and after cancer treatment, cancer pain and symptom management, and opioid side effects. As we know, cancer not only attacks organ systems, but also influences neuroendocrine function, neurocognitive function and, directly or indirectly, affects emotions, thinking, behaviors, physical symptoms, family systems - in short the whole person. Our Biobehavioral Sciences research investigates methods of integrating behavioral and biological treatments, with goals of 1) optimizing patients' participation in their own care, 2) reducing symptoms and complications of treatment or the disease, and 3) improving long term outcomes.

At the Center, our research first designed and tested interventions to treat the most common symptoms during cancer treatment. Targeted symptoms included pain, stress and nausea/emesis. Methods included hypnosis, imagery and coping skills training combined with patient-controlled-analgesia. As our research progressed, we identified needs for cancer patients with pain to better understand their treatments, and needs for better scientific understanding of opioid side effects so that cancer patients could receive effective pain relief. Our longitudinal prospective studies out to 10 years have also identified problems in cancer survivors that require more actively integrated medical and behavioral treatments. These problems included long term fatigue, cognitive deficits, and hormone-related outcomes such as menopausal symptoms and sexual dysfunction. All of our intervention research is tested through randomized controlled clinical trials, with interdisciplinary collaborators. In a multi-site trial to enhance recovery after high dose treatment, we have tested interventions provided by telephone, along with print and video materials, to patients around the country. This is the second step in our trials to improve outcomes one to five years after treatment. Other trials examine Internet-based methods for improving communication and surveillance of complications for cancer patients and caregivers.

To achieve our goals of providing cost-effective and time-conserving methods for physicians, nurses, psychologists and other health care providers to treat cancer-related problems, we have developed videotapes and print materials for patients and family members. These materials educate patients and family members living with treatment effects (Relieving Cancer Pain, Focus Forward: Life after Transplant). Dr. Syrjala also has participated in developing guidelines for treating cancer pain including those by the American Pain Society and the National Comprehensive Cancer Network.

Measures have been needed that adequately assess symptoms so that we can effectively determine appropriate treatment and assess outcomes. We have developed a number of self-report tools for this purpose: Patient Cancer and Treatment Distress; Caregiver Cancer and Treatment Distress, Sexual Function Questionnaire, Family & Work Function, Somatic Side Effects of Opioids, Cognitive & Affective Side Effects of Opioids.

All of this biobehavioral research is interdisciplinary, integrating psychology and psychiatry investigators with our colleagues in pharmacology, anesthesiology, oncology, neurosciences, and rehabilitation medicine.