A Novel Intervention for Avoidance-Related Opioid Misuse in Patients with Cancer - Project Summary/Abstract Between 18% and 56% of patients with cancer misuse opioids. Opioid misuse can result in worse healthcare outcomes, such as neurotoxicity, infection, and compromised immune functioning. Further, it predisposes patients to developing substance use disorder (SUD). People living with cancer have multiple risk factors for developing SUD and face unique prevention and risk management issues. Anxiety and depression (i.e., psychological suffering) that drive avoidant coping increase SUD risk in patients with cancer. While specific psychological risk factors for opioid misuse have been identified, no interventions targeting these factors currently exist to reduce SUD risk in this population. Uncoupling psychological suffering and opioid misuse represents an opportunity to reduce SUD risk and better enable individuals with cancer to use their opioids as prescribed. The framework of Acceptance and Commitment Therapy (ACT) appears ideally suited for this problem. Since substance use interventions are most effective when tailored to populations, patients would be best served through an intervention specifically designed for individuals with cancer on opioid therapy. This study seeks to: (1) refine a behavioral intervention targeting SUD risk and psychological suffering in individuals with cancer; (2) pilot test the tailored intervention for this population; and (3) estimate effect sizes for an adequately- powered RCT. Dr. Yusufov’s career goal is to leverage her background in health behavior risks to conduct patient-oriented research that addresses psychological suffering and substance use in individuals with cancer. The integrated training and research plans proposed in this revised application will provide Dr. Yusufov with advanced training in several critical areas needed to enhance her program of research toward this career goal. With mentorship and guidance from national leaders in palliative care, psychosocial oncology, substance use, patient engagement methods, and ACT, the training is targeted to the following domains: (1) research in palliative care (Dr. James Tulsky), (2) SUD treatment (Dr. Kathryn McHugh), (3) development/testing of psychosocial interventions, patient-oriented research, and patient engagement methods (Dr. Joseph Greer), (4) clinical research in palliative care/psychosocial oncology (Dr. William Pirl), and (5) adaptation of ACT interventions (Dr. Kristy Dalrymple). These training objectives will be achieved through a combination of didactic/applied activities in a Stage I behavioral trial involving pilot testing. Dana-Farber Cancer Institute and Harvard Medical School provide an outstanding environment for these training and research objectives, including clinics supportive of patient-oriented research, seminars/courses in designated training areas, and a highly active Clinical and Translational Science Center with a wide array of resources for career development and training. This K08 award will provide an essential bridge between Dr. Yusufov’s prior training and experience and her career goal of becoming an independent scientist conducting patient-oriented research to reduce the public health burden of SUD risk in cancer settings by targeting underlying psychological suffering.
