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.