No shortage of postdocs in psycho-oncology

Postdoctoral appointments offer psychologists specialized, intensive training in cancer research and clinical work.

By Bridget Murray
Monitor staff

Even before she got her PhD, Karen Hurley knew that if she wanted to specialize in cancer prevention and treatment she would need the kind of training only a postdoctoral program can provide. Luckily, she could choose from a small, but growing, group of solid postdoc programs, like the one at Mount Sinai School of Medicine's Ruttenberg Cancer Center, where she now has an appointment.

There, at the center's base in New York City, she's involved in one research project on women's decision-making about genetic testing and preventive surgery for breast and ovarian cancer, and other projects on people's colorectal cancer screening practices. The work is preparing her "to be an independent researcher and manage my own grants," she says.

Her experience reflects the intensive, structured bio-behavioral and psycho-oncology training that's increasingly available through postdoc fellowships. In fact, the postdoctoral level typically provides psychologists with more specialized cancer training than any predoctoral level, and postdoc opportunities are expanding, according to psycho-oncology trainers.

In part, the growth can be attributed to the National Cancer Institute (NCI), which has increased its focus on behavioral and preventive aspects of cancer (see sidebar). But it can also be traced to psychologists'--and other disciplines'--growing involvement in multidisciplinary research on cancer.

Memorial Sloan-Kettering Cancer Center, also in New York City, pioneered the behavioral side of cancer training 20 years ago with its postdoctoral fellowships in psycho-oncology. Since then its graduates have brought a focus on behavioral and psychosocial aspects of cancer to hospitals and cancer centers country-wide.

Psychologists interested in cancer can now fill postdoctoral spots--or carve out their own--at a multitude of institutions, mostly with support from the home institution or through funding from NCI and the U.S. Department of Defense (DoD). Often they're the lone psychologist on a team of medical professionals working with cancer patients or one of a few on a cancer center's staff. But many cancer centers are stepping up their efforts to recruit behavioral scientists.

Within the past few years, Sinai's Ruttenberg Cancer Center, for example, has grown markedly, and Georgetown University Medical Center's Lombardi Cancer Center is also poised to expand its behavioral science focus.

"In the beginning of the program, the PhDs don't know as much about medical management and terminology as the MDs, but the PhDs come in with a lot more experience and training in psychological methods and research," says William Breitbart, MD, who runs Memorial Sloan-Kettering's clinical fellowship program in psycho-oncology. "So they learn from each other and develop an integrated approach."

Bio-behavioral cancer training

Perhaps the largest training programs for psychologists are the ones at Sinai Ruttenberg, part of the Mount Sinai/New York University Medical Center, and Sloan-Kettering, affiliated with the Weill College of Medicine of Cornell University. At Memorial Sloan-Kettering, where psychological research on cancer started, the department of psychiatry and behavioral sciences trains up to 17 fellows at a time in clinical and research aspects of cancer. Supported mainly by NCI and American Cancer Society funding, the fellows investigate prevention, pain and quality-of-life aspects of gynecological, prostate, lung and other cancers.

One current psychology fellow, Jack Burkhalter, PhD, is studying psychosocial and other factors associated with continued tobacco use in recently diagnosed cancer patients. He hopes to develop interventions to help them quit for good. Another fellow, Alfredo Bimbela, PhD, is working as a project director on a breast-cancer education and outreach program, providing technical and program development consultation to community agencies.

A major Memorial Sloan-Kettering emphasis is interdisciplinary work with physicians, psychiatrists and other medical professionals, as well as mentoring by senior researchers, says Jamie Ostroff, PhD, co-director of the research fellowship program in psycho-oncology there and chief of the Behavioral Science Service in the department of psychiatry.

"We help fellows translate clinical phenomena into researchable questions," she says.

In addition, the program features formal didactic curricula in such areas as research ethics and advanced research methods. Similarly, the fellowship training program at Sinai emphasizes interdisciplinary work and offers seminars in bio-statistics and research design to its psychology, public health and medical trainees. Funded mainly by NCI and DoD, researchers there focus largely on psycho-immunology and on cancer prevention and control, with a large focus on breast cancer. For example, Sinai psychology fellow Joel Erblich, PhD, is researching barriers and motivators for obtaining breast-cancer screening, as well as the cognitive and behavioral impact of testing positive for breast-cancer susceptibility genes.

Other training

At other cancer facilities across the country, training is often more medical than behavioral, but the federal government's emphasis on cancer prevention and control offers psychologists increased training opportunities, says Dana Bovbjerg, PhD, head of the program in bio-behavioral medicine at Mount Sinai.

Georgetown's Lombardi Cancer Center, for example, doesn't have a formal postdoctoral training program for psychologists. But it does have a program in breast cancer prevention and control and has recently proposed a postdoctoral training core program as part of a tobacco research center grant application submitted to NCI by the cancer genetics program. Psychologists could apply for these slots by focusing on how behavior and biology work together to influence health, says psychologist Jon Kerner, PhD, head of Lombardi's cancer prevention and control training research program. Kerner also notes that several of the center's psychology junior faculty fellows--through career-development (K07) awards from NCI--are working on studying psychosocial aspects of genetic testing for cancer, behavioral/ genetic interactions in nicotine addiction and improved decision-making in prostate cancer screening.

Pediatrics

Another area of training opportunity for psychologists is pediatric oncology. One of the numerous sites where psychologists can seek such training is the University of Miami, where postdoctoral training is available in clinical and research areas.

Miami's research postdocs focus on ways to alleviate children's pain during spinal taps, intravenous injections and other such procedures. Meanwhile, clinical postdocs help children with leukemia and brain tumors to cope with bone-marrow transplants, surgery and chemotherapy. They also help to assess the neurological aftermath of chemotherapy and brain-tumor removal. All postdocs attend seminars on cancer treatment and work on multidisciplinary teams.

Also, because neurological problems are among the major complications of pediatric cancers, some sites, such as one at Cincinnati's Children's Hospital Medical Center, affiliated with the University of Cincinnati, include a neuropsychology focus in their programs. At Cincinnati, for example, two postdoctoral fellows explore the effects of chemotherapy and radiation treatment on children's brains to determine whether the children might be at risk for learning disabilities.

Psychologist M. Douglas Ris, PhD, who directs Cincinnati's neuropsychology program, says the best way for psychology students to find postdocs in neuro-oncology, or other cancer-related areas that interest them, is to locate and contact faculty doing research in the area.

"It's as simple as doing a literature search," says Ris. "You see who's actively involved in research, publishing and clinical service, then you look at the programs they're affiliated with."



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