Mass General Brigham Launches Two Trials Aiming to Boost Resilience After Lymphoma Treatment

Upon completing cancer treatment, people often expect life to return to “normal.” The transition, however, can be difficult. Many individuals find themselves contending with feelings of isolation, uncertainty about the future, struggles in navigating social relationships, and other new challenges.

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Clinical psychologist Giselle Perez, PhD, is program director of the Stress Management & Resiliency Training (SMART) Mind Body Program for Cancer Survivors at Mass General Brigham Cancer Institute. In her research, she explores ways to support patients in the post–cancer treatment transitional period, particularly to foster well-being in long-term survivorship.

Dr. Perez is principal investigator of two new randomized clinical trials examining different points in the survivorship journey of lymphoma patients:

• Project LIFT aims to learn if a resilience program can lead to improvement in individuals’ quality of life.
• Project INSPIRE aims to learn if a resilience program can improve individuals’ ability to cope with and manage the challenges that come with the transition into early post-treatment survivorship.

The resilience intervention being studied in both trials, SMART3RP-Lymphoma, is based on SMART-3RP, a program that combines strategies from mind body medicine, positive psychology, and cognitive behavioral treatment to teach participants how to manage cancer-related and general life stressors. Dr. Perez and her colleagues adapted SMART-3RP to address the specific needs of lymphoma patients in the post-treatment period.

Dr. Perez is focusing on lymphoma for several reasons. One, many survivors feel unsettled and even overlooked about having had a disease that is often considered highly treatable and yet still a cancer. Two, even if they have achieved remission or curative status, survivors must deal with the reality that lymphoma has high rates of recurrence.

“Plus, this is quite a heterogeneous patient population,” Dr. Perez says. “Based on their lymphoma subtype, they may face a wide and complex range of physical and psychosocial effects. And unlike some cancers, lymphoma affects men and women alike, as well as those who are younger and older. If we can determine an approach that is helpful to a heterogeneous population of lymphoma survivors, we may be able to generalize those findings to the broader cancer population.”

Project LIFT

Project LIFT, a $4 million study funded by the National Cancer Institute, is enrolling individuals aged 18 years and older who are within one to five years of treatment completion for lymphoma. The research team is partnering with Blood Cancer United (formerly the Leukemia & Lymphoma Society) and leveraging social media to disseminate study information to and recruit participants from a diverse audience.

Participants will take part in eight weekly, virtual group sessions. One group will receive the experimental SMART-3RP Lymphoma intervention. Meanwhile, an attention control group will take part in a health education program that covers the co-occurrence of mental and physical problems, goal setting for health behavior change, and self-monitoring.

The primary outcome measure is quality of life, as gauged by the PROMIS-29 questionnaire. The investigators will compare outcomes in the following sub-groups of participants: 

• Ages 18-39 versus ages 40+
• Rural dwellers versus non–rural dwellers
• English speakers versus Spanish speakers

“We have implementation questions such as, how does this program work for patients and for providers? Where could it live in the future? How could we make it more accessible?” Dr. Perez says. “We’re also collecting hair cortisol samples to see if there are physiological changes that happen as a result of participating in this program.”

Mass General Brigham Cancer Institute is collaborating with the University of Utah Huntsman Cancer Institute and the University of Miami Sylvester Comprehensive Cancer Center on Project LIFT. The University of Miami’s Craig Moskowitz, MD, is a co-investigator.

Project INSPIRE

Mass General Brigham Cancer Institute is also collaborating with the Huntsman Cancer Institute on Project INSPIRE. This $1.1 million trial, funded by the American Cancer Society, is enrolling individuals aged 18 years and older who are at least six months’ post-diagnosis and within two years of treatment completion for lymphoma. 

One cohort in Project INSPIRE will take attend eight weekly, virtual group sessions as part of the SMART-3RP Lymphoma intervention. The other will be referred to their site social work team, where they will receive an enhanced version of usual care (i.e., care that includes proactive identification and referral of post-treatment survivors, neither of which is typically done).

The primary outcome measure is change from baseline in coping scores on the Management of Current Stress (Part A) scale, which measures coping processes on four domains: ability to relax, recognize stress, elicit support, and restructure thoughts.

Project INSPIRE also accounts for social determinants of health (SDOH).

“A variety of factors, from food insecurity to financial instability, can impede access to care, increase stress, and impact one’s health and well-being,” Dr. Perez says. “We’re conducting SDOH screening before randomization to determine each participant’s risk level and recommend the most appropriate resources to reduce those sources of stress. Then, we’ll be able to see more clearly how referral to social work compares with our resilience program in improving coping.”

Recruitment has been a major point of emphasis for the research team. Dr. Perez and her colleagues reached out directly to lymphoma clinicians at Huntsman and Massachusetts General Hospital to garner support. To promote study awareness, they also leveraged clinician advocates at each site: Mallorie B. Heneghan, MD, in Utah, along with Jeremy S. Abramson, MD, MMSC, and Patrick C. Johnson, MD, in Boston.

“Our clinician partners have been wonderful throughout this process,” Dr. Perez says. “I also want to thank the social worker at our Lymphoma Program, Allie Giza, who will be receiving the referrals.”

High hopes for trials

With the two trials now underway, Dr. Perez hopes that SMART3RP-Lymphoma proves to be effective for patients and clinicians alike.

“I want to demonstrate that our resilience program can help anyone, no matter what their level of stress, feel more empowered, less alone, and better able to ask for the type of support they need,” she says. “The second piece is that it’s of value for providers. I want to be able to tell them, ‘Here’s something that will be helpful for your patients, and this is why.’”

For details on patient enrollment, please email projectlift@mgb.org or mghprojectinspire@mgb.org.

Learn about the SMART Mind Body Program for Cancer Survivors

Learn about Mass General Brigham Cancer Institute