Giselle K Perez

Massachusetts General Hospital | MGH · Department of Psychiatry

12132 Background: Adolescent and young adults (AYAs) with cancer experience chronic stress and poor quality of life, particularly in early posttreatment as AYAs grapple with a “new normal.” Mind-body programs introduced early posttreatment hold promise for providing AYAs with skills to mitigate the adverse psychosocial and physiological effects of...

e24048 Background: Adolescent and young adults (AYA) cancer survivors have worse long-term physical health than survivors of adult cancers. Healthy lifestyle behaviors can maximize physical health and enhance quality of life. The National Comprehensive Cancer Network (NCCN) publishes survivorship guidelines for healthy behaviors; however, it is unc...

The COVID-19 pandemic has resulted in unprecedented stress and uncertainty, particularly among vulnerable populations such as healthcare workers who are facing a multitude of current and looming economic and psychosocial stressors. As clinician-scientists delivering mind-body interventions in our hospital, we suggest applying evidence-based mind-bo...

Background: Adolescent and young adult (AYA) cancer patients commonly report health insurance concerns and financial burden that emerge due to their cancer treatment. AYAs often have limited experience with health care prior to their cancer diagnosis, which may limit their understanding of health insurance concepts and affect their medical costs. A...

Objectives To adapt and test the feasibility, acceptability, and preliminary efficacy of an 8-week resiliency group program for posttreatment lymphoma survivors. Design and outcomes. This is an exploratory mixed methods study. Phase 1: We conducted qualitative interviews to inform program adaptation. Phase 2: Using a single-arm pilot design, we ass...

Importance Persistent smoking may cause adverse outcomes among patients with cancer. Many cancer centers have not fully implemented evidence-based tobacco treatment into routine care. Objective To determine the effectiveness of sustained telephone counseling and medication (intensive treatment) compared with shorter-term telephone counseling and m...

65 Background: Adolescent and young adult (AYA) cancer patients (15-39 years of age) often report health insurance concerns and financial toxicity due to their life-saving treatment. AYAs often have limited experience with healthcare prior to their diagnosis, which may limit their understanding of health insurance concepts, coverage, and costs. To...

83 Background: Cancer patients in the United States often experience distress surrounding out of pocket costs from treatment. Adolescents and young adults (AYA) are more likely to be underinsured, skip care due to cost, go into debt, and file for bankruptcy after a cancer diagnosis than patients diagnosed at older ages. We conducted semi-structured...

IntroductionExercise is recommended for all patients with cancer, but there has been limited study of exercise habits in patients across the spectrum of illness.PurposeThis pragmatic survey aimed to identify the unmet supportive care needs, self-reported symptoms, and exercise habits among both cancer survivors and patients living with advanced dis...

Parents of children with Autism experience high levels of stress. Resiliency is the ability to cope and adapt when faced with stressful events. This randomized, waitlist controlled pilot trial examines the feasibility, acceptability, and preliminary efficacy of an adapted virtual mind–body group intervention for parents of children with ASD. The in...

e19062 Background: Ethnic/racial minorities and socioeconomically disadvantaged patients remain underrepresented in cancer clinical trials (CCT), challenging the accuracy and generalizability of findings. While oncologists’ recommendations influence trial participation, we know little about their perspectives on recommending CCT to underrepresented...

e24079 Background: One of the most common concerns of cancer survivors is cancer-related cognitive impairment (CRCI), which affects an individual’s ability to return to work, school, or other life activities. The etiology of CRCI is poorly understood. Numerous studies have demonstrated a relationship between emotional distress and cognitive dysfunc...

Objective: Parents of children with special needs such as learning and attentional disabilities (LADs) and autism spectrum disorder (ASD) are at high risk for stress-related disorders. The demands of parenting may compete with time for self-care behaviors such as physical activity, healthy eating, and adequate sleep. The objective was to describe...

Research on adolescents and young adults (AYAs) with cancer has flourished over the past decade, underscoring the unique medical and psychosocial needs of this vulnerable group. A cancer diagnosis during adolescence and young adulthood intersects with the developmental trajectory of AYAs, derailing critical physical, social, and emotional developme...

Objectives One in five children have a learning and attentional disability (LAD). Parents of children with LAD are vulnerable to distress, but an evidence-based treatment has not been developed. Methods From June 2016 to November 2017, we conducted a mixed methods study to adapt and assess the virtual delivery of a mind-body group resiliency progr...

Purpose: Fear of cancer recurrence is highly prevalent among adult survivors of cancer. The role of fear of recurrence in the emotional distress of survivors of cancer, as well as health behaviors that may directly affect their health, remains unclear. To advance oncology practice, this study sought to examine the extent to which fear of recurrenc...

6640 Background: Costs of cancer care may impact access to therapy, adherence, and distress among patients. However, the degree to which patients with metastatic breast cancer (MBC) wish to discuss financial issues when making treatment decisions is unknown. Methods: In a single arm feasibility trial, 40 women with newly diagnosed or progressive MB...

11622 Background: Individualized treatment planning is a critical part of quality cancer care, but how best to achieve this for patients with metastatic breast cancer (MBC) is unclear. We evaluated the feasibility, acceptability and impact of using a simple and scalable “Individualized Goals of Care Discussion Guide” (IGCDG) to facilitate patient-p...

Previous work suggests that, compared to white adults, black adults have lower perceived risk for smoking-related diseases (SRDs), which may influence cessation behavior and health outcomes; however, racial differences in SRD risk perceptions among high-risk patients (i.e., a group that exhibits elevated risk for SRDs) following lung screening rema...

Background: Individuals with serious mental illness (SMI) experience increased cancer mortality due to inequities in cancer treatment. Psychiatric care at cancer diagnosis may improve care delivery, yet models for integrating psychiatry and cancer care are lacking. We assessed the feasibility and acceptability of a person-centered collaborative ca...

Background The aim of this study was to test the efficacy of a tailored cognitive-behavioral therapy (CBT) mobile application (app) to treat anxiety in patients with incurable cancer. Materials and Methods Patients with incurable cancers (n = 145) who reported elevated anxiety symptoms at two cancer centers were randomized to receive either the CB...

BACKGROUND Nondaily smoking is an increasingly prevalent smoking pattern, which poses substantial health risks, and which disproportionally affects ethnic minorities and adults with a mental health or substance use problem. OBJECTIVE To test the feasibility of using a smartphone app with positive psychology exercises to support smoking cessation i...

Background: Nondaily smoking is an increasingly prevalent smoking pattern that poses substantial health risks. Objective: We tested the feasibility of using a smartphone app with positive psychology exercises to support smoking cessation in nondaily smokers. Methods: In this prospective, single-group pilot study, nondaily smokers (n=30) used v...

Purpose: Survivors of childhood cancer require life-long outpatient healthcare, which may be impacted by health insurance. This study sought to understand survivors' utilization of outpatient healthcare provider services. Methods: The study examined cross-sectional survey data using an age-stratified sample from the Childhood Cancer Survivor Stu...

PurposeTo describe and compare the prevalence of mental health access, preference, and use among pediatric cancer survivors and their siblings. To identify factors associated with mental health access and use among survivors. Methods Six hundred ninety-eight survivors in the Childhood Cancer Survivor Study (median age = 39.4; median years from diag...

Background: In efforts to inform clinical screening and development of survivorship care services, we sought to characterize patterns of health care needs among cancer survivors by (a) identifying and characterizing subgroups based on self-reported health care needs and (b) assessing sociodemographic, clinical, and psychosocial factors associated...

Importance Cancer survivors face ongoing health issues and need access to affordable health care, yet studies examining health care access and affordability in this population are lacking. Objectives To evaluate health care access and affordability in a national sample of cancer survivors compared with adults without cancer and to evaluate tempora...

62 Background: In efforts to inform clinical screening and development of survivorship care services, we sought to characterize patterns of healthcare needs among cancer survivors by 1) identifying and characterizing subgroups of survivors based on self reported health care needs, and 2) assessing socio-demographic, clinical and psychosocial factor...

Cancer represents a significant and growing worldwide health burden. Cancer care involves intensive multidisciplinary treatments that can cause substantial symptom burden and require a high level of coordination among providers. Active therapies are primarily administered in outpatient settings and patients must triage complications while at home,...

Smoking remains the leading cause of preventable death in the United States. This chapter provides an overview of smoking prevalence in the USA and features psychological comorbidities associated with smoking. We present information on smoking patterns amongst specific medical and racial/ethnic minority populations. Additionally, an overview of app...

175 Background: Patients with incurable cancer often experience marked anxiety that is associated with poor quality of life (QOL), high symptom burden, and complications with medical treatment. The aim of this study was to test the efficacy of a mobile app-based cognitive-behavioral therapy (CBT) intervention to treat anxiety symptoms in patients w...

200 Background: Despite the recognized need for high quality survivorship care, barriers to identifying and addressing patients’ needs still remain. We sought to evaluate cancer survivor care priorities, awareness of available services, and factors associated with care and informational needs. Methods: A needs assessment survey was distributed to p...

Importance Childhood cancer survivors may be reluctant to make changes in their employment because of access to health insurance. Objective To examine the prevalence of “job lock” (staying at a job to keep work-related health insurance) in a sample drawn from an established, multi-institutional cohort of full-time employed childhood cancer survivo...

Purpose Survivors of childhood cancer may experience financial burden as a result of health care costs, particularly because these patients often require long-term medical care. We sought to evaluate the prevalence of financial burden and identify associations between a higher percentage of income spent on out-of-pocket medical costs (≥ 10% of annu...

10051 Background: Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) are asymptomatic clonal precursors to multiple myeloma, a hematological malignancy. Because observation is currently the standard of care, a diagnosis of MGUS or SMM can be associated with stress and worry about progression. We evaluate...

e21603 Background: Insomnia is prevalent among cancer survivors. However, screening and treatment is inconsistent across U.S. cancer centers. We sought to identify factors associated with moderate to severe insomnia (MSI) to inform the development of a screening and treatment program for survivors. Methods: As part of a comprehensive supportive car...

e21601 Background: Exercise can improve outcomes and quality of life following cancer diagnosis. The American College of Sports Medicine (ACSM) recommends 150 minutes of moderate aerobic activity for patients with cancer. We sought to evaluate exercise patterns and barriers to exercise among patients presenting for follow-up care. Methods: Patients...

10053 Background: Fear of cancer recurrence (FoCR) following definitive cancer therapy is often reported by patients, but little is known about who is most likely to be impacted, how FoCR influences emotional distress, and what interventions may mitigate patients’ FoCR. We sought to determine the prevalence of FoCR among cancer survivors and to eva...

10022 Background: Patients with incurable cancer often experience marked anxiety that is associated with poor quality of life (QOL), high symptom burden, and complications with medical treatment. The aim of this study was to test the efficacy of a mobile app-based cognitive-behavioral therapy (CBT) intervention to treat anxiety symptoms in patients...

Background: Human papillomavirus (HPV) is prevalent among college-aged women. Although HPV vaccines decrease women's risk for cervical cancer, the vaccination rates remain inadequate. Objective: This study explored the utility of an information-motivation-behavioral skills (IMB) intervention in promoting HPV vaccination knowledge, motivation, an...

Mind–body interventions can improve vulnerabilities that underlie smoking behavior. The characteristics of smokers who use mind–body medicine have not been explored, preventing the development of targeted interventions. Patients (N = 593) presenting to a mind–body medicine clinic completed self-report measures. Patients were 67 percent never smoker...

Background: Despite the well-established risks of persistent smoking, 10-30% of cancer patients continue to smoke after diagnosis. Evidence-based tobacco treatment has yet to be integrated into routine oncology care. This paper describes the protocol, manualized treatment, evaluation plan, and overall study design of comparing the effectiveness an...

Objective: There is a growing demand for interpreters in the cancer setting. Interpreters, the link to quality care for limited English proficiency patients, face many psychosocial stressors in their work. This project assessed interpreters' experiences of stress and piloted a resiliency program to help interpreters cope with stressors. Methods:...

Background Black smokers have demonstrated greater lung cancer disease burden and poorer smoking cessation outcomes compared with whites. Lung cancer screening represents a unique opportunity to promote cessation among smokers; however, little is known about the differential impact of screening on smoking behaviors among black and white smokers. Us...

Context: Palliative care clinicians (PCCs) are vulnerable to burnout as a result of chronic stress related to working with seriously ill patients. Burnout can lead to absenteeism, ineffective communication, medical errors, and job turnover. Interventions that promote better coping with stress are needed in this population. Objectives: This pilot...

Methods: From May 2011-April 2012, we surveyed a randomly selected sample of cancer survivors from the Childhood Cancer Survivor Study to assess survivors' 1) financial distress, 2) monetary insecurity and 3) cost-motivated health behavior in the past year. We estimated the proportion of survivors with high OOP costs (≥10% of their annual househol...

Methods: Development of the CBT app proceeded in two phases. First, we enrolled five patients with advanced cancer and anxiety (HADS-Anxiety subscale score ≥ 8) to review a preliminary CBT app prototype and to provide qualitative feedback regarding intervention acceptability and utility. Using content analysis of the recorded data, we identified k...

Background: Palliative care clinicians (PCCs) are susceptible to burnout, as they regularly witness immense patient and family suffering; however, little is known about their specific challenges and training needs to enhance their long-term sustainability. Objective: The purpose of this qualitative study was to explore common stressors, coping s...

The Patient Protection and Affordable Care Act (ACA) established provisions intended to increase access to affordable health insurance and thus increase access to medical care and long-term surveillance for populations with pre-existing conditions. However, childhood cancer survivors' coverage priorities and familiarity with the ACA are unknown. Be...

Understanding how stigmatized identities contribute to increased rates of depression and anxiety is critical to stigma reduction and mental health treatment. There has been little research testing multiple aspects of stigmatized identities simultaneously. In the current study, we collected data from a diverse, urban, adult community sample of peopl...

Anxiety disorders are the most prevalent class of mental disorders, often characterized by a chronic course and comorbid psychopathology. Reports of anxiety-cortisol relationships are inconsistent in the literature. Salivary alpha- amylase (sAA), a biomarker of autonomic nervous system activation, provides an opportunity to examine the stress respo...

Cervical cancer is a virally mediated disease with the majority of cases due to the human papillomavirus (HPV). HPV infections are the most prominent sexually transmitted diseases among college-aged women. Although HPV vaccines such as Gardasil afford women with a valuable method of cancer prevention, vaccination rates are often incomplete or inade...

The rapidly expanding number of Hispanics living in USA has increased the need for their inclusion in research on physical and mental health. Current studies that have explored health outcomes among Hispanics have often noted an ‘epidemiological paradox’, in which there is a discrepancy between their minority status and positive health outcomes whe...

Genetic testing for the breast cancer genes 1/2 (BRCA 1/2) has helped women determine their risk of developing breast and ovarian cancer. As interest in genetic testing has grown, companies have created strategies to disseminate information about testing, including direct-to-consumer advertising (DTCA) and online genetic testing. This study examine...

For individuals with HIV who are current or former injection drug users, depression is a common, distressing condition that can interfere with a critical self-care behavior—adherence to antiretroviral therapy. The present study describes the feasibility and outcome, in a case series approach, of cognitive behavioral therapy to improve adherence and...