Julie Schnur

Icahn School of Medicine at Mount Sinai | MSSM · Department of Oncological Sciences

Background While it is often presumed that undergoing breast reconstruction (BR) after mastectomy has positive psychosocial effects, a comprehensive review of current knowledge on the topic is to date absent. The aim of this systematic review is to summarize the available literature on the effects of BR on postoperative psychological distress. Met...

Objective: To present primary care physician (PCP) suggestions for design and implementation of a decision aid (DA) tool to support patient-provider shared decision-making on lung cancer screening (LCS). Study design: Semistructured interviews were conducted with 15 PCPs at an academic medical center. Methods: The deidentified transcripts were...

Purpose: Many individuals who are eligible for lung cancer screening have comorbid conditions complicating their shared decision-making conversations with physicians. The goal of our study was to better understand how primary care physicians (PCPs) factor comorbidities into their evaluation of the risks and benefits of lung cancer screening and in...

The aim of this study was to test the efficacy of a three-session hypnosis intervention to manage musculoskeletal pain (MSP) in breast cancer survivors taking aromatase inhibitors (AIs). We hypothesized that patients in the hypnosis group would have lower levels of pain than patients in an attention control group. A secondary outcome was to examine...

Introduction Many women with cancer struggle with sexual side effects during and after treatment. Although preliminary evidence indicates that psychosocial interventions may be efficacious in improving sexual functioning for women with cancer, no systematic review has summarized the state of the science in this area. Objectives The primary goal of...

Objective To assess prevalence of elevated blood pressure readings, rates of established hypertension diagnosis, and blood pressure control medication prescription rates in a cohort of older people experiencing unsheltered homelessness presenting to a Street Medicine clinic in Miami‐Dade County, Florida. In addition, we will compare outcomes found...

Participation in sexual medicine research may depend on a patient’s willingness to speak openly about sex, sexual function, or other sensitive topics. These topics may be difficult or uncomfortable to talk about, and this discomfort may be further amplified when a patient comes from a cultural background that stigmatizes open conversation about sex...

Introduction: Research shows that for survivors of sexual violence (SV), cancer procedures can be retraumatizing due to perceived similarities to the original SV. To date, there is no training program designed specifically for the radiation therapist (RTT) on how to deliver care sensitively to survivors of SV. A key component of sensitive practice...

Introduction Research suggests that over 60% of women with cancer report sexual functioning difficulties. Cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBIs) have been used to treat sexual functioning difficulties in women with cancer. Objective The purpose of the current systematic review is to examine the state of the s...

Introduction BRCA 1 and 2 genes increase a patient’s risk for developing cancer of breast and ovarian origin. There are two methods of preventative care offered to BRCA-positive patients: prophylactic surgery or high risk screening for cancer accompanied by endocrine therapy. Preventative surgeries for BRCA-positive patients – bilateral salpingo-oo...

Introduction Preventative surgical procedures for patients who are breast cancer (BRCA) positive—namely, bilateral salpingo-oophorectomy and mastectomy—have been linked to changes in sexual function, including surgically induced menopause. A patient’s decision to undergo preventive surgery as opposed to high-risk screening is heavily reliant on adv...

Background Sexual dysfunction is a known side effect of pelvic radiotherapy, resulting from a complex intersection of physiologic and psychosocial factors. Maintaining sexual function is relevant to long-term quality of life and is an important aspect of survivorship. Many female patients report being insufficiently informed before treatment about...

Purpose This manuscript aims to compare and contrast acceptability and perceived benefits of yoga-skills training (YST) and an empathic listening attention control (AC) in the Pro-You study, a randomized pilot trial of YST vs. AC for adults receiving chemotherapy infusions for gastrointestinal cancer. Methods Participants were invited for a one-on...

Introduction:. Women who undergo breast cancer surgery risk suffering from postsurgical pain long after their surgery. Still, research on postsurgical pain in the subacute phase has been neglected. Objective:. This study aims to investigate the incidence, intensity, unpleasantness, and presurgical predictors of acute and subacute postsurgical pain...

Objective: To learn about the beliefs and preferences of lung cancer screening (LCS) among patients undergoing LCS decision making. Specifically, we investigated how their comorbidity influences their interest in screening. The goal was to inform shared-decision making discussions around the role of comorbidities and LCS. Methods: We recruited E...

Objective For childhood sexual abuse (CSA) survivors, cancer care can be retraumatizing due to perceived similarities to the original sexual violence. Our group designed and implemented a sensitive practice tool (SPT) and evaluated the feasibility of the tool in female patients receiving breast radiation. Methods The SPT was offered as a “universa...

Introduction Impaired sexual function significantly decreases quality of life in female survivors of pelvic cancer who receive radiation therapy (RT). The literature estimates that 40-100% of gynecologic cancer survivors and 18-59% of rectal cancer survivors experience sexual dysfunction. Despite this prevalence, many patients report being insuffic...

Objective BI-RADS-0 screening mammograms require follow-up diagnostic imaging, optimally within 60 days. Our study aims to identify risk factors for delayed follow-up. Methods We conducted a retrospective case-control study of individuals who had a nondiagnostic BI-RADS-0 screening mammogram between 3/19/18-3/19/20. Sociodemographic information wa...

Introduction Vaginal stenosis is a distressing side effect of radiation therapy that can impair quality of life. Dilator therapy is an option for patients undergoing pelvic radiotherapy to mitigate vaginal stenosis. Currently, the dilators given to patients by most hospitals are made of plastic, compared to silicone dilators which are available on...

Purpose Breast arterial calcifications (BAC), detected by digital mammography are a potential marker of coronary artery disease (CAD). Past BAC research has been limited by having primarily racially and ethnically homogeneous samples, samples at higher risk for CAD, and neglecting to explore the influence of women's health factors. The purpose of t...

Objective Among the major impediments to successful smoking cessation are strong cravings, especially during times of heightened stress. Affective responses to stress (e.g., acute anxious and depressed mood) may serve as important mediators of cigarette cravings that are amenable to intervention. Experimental models have been developed to reliably...

Objective Digital mammography can reveal not only breast cancer but also breast arterial calcification (BAC), which can indicate potential coronary artery disease. To explore ways to inform women of their BAC status in the context of a standard mammography results letter, we conducted a preliminary study comparing gain- and loss-framed messages to...

Aims To evaluate the feasibility and acceptability of a randomized controlled trial of a hypnosis intervention for the treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) in women. Methods We conducted a parallel arm, non-blinded, pilot randomized controlled trial of standardized hypnosis sessions including a hypnosis web tool versus...

Objective: The bulboclitoris (clitoris and vestibular bulbs) is the primary organ responsible for female sexual arousal and orgasm. Effects of radiotherapy on the bulboclitoris are unknown, as its structure/function has yet to be described in radiotherapy, and it overlaps only partially with the external genitalia structure. Our aim was to: descri...

There is growing literature to support the use of hypnosis as an evidence-based behavioral medicine intervention to manage a wide variety of symptoms and side effects associated with cancer and its treatment (e.g., pain, nausea, fatigue). However, formal training in hypnosis is often lacking among cancer care providers. The purpose of this study is...

Cigarette smoking continues to be the number one modifiable risk factor for the development of cancer. Among the major impediments to successful smoking cessation are strong cravings to smoke, especially during times of heightened stress. Affective responses to stress (e.g., acute anxious and depressed mood) may serve as important mediators of ciga...

Hypnosis has been shown to be efficacious in the control of the symptoms and side effects of cancer and its treatment across all stages of the cancer continuum. Yet, hypnosis has generally failed to widely disseminate to clinical cancer settings, potentially due in part to provider attitudes about hypnosis. In a sample of 340 trainees (psychosocial...

Despite the available empirical evidence supporting the efficacy of hypnosis for alleviating symptoms and side effects across a variety of clinical contexts, hypnosis has failed to disseminate widely. One way to try to better understand the lack of hypnosis dissemination is to apply a marketing theory approach, focusing on attitudes and beliefs abo...

Identifying as a ‘cancer victim’ has been linked to adverse psychosocial sequelae in individuals who have been diagnosed with cancer. Being a childhood sexual abuse (CSA) survivor may predispose individuals towards a “victim” identity in general. The aim of this study was to determine the prevalence of identifying as a ‘cancer victim’ among CSA sur...

Aims: In the field of radiogenomics, several potential predictive genetic markers have been identified that are associated with individual susceptibility to radiation toxicity. Predictive models of radiation toxicity incorporating radiogenomics and other biomarkers are being developed as part of the ongoing multicentre REQUITE trial. The purpose o...

Radiotherapy is a common and effective treatment for women with breast cancer. However, radiotherapy has also been shown to adversely affect patients’ emotional well-being. Currently, few mind–body interventions are designed to improve patients’ quality of life during radiotherapy. One intervention which has demonstrated clinical efficacy in the br...

Objective Some 25% of women and 8% of men in the United States have experienced childhood sexual abuse (CSA) before the age of 18. For these individuals, healthcare visits and interactions can be retraumatizing due to perceived similarities to past abuse (e.g., pain, undressing, lack of control). However, no prior studies have provided formal quali...

Hypnosis has been shown to alleviate symptoms and side effects of cancer and its treatment. However, less is known about the use of hypnosis at the end of life in individuals with cancer. Our goal was to systematically review the literature on the use of hypnosis to manage the most common symptoms of end-of-life cancer patients: fatigue, sleep dist...

Objective: One in 4 women and 1 in 10 men in the United States are survivors of sexual abuse (SA). For these survivors, healthcare experiences may trigger memories, thoughts, feelings or sensations related to this past abuse. Such triggering can be associated with negative responses to healthcare (e.g., anxiety, avoidance). However, to date, no he...

Background: Although family satisfaction is recognized as a critical indicator of quality for patients with advanced cancer, it is rarely assessed as part of routine clinical care. Measurement burden may be one barrier to widespread use of family satisfaction measures. Objective: The goal of this study was to test the ability of a new, brief 5-i...

Introduction: Satisfaction with breast reconstruction is thought to be greatest among patients who complete nipple and areolar complex (NAC) reconstruction. Anecdotally, many patients are known to decline NAC reconstruction. The authors aimed to characterize the epidemiology of and factors associated with incomplete breast reconstruction. Methods...

Although colorectal cancer (CRC) screenings can effectively detect and prevent cancer, a large portion of African-Americans and Latinos do not undergo regular colonoscopy screening. Research suggests that anticipatory distress can significantly hinder minorities' adherence to colonoscopy recommendations. There is significant promise that hypnosis m...

This study aimed (i) to determine whether people could be differentiated on the basis of their sun protection belief profiles and individual characteristics and (ii) explore the use of a crowdsourcing web service for the assessment of sun protection beliefs. A sample of 500 adults completed an online survey of sun protection belief items using Amaz...

Purpose: The aim of this study was to explore how women respond to the wording of dense breast tissue notifications, which are increasingly required by state law after mammography. The specific aims were to (1) determine whether perceived lifetime risk for breast cancer and intentions to undergo mammography increase after reviewing a sample notifi...

Reach: In medical settings, hypnosis is capable of helping a diverse range of individuals with a wide variety of problems. Efficacy: There is evidence supporting the use of hypnosis for chronic pain, acute pain and emotional distress arising from medical procedures and conditions, cancer treatment-related side-effects and irritable bowel syndrom...

The objective of this study was to test the efficacy of cognitive-behavioral therapy plus hypnosis (CBTH) to control fatigue in patients with breast cancer undergoing radiotherapy. We hypothesized that patients in the CBTH group receiving radiotherapy would have lower levels of fatigue than patients in an attention control group. Patients (n = 200)...

Objective: Skin toxicity is one of the most common acute side effects of breast cancer radiotherapy (RT). Past research has largely neglected non-medical out-of-pocket (OOP) spending associated with this side effect. We therefore developed a Skin Toxicity Costs (STC) questionnaire to assess such spending. The primary goal of the present study was t...

Abstract This study systematically reviews the hypnosis apps available via iTunes that were compatible with iPhone or iPad. Of 1455 apps identified on iTunes, 407 met inclusion criteria and were further reviewed. Most common hypnosis app targets were weight loss (23%), boosting self-esteem (20%), and relaxation/stress reduction (19%); 83% of apps d...

ABSTRACT Although therapeutic alliance is a crucial factor in face-to-face therapies, no data exist on clinicians' attitudes towards alliance in E-therapy. The study explored clinicians' perceived importance of alliance in E-therapy, clinicians' confidence in their skills to develop alliance in E-therapy, and whether attitudes towards alliance in E...

Objectives: Research suggests that the strength of the relationship between body image and emotional distress decreases with age. Past research has focused on expected aging-related body changes, and has not yet examined unexpected body changes (e.g., breast cancer surgery). The present post-hoc study assessed relationships between age, body image...

The goal of the study was to examine the relationships among fatigue catastrophizing, core dysfunctional beliefs, and fatigue in breast cancer radiotherapy patients. Seventy-eight patients participated in the study (mean age = 56.3, standard deviation = 10.5). Patients completed questionnaires on fatigue catastrophizing, core dysfunctional beliefs,...

Painful HIV distal sensory polyneuropathy (HIV-DSP) is the most common nervous system disorder in HIV patients. The symptoms adversely affect patients' quality of life and often diminish their capacity for independent self-care. No interventions have been shown to be consistently effective in treating the disorder. The purpose of the present study...

The present exploratory study investigated the interrelations among irrational cognitive processes, cognitive contents and specific emotions in breast cancer patients undergoing radiotherapy. The data were collected during a randomized clinical trial investigating a cognitive behavioral therapy intervention for breast cancer women undergoing radiot...

Answer questions and earn CME/CNE Hypnosis has been used to provide psychological and physical comfort to individuals diagnosed with cancer for nearly 200 years. The goals of this review are: 1) to describe hypnosis and its components and to dispel misconceptions; 2) to provide an overview of hypnosis as a cancer prevention and control technique (c...

Background Excisional/surgical breast biopsy has been related to anticipatory emotional distress, and anticipatory distress has been associated with worse biopsy-related outcomes (e.g., pain, physical discomfort). Purpose The present study was designed to investigate (a) whether anticipatory distress before an image-guided breast biopsy would corre...

E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health se...

Mindfulness-based interventions and mindfulness techniques have become increasingly popular in psychosocial care. These interventions have also been increasingly used with cancer patients and survivors. However, more attention is due to issues such as how these techniques may be specifically relevant for an oncology population and whether the relig...

Acute skin toxicity is one of the most common side effects of breast cancer radiotherapy. To date, no one has estimated the nonmedical out-of-pocket expenses associated with this side effect. The primary aim of the present descriptive, exploratory study was to assess the feasibility of a newly developed skin toxicity costs questionnaire. The second...

In the cancer setting, e-counseling interventions may be uniquely beneficial as they spare patients the cost and burden of traveling to a hospital or clinic for psychosocial care. However, the prevalence of e-counseling among psychosocial cancer care providers is unknown, as are the training needs with regard to e-counseling among this group of pro...

During breast cancer radiotherapy, nearly all patients will experience radiodermatitis. Study objectives were as follows: (1) systematically review the literature on radiodermatitis and breast cancer; (2) summarize and describe patient-rated radiodermatitis measures; (3) determine whether consensus exists regarding subjective radiodermatitis measur...

Beliefs about yoga may influence participation in yoga and outcomes of yoga interventions. There is currently no scale appropriate for assessing these beliefs in the general U.S. population. This study took the first steps in developing and validating a Beliefs About Yoga Scale (BAYS) to assess beliefs about yoga that may influence people's engagem...

An optical illusion mesmerizes us with its ability to look entirely different depending on our perspective. Our patients can challenge our perceptions, too. Many people are familiar with the famous illusion of Rubin's vase; the picture can appear to be two faces in profile or simply a vase. With someone pointing the way, viewers can learn to see bo...

Hypnotic suggestibility has been described as a powerful predictor of outcomes associated with hypnotic interventions. However, there have been no systematic approaches to quantifying this effect across the literature. This meta-analysis evaluates the magnitude of the effect of hypnotic suggestibility on hypnotic outcomes in clinical settings. Psyc...

Diabetes is increasingly prevalent, and nonadherence with diabetes treatment regimens is associated with physical and social costs. Psychological predictors of adherence have been investigated in the literature, including cognitive factors. The present meta-analysis was conducted to investigate the association between beliefs related to diabetes an...

Our objective was to conduct a critical review of the factors that account for psychological insulin resistance (PIR) and of the available strategies to reduce it. Medline, PubMed, Cochrane reviews, PsycInfo, ProQuest, Science Direct, and EBSCO databases were searched and 60 studies were included in the final review. Topics reviewed included: resea...

One of the most common acute side effects of breast cancer radiotherapy is treatment-induced skin changes, referred to as skin toxicity. Yet no research to date has focused expressly on skin toxicity-related quality of life (QOL) in breast cancer radiotherapy patients. Therefore, our aim was to use qualitative approaches to better understand the im...

Understanding precursors to distress and emotional well-being (EWB) experienced in anticipation of radiotherapy would facilitate the ability to intervene with this emotional upset (i.e. higher distress, lower EWB). Thus, this study tested an expectancy-based model for explaining emotional upset in breast cancer patients prior to radiotherapy. Women...

Evidence suggests that hypnosis is an effective intervention for reducing distress, pain and other side effects associated with cancer and its treatment. However, hypnosis has failed to be adopted into standard clinical practice. This study (n = 115) investigated overall intentions to use hypnosis to control side effects of cancer and its treatment...

This study explored the relationship between psychological factors (including intrusive thoughts, anxiety, well-being, depressed mood) and poor sleep the night before surgery. Patients (N = 39) scheduled for breast surgery (mean age = 47 years) wore an actiwatch at home the night before surgery to provide an objective indication of sleep duration a...

Before scheduled surgery, breast cancer surgical patients frequently experience high levels of distress and expect a variety of postsurgery symptoms. Previous literature has supported the view that presurgery distress and response expectancies are predictive of postsurgery outcomes. However, the contributions of distress and response expectancies t...

The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years; 63% White, 15% Hispani...

In this book leading scholars, researchers, and practitioners of rational emotive behavior therapy (REBT) and other cognitive-behavioral therapies (CBTs) share their perspectives and empirical findings on the nature of rational and irrational beliefs, the role of beliefs as mediators of functional and dysfunctional emotions and behaviors, and clini...

The effects of four empirically supported therapeutic relationship factors (therapeutic alliance, empathy, goal consensus/collaboration, and group cohesion) on the outcome of psychotherapeutic interventions conducted with individuals living with cancer were systematically reviewed. PubMed, PsycINFO, and CINAHL were searched from their inception thr...

Response expectancies, defined as expectations for nonvolitional responses, have been proposed to contribute to the experience of side effects of cancer and its treatment. To statistically evaluate this association, a systematic search of the published literature was conducted, resulting in 14 studies appropriate for meta-analysis. Results revealed...

Radiotherapy is a critical component of treatment for the majority of women with breast cancer, particularly those who receive breast conserving surgery. Although medically beneficial, radiotherapy can take a physical and psychological toll on patients. However, little is known about the specific thoughts and feelings experienced by women undergoin...

e20562 Background: Most women with gynecologic cancer must undergo surgery as part of their treatment. Research suggests that laparoscopic surgery may lead to fewer side effects and faster recovery than laparotomy. Clinically, however, it is unclear if these benefits have led to decreased levels of emotional distress in patients prior to the proced...

The study purpose was to test the effectiveness of a psychological intervention combining cognitive-behavioral therapy and hypnosis (CBTH) to treat radiotherapy-related fatigue. Women (n = 42) scheduled for breast cancer radiotherapy were randomly assigned to receive standard medical care (SMC) (n = 20) or a CBTH intervention (n = 22) in addition t...