Lauren C Heathcote

• PhD (DPhil) in Experimental Psychology
• PostDoc Position at Stanford Medicine

Objective Somatic symptoms (e.g., pain, fatigue) are common after childhood cancer and are associated with greater fear of cancer recurrence and poorer health‐related quality of life (HRQoL). Qualitative studies indicate that survivors of childhood cancer (SCCs) worry about somatic symptoms as indicating cancer recurrence, which could in part expla...

Objective: Providing opportunities to communicate about possible cancer recurrence may be adaptive for youth in remission, yet parents may experience difficulty guiding discussions related to fears of cancer recurrence (FCR). This study aimed to characterize mother-child discussions about potential cancer recurrence during post-treatment survivors...

Aims: Fear of cancer recurrence (FCR) is among the most prevalent and distressing concerns reported by cancer survivors. While younger age is the most consistent predictor of elevated FCR, research to date has focused almost exclusively on adult cancer survivors. This is despite the fact that children with cancer are more likely to survive compare...

Diagnostic uncertainty, the perceived lack of an accurate explanation of the patient's health problem, remains relatively unstudied in children. This study examined the prevalence, familial concordance, and correlates of diagnostic uncertainty in children and their parents presenting to a multidisciplinary pain clinic in the United States. One hund...

Background Adolescent and young adult (AYA) females are vulnerable to psychological sequelae following cancer diagnosis and treatment. Fear of cancer recurrence (FCR) is well‐documented in cancer survivors, however AYA survivors of breast and gynaecological cancers are less well‐studied. Moreover, little is known about scan‐related fears and anxiet...

Objective: Cancer-specific psychological interventions like cognitive behavioral stress management (CBSM) demonstrate distress (e.g., anxiety/depression) and quality of life (QoL) benefits. Digital formats can expand access. Method: Patients (80.6% female; 76.5% White; 25–80 years) with Stage I–III cancer and elevated anxiety within 6 months of tre...

Memory biases for pain-related information may contribute to the development and maintenance of chronic pain; however, evidence for when (and for whom) these biases occur is mixed. Therefore, we examined neural, stress, and psychological factors that could influence memory bias, focusing on memories that motivate disabling behaviors: pain perceptio...

The Stanford Cancer Survivorship Program is a key initiative of Stanford Cancer Institute. The program’s mission is to improve the experience and outcomes of patients and family caregivers throughout all phases of the cancer trajectory by advancing survivorship research, clinical care, and education. The four pillars of the program include clinical...

Objective Bodily threat monitoring is a core clinical feature of Fear of cancer recurrence (FCR) and is targeted in psycho‐oncology treatments, yet no comprehensive self‐report measure exists. The aim of this study was the theory‐informed development and initial validation of the Bodily Threat Monitoring Scale (BTMS). Methods Adult survivors of br...

Purpose: Patients with cancer often experience elevated levels of distress. This double-blind, randomized controlled trial compared the impact of an app-based version of cognitive behavioral stress management (CBSM) versus a health education sham app on anxiety and depression symptoms. Methods: Patients with nonmetastatic (stage I-III) cancer wh...

Background The Sensation and Pain Rating Scale (SPARS) allows rating of non-painful as well as painful percepts. While it performs well in the experimental context, its clinical utility is untested. This prospective, repeated-measures study mixed qualitative and quantitative methods to examine the utility and performance of the SPARS in a clinical...

Introduction Parents of survivors of childhood cancer may be particularly vulnerable to the experience of poor mental health amid the COVID-19 pandemic. This study aimed to (1) describe the mental health of parents of childhood cancer survivors; (2) explore the role of intolerance of uncertainty (IU) in mental health; and (3) explore the associatio...

Pain is a common consequence of childhood cancer. While most research has examined biomedical predictors of post-cancer pain, biopsychosocial conceptualisations such as the Cancer Threat Interpretation (CTI) model hold promise for guiding comprehensive pain management strategies. Guided by the CTI model, this cross-sectional study evaluated correla...

Atopic dermatitis (AD) is a chronic, pruritic and inflammatory, dry skin condition with many known comorbidities. These include airway disease, food allergies, atopic eye disease and autoimmune conditions. Furthermore, there is often significant sleep disturbance as well as increased psychological distress and mental health problems. Severe AD ther...

Background: Side-effect concerns are a major barrier to vaccination against COVID-19 and other diseases. Identifying cost- and time-efficient interventions to improve vaccine experience and reduce vaccine hesitancy-without withholding information about side effects-is critical. Purpose: Determine whether a brief symptom as positive signals minds...

1507 Background: Patients with cancer often experience clinically elevated levels of distress, including anxiety and depression. Psychological interventions, such as Cognitive Behavioral Stress Management (CBSM), have evidenced benefits on distress, quality of life, and long-term health outcomes, however, they are not widely available or easily acc...

Objectives/purpose Childhood cancer survival brings continued mental and physical health challenges both for the child and for the family. In this study, we investigated how parents viewed their roles in their child’s health and symptom monitoring during the survivorship period. Methods Twenty-one parents of childhood cancer survivors (n = 18 moth...

Simple Summary “Scanxiety”, or the distress and/or anxiety occurring before, during, and after cancer-related imaging/scans, is an upsetting experience during and following cancer. To better understand the nature of scanxiety, related research gaps and practices, and possible ways to help manage it, we conducted a review of the literature using a s...

Purpose: Childhood cancer survivors report self-monitoring for and worrying about symptoms of disease recurrence and secondary cancers, although symptom-related worry is associated with poorer health-related quality of life. This survey captured pediatric oncologists' beliefs and communication practices regarding symptom self-monitoring for childh...

(1) Background: The COVID-19 global pandemic has impacted people worldwide with unique implications for vulnerable groups. In this cross-sectional study, we examined the impact of the early pandemic on children undergoing active cancer treatment and their parents. (2) Methods: In May 2020, 30 parents of children undergoing active cancer treatment c...

Purpose Here, we describe the development and pilot study of a personalized eHealth intervention containing a pain science education program and self-management support strategies regarding pain and pain-related functioning in female survivors of breast cancer. First, we aimed to evaluate the eHealth intervention’s acceptability, comprehensibility,...

Background: Pain science education is commonly integrated into treatments for childhood-onset chronic pain. A core component of pain science education is learning about, and often reconceptualizing, the biology of chronic pain. Yet, few interventions have been developed specifically for young adults and little is known about how young adults conce...

Objectives: An important part of providing pain science education is to first assess baseline knowledge and beliefs about pain, thereby identifying misconceptions and establishing individually-tailored learning objectives. The Concept of Pain Inventory (COPI) was developed to support this need. This study aimed to characterize concept of pain in c...

Objective: The Cancer Threat Interpretation model proposes that clinically significant fear of cancer recurrence/progression (FCR/P) can occur when people misinterpret ambiguous physical symptoms as a sign of recurrence. The aim of this research is to test whether interpretation biases moderate the relationship between pain and FCR/P in women with...

Purpose Patient-reported outcome measurements (PROMs) are increasingly used for cancer patients receiving active treatment, but little is known about the implementation and usefulness of PROMs in cancer survivorship care. This systematic review evaluates how cancer survivors and healthcare providers (HCPs) perceive PROM implementation in survivorsh...

Pain in children living with and beyond cancer is understudied and undertreated. Pain science education (PSE) is a conceptual change strategy facilitating patients’ understanding of the biopsychosocial aspects of pain. Preliminary studies on the adaptation of PSE interventions to adults with and beyond cancer provide a foundation for pediatric rese...

Objectives: Theoretical models suggest that anxiety, pain intensity, and pain catastrophizing are implicated in a cycle that leads to heightened fear of cancer recurrence (FCR). However, these relationships have not been empirically examined. The objective of this study was to examine the relationships between anxiety symptoms, pain intensity, pai...

Background Adolescent and young adult (AYA; 13 to 39 years) survivors of childhood cancer may be especially vulnerable to physical health and mental health concerns during the pandemic. We investigated the impact of COVID-19 on the mental health status of AYA survivors (Aim 1) and shared tailored, evidence-based health-related information on COVID-...

Background: The predominant definition of fear of cancer recurrence (FCR) conflates FCR with fear of progression (FOP). However, this assumption has never been tested. Importantly, if FCR and FOP are distinct and have different predictors, existing interventions for FCR may not be equally effective for survivors who fear progression rather than re...

Introduction: Pain is common during childhood cancer treatment, can persist into survivorship, and can negatively affect health-related quality of life in survivors of childhood cancers (SCCs). Objective: The objective of this brief report was to assess pain frequency, pain-related worry, and their (unique) associations with health-related quali...

Objective: Scan-related anxiety ("scanxiety") refers to the fear, stress, and anxiety in anticipation of tests and scans in follow-up cancer care. This study assessed the feasibility of Ecological Momentary Assessment (EMA) for real-world, real-time capture of scanxiety using patients' personal smartphone. Methods: Adolescent and Young Adult (AY...

This paper discusses the growing problem of persisting pain after successful treatment of breast cancer and presents recommendations for improving pain-related outcomes for this group. We discuss the dominant treatment approach for persisting pain post-breast cancer treatment and draw contrasts with contemporary treatment approaches to persistent p...

Introduction: Functional improvement is a critical outcome for individuals living with chronic pain. Graded exposure treatment has been associated with statistically significant improvements in functional outcomes for youth with chronic pain by targeting pain-related fear and avoidance. Objective: The aim of the present study was to explore clin...

Rationale As the SARS-COV-2 virus spread across the world in the early months of 2020, people sought to make sense of the complex and rapidly evolving situation by adopting mindsets about what the pandemic was and what it meant for their lives. Objective We aimed to measure the mindsets of American adults over the first six months of the COVID-19...

Pain in children living with and beyond cancer is understudied and undertreated. Pain science education (PSE) is a conceptual change strategy facilitating patients’ understanding of the biopsychosocial aspects of pain. Preliminary studies on the adaptation of PSE interventions to adults with and beyond cancer provide a foundation for pediatric rese...

Objective Fear of cancer recurrence (FCR) is a common and distressing psychosocial concern for adult cancer survivors. Data on this construct in child survivors is limited and there are no validated measures for this population. This study aimed to adapt the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) for survivors of childhood cancer...

Letter to the Editor-in-Chief in response to JOSPT article “Education With Therapeutic Alliance Did Not Improve Symptoms in Patients With Chronic Low Back Pain and Low Risk of Poor Prognosis Compared to Education Without Therapeutic Alliance: A Randomized Controlled Trial” by Miyamoto et al. J Orthop Sports Phys Ther 2021;51(10):526–527. doi:10.251...

Cancer and its treatment can have lasting consequences on somatosensation, including pain, which is often underrecognized and undertreated. Research characterizing the impact of cancer on pain and sensory processing in survivors of childhood cancer is scarce. This study aimed to quantify generalized differences in pain and sensory processing in sur...

There is a need to identify brain connectivity alterations predictive of transdiagnostic processes that may confer vulnerability for affective symptomology. Here, we tested whether amygdala resting-state functional connectivity (rsFC) mediated the relationship between catastrophizing (negative threat appraisals and predicting poorer functioning) an...

The effective prevention and treatment of pain in pediatric patients requires multimodal analgesia. Safe and efficacious multimodal analgesia may include one, several, or all of the following approaches: pharmacology (e.g., simple analgesia and/or opioids and/or adjuvant analgesia), anesthetic interventions (e.g., neuroaxial analgesia, nerve blocks...

As the SARS-COV-2 virus spread across the world in the early months of 2020, people sought to make sense of the complex and rapidly evolving situation. This longitudinal study of N=5,365 Americans assessed three mindsets people formed about the COVID-19 pandemic and what it meant for their lives: ‘the pandemic is a catastrophe’, ‘the pandemic is ma...

Attentional biases have been posited as one of the key mechanisms underlying the development and maintenance of chronic pain and co-occurring internalizing mental health symptoms. Despite this theoretical prominence, a comprehensive understanding of the nature of biased attentional processing in chronic pain and its relationship to theorized antece...

10050 Background: The COVID-19 pandemic has affected oncology practice in a variety of ways. We sought to evaluate the impact on pediatric oncology parent and young adult (YA) patient experiences, concerns, and perceived stress. Methods: We conducted a cross-sectional Internet-based survey of parents and YA patients in the pediatric oncology and su...

Exaggerated recall of pain may pose a risk for pain persistence and elevated pain-related distress. In adults with chronic pain, such discrepancy (or memory bias) has been correlated to hippocampal morphology. However, this has not been examined in youth with chronic pain nor applied to the recall of fear and negative affect, and to amygdala morpho...

Pain is common during childhood cancer treatment, can persist into survivorship, and is under-managed in young survivors of childhood cancer (SCCs). Pain may influence health-related quality of life in SCCs simply via its frequency, and/or by triggering worries about cancer recurrence. The purpose of this study was to explore proximal associations...

Negatively-biased memories for painful events (recalled pain greater than initial reported pain) are consistently associated with worse pain outcomes in adults and youth; thus, the tendency to develop negative memory biases is suggested to be a risk factor for chronic pain. From a transdiagnostic perspective, this may reflect a more general bias in...

Adolescent and young adult (AYA) cancer survivors commonly experience worry about new or recurrent pain as a potential sign of cancer recurrence. Those with higher intolerance of uncertainty (IU) may be more likely to interpret bodily sensations as threatening, thus amplifying their pain experience and interference with regular activities. This stu...

Background Cancer‐related worry (CRW) is common among cancer survivors; however, little is known about factors associated with CRW or its impact on health behaviors in adult survivors of childhood cancer. Methods Survivors in the St. Jude Lifetime Cohort Study (n = 3211; 51% male; mean age, 31.2 years [SD, 8.4 years]; mean time after diagnosis, 22...

Pain education is a popular treatment approach for persistent pain that involves learning a variety of concepts about pain (ie, target concepts), which is thought to be an important part of recovery. Yet, little is known about what patients value learning about pain. A mixed-methods survey was conducted to identify pain concepts that were valued by...

Clinicians have an increasing number of evidence-based interventions to treat pain in youth. Mediation analysis offers a way of investigating how interventions work, by examining the extent to which an intermediate variable, or mediator, explains the effect of an intervention. This systematic review examined studies that used mediation analysis to...

Objectives: Parents have a vital influence over their child's chronic pain treatment and management. Graded exposure in-vivo treatment (GET) is emerging as a promising intervention for youth with chronic pain. Yet, little is known about how parents perceive GET and its impact on their child's pain condition. This study aimed to characterize caregi...

Survivors of childhood cancer may be at risk of experiencing pain, and a systematic review would advance our understanding of pain in this population. The objective of this study was to describe: 1) the prevalence of pain in survivors of childhood cancer, 2) methods of pain measurement, 3) associations between pain and biopsychosocial factors, and...

Objective: Somatic symptoms capture attention, demand interpretation , and promote health behaviors. Symptom appraisal is particularly impactful within uncertain health contexts such as cancer survivorship. Yet, little is known about how individuals make sense of somatic symptoms within uncertain health contexts , nor how this process guides health...

Background: Despite evidence that intensive interdisciplinary pain treatment (IIPT) is effective in facilitating functional recovery in adolescents with chronic pain, engagement with IIPT is suboptimal among adolescents. A key aspect of IIPT is to support functional recovery via (re)engagement with age-appropriate daily activities. The aim of this...

Introduction: Chronic pain conditions are common among children and engender cascading effects across social, emotional, and behavioral domains for the child and family. Mobile health (mHealth) describes the practice of delivering healthcare via mobile devices and may be an ideal solution to increase access and reach of evidence-based behavioral h...

Previous meta-analyses investigating attentional biases towards pain have utilized reaction time measures. Eye-tracking methods have been adopted to more directly and reliably assess biases, but this literature has not been synthesized in relation to pain. This meta-analysis aimed to investigate the nature and time-course of attentional biases to p...

Key Points: • Fear of cancer recurrence (FCR) is a primary survivorship issue requiring more research to guide intervention development. • Qualitative interview methods are ideally suited to gain rich insights into the nature, triggers, and consequences of FCR, yet one barrier to using these methods is concern of causing distress. • Using a validat...

A growing literature suggests that facial expression of certain emotions, such as fear or anger, may be pre-consciously detectable by observers, possibly facilitating more rapid neural processing for adaptive reasons. Might facial expressions of pain be similarly privileged for pre-conscious detection and processing? In this paper, we provide theor...

To the Editor We commend Baker¹ for his call to action to “do better” in cancer survivorship care. Baker advocates for an increased focus on treatment-specific late effects; this work can promote precision in survivorship care by targeting prevention efforts and increasing medical surveillance for those with elevated biomedical risk.

Attentional biases are posited to play a key role in the development and maintenance of chronic pain in adults and youth. However, research to date has yielded mixed findings and few studies have examined attentional biases in pediatric samples. The present study used eye-gaze tracking to examine attentional biases to pain-related stimuli in a clin...

Background: Attending towards pain is proposed as a key mechanism influencing the experience and chronification of pain. Persistent attention toward pain is proposed to drive poor outcomes in both adults and children with chronic pain. However, there are no validated self-report measures of pain-related attention for children. Methods: The goals...

Engaging youth in evidence‐based health education has the capacity to positively impact their experiences of health and illness across the lifespan. In particular, pain science education is now an established part of the treatment arsenal for persistent pain conditions in adults, and there are calls to build educational resources for youth with pai...

Objective: Parent responses can have a major impact on their child's pain. The purpose of this systematic review is to (a) identify and describe measures assessing pain-related cognitive, affective, and behavioral responses in parents of children with chronic pain and (b) meta-analyze reported correlations between parent constructs and child outco...

Theoretical models and evidence increasingly identify chronic pain as a family issue. To date, much of this work has focused on risk conferred by parental chronic pain status despite evidence suggesting parent mental illness and non-pain-related chronic illness may also contribute to poorer chronic pain outcomes in children. This study is the first...

Background: Adolescence is a time of considerable social, cognitive, and physiological development. It reflects a period of heightened risk for the onset of mental health problems, as well as heightened opportunity for flourishing and resilience. The CogBIAS Longitudinal Study (CogBIAS-L-S) aims to investigate psychological development during adol...

Approximately 1.7 million youth suffer from debilitating chronic pain in the US alone, conferring risk for continued pain in adulthood. Abberations in threat-safety (T-S) discrimination are proposed to contribute to pain chronicity in adults and youth by interacting with pain-related distress. Yet, few studies have examined the neural circuitry und...

147 Background: Symptom monitoring plays an important role in both the physical and psychological challenges of surviving cancer. Anecdotally, cancer survival is characterized by uncertainty, symptom-related fear, and the interpretation of normal bodily sensations as symptomatic of cancer recurrence. This fear may lead to over-vigilance of benign b...

Background: Persistent pain is a prevalent condition that negatively influences physical, emotional, social and family functioning in adolescents. Pain science education is a promising therapy for adults, yet to be thoroughly investigated for persistent pain in adolescents. There is a need to develop suitable curricula for adolescent pain science e...

Stress and pain are interleaved at multiple levels - interacting and influencing each other. Both are modulated by psychosocial factors including fears, beliefs, and goals, and are served by overlapping neural substrates. One major contributing factor in the development and maintenance of chronic pain is threat learning, with pain as an emotionally...

The tendency to select threatening over benign interpretations of ambiguous bodily sensations and cues characterises young people with chronic pain. However, previous studies disagree over whether these biases extend to non-bodily harm situations such as social evaluation. Understanding the content of these biases is crucial to the development of p...

Pain-related fear and avoidance are increasingly demonstrated to play an important role in adult and childhood chronic pain. The Fear of Pain Questionnaire for Children (FOPQC) is a 24-item measure of pain-related fear-avoidance in youth that has demonstrated good indices of reliability and validity, treatment responsiveness, and associations with...

Objective: Today over 80% of children diagnosed with cancer are expected to survive. Despite the high prevalence of pain associated with the diagnosis and treatment of childhood cancer, there is a limited understanding of how having cancer shapes children's experience and meaning of pain after treatment has ended. This study addresses this gap by...

Objective: Pain and fatigue are under-researched late effects of childhood cancer and its treatment, and may be interpreted by survivors as indicating cancer recurrence. Moreover, unmet information needs for managing pain and fatigue may be related to fear of cancer recurrence. We investigated the complex relationships between perceived cancer-rel...

Objective: This study aims to assess the feasibility of digital perioperative behavioral pain medicine intervention in breast cancer surgery and evaluate its impact on pain catastrophizing, pain, and opioid cessation after surgery. Design and setting: A randomized controlled clinical trial was conducted at Stanford University (Palo Alto, CA, USA...

We know little about the safety or efficacy of pharmacological medicines for children and adolescents with chronic pain, despite their common use. Our aim was to conduct an overview review of systematic reviews of pharmacological interventions that purport to reduce pain in children with chronic non-cancer pain or chronic cancer-related pain. We se...

Pain is an understudied and undertreated consequence of cancer survival. Pain education is now a recommended treatment approach for persistent non-cancer pain, yet it has not been well applied to the context of adolescent and young adult (AYA) cancer survival. In March 2018, an interdisciplinary meeting was held in Adelaide, South Australia to set...

Objectives The Internet in general, and YouTube in particular, is now one of the most popular sources of health-related information. Pain neuroscience education has become a primary tool for managing persistent pain, based in part on the discovery that information about pain can change pain. Our objective was to examine the availability, characteri...

Raw data for systematic review of pain neuroscience education videos on YouTube

Among youth with chronic pain, elevated somatic symptoms across multiple body systems have been associated with greater emotional distress and functional disability and could represent poor adaptation to pain. The Children's Somatic Symptoms Inventory (formerly the Children's Somatization Inventory) is commonly used to assess somatic symptoms in ch...

We would like to thank Oana Lindner and colleagues for their response to our Personal View, and for highlighting the potential of digitally enhanced patient-reported outcome measures for care of survivors. We agree and would like to emphasise the potential value of this technology for the psychosocial care of cancer survivors. Among the most diffic...

Objectives: The Internet in general, and YouTube in particular, is now one of the most popular sources of health-related information. Pain neuroscience education has become a primary tool for managing persistent pain, based in part on the discovery that information about pain can change pain. Our objective was to examine the availability, character...

Empathy is an essential component of our social lives, allowing us to understand and share other people's affective and sensory states, including pain. Evidence suggests a core neural network—including anterior insula (AI) and mid-cingulate cortex (MCC)—is involved in empathy for pain. However, a similar network is associated to empathy for non-pai...

Wellbeing after successful cancer treatment depends on more than merely reducing the risk of disease recurrence. Cancer survival can be characterised by uncertainty, fear, and the interpretation of bodily sensations as potentially symptomatic of cancer recurrence. This fear can lead to over-vigilance of bodily sensations and precautionary visits to...

Pain by its evolutionary nature demands attention, warrants interpretation, and often etches itself into our lifelong memories. These cognitive processes of attending, interpreting, and remembering are central components of the pain experience and guide our approach and avoidance of future pain-related experiences. In this chapter, we discuss how c...

How parents attribute cause to their child’s physical symptoms is likely important in understanding how the parent responds to the child, as well as the child’s health outcomes, especially within the context of chronic illness. Here, we adapt the Symptom Interpretation Questionnaire for parent report (SIQ-PR) and provide preliminary validation in a...

Introduction: The epidemiology of chronic pain in youth has been increasingly documented over the past decade. However, the precipitating events associated with the onset of pediatric chronic pain are not well studied. Objectives: Understanding the events that precede the onset of pain, and are reported by patients as germane to the early stages...