A cancer diagnosis disrupts daily life with medical jargon, complex treatments, and pervasive fear, often extending stress to family caregivers. Timothy Sannes, PhD, blends clinical care and research to alleviate this impact.
A first step toward achieving this goal involves adopting a model that integrates health psychology into the routine care for cancer patients. The commitment of Jonathan Gerber, MD, in the division of hematology/oncology, and Kimberly Yonkers, MD, in the department of psychiatry, embracing this approach, propelled Dr. Sannes' decision to join UMass in November 2022. Dr. Sannes’ position gives him the latitude to develop his clinical program while maintaining an active research program that implements supportive interventions to meet the psychosocial needs of patients and their family caregivers.
We caught up with Dr. Sannes to hear about his methods for reducing the barriers patients and family caregivers confront when mental health support is sorely needed.
You began your career by examining physiological biomarkers of stress in cancer patients. Can you tell us some interesting findings as well as what prompted you to extend your focus to include family caregivers of cancer patients?
In some of my early work, we measured stress hormones in cancer patients’ saliva and found disrupted cortisol rhythms in women with gynecologic cancer. We moved on to measuring stress hormones in blood and even hair! In one study, we measured cortisol—often referred to as the stress hormone—and found heightened levels in cancer patients with depression. Surprisingly, we found no correlation with anxiety symptoms.
One of my mentors at the University of Colorado, the late Mark Laudenslager, a pioneer in studying biomarkers of stress and whose laboratory originated some of the hair cortisol work, was instrumental in shifting my research focus to include family caregivers. During my post-doctoral training, we consistently encountered not only cancer patients but also their often more stressed family caregivers. Because the stress was palpable in both patients and their caregivers, incorporating the family caregivers into our studies made sense. Eventually,we would go on to design interventions to better support caregivers and I continue to collaborate with the team out in the Rockies!
Is there a relationship between stress in patients and their caregivers?
This is such a complicated question but, yes, often patients and their caregivers overlap. Their shared experience is multi-faceted, including their emotions, social circle and sleep. This overlap is particularly important in bone marrow transplants where their shared experience lasts for months if not years. In one study I led, we identified a relationship between caregiver sleep before transplant and the time it took for donors' neutrophils —a type of white blood cell—to recover. This critical milestone during the transplant process indicates the donor cells have taken root and are beginning to replenish the patient’s blood supply. Studies, including one I led, emphasize the interconnected experiences of patients and caregivers, underlining the need to support both the patients and their caregivers.
What care models effectively encourage patients to take advantage of psychosocial support?
This is such a great question and directly related to some of the barriers to patient willingness. Closer integration of psychosocial providers with medical providers in our healthcare system, known as 'colocation,' reduces barriers for patients. With this model, psychosocial providers are in the same physical clinic as their medical providers. I find it exciting to work in real-time alongside oncologists during chemotherapy infusions to better support patients and families. I think my oncologist colleagues also appreciate this model as it offers better support to patients and their families.
What do you see as a significant barrier for caregivers getting the help they need?
Despite national attention, barriers like creating medical charts and defining billing codes for caregiver burdens hinder support. I'm working with colleagues, including Allison Applebaum, PhD, at Memorial Sloan Kettering—a world leader in cancer caregiving—to address these issues and advocate for specific billing codes that capture caregiver burden. We hope this will incentivize providers to turn more attention to family caregivers and create a pathway for additional support.
How can we effectively encourage patients and caregivers to seek supportive care?
One strategy we can use is to incorporate a targeted simple question at the end of the intake form, directly asking if they are interested in additional support. This approach gauges their openness to assistance and sets the groundwork for ongoing measurement of variables such as patients' willingness over time. This data-driven approach allows dynamic triaging of support services based on evolving needs and preferences, and it is one that I plan to incorporate into future research projects.
What is your favorite part about your job?
I love the teamwork involved as an embedded psychologist in the Cancer Center. I referenced colocation as a model of healthcare delivery, but on a day-to-day basis, it makes my job fun. I never know what a particular day might bring, and I work with an incredible group of oncologists. I think my role is a testament to UMass’ commitment to patients’ well-being!
About Timothy Sannes PhD
Timothy Sannes, PhD, is an associate professor in the Department of Psychiatry at the University of Massachusetts Chan Medical School and is affiliated with UMass Memorial Health. Dr. Sannes earned his doctorate from the University of Florida and was a Postdoctoral Palliative Care and Aging Research Fellow at the University of Colorado Anschutz Medical Campus. He received a Young Investigator Award from the American Psychosomatic Society in 2016.
