2007/2008 CPH Magazine - College of Public Health - University of ...

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Epidemiology and BiostatisticsDr. Claire Robb (right) metwith Dr. Martine Extermannand Dr. William Haley atMoffitt Cancer Center inTampa, Fla, to discuss hercontinuing research in thearea of cancer and aging.Life After Breast CancerThere’s no need for aging adults toresign themselves to illness. After all,aging is natural, but disease is not”, saysClaire Robb, assistant professor of Epidemiologyin the Department of Epidemiologyand Biostatistics.“Sometimes illness is thought togo hand-in-hand with aging,” saysRobb. “It doesn’t, and it is importantfor health care professionals workingwith older adults to distinguish the differencebetween normal age-relatedchanges that occur in the elderly andthose changes that are a direct result ofillness and disease.”Robb’s mission is simple: “Drawsome attention to the plight of the oldercancer patient and survivor,” she says.Her initial interest in this field wasin the area of older breast cancer survivors.Although 70 percent of breastcancer cases occur in women age 65 orolder, some of the most aggressive casescan be found in young women—so thatdemographic has had much of the researchfocus. It’s only in the past decadethat researchers have started paying attentionto older cancer survivors, partlybecause there are simply more oldercancer survivors alive these days as cancertreatment has improved.Even though older breast cancersurvivors are living longer, they are notnecessarily living well, as Robb’s researchreveals.Robb co-authored two papers thatwere published in the Critical Reviewsin Oncology/Hematology journal lastApril: “Impact of Breast Cancer Survivorshipon Quality of Life in OlderWomen” and “Individual Differencesin Well-Being in Older Breast CancerSurvivors.” Working with principalinvestigator William E. Haley ofthe University of South Florida, Robbsurveyed 127 survivors who had beenpatients at the H. Lee Moffitt CancerCenter and Research Institute in Tampa,Fla., as well as a control group of 87cancer-free women. The cancer survivors,whose mean age was 78, were onaverage five years from initial diagnosiswithout recurrence—a benchmark oftenthought of as a sign that the patientis cancer-free.“We thought we might see a littlemore functional disability in the survivors,”says Robb. “We weren’t surewhat we’d find.”What Robb and her colleagues didfind was that, on the average, older patientsfare worse in physical function,general health and mental health.Part of that can be due to the factthat older women take a longer time torecover from the primary treatment—a10 College of Public Health
lumpectomy or mastectomy—followedby radiation therapy, chemotherapyor, more recently, hormonal therapy.While younger women treated forbreast cancer usually recover fully withintwo years, “It just takes older peoplelonger to recover,” says Robb.Some of this may be due to alessening of reserve capacity in olderadults, she explains. In other words,it takes older adults a longer time to“bounce back” from a physical assaulton the system than it does in youngeradults.Also, the women who were survivorsdid not report more depressionthan the control group, but did reportsignificantly less satisfaction in theirlives than their cancer-free counterparts.The ultimate goal of Robb’s researchis to design interventions andspecial therapies that will help womenrecover more fully, and bring the researchshe and colleagues have done ina cancer center into the community.“Everyone has a right to live theirlife the best they possibly can,” shesays.In the meantime, Robb continuesto research “the next frontier” in cancerpatient support: the community setting.In September, Robb brought MartineExtermann, the research director of theMoffitt Center’s Senior Adult OncologyProgram, to speak at the Cancer andAging Salon sponsored by the Instituteof Gerontology. Robb also representedthe College of Public Health as a memberof the planning committee—alongwith Georgia Comprehensive CancerPrevention and the Centers for DiseaseControl and Prevention—for the state’sfirst Cancer Survivorship Conference,held in Peachtree City, GA.Her inspiration is simple. “A greataffinity for courageous older adults—that’s what got me interested in this,”she says.—Mary Jessica HammesPalm Pilotsto HelpPeople QuitSmokingThere are lots of reasonswhy people smoke,and everyone knows it’s hardto quit. But if researchers can analyzepatterns of quitting and relapse, then bettertherapies can be created for smoking cessation.Enter Steve Rathbun, associate professor of biostatistics,who is studying smokers’ habits using a new technology: PalmPilots. Test subjects record when they light up and can giveresponses in the moment regarding how they’re feeling, describetheir surroundings or note whether they’re alone. Datais collected while following subjects in their own environment.It’s called ecological momentary assessment data—real timeresponses, as opposed to vague memories recorded later.“One of the problems with previous studies is they weredone with paper surveys, where they asked smokers to recalltheir memories,” says Rathbun. “When you try to recall yourmood from two weeks ago, you may not remember correctly.”Patterns in the study are still emerging, but there havebeen a few observations already, some expected and somenot: Subjects tend to smoke when restless and alone; thewomen in the study are more likely to be affected by beingalone; the men, meanwhile, seem to be more affected by moodvariables.As a biostatistician, Rathbun’s job is to come up with a newmethodology to find unbiased results that can be mathematicallyproven valid. When he’s not doing that, Rathbun keepsbusy with an online course offered in collaboration with theCollege of Pharmacy’s regulatory affairs department, teachingstudents the statistical principles and issues involved in clinicaltrials. The course was first offered last summer.Rathbun is not new to collaboration. He often works withother departments on campus, an opportunity common inbiostatistician programs, he says: Grant proposals are morelikely to be funded with a statistician on board. And there arealways more collaborations on the horizon.“It’s a pretty exciting opportunity to be in on the groundfloor of a new college,” he says.—Mary Jessica HammesWinter 2007 11
Page 1 and 2: Public HealthTh e Un i v e r s i t
Page 5: Dahl Galen HepburnAssociate and Ass
Page 9 and 10: Caspary received his bachelor’s d
Page 11: susceptible targets: pregnant women
Page 15 and 16: Researching to Impact PolicyAngela
Page 17 and 18: Student Spotlight:Alex WrightSimply
Page 19 and 20: Alumni Spotlight:Linda Samuelmer wh
Page 21 and 22: Building a Constituency toRespond t
Page 23 and 24: A Life Long Commitmentto Equal Righ

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