Moving from Best Evidence To Best Practice

Thanks to her new CIHR Chair, Dr. Linda Carlson continues to successfully combine her passion for mentorship and patient engagement with integrative oncology research.

Dr. Linda E. Carlson

For those exploring new ground, there is an inherent challenge in talking about one’s work. This is particularly true for those working in innovative fields such as Integrative Oncology. Though Dr. Linda Carlson is a university professor, a psychologist, and a researcher, her work does not involve teaching large classes, offering therapy to patients, or working in a wet lab. Her work goes beyond the traditional boundaries, and ventures into the future of behavioural medicine as interdisciplinary, evidence-based, and patient-oriented.

During her graduate school days studying psychoneuroendocrinology at McGill University in Montréal as part of her training as a Clinical Health Psychologist, Dr. Linda Carlson explored yoga and meditation out of personal interest. Her internship rotation brought her to the Tom Baker Cancer Centre (Alberta, Canada) where she met Dr. Michael Speca who was developing a mindfulness program for oncology patients. Its aim was to offer increased support to patients coping with the vulnerability and stress of cancer treatment. She was excited by the opportunity to combine personal practice with professional life and was eager to explore this blend of research and clinical practice.

She subsequently received a Canadian Institutes of Health Research (CIHR) New Investigator Award from 2002 to 2007 for her research in mindfulness-based cancer recovery, followed by numerous other awards between 2006 and 2013 as new investigator and for research excellence.

Beyond the more than 150 papers and book chapters she has published in the area of psycho-oncology, she published a professional training manual in 2009 with Dr. Shauna Shapiro (The Art and Science of Mindfulness: Integrating Mindfulness into Psychology and the Helping Professions) and a patient manual in 2010 with Dr. Speca, Mindfulness-Based Cancer Recovery: A Step-by-Step MBSR Approach to Help You Cope with Treatment and Reclaim your Life.

On any given week, after meeting with students and co-investigators to monitor progress and troubleshoot project questions, Dr. Carlson teaches mindfulness-based cancer recovery classes to patients at the Tom Baker Cancer Centre, and conducts patient education seminars on complementary therapies.

Her week also includes working on publishing study results, dutifully seeking research funding, and fulfilling her editorial and administrative duties with a number of societies, including the Health Psychology journal (of which she is Associate Editor), the executive committee of the Society for Integrative Oncology, and the annual meeting planning committee of the American Psychosomatic Society.

Dr. Carlson believes networking with other researchers is not merely advantageous, it is fundamental in health research. Accordingly, her interdisciplinary approach has brought her to work with immunologists, cell biologists, and other basic scientists, as well as oncologists, nurses, kinesiologists and others. She has also worked with innumerable other co-investigators from the University of Calgary, from Canada, and from around the world in the course of publishing her study results and serving as a consultant.

When asked about the biggest challenge facing the field today, Dr. Carlson underlines the systemic barriers to knowledge translation and the inability of the health care system to integrate new technologies and keep up with research findings. Looking ahead, she believes that more real-world, pragmatic patient-centred research focused on effectiveness will translate into improving everyday clinical practice. She also foresees research that integrates technology with traditional behavioural intervention methodology will greatly help to advance the field, notably by improving reach and access, and enabling the collection of large amounts of tracking, usage, and outcome data from users. That said, she believes the use of online and mobile technology in this field of research must be rigorously tested. “It is essential to work towards improving reach and access for patients no matter where they reside,” explains Dr. Carlson. Over the next decade, Dr. Carlson hopes to see increased knowledge accessibility and integration, and sees strong interdisciplinary networks as fundamental in making this happen.

MENTORSHIP CHAIR

Most recently, Dr. Carlson was awarded a Chair from the Canadian Institutes of Health Research (CIHR) under a grant entitled Mentorship Program in Innovative Integrative Oncology Clinical Trials: Moving from Best Evidence to Best Practice. The training program involved in this grant is called TRACTION, Training in Research and Clinical Trials in Integrative Oncology.

TRACTION is multidisciplinary. It is geared towards training students from different programs at the undergraduate, graduate, and postdoctoral levels studying innovative behavioural clinical trial design and execution in integrative oncology.

Using a mentorship approach, the program trains students in patient-oriented research methods, including Patient Engagement (PE) and Knowledge Translation (KT) strategies, and conducts cutting-edge clinical research in integrative cancer therapies. It engages directly with students and involves them as active team members. It also provides its students opportunities to develop mentoring skills by working with junior trainees.

Beyond providing students the opportunity to publish their results, attend and present their work at conferences, TRACTION also helps them engage with community partners in knowledge translation and program dissemination. The ultimate objective is to increase capacity for patient-oriented research in the area of integrative oncology.

BUILDING NETWORKS AND RELATIONSHIPS

Dr. Carlson has successfully combined personal and professional interests in her work and is excited that her new mentorship chair continues to weave together her passion for mentoring students and her commitment to engaging patients in their recovery process. The program also allows her to leverage her enthusiasm for translating knowledge arising from study results, and she is particularly keen about conduction leading-edge and unprecedented clinical trials, such as she did with the MATCH study.

Dr. Carlson encourages her students to believe that nothing is beyond their grasp once they have clearly articulated and developed what they want to accomplish. Perseverance is one of the best tools in a researcher’s toolkit. She also believes in the importance of building strong team relationships, particularly within postdoctoral training programs, and the need to build teams with an interdisciplinary approach. Team work is a skill that can be learned, shared, improved, and leveraged, and indeed should be.

This year, Dr. Carlson plans on attending the Society for Integrative Oncology annual meeting, the American Psychosomatic Society meeting, and other psycho-oncology meetings. She will be speaking in November at the Psycho-Oncology New Zealand (or PONZ) annual meeting.

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Dr. Carlson is a sought-after speaker and travels internationally to share her research findings. She holds the Enbridge Research Chair in Psychosocial Oncology at the University of Calgary, and works as a Clinical Psychologist and serves as Director of Research at the Department of Psychosocial Resources at the Tom Baker Cancer Centre. She is also a fellow of the Society of Behavioral Medicine and the Mind and Life Institute, an Alberta Innovates-Health Solutions Health Scholar, a Full Professor in Psychosocial Oncology in the Department of Oncology, Cumming School of Medicine at the University of Calgary, and Adjunct Professor in the Department of Psychology.

 

Integrative Oncology is a subspecialty of behavioural medicine which focuses on a broad range of interventions to treat common emotional, social, behavioural, and psychological risk factors for and consequences of cancer. Integrative Oncology includes many complementary therapy (CT) approaches such as natural health products (herbs, vitamins, and minerals), nutrition, acupuncture, music therapy, touch therapies (such as massage), physical activity, and mind-body therapies (MBTs) such as meditation, yoga, relaxation, imagery, and tai chi/Qigong.

It incorporates a system of interdisciplinary care blended throughout cancer care as necessary for each person, employing a collaborative interdisciplinary team approach which is patient-centred, so that the patient’s needs, values and preferences dictate the course of care.

It is an evidence-based approach that uses complementary therapies in concert with conventional medical treatment to enhance efficacy, improve symptom control, alleviate patient distress, and improve overall quality of life.

The MATCH study (Mindfulness and Tai Chi for Cancer Health) is an innovative preference-based clinical effectiveness trial that is being conducted in Calgary and Toronto for treating distressed cancer survivors. It will serve as a training ground for many of the TRACTION fellows, giving them first-hand learning about innovative methods involved in running a complex clinical trial. Download the protocol paper (PDF).

The MATCH study stemmed directly from a previous trial (called MINDSET) that compared mindfulness to supportive-expressive therapy in breast cancer survivors, using a more traditional RCT design. MINDSET uncovered that preference made a difference to outcomes and this is what lead her to incorporate preference-based treatment arms into MATCH.

KEYWORDS: Behavioural medicine, complementary therapies, health psychology, integrative oncology, mindfulness, psychosocial oncology