Psychosocial Oncology
Dr. Barry Bultz, Division Head
Carly Sears, Administrative Assistant
The Division of Psychosocial Oncology in the Department of Oncology, Cumming School of Medicine, is one of the first academic programs of its kind in North America. First established in 1992 along with the clinical Department at the Tom Baker Cancer Centre, it is the first cancer program to be accredited by the Canadian Psychological Association. The Division is committed to research, education, and furthering the science and practice of the emotional, psychological, social, spiritual, and functional aspects of patients’ and families’ experience of living with cancer.
Members of the division include full-time researchers and an international multidisciplinary team of academic and clinical professionals (Psychologists, Psychiatrists and Social Workers) who are actively involved in many facets of psychosocial research.
The Division offers education and training opportunities for students/interns and post-doctoral fellows in collaboration with The Tom Baker Cancer Centre, Alberta Children’s Hospital, and the University of Calgary Faculty of Arts (Department of Psychology), Cumming School of Medicine, and Faculty of Kinesiology.
The Division has a strong and successful record of academic and clinical achievement, with an international reputation for leading the way in integrated psychosocial care and research. The Division is able to offer supervision and mentorship to clinical and research students, residents, and fellows. Faculty members have received numerous accolades for their accomplishments, grants, and published papers. Well recognized in the community, philanthropic funds continue to be directed to further research in our science of caring.
Strategic Plan and Research Philosophy
The mandate of the Division is to conduct clinical research and education in the area of psychosocial oncology. The Division develops and evaluates evidence-based psychosocial treatment in collaboration with Cancer Care Alberta (CCA), Alberta Health Services (AHS). Supportive Care CCA is responsible for providing patient-centered and evidence-informed psychosocial and rehabilitation treatment, bringing research into practice and contributing to state-of-the-art knowledge concerning the science of Psychosocial Oncology. The Division and Supportive Care, CCA collaborate to ensure health care providers and the public are informed about the impact of cancer on the individual patient and family, as well as evidence-based interventions, thereby promoting optimal psychosocial care.
Over the years, the Division has conducted numerous clinical trials validating the psychological, social, quality of life, and physiological benefits of our clinical research programs. Some examples (described in more detail below) include: mindfulness-based cancer recovery, supportive-expressive group therapy, cognitive behavioral therapy for insomnia, partner support groups, Hematopoietic Cell Transplantation (HCT) quality of life, exercise interventions, online support groups, sexual health programs and our screening for distress initiatives. These research and training programs strive to improve quality of life and provide patients and their family members with skills and support to help them throughout their cancer journey.
Chairs
Enbridge Endowed Research Chair – The Enbridge Research Chair in Psychosocial Oncology, co-funded by the Alberta Cancer Foundation and the Canadian Cancer Society, Alberta/NWT Division, was announced in 2005, with objectives to conduct high-quality nationally funded multidisciplinary research in Psychosocial Oncology that could be translated into practice, and to attract top-level students and postdoctoral fellows to the program. The recruitment of the first Chair concluded in March of 2007 with the selection of Dr. Linda Carlson, with research priorities in Screening for Distress, Integrative Oncology and Survivorship research. Dr. Carlson continues to hold this Chair.
The Daniel Family Leadership Chair in Psychosocial Oncology – The Daniel Family Leadership Chair in Psychosocial Oncology was created in 2016 by the Daniel Family Foundation. The purpose of this Leadership Chair is to help the Division grow and to further develop the academic psychosocial oncology field. The Leadership Chair enables the Division to expand its scope of research specialties and to promote the impact of psychosocial oncology research on a global level. Dr. Barry Bultz, the Division Head, is the inaugural Chair holder.
With funding support from the Daniel Leadership Chair, the Division was able to expand to include a focus on Pediatric, Adolescent and Young Adult Psychosocial Oncology by recruiting Dr. Fiona Schulte. Dr. Schulte joined the Division in 2017 and has established a strong research and academic program. This has given the Division the impetus to pursue establishing a formalized academic program in Pediatric, Adolescent and Young Adult Psychosocial Oncology. The Chair has also funded the work of Dr. Lauren Walker in Sexual Health, postdoctoral fellow Dr. Devesh Oberoi, and work investigating the role of Medical Assistance in Dying in oncology. The Chair has also supported clinical research in GI and HCT clinics.
Programs
Psychosocial Screening
Dr. Barry Bultz initiated movement toward the wide-scale recognition of the importance of emotional distress in cancer patients. He and Dr. Carlson conducted some of the first large clinical trials evaluating the best methods to implement screening for distress and strengthened the evidence-base for its efficacy. These efforts, combined with a series of presentations, publications, and editorials by Drs. Bultz and Carlson resulted in the endorsement of Emotional Distress as the 6th Vital Sign by the Council of Canadian Strategy for Cancer Control (CSCC) in 2005. In 2009, Accreditation Canada stated that all cancer patients should be routinely screened for distress. In Alberta, this Calgary-catalyzed initiative became a standard of practice through a CancerControl Alberta provincial initiative called “Putting Patients First”. This initiative not only works to improve the patient experience, but creates a better understanding of patients’ cancer journey. Globally, Screening for Distress as the 6th Vital Sign has been endorsed and implemented as a standard of practice in over 75 countries and cancer agencies, promoted by Dr. Bultz in his role as then-president of the International Psycho-Oncology Society.
Currently, data collected routinely through the “Putting Patients First” program, implemented across Alberta, has been used in a number of research projects, including a project looking at distress over time in HCT patients.
Integrative Oncology (IO)
Integrative oncology is defined as “a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment.” Hence, IO complements overall psychosocial care and research by expanding into therapies such as acupuncture, yoga, mindfulness meditation, and lifestyle factors such as diet, nutrition, natural health products and exercise
The Integrative Oncology program is led by Dr. Carlson and overseen by the ACTION (Alberta Complementary Therapy and Integrative Oncology) Centre. It has five components: 1) Patient and healthcare provider complementary therapy education; 2) Individualized IO consultation and treatment planning; 3) Access to complementary therapies; 4) Clinical trials of IO interventions, and; 5) Student training through the TRACTION (Training in Clinical Trials and Integrative Oncology) program. The philosophy of the ACTION centre is to be patient-oriented, collaborative and evidence-based.
Pediatric, Adolescent and Young Adult (AYA) Psychosocial Oncology
Dr. Fiona Schulte leads The Cancer Research For Kids (CARE4Kids) Lab at the University of Calgary. The lab conducts research to enhance the patient and family experience for young people diagnosed with cancer. Research is primarily focused on those who have survived their disease and are in the experience of late effects that result from toxic therapies delivered at critical stages of development. The CARE4Kids Lab focuses on three primary areas of interest including: 1) understanding the burden of symptoms (e.g., pain, sleep) among survivors; 2) mental health (e.g., anxiety, fear of cancer recurrence); and 3) quality of life, primarily within the context of multi-site clinical trials. The ultimate goal of the CARE4Kids Lab is to enhance the quality of life of this vulnerable population.
Cancer Related Sexual Health
The Oncology Sexual Health Lab is led by Dr. Lauren Walker, a nationally recognized expert in cancer-related sexual dysfunction, supported by the Daniel Family Leadership Chair. Her work is focused on research and clinical resource development for cancer patients dealing with sexual concerns during and after treatment. Dr. Walker and members of her team have established several innovative clinical research programs, including the now-AHS provincially operated Oncology and Sexuality, Intimacy and Survivorship (OASIS) Program, and the “LowDown on Down There”: a group-based vaginal health workshop. Her work to develop programs for prostate cancer patients includes the internationally operated Androgen Deprivation Therapy Educational Program, as well as several sexual rehabilitation programming initiatives. Her efforts to create and freely disseminate these programs has led psychosocial clinicians from across the globe to travel to the University of Calgary to become trained to offer these programs at their home sites, thereby raising the international profile of the Psychosocial Oncology Department.
Active research studies also include the BREAST study: a randomized controlled trial comparing supportive psychoeducation and mindfulness-based group interventions for breast cancer survivors with sexual concerns. This study, funded by the Canadian Cancer Society Research Institute, is offered in both Alberta and British Columbia. Other initiatives focus on underserved cancer patients, characterizing the fertility needs of adolescent and young adult cancer survivors, and the sexual needs of patients with multiple myeloma. Her work also extends into sexuality measurement development, championing the development and validation of the short-form Sexual Distress Scale in multiple populations. Her more recent endeavors involve exploring assessment of sexual function in transgender and non-binary individuals, trauma-informed clinical care related to pelvic health and gynecological oncology, and exploration of sexual response models in various patient groups including women with pelvic organ prolapse. Training opportunities in the lab include undergraduate and summer studentships, as well as post-doctoral fellowships.
Psychological interventions for Advanced cancer
A team of clinician-researchers led by Dr. Janet de Groot, psychiatrist, has introduced the Managing Cancer and Living Meaningfully (CALM) intervention for persons with advanced solid tumour cancers across Southern Alberta through an Alberta Cancer Foundation funded implementation study. In addition, we continue to have several supportive-expressive groups for individuals with advanced gastro-intestinal cancer, lung cancer, breast cancer and ovarian and endometrial cancers.
Dr. de Groot is currently the co-chair of the International Psychosocial Oncology Society Palliative Care Education subcommittee, which provides webinars for psychosocial clinicians world-wide. The webinars highlight the importance of continuing to attend to palliative and psychosocial care during the pandemic and humanitarian crises.
Dr. Andrea Feldstain, psychologist, is researching the role of psychosocial care within palliative care in our setting, as well as Canada wide. Dr. Feldstain is a clinical and health psychologist. Her research focuses on advanced disease and end-of-life care. Her work has highlighted the lack of psychosocial intervention in palliative care across Canada, health care providers as social support to patients, outcomes of inpatient and outpatient palliative care programs, and rehabilitation for patients with advanced cancer.
Hematology and Cellular Therapy
Drs. Sara Beattie and Andrea Feldstain are clinical and health psychologists who work in the hematology and cellular therapy teams at the Tom Baker Cancer Centre. Their collaborative work has examined psychosocial assessment in preparation for stem cell transplant locally and nationally. They have incorporated the sparse existing evidence into their clinical program and are working to bolster the psychosocial evidence base and enhance patient care through their clinical research.
Dr. Beattie’s research focuses on the psychosocial impact of Hematopoietic Cell Transplantation (HCT) on patients and their loved ones throughout the transplant trajectory. Her recent endeavors have focused on how couples cope with HCT, the importance of caregivers and social support on medical outcomes, quality of life, and screening for distress.
Exercise and Cancer
Dr. Nicole Culos-Reed, Professor and Associate Dean Graduate, Faculty of Kinesiology, leads the Health and Wellness Lab (HWL) and is the Director of the Thrive Centre. The HWL research team examines the role of exercise in cancer survivorship. This research includes national and international collaboration, including a recently awarded CIHR-CCS Research Cancer Survivorship Team Grant to bring the exercise oncology program to rural and remote cancer survivors across Canada (2020-25, $2.5m). This work builds upon the Alberta Cancer Exercise (ACE) program, designed to bring exercise into standard of care for all cancer survivors. With the goal of having all cancer survivors move more, this work directly impacts the quality of life and well-being (physical and psychosocial outcomes) of cancer survivors. The Thrive Centre is a free, safe, and supportive volunteer-run fitness centre, offering programs and open gym times specifically for cancer survivors. Numerous implementation trials (ACE, EXCEL) and projects (Cancer-related fatigue) are run out of the centre. The overall goal of the HWL and Thrive Centre is to increase the physical activity levels of all cancer survivors by moving research evidence to practice.
Education
The Division of Psychosocial Oncology is one of the first University Psychosocial Oncology programs in North America, and offers one of the only accredited courses in Psychosocial Oncology in Canada – MDSC 535/635. Students from various faculties at the U of C (Medicine, Social Work, Psychology and Nursing) enroll in this course. The Psychosocial Oncology rotation within the Calgary Clinical Psychology Residency Training Program, CPA accredited since 1991 (Calgary Clinical Psychology Residency | Alberta Health Services), continues to be a highly sought after opportunity for Clinical Psychology trainees from across the country. The Division offers Pre- and Post-Doctoral Research and Clinical Fellowships. In addition, the Department of Psychosocial Oncology, Cancer Care Alberta offers clinical training opportunities for Social Workers and Psychology students, as well as Psychiatry and Palliative Medicine Residents.
Publications
Here is a list of publications by the division (last updated April 2022): Psychosocial Division Publications
Research Areas
Members of the Division (see Brief Bios) are involved in ongoing research activities. A few of the key study areas currently being researched in the Division include: mind-body interactions, Mindfulness Based Cancer Recovery, Pediatric Psychosocial Oncology, Cancer Related Sexual Health, Cancer Survivorship, Integrative Oncology, Medical Assistance in Dying, Exercise and Cancer as well as Palliative Care.
Mind-body Interactions -This broad area covers a number of associations, interventions, and outcomes relevant to an oncology context. The exciting multidisciplinary field of psychoneuroimmunology and endocrinology provides methods and tools to investigate the interactions between psychological states and biological functions that may be important for cancer incidence or progression. We have just added the capacity to investigate, with state-of-the-art techniques, the impact of emotional expression in relationships, important throughout the cancer trajectory.
Survivorship
Given that the majority of people now survive cancer treatment (over 65% of all patients will now live beyond 5 years post-diagnosis), there is a clear need to study and understand issues that arise well after the acute life threat of cancer has passed. Within survivorship, two distinct populations will be considered: survivors of childhood or adolescent cancer, and survivors of adult cancers in both rural and urban contexts.
Clinical Research
Providing evidence-based psychosocial treatment that is well-integrated into the cancer patient’s medical trajectory is a hallmark of the Psychosocial Group. Over the years, the Division has conducted numerous clinical trials validating the psychological, social, quality of life, and physiological benefits of our clinical research programs. Some examples include: mindfulness meditation, supportive-expressive group therapy, partner support groups, exercise interventions, online support groups, sexual health programs and our screening for distress initiatives. These research and training programs strive to improve quality of life and provide patients and their family members with skills and support to help them throughout their cancer journey.