Understanding Cancer Survivorship: Q and A with Dr. Frank J. Penedo
The director of Sylvester Comprehensive Cancer Center’s cancer survivorship and supportive care talks about gaps in survivorship research, the impact of behavioral interventions and how his work is shaping the future of cancer care.
Frank Penedo, Ph.D., a leading national authority in cancer survivorship research, is the associate director for population sciences at Sylvester Comprehensive Cancer Center, part of University of Miami Miller School of Medicine. He also directs cancer survivorship and supportive care. With more than two decades of experience, he focuses on closing the gap between research, survivorship and patient care, ensuring that effective interventions reach those who need them most.
Dr. Penedo’s work evaluates sociocultural, biobehavioral and psychosocial mechanisms underlying chronic diseases and the effectiveness of evidence-based psychosocial and behavioral interventions in improving health outcomes. His work also focuses on implementation research in South Florida communities experiencing an elevated cancer burden.
The NIH has continuously funded Dr. Penedo for more than 20 years, and he has authored more than 350 publications. He served as president of the International Society of Behavioral Medicine and his research and mentoring have been recognized by numerous awards from societies in his field. He is an elected fellow of the Society of Behavioral Medicine and the Academy of Behavioral Medicine Research, served in numerous NIH study sections and is an associate editor for multiple journals.
We spoke with Dr. Penedo about key gaps in survivorship research, the impact of behavioral interventions and how his work is shaping the future of cancer care.
What are the biggest gaps in cancer survivorship research?
There are quite a few gaps. A major one we are studying is understanding how cancer and aging intersect. Most cancer patients are over 65 and often must manage other chronic conditions, such as diabetes or hypertension. Cancer treatment and the survivorship experience do not happen in isolation and the combination of these conditions can adversely impact the quality of life and health outcomes of cancer survivors.
Aging-related changes, such as declines in physical and cognitive function, are not uncommon and are exacerbated by cancer-related treatments. While such treatments have become more effective than ever, they can be toxic and contribute to frailty and accelerated aging. For example, chemotherapy, immunotherapy and other treatments can lead to cardiac dysfunction, bone loss, fatigue and reduced muscle mass. At Sylvester, we integrate research and clinical care to assess frailty in survivors, identify patients at risk and develop interventions to improve their overall health despite the treatment regimens they undergo. These range from lifestyle programs such as nutrition and physical activity to stress management and care coordination.
How has your research improved cancer survivors’ quality of life?
For over 20 years, my research has focused on interventions that lessen symptom burden and improve quality of life. We conduct randomized controlled trials comparing standard care or control conditions to evidence-based programs, such as cognitive-behavioral stress management and self-management therapy. These interventions have been offered in person, through websites and via mobile devices. Participants in several of these programs experience significant improvements in physical functioning, emotional well-being and overall quality of life.
We have started making these tools more convenient to patients, bringing them to their local primary care clinic, for example.
Can you give examples of effective interventions?
The first example is cognitive behavioral stress and self-management programs for prostate cancer survivors.
Prostate cancer, particularly in its early stages, has a survival rate of 99% at five years. Still, the impact on what we refer to as disease-specific quality of life can be profound: sexual dysfunction, urinary dysfunction, bowel dysfunction, fatigue and cognitive challenges are all common and persistent consequences of treatments.
Cancer was once almost a guaranteed death sentence, but advancements have transformed this situation. Understanding the emotional and psychosocial aspects of survivorship remains vital, providing me with significant motivation to identify interventions that are proven to be safe and effective.
Dr. Frank Penedo
To address these issues, we offer a 10-session program in person or online, involving groups of six to eight participants. These sessions provide practical tools such as stress awareness, coping strategies, communication skills, mindfulness and relaxation techniques. They also offer group support, which has been shown to enhance outcomes. Each session includes a didactic or instructional component alongside within-session exercises and roleplaying.
Another program, “My Well-Being Guide,” identifies patients with clinically elevated anxiety or depression and offers digital modules that cover techniques such as emotional processing, coping strategies and social support skills to alleviate depressive and anxious symptoms. In federally qualified health centers, we are introducing interactive voice response (IVR) to deliver these interventions via phone for those with limited internet access.
How do you select participants for your program-based research?
We consider factors such as cancer stage. Early-stage prostate cancer demands different support compared to advanced cases. Patients are recruited from hospitals, VA centers and community health systems, ensuring wide accessibility and participation that reflects our community.
Are these programs available outside of research settings?
Yes, components are now available to patients. For example, “My Well-Being Guide” provides online access to self-paced materials for those identified as having clinically elevated anxiety or depression. In the federally qualified health centers we work with, we will offer interventions to all cancer survivors to help them manage symptom burden and care coordination.
How do patients access these resources?
At Sylvester, patients complete assessments to identify the need for interventions through our patient portal or are referred by their providers. Community clinics implement a similar process to identify cancer survivors, who are then provided the tools we have developed. These include PDFs and mobile-friendly educational content, such as videos, and we are currently developing IVR, phone-based delivery for those with limited internet access.
What inspired you to focus on cancer survivorship?
I originally pursued a pre-med path but became interested in behavioral medicine after participating in stress management research related to HIV. During my clinical internship, I concentrated on oncology and developed a passion for the mind-body connection in cancer care. Working with older adults, who represent the majority of cancer patients, felt like a natural fit.
Cancer was once almost a guaranteed death sentence, but advancements have transformed this situation. Understanding the emotional and psychosocial aspects of survivorship remains vital, providing me with significant motivation to identify interventions that are proven to be safe and effective.
How do you spend your time outside of work?
I love traveling. My recent trip to South Africa and Zimbabwe was incredible, and I hope to visit New Zealand next.
Any time for books, podcasts or TV shows recently?
I am now reading Victor Frankl’s “Man’s Search for Meaning” and just finished watching Korean TV shows such as “Pachinko” and “Light Shop.” My interest in these international shows likely stems from anthropology, which was my second major during college, along with psychology. I love exploring different cultures, and Korea is my latest fascination.
Tags: cancer survivorship, Cancer Survivorship Program, Dr. Frank Penedo, Sylverster Comprehensive Cancer Center