A Conversation With

Paige McDonald, Ph.D., M.P.H.

Program Director and Chief of Basic Biobehavioral Research Branch,
Behavioral Research Branch,
Division of Cancer Control and Population Sciences

Q: Please provide an overview of the Basic Biobehavioral Research Branch (BBRB) of the Behavioral Research Program and your role as Branch Chief.

The Basic and Biobehavioral Research Branch (BBRB) supports extramural research on fundamental behavioral science to develop theoretical models, identify underlying mechanisms and principles of behavior change and conduct pre-intervention research to inform the next generation of cancer control interventions and social policies. BBRB funds studies that examine health-related behavior across age, racial, and ethnic groups; socioeconomic strata; and cancer diagnoses.

Examples of BRBB’s research agenda include: basic research in social, cognitive, and psychological processes (e.g., social comparison, mechanisms underlying neurocognitive changes associated with cancer treatment, emotion and motivation); biological mechanisms of psychosocial or behavioral processes related to cancer control (e.g., stress-mediated regulation of tumor biology); and methodology and measurement in behavioral science research (e.g., psychophysiological assessment, measurement of stress and other psychological constructs).

As chief for BBRB, I plan, develop, coordinate, and administer the extramural program. I lead the strategic planning, evaluation of emerging research priorities, and the evaluation of return on research investment in basic behavioral and biobehavioral research. I also coordinate and manage scientific, fiscal, and administrative responsibilities of the program.

Q: In what ways is complementary and alternative medicine (CAM) a part of the BBRB’s work?

BRBB is involved in the funding of extramural research grants [projects taking place outside of NIH], some of which are on the topic of CAM. Specifically, one area of programmatic interest that involves CAM is the initiative on medical decision-making and biological mechanisms of psychosocial or behavioral processes in cancer control. BBRB Program Director, Dr. Wendy Nelson has championed NCI’s support of research to enhance understanding of human decision-making processes so that individuals can make informed and satisfying choices regarding their health, health care, and quality of life. Dr. Nelson is the NCI program contact on a funding opportunity announcement (FOA) (PAR-08-045); this FOA encourages the submission of high quality observational studies that evaluate the effectiveness and cost-benefit of CAM approaches used in the community and the processes employed by patients and providers when deciding to use CAM.

As noted in the FOA, data on the actual decision processes that patients and providers use when making judgments about CAM are sparse. We hope our support of research in this area will contribute fundamental knowledge about the cognitive and affective processes involved in the initiation and maintenance of CAM practices for cancer prevention and control.

From a biobehavioral research perspective, BBRB has an interest in the biological mechanisms associated with mind-body interventions for cancer-related symptom and stress management. We have supported a wide range of projects that can be considered CAM-related:

• Virtual reality analgesia for procedural cancer pain
• Cranial stimulation for chemo symptoms in breast cancer
• Healing touch, immunity, and fatigue in breast cancer
• Acupuncture for hot flashes in prostate cancer patients
• Tai chi effects on chronic insomnia in breast cancer survivors: Immune mechanisms
• Mindfulness-based stress reduction for psycho-immune dysregulation in cancer
• Psychoneuroimmunology-based stress management in early breast cancer
• Stress, immunity & cervical cancer: Biobehavioral outcomes of a randomized clinical trial

Q: In 2002, you helped organize a scientific initiative, the Biological Mechanisms of Psychosocial Effects on Disease. Please explain the initiative, OCCAM’s role, and progress made over the past few years.

In 2001, a group of program officers representing several NIH institutes and offices, including OCCAM, met to discuss their shared interest in psychoneuroimmunology (PNI). Discussions from this initial meeting were the impetus for the first scientific meeting of the initiative titled “Biological Mechanisms of Psychosocial Effects on Disease"(BiMPED), which was held in March 2002. The meeting brought scientists from diverse behavioral and biomedical disciplines who were conducting both human and animal work in PNI and related fields to present their research. Goals for the meeting were to review current knowledge of biological mechanisms associated with psychosocial effects on disease, discuss the state-of-the-science, applicability of PNI-related research to cancer control, as well as identify critical research needs.

Through BiMPED, our branch seeks to encourage mechanistic studies to identify biological signaling pathways. BBRB and BiMPED strives to support transdisciplinary research that bridges basic cancer biology and biobehavioral science to advance our fundamental knowledge of the extent and specificity by which central nervous system regulated factors like stress, chronic depression, and social support might regulate tumor biology.

Additionally, we have sought opportunities to vet the science in public forums and disseminate the perspectives of this research and highlights from BiMPED activities. We have made these information resources available on our Web site (http://cancercontrol.cancer.gov/bimped/accomplish.html), including a supplement about the 2002 BiMPED meeting published in the official journal of the Psychoneuroimmunology Research Society—Brain, Behavior, and Immunity. OCCAM’s support was instrumental in the publication of that supplement.

(Brain, Behavior, and Immunity. February 2003, Volume 17, Supplement 1)

Q: What CAM approaches look most promising for further research?

In accordance with NCI’s strategic priorities, BRBB remains most interested in CAM approaches that can be integrated as effective and efficient treatments for cancer and those that serve to improve the quality of cancer care and quality of life for cancer patients. As reflected by our research mission, we are interested in CAM approaches that meet psychological, behavioral, and social health related needs of patients and their caregivers. We will continue to support rigorous trials of mind-body interventions (e.g., mindfulness based stress management, yoga, meditation, spirituality) that elucidate mechanisms of action.