Publications & Awards

Associate Professor of Psychiatry and Behavioral Sciences (Public Mental Health and Population Sciences) at the Stanford University Medical Center


  • Pilot Study of a Novel Approach Management of Sleep Associated Problems in Breast Cancer Patients (MOSAIC) During Chemotherapy. Sleep Palesh, O., Solomon, N., Hofmeister, E., Jo, B., Shen, H., Cassidy-Eagle, E., Innominato, P. F., Mustian, K., Kesler, S. 2020


    This pilot RCT was conducted to assess the preliminary effects of Brief Behavioral Therapy for Cancer-Related Insomnia (BBT-CI) delivered by trained research staff in comparison to a sleep hygiene pamphlet control, and to assess moderators of treatment effect in breast cancer patients undergoing chemotherapy.Of 74 participants recruited, 37 were randomized to BBT-CI and 37 were randomized to the control condition. Trained staff members delivered the intervention during chemotherapy treatments to reduce burden on the patients. Insomnia was assessed with the Insomnia Severity Index (ISI), anxiety was assessed with the Spielberger State-Trait Anxiety Inventory (STAI), symptom burden was assessed with the Symptom Inventory (SI), and study staff recorded previous treatments and surgeries received by patients.Patients randomized to BBT-CI showed significantly greater improvements in their ISI scores than the sleep hygiene group. Additionally, several treatment moderators were identified. The effect of BBT-CI was greater among individuals with lower baseline state-trait anxiety, with previous surgery for cancer, and with higher baseline somatic symptom severity.BBT-CI shows preliminary efficacy compared to the sleep hygiene handout on insomnia in cancer patients undergoing chemotherapy. A large phase III RCT needs to be conducted to replicate the preliminary findings.

    View details for DOI 10.1093/sleep/zsaa070

    View details for PubMedID 32274500

  • Secondary Outcomes of a Behavioral Sleep Intervention: A Randomized Clinical Trial HEALTH PSYCHOLOGY Palesh, O., Scheiber, C., Kesler, S., Gevirtz, R., Heckler, C., Guido, J. J., Janelsins, M., Cases, M. G., Tong, B., Miller, J. M., Chrysson, N. G., Mustian, K. 2019; 38 (3): 196–205


    Nearly 80% of cancer patients struggle with insomnia, which is associated with decreased heart rate variability (HRV) and quality of life (QOL). The aim of this secondary analysis was to evaluate the possible effects of Brief Behavioral Therapy for Cancer-Related Insomnia (BBT-CI), delivered during chemotherapy visits, on QOL and HRV in patients with breast cancer (BC).QOL and HRV data were obtained during a pilot clinical trial assessing the feasibility and effects of BBT-CI on insomnia. A total of 71 BC patients (mean age = 52.5 years) were randomly assigned to either BBT-CI or a healthy-eating control intervention (HEAL). BBT-CI and HEAL were delivered over 6 weeks (2 face-to-face sessions plus 4 phone calls) by trained staff at 4 National Cancer Institute-funded Community Oncology Research Program clinics. QOL was measured with the Functional Assessment of Cancer Therapy (FACT-G) and HRV with the Firstbeat device at baseline and after intervention.There were significant improvements in QOL after intervention for BBT-CI (FACT-G, p = .009; FACT-B, p = .016; ANCOVA) and 5-min supine HRV measures (SDNN, p = .005; rMSSD, p = .004; HF, p = .009; ANCOVA) compared with HEAL.Patients randomized to BBT-CI showed improvements in QOL and HRV, providing support for BBT-CI's possible benefit when delivered in the community oncology setting by trained staff. A more definitive efficacy trial of BBT-CI is currently being planned with sufficient statistical power to evaluate the intervention's clinical utility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

    View details for PubMedID 30762399

  • Feasibility and acceptability of brief behavioral therapy for cancer-related insomnia: effects on insomnia and circadian rhythm during chemotherapy: a phase II randomised multicentre control trial. British journal of cancer Palesh, O., Scheiber, C., Kesler, S., Janelsins, M. C., Guido, J. J., Heckler, C., Cases, M. G., Miller, J., Chrysson, N. G., Mustian, K. M. 2018


    BACKGROUND: This phase II RCT was conducted to determine the feasibility and acceptability of brief behavioral therapy for cancer-related insomnia (BBT-CI) in breast cancer patients undergoing chemotherapy. We also assessed the preliminary effects of BBT-CI on insomnia and circadian rhythm in comparison to a Healthy Eating Education Learning control condition (HEAL).METHODS: Of the 71 participants recruited, 34 were randomised to receive BBT-CI and 37 to receive HEAL. Oncology staff was trained to deliver the intervention in four community clinics affiliated with the NCI. Insomnia was assessed with the Insomnia Severity Index (ISI), and circadian rhythm was assessed using a wrist-worn actiwatch.RESULTS: Community staff interveners delivered 72% of the intervention components, with a recruitment rate of 77% and an adherence rate of 73%, meeting acceptability and feasibility benchmarks. Those randomised to BBT-CI improved their ISI scores by 6.3 points compared to a 2.5-point improvement in those randomised to HEAL (P=0.041). Actigraphy data indicated that circadian functioning improved in the BBT-CI arm as compared to the HEAL arm at post-intervention (all P-values <0.05).CONCLUSIONS: BBT-CI is an acceptable and feasible intervention that can be delivered directly in the community oncology setting by trained staff. The BBT-CI arm experienced significant improvements in insomnia and circadian rhythm as compared to the control condition.

    View details for PubMedID 30026614

  • Does circadian rhythm influence gastrointestinal toxicity? Current opinion in supportive and palliative care Hofmeister, E. N., Fisher, S., Palesh, O., Innominato, P. F. 2020


    PURPOSE OF REVIEW: The current review outlines the existing research on the impact of circadian rhythm on gastrointestinal toxicity associated with cancer treatment and explores clinical evidence for utilizing circadian-based approaches in addressing gastrointestinal symptoms such as nausea, vomiting, diarrhea, mucositis, and hepatotoxicity.RECENT FINDINGS: Recent evidence highlights circadian control of gastrointestinal physiology of appetite, digestion, nutrient absorption, and cellular proliferation in the digestive system. In addition, animal models support the mechanistic rationale of using chronotherapy (a type of anticancer therapy delivered at specific times with the goal of producing less toxicity and greater treatment response) to minimize gastrointestinal-impact of systemic cancer treatments. In addition, earlier research demonstrates that many chemotherapeutic agents are responsive to circadian timing in animals. On the contrary, clinical trials focused on minimizing gastrointestinal toxicity using chronotherapy have been limited in recent years and have not yielded the efficacy initially hoped for. Instead, researchers focused on understanding circadian rhythm's influence on the gastrointestinal system at a mechanistic level as well as measuring circadian rhythm at an individual level.SUMMARY: Although using circadian timing is a promising target for reducing gastrointestinal toxicity, recent evidence suggests that more research is needed to understand circadian rhythm before circadian-based interventions can be developed that will result in lessening of gastrointestinal toxicity.

    View details for DOI 10.1097/SPC.0000000000000498

    View details for PubMedID 32332211

  • Functional connectome biotypes of chemotherapy-related cognitive impairment. Journal of cancer survivorship : research and practice Kesler, S. R., Petersen, M. L., Rao, V., Harrison, R. A., Palesh, O. 2020


    PURPOSE: Cancer-related cognitive impairment (CRCI) is a common neurotoxicity among patients with breast and other cancers. Neuroimaging studies have demonstrated measurable biomarkers of CRCI but have largely neglected the potential heterogeneity of the syndrome.METHODS: We used retrospective functional MRI data from 80 chemotherapy-treated breast cancer survivors to examine neurophysiologic subtypes or "biotypes" of CRCI. The breast cancer group consisted of training (N=57) and validation (N=23) samples.RESULTS: An unsupervised clustering approach using connectomes from the training sample identified three distinct biotypes. Cognitive performance (p<0.05, corrected) and regional connectome organization (p<0.001, corrected) differed significantly between the biotypes and also from 103 healthy female controls. We then built a random forest classifier using connectome features to distinguish between the biotypes (accuracy =91%) and applied this to the validation sample to predict biotype assignment. Cognitive performance (p<0.05, corrected) and regional connectome organization (p<0.005, corrected) differed significantly between the predicted biotypes and healthy controls. Biotypes were also characterized by divergent clinical and demographic factors as well as patient reported outcomes.CONCLUSIONS: Neurophysiologic biotypes may help characterize the heterogeneity associated with CRCI in a data-driven manner based on neuroimaging biomarkers.IMPLICATIONS FOR CANCER SURVIVORS: Our novel findings provide a foundation for detecting potential risk and resilience factors that warrant further study. With further investigation, biotypes might be used to personalize assessments of and interventions for CRCI.

    View details for DOI 10.1007/s11764-020-00863-1

    View details for PubMedID 32157609

Honors and Awards

Outstanding Doctor of Philosophy in Clinical Psychology Award, CSPP-San Diego (2002)

ASCO Merit Award, American Society of Clinical Oncology (ASCO) (2008)

Young Investigator Award, Multinational Association of Supportive Care in Cancer (MASCC) (2009, 2008)

Honorable Mention Poster Award, American Society of Preventive Oncology (ASPO) (2009)

National Institutes of Health Summer Distinguished Fellow Award, NIH (2009)

Socioeconomic Status Related Cancer Disparities Behavior and Social Science Volunteer Awardee, APA, Washington, DC (2012)