Featured Publications

Jack, Lulu and Sam Willson Professor of Medicine


  • Tranceformation: Digital dissemination of hypnosis. Neuron Spiegel, D. 2024


    Hypnosis is an underutilized tool despite evidence of efficacy from randomized clinical trials. In this NeuroView, I discuss potential mechanisms in the context of brain networks and propose the use of app-based instruction in self-hypnosis.

    View details for DOI 10.1016/j.neuron.2023.12.010

    View details for PubMedID 38262415

  • Emotion regulation and choice of bilateral mastectomy for the treatment of unilateral breast cancer. Cancer medicine Zhang, J. X., Kurian, A. W., Jo, B., Nouriani, B., Neri, E., Gross, J. J., Spiegel, D. 2023


    There has been steadily increasing use of bilateral mastectomy (BMX) in the treatment of primary breast cancer (BC). In this study, we utilized functional magnetic resonance imaging (fMRI) to examine the influence of emotion regulation on the decision of newly diagnosed BC patients to choose BMX rather than non-BMX treatments.We recruited 123 women with unilateral BC, 61 of whom received BMX and 62 of whom received non-BMX treatments, and 39 healthy controls. While participants were in the fMRI scanner, we showed them BC-related and non-BC-negative images. In one condition, they were instructed to watch the images naturally. In another, they were instructed to regulate their negative emotion. We compared the fMRI signal during these conditions throughout the brain.With non-BC-negative images as the baseline, BC patients showed greater self-reported reactivity and neural reactivity to BC-related images in brain regions associated with self-reflection than did controls. Among the BC patients, the BMX group showed weaker activation in prefrontal emotion regulation brain regions during emotion regulation than did the non-BMX group.BC patients are understandably emotionally hyper-reactive to BC-related stimuli and those who ultimately received BMX experience more difficulty in regulating BC-related negative emotion than non-BMX BC patients. These findings offer neuropsychological evidence that difficulty in managing anxiety related to the possibility of cancer recurrence is a factor in surgical treatment decision-making and may be an intervention target with the goal of strengthening the management of cancer-related anxiety by nonsurgical means.NCT03050463.

    View details for DOI 10.1002/cam4.5963

    View details for PubMedID 37083300

  • Point of care testing of enzyme polymorphisms for predicting hypnotizability and postoperative pain. The Journal of molecular diagnostics : JMD Cortade, D. L., Markovits, J., Spiegel, D., Wang, S. X. 2023


    Hypnotizability is a stable trait that moderates the benefit of hypnosis for treating pain, but limited availability of hypnotizability testing deters widespread use of hypnosis. Inexpensive genotyping of 4 single nucleotide polymorphisms in the catechol-o-methyltransferase (COMT) gene was performed using giant magnetoresistive biosensors to determine if hypnotizable individuals can be identified for targeted hypnosis referrals. For individuals with the proposed 'optimal' COMT diplotypes, 89.5% score highly on the Hypnotic Induction Profile (OR = 6.12, 95%CI = 1.26-28.75), which identified 40.5% of the treatable population. Mean hypnotizability scores of the optimal group were significantly higher than the total population (p = 0.015 effect size = 0.60), an effect that was present in females (p = 0.0015, effect size = 0.83), but not in males (p = 0.28). In an exploratory cohort, optimal individuals also reported significantly higher postoperative pain scores (p = 0.00030, effect size = 1.93), indicating a greater need for treatment.

    View details for DOI 10.1016/j.jmoldx.2023.01.002

    View details for PubMedID 36702396

  • Brief structured respiration practices enhance mood and reduce physiological arousal. Cell reports. Medicine Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., Huberman, A. D. 2023: 100895


    Controlled breathwork practices have emerged as potential tools for stress management and well-being. Here, we report a remote, randomized, controlled study (NCT05304000) of three different daily 5-min breathwork exercises compared with an equivalent period of mindfulness meditation over 1 month. The breathing conditions are (1) cyclic sighing, which emphasizes prolonged exhalations; (2) box breathing, which is equal duration of inhalations, breath retentions, and exhalations; and (3) cyclic hyperventilation with retention, with longer inhalations and shorter exhalations. The primary endpoints are improvement in mood and anxiety as well as reduced physiological arousal (respiratory rate, heart rate, and heart rate variability). Using a mixed-effects model, we show that breathwork, especially the exhale-focused cyclic sighing, produces greater improvement in mood (p < 0.05) and reduction in respiratory rate (p < 0.05) compared with mindfulness meditation. Daily 5-min cyclic sighing has promise as an effective stress management exercise.

    View details for DOI 10.1016/j.xcrm.2022.100895

    View details for PubMedID 36630953

  • Marital status and survival in cancer patients: A systematic review and meta-analysis. Cancer medicine Krajc, K., Mirosevic, S., Sajovic, J., Klemenc Ketis, Z., Spiegel, D., Drevensek, G., Drevensek, M. 2022


    BACKGROUND: In recent years, authors have repeatedly reported on the significance of social support in cancer survival. Although overall the studies appear to be convincing, little is known about which types of social support promote better survival rates, and which subgroups of cancer patients are more susceptible to the benefits of it. The aim of this study was to identify, organize, and examine studies reporting on the significance of social support in cancer survival.METHODS: The PubMed, CINAHL and EBSCO databases were searched using the keywords social support/marital status, cancer, and survival/mortality. Where possible we used a meta-analytical approach, specifically a random effect model, in order to combine the results of the hazard ratios in studies from which this information could be obtained. When interpreting clinical relevance, we used the number needed to treat (NNT).RESULTS: Better survival was observed in married patients when compared to unmarried (single, never-married, divorced/separated, and widowed) in overall and cancer-specific survival. Gender group differences showed that the association was statistically significant only in cancer-specific survival when comparing divorced/separated male and female cancer patients (p<0.001), thus confirming results from the previous meta-analysis.CONCLUSIONS: Being unmarried is associated with significantly worse overall and cancer-specific survival. The most vulnerable group found in our study were divorced/separated men. The results of this review can motivate physicians, oncologists, and other healthcare professionals to be aware of the importance of patients' social support, especially in the identified sub-group.

    View details for DOI 10.1002/cam4.5003

    View details for PubMedID 35789072

  • Effects of hypnosis versus enhanced standard of care on postoperative opioid use after total knee arthroplasty: the HYPNO-TKA randomized clinical trial. Regional anesthesia and pain medicine Markovits, J., Blaha, O., Zhao, E., Spiegel, D. 2022


    BACKGROUND: Hypnosis decreases perioperative pain and has opioid-sparing potential but has not been rigorously studied in knee arthroplasty. This trial investigates the impact of perioperative hypnosis on inpatient opioid use following total knee arthroplasty.METHODS: This prospective randomized controlled trial was conducted at a single academic medical center. The hypnosis arm underwent a scripted 10min hypnosis session prior to surgery and had access to the recorded script. The control arm received hypnosis education only. The primary outcome was opioid use in milligram oral morphine equivalents per 24 hours during hospital admission. A secondary analysis was performed for patients taking opioids preoperatively.RESULTS: 64 primary knee arthroplasty patients were randomized 1:1 to hypnosis (n=31) versus control (n=33) and included in the intent-to-treat analysis. The mean (SD) postoperative opioid use in oral morphine equivalents per 24 hours was 70.5 (48.4) in the hypnosis versus 90.7 (74.4) in the control arm, a difference that was not statistically significant (difference -20.1; 95% CI -51.8 to 11.4; p=0.20). In the subgroup analysis of the opioid-experienced patients, there was a 54% daily reduction in opioid use in the hypnosis group (82.4 (56.2) vs 179.1 (74.5) difference of -96.7; 95% CI -164.4 to -29.0; p=<0.01), equivalent to sparing 65mg of oxycodone per day.CONCLUSION: Perioperative hypnosis significantly reduced inpatient opioid use among opioid-experienced patients only. A larger study examining these findings is warranted.TRIAL REGISTRATION NUMBER: NCT03308071.

    View details for DOI 10.1136/rapm-2022-103493

    View details for PubMedID 35715013

  • Shared cognitive mechanisms of hypnotizability with executive functioning and information salience. Scientific reports Faerman, A., Spiegel, D. 2021; 11 (1): 5704


    In recent years, evidence linked hypnotizability to the executive control and information salience networks, brain structures that play a role in cognitive conflict resolution and perseveration (insisting on applying a previously learned logical rule on a new set). Despite the growing body of neuroimaging evidence, the cognitive phenotype of hypnotizability is not well understood. We hypothesized that higher hypnotizability would correspond to lower perseveration and set-shifting. Seventy-two healthy adults were tested for hypnotizability and executive functions (perseveration and set-shifting). Multiple regression analyses were performed to test the relationship between hypnotizability and perseveration and set-shifting. Higher hypnotizability was associated with lower perseveration after accounting for age and education. Hypnotizability significantly predicted perseveration but not set-shifting. Our results indicate an inverse relationship between trait hypnotizability and perseveration, an executive function that utilizes regions of both the executive control and the salience systems. This suggests that hypnotizability may share a common cognitive mechanism with error evaluation and implementation of logical rules.

    View details for DOI 10.1038/s41598-021-84954-8

    View details for PubMedID 33707531

  • Testing Hypnotizability by Phone: Development and Validation of the Remote Hypnotic Induction Profile (rHIP). The International journal of clinical and experimental hypnosis Kittle, J., Zhao, E., Stimpson, K., Weng, Y., Spiegel, D. 2021; 69 (1): 94–111


    Standard hypnotizability scales require physical contact or direct observation by tester and participant. The authors addressed this limitation by developing and testing the remote Hypnotic Induction Profile (rHIP), a hypnotizability test derived from the Hypnotic Induction Profile that is completed by telephone. To assess the validity of the rHIP, 56 volunteers naive to hypnotizability testing completed both the HIP and the rHIP, with order of testing randomized. Results indicate a strong correlation between HIP and rHIP scores, r s=.71(0.53-0.84), p <.0001, and good concordance, difference=.03(-0.53, 0.59), p =.91, independent of testing order. The rHIP had few complications. Possible advantages of using the rHIP include improving patient expectancy prior to scheduling a hypnosis session, increasing access to hypnotizability testing for remote interventions, and obviating resource-intensive in-person hypnotizability screening for trials that exclude subjects with certain scores.

    View details for DOI 10.1080/00207144.2021.1827937

    View details for PubMedID 33513064

  • When Physicians Engage in Practices That Threaten the Nation's Health. JAMA Pizzo, P. A., Spiegel, D. n., Mello, M. M. 2021

    View details for DOI 10.1001/jama.2021.0122

    View details for PubMedID 33538765

  • International Prevalence and Correlates of Psychological Stress during the Global COVID-19 Pandemic. International journal of environmental research and public health Adamson, M. M., Phillips, A. n., Seenivasan, S. n., Martinez, J. n., Grewal, H. n., Kang, X. n., Coetzee, J. n., Luttenbacher, I. n., Jester, A. n., Harris, O. A., Spiegel, D. n. 2020; 17 (24)


    This study reports perceived stress and associated sociodemographic factors from an international sample of adults, during the COVID-19 pandemic. The Perceived Stress Scale (PSS-10) along with socio-demographic questions were conducted between 8 April 2020 and 11 May 2020. The survey was translated from English into five languages. Recruitment was conducted worldwide using social media. A total of 1685 survey responses were collected across 57 countries with eleven countries (≥30 responses/country) included in the sub-analyses. Overall, the mean PSS-10 score was 19.08 (SD = 7.17), reflecting moderate stress compared to previously reported norms. Female gender was associated with a higher PSS score (3.03, p < 0.05) as well as four-year degree holders (3.29, p < 0.05), while adults over 75 years (-7.46, p < 0.05) had lower PSS scores. Personal care composite score (including hours of sleep, exercise, and meditation) was associated with lower PSS scores (-0.39, p < 0.01). Increases in personal care and changes in work expectations were associated with lower PSS scores (-1.30 (p < 0.05) and -0.38 (p < 0.01), respectively). Lower total PSS scores were reported in Germany (-4.82, p < 0.01) compared to the global response sample mean. This information, collected during the initial period of global mitigation orders, provides insight into potential mental health risks and protective factors during crises.

    View details for DOI 10.3390/ijerph17249248

    View details for PubMedID 33321950

Journal Articles

Jack, Lulu and Sam Willson Professor of Medicine


  • Preliminary testing of "roadmap to parenthood" decision aid and planning tool for family building after cancer: Results of a single-arm pilot study. Psycho-oncology Benedict, C., Ford, J. S., Schapira, L., Davis, A., Simon, P., Spiegel, D., Diefenbach, M. 2024; 33 (4): e6323


    Many young adult female cancer survivors need to use reproductive medicine, surrogacy, or adoption to have a child. This study pilot tested Roadmap to Parenthood, a web-based, self-guided decision aid and planning tool for family building after cancer (disease agnostic).A single-arm pilot study tested feasibility, acceptability, and obtained effect size estimates of the Roadmap tool. Participants, recruited via hospital-based and social media strategies, completed a baseline survey (T1), accessed the Roadmap tool (website), then completed surveys at one- and 3-months (T2 and T3, respectively). Feasibility and acceptability were evaluated with rates of eligibility, enrollment, and survey completion, and feedback. Pairwise t-tests and repeated measures ANOVA evaluated usage effects. Effect size estimates were calculated.Participants (N = 98) averaged 31 years old (SD = 5.61); 71% were nulliparous. Enrollment rate was 73%, T1-T2 completion rate was 80%, and 93% accessed the website. From T1-T2, participants reported improvements in decisional conflict (p < 0.001; Cohen's d = 0.85), unmet information needs (p < 0.001; Cohen's d = 0.70), self-efficacy (p = 0.003; Cohen's d = 0.40), and self-efficacy for managing negative emotions (p = 0.03; Cohen's d = 0.29); effects were sustained at T3. There was no change in reproductive distress (p = 0.22). By T3, 94% reported increased consideration of preparatory actions and 20%-61% completed such actions.The Roadmap intervention was feasible to conduct, acceptable to users, and led to improvements in key psychosocial outcomes. Future directions will test intervention efficacy in a randomized controlled trial with a larger sample and over a longer period. A web-based tool may help women make decisions about family building after cancer and prepare for potential challenges.

    View details for DOI 10.1002/pon.6323

    View details for PubMedID 38629761

  • Dyadic Investigation of Posttraumatic Stress Symptoms and Daily Sleep Health in Patients with Cancer and their Caregivers. Psychosomatic medicine Tsai, T. C., Mitchell, H. R., Zeitzer, J., Ting, A., Laurenceau, J. P., Spiegel, D., Kim, Y. 2024


    Cancer can be a traumatic experience affecting multidimensional aspects of sleep among patients and caregivers. This study examined the differential associations of cancer-related post-traumatic stress symptoms (PTSS) with various sleep markers in this population.Patients newly diagnosed with colorectal cancer (n = 138, mean age = 56.93 years, 31.88% female, 60.14% Hispanic, 6.53 months post-diagnosis) and their sleep-partner caregivers (n = 138, mean age = 55.32 years, 68.12% female, 57.97% Hispanic) completed questionnaires assessing the four PTSS clusters (intrusion, avoidance, alterations in arousal and reactivity, negative alterations in cognitions and mood). Participants also completed daily sleep diaries for 14 consecutive days, from which sleep onset latency (SOL), wake after sleep onset (WASO), and sleep duration were derived.Actor-partner interdependence model revealed that caregivers' greater alterations in arousal and reactivity were associated with their own longer SOL (b = 14.54, p < .001) and their patients' longer sleep duration (b = 0.47, p = .040), whereas patients' arousal and reactivity were associated with their caregivers' shorter SOL (b = -8.34, p = .047) and WASO (b = -8.12, p = .019). Patients' and caregivers' greater negative alterations in cognitions and mood were associated with patients' longer SOL (b = 8.89, p = .016) and shorter sleep duration (b = -0.40, p = .038), respectively. Caregivers' greater intrusion was related to their own shorter SOL (b = -10.92, p = .002).The four PTSS clusters, particularly arousal and reactivity and negative cognitions and mood, have distinct associations with sleep markers individually and dyadically in patients and caregivers affected by cancer. Investigations of psychosocial and biobehavioral pathways underlying these relations are warranted. Tailored trauma treatments and sleep interventions may improve the well-being of this population.

    View details for DOI 10.1097/PSY.0000000000001283

    View details for PubMedID 38345316

  • The Neural Separability of Emotion Reactivity and Regulation. Affective science Zhang, J. X., Dixon, M. L., Goldin, P. R., Spiegel, D., Gross, J. J. 2023; 4 (4): 617-629


    One foundational distinction in affective science is between emotion reactivity and regulation. This conceptual distinction has long been assumed to be instantiated in spatially separable brain systems (a typical example: amygdala/insula for reactivity and frontoparietal areas for regulation). In this research, we begin by reviewing previous findings that support and contradict the neural separability hypothesis concerning emotional reactivity and regulation. Further, we conduct a direct test of this hypothesis with empirical data. In five studies involving healthy and clinical samples (total n = 336), we assessed neural responses using fMRI while participants were asked to either react naturally or regulate their emotions (using reappraisal) while viewing emotionally evocative stimuli. Across five studies, we failed to find support for the neural separability hypothesis. In univariate analyses, both presumptive "reactivity" and "regulation" brain regions demonstrated equal or greater activation for the reactivity contrast than for the regulation contrast. In multivariate pattern analyses (MVPA), classifiers decoded reactivity (vs. neutral) trials more accurately than regulation (vs. reactivity) trials using multivoxel data in both presumptive "reactivity" and "regulation" regions. These findings suggest that emotion reactivity and regulation-as measured via fMRI-may not be as spatially separable in the brain as previously assumed. Our secondary whole-brain analyses revealed largely consistent results. We discuss the two theoretical possibilities regarding the neural separability hypothesis and offer thoughts for future research.The online version contains supplementary material available at 10.1007/s42761-023-00227-9.

    View details for DOI 10.1007/s42761-023-00227-9

    View details for PubMedID 38156247

    View details for PubMedCentralID PMC10751283

  • Circadian, hormonal, and sleep rhythms: effects on cancer progression implications for treatment. Frontiers in oncology Jagielo, A. D., Benedict, C., Spiegel, D. 2023; 13: 1269378


    Circadian, hormonal, and sleep rhythm disruptions are commonly experienced concerns among cancer patients throughout the cancer care continuum. This review aims to summarize the existing literature on circadian, hormonal, and sleep rhythms in the oncological population, focusing on circadian disruption and physiological and psychological abnormalities, disease progression, and chronomodulated treatment approaches. The findings demonstrate that subjectively and objectively measured circadian rhythm disruption is associated with adverse mental health and disease outcomes in patients with cancer. Chronomodulated chemotherapy, light therapy, cognitive behavioral therapy for insomnia, and physical activity have shown evidence of effectiveness in improving sleep, and occasionally, disease outcomes.

    View details for DOI 10.3389/fonc.2023.1269378

    View details for PubMedID 37746277

    View details for PubMedCentralID PMC10514358

  • Changing cancer mindsets: A randomized controlled feasibility and efficacy trial. Psycho-oncology Zion, S. R., Schapira, L., Berek, J. S., Spiegel, D., Dweck, C. S., Crum, A. J. 2023


    OBJECTIVE: A cancer diagnosis and subsequent treatment can disrupt the full spectrum of physical, social, emotional, and functional quality of life. But existing psychological treatments are focused primarily on specific psychological symptoms as opposed to improving the overall patient experience. We studied the feasibility and efficacy of a novel digital intervention targeting patient mindsets-core assumptions about the nature and meaning of illness-designed to improve overall health-related quality of life (HRQoL) in newly diagnosed cancer patients undergoing treatment with curative intent.METHODS: Recently diagnosed (≤150days) adult patients with non-metastatic cancers undergoing systemic treatment (N=361) were recruited from across the United States to participate in this decentralized clinical trial. Patients were randomized 1:1 to receive the Cancer Mindset Intervention (CMI) or Treatment as Usual (TAU). Participants in the CMI group completed seven online modules over 10weeks (2.5h total) targeting mindsets about cancer and the body. The primary outcome was overall HRQoL, and secondary outcomes were coping behaviors and symptom distress.RESULTS: Patients in the CMI group reported significant (p<0.001) improvements in adaptive mindsets about cancer and the body over time. Compared with the TAU condition, the CMI group reported significant improvements in overall HRQoL (B=0.60; 95% CI 0.34-0.85; p<0.001), increased engagement in adaptive coping behaviors (B=0.03; 95% CI 0.02-0.04; p<0.001), and reduced distress from physical symptoms (B=-0.29; 95% CI -0.44 to -0.14; p<0.01). Effect sizes of these changes ranged from d=0.42-d=0.54.CONCLUSION: A brief mindset-focused digital intervention was effective at improving physical, social, emotional, and functional HRQoL. increasing adaptive coping behaviors, and reducing physical symptom distress in newly diagnosed cancer patients.

    View details for DOI 10.1002/pon.6194

    View details for PubMedID 37529924

  • Rest-activity rhythm as a clinical biomarker in cancer LANCET HEALTHY LONGEVITY Innominato, P. F., Wreglesworth, N., Karaboue, A., Spiegel, D., Levi, F. A. 2023; 4 (7): E304
  • Real-Time Semi-Automated and Automated Voxel Placement using fMRI Targets for Repeated Acquisition Magnetic Resonance Spectroscopy. Journal of neuroscience methods Bishop, J. H., Geoly, A., Khan, N., Tischler, C., Krueger, R., Keshava, P., Amin, H., Baltusis, L., Wu, H., Spiegel, D., Williams, N., Sacchet, M. D. 2023: 109853


    BACKGROUND: Currently, magnetic resonance spectroscopy (MRS) is dependent on the investigative team to manually prescribe, or demarcate, the desired tissue volume-of-interest. The need for a new method to automate precise voxel placements is warranted to improve the utility and interpretability of MRS data.NEW METHOD: We propose and validate robust and real-time methods to automate MRS voxel placement using functionally defined coordinates within the prefrontal cortex. Data were collected and analyzed using two independent prospective studies: 1) two independent imaging days with each consisting of a multi-session sandwich design (MRS data only collected on one of the days determined based on scan time) and 2) a longitudinal design. Participants with fibromyalgia syndrome (N=50) and major depressive disorder (N=35) underwent neuroimaging. MRS acquisitions were acquired at 3-tesla. Evaluation of the reproducibility of spatial location and tissue segmentation was assessed for: 1) manual, 2) semi-automated, and 3) automated voxel prescription approaches RESULTS: Variability of voxel grey and white matter tissue composition was reduced using automated placement protocols. Spatially, post- to pre-voxel center-of-gravity distance was reduced and voxel overlap increased significantly across datasets using automated compared to manual procedures COMPARISON WITH EXISTING METHODS: Manual prescription, the current standard in the field, can produce inconsistent data across repeated acquisitions. Using automated voxel placement, we found reduced variability and more consistent voxel placement across multiple acquisitions CONCLUSIONS: These results demonstrate the within subject reliability and reproducibility of a method for reducing variability introduced by spatial inconsistencies during MRS acquisitions. The proposed method is a meaningful advance toward improved consistency of MRS data in neuroscience and can be utilized for multi-session and longitudinal studies.

    View details for DOI 10.1016/j.jneumeth.2023.109853

    View details for PubMedID 37031764

  • Development of a Web-Based Decision Aid and Planning Tool for Family Building After Cancer (Roadmap to Parenthood): Usability Testing. JMIR cancer Benedict, C., Dauber-Decker, K. L., Ford, J. S., King, D., Spiegel, D., Schapira, L., Simon, P., Diefenbach, M. 2022; 8 (2): e33304


    Owing to gonadotoxic cancer treatments, young adult female survivors often report uncertainty about their fertility, reproductive potential, and family-building options after treatment. Roadmap to Parenthood is a web-based decision aid and planning tool for family building after cancer.As part of a patient-centered development process, this study evaluated the usability of the decision aid website to inform design modifications and improve user experience.In total, 2 rounds of usability testing were conducted with the target population of young adult female cancer survivors. During the testing sessions, participants viewed the website twice; first, as a think-aloud exercise, and second, while a researcher interrupted at key points to obtain user feedback. Quantitative and qualitative data were collected to assess website usability. Quantitative measures included the System Usability Scale, WebQual, and eHealth Impact Questionnaire. An exit interview with open-ended questions gathered feedback on likes and dislikes and suggestions for improvement.Participants (N=10) were young adult women, with average age of 30.9 (SD 4.51) years, and average time since treatment was 4.44 (SD 3.56) years. Website usability scores improved on the System Usability Scale from "acceptable" in round 1 to "excellent" in round 2 after making design changes based on user feedback (scores of 68 and 89.4, respectively). WebQual scores showed similar improvement from round 1 to round 2 of testing (mean 5.6 to 6.25; range 1-7). On the eHealth Impact Questionnaire, the information and presentation of the website was perceived as comprehensive, easy to understand, and trustworthy. Participants also reported improved confidence to discuss and manage fertility and family-building issues and felt encouraged to play a more active role in managing their fertility. In all, 3 usability themes were identified from the qualitative feedback: ease of use, visibility and navigation, and informational content and usefulness. Overall feedback was positive, and participants reported intentions to use the decision aid website in the future. In total, 10% (1/10) of the participants reported negative emotions when learning about infertility risks and potential family-building challenges.Website usability improved after design changes were made in response to user feedback. Young adult female survivors reported positive views about the website and indicated that the decision aid would be useful in decision-making about family building after cancer. Future studies will include further design modifications to consider the emotional experiences of users and any additional navigational features or content to optimize the ease of use and support provided by the tool.

    View details for DOI 10.2196/33304

    View details for PubMedID 35639461

  • The longitudinal effects of chronotype on chemotherapy-induced nausea and vomiting in patients with breast cancer receiving neoadjuvant chemotherapy. Journal of psychosomatic research Jung, S., Son, K., Jung, S., Moon, J. Y., Oh, G. H., Yeom, C., Lee, K., Kim, W., Jung, D., Kim, T., Im, S., Lee, K., Spiegel, D., Hahm, B. 2022; 157: 110804


    OBJECTIVE: The object of this longitudinal cohort study was to investigate whether chronotype affects the incidence of chemotherapy-induced nausea and vomiting (CINV) among patients with breast cancer.METHODS: The study included a total of 203 breast cancer patients who received neoadjuvant chemotherapy using a regimen of doxorubicin and cyclophosphamide with high emetogenicity. Patients received four cycles of chemotherapy in approximately three months. Patients completed questionnaires including the Munich Chronotype Questionnaire (MCTQ) before the first chemotherapy and the Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) after each of the four chemotherapy sessions. To confirm the effect of chronotype on CINV during the four cycles, we performed statistical analyses using a generalized estimating equation (GEE).RESULTS: CINV occurred in 108 (53.2%), 112 (55.2%), 102 (50.3%), and 62 (30.5%) patients during four cycles of treatment. In the GEE approach, late and early chronotypes (vs. intermediate chronotype) were associated with an increased risk of CINV (late chronotype: odds ratio [OR], 2.06; 95% confidence interval [CI], 1.41-2.99; p<0.001, early chronotype: OR, 1.84; CI, 1.25-2.73; p=0.002), which remained significant even after adjusting for age, BMI, antiemetic treatment, history of nausea and vomiting, anxiety, and sleep quality.CONCLUSION: Chronotype affected CINV across the four cycles of neoadjuvant chemotherapy in patients with breast cancer, suggesting the need to consider chronotype in predicting and managing CINV.

    View details for DOI 10.1016/j.jpsychores.2022.110804

    View details for PubMedID 35381494

  • Morning Chronotype Decreases the Risk of Chemotherapy-Induced Peripheral Neuropathy in Women With Breast Cancer. Journal of Korean medical science Son, K., Jung, D., Lee, K., Yeom, C., Oh, G. H., Kim, T., Im, S., Lee, K., Spiegel, D., Hahm, B. 2022; 37 (5): e34


    BACKGROUND: The purpose of this longitudinal prospective cohort study was to investigate the role of chronotype in the incidence of chemotherapy-induced peripheral neuropathy (CIPN) among women with breast cancer.METHODS: We recruited women with breast cancer awaiting adjuvant chemotherapy, including four cycles of docetaxel. Participants reported peripheral neuropathy symptoms of numbness/tingling at the baseline, and at 4weeks after completion of chemotherapy. Candidate psychiatric factors associated with CIPN were assessed at the baseline, using the Composite Scale of Morningness, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale. To examine the association between chronotype and CIPN, we built logistic regression models, adjusting for demographic, clinical, and other psychiatric variables.RESULTS: Among 48 participants, 29 participants developed CIPN. The morning chronotype was inversely associated with CIPN (odds ratio, 0.06; confidence interval, 0.01-0.74; P = 0.028) after adjusting for age, BMI, education, type of operation, alcohol use, smoking, sleep quality, depression, and anxiety.CONCLUSION: Our results suggest that the morning chronotype is a protective factor against the development of CIPN in patients with breast cancer who were treated with docetaxel.TRIAL REGISTRATION: Identifier: NCT01887925.

    View details for DOI 10.3346/jkms.2022.37.e34

    View details for PubMedID 35132840

Conference Proceedings

Jack, Lulu and Sam Willson Professor of Medicine


  • Changing Cancer Mindsets: A Randomized Controlled Feasibility and Efficacy Trial Zion, S., Schapira, L., Berek, J., Spiegel, D., Dweck, C., Crum, A. WILEY. 2023: 17
  • Altered Neurochemical Ratio in the Prefrontal Cortex is Associated With Pain in Fibromyalgia Syndrome Bishop, J., Faerman, A., Geoly, A., Maron-Katz, A., Sacchet, M., Spiegel, D., Williams, N. SPRINGERNATURE. 2021: 163
  • PROTEOMIC BIOMARKERS OF CIRCADIAN TIME Ambati, A., Lin, L., Zitting, K., Duffy, J. F., Zeitzer, J., Spiegel, D., Czeisler, C. A., Mignot, E. OXFORD UNIV PRESS INC. 2019
  • MATURITY OF DEFENSES, DIURNAL CORTISOL PROFILES, AND DEPRESSIVE SYMPTOMS IN WOMEN WITH PRIMARY BREAST CANCER Rouleau, C., Dutta, N., Li, Y., Sephton, S. E., Tomfohr-Madsen, L., Golant, M., Kronenwetter, C., Spiegel, D., Giese-Davis, J. LIPPINCOTT WILLIAMS & WILKINS. 2018: A31
  • Meta-Analysis of Psychosocial Treatment Effects on Cancer Survival and Sources of Heterogeneity Spiegel, D., Krizanec, S., Kraemer, H., Jo, B., Ershadi, M., Neri, E., Nouriani, B., Aasly, L. NATURE PUBLISHING GROUP. 2017: S331
  • Modulation of the Neural Circuitry Underlying Trait Hypnotizability With Spaced Continuous Theta-Burst Stimulation Williams, N., Sudheimer, K., Stimpson, K., Duvio, D., Chung, C., DeSouza, D., Jo, B., Williams, L., Yeomans, D., Spiegel, D. NATURE PUBLISHING GROUP. 2017: S508–S509