Fighting against cancer doesn’t stop with beating the cancer alone – the struggle with perceived injustice.

Introduction: Pain is a debilitating symptom experienced by almost one out of two cancer survivors, which not only reduces the quality of life but also prevents the resumption of daily life activities at pre-diagnosis level. Recent work revealed that perceived injustice (PI) is associated with negative treatment-related outcomes. Unfortunately, research on PI in cancer survivors is lacking. By diving deeper into the associations of PI in cancer survivors with treatment-related sequelae, new (PI-)targeted non-pharmacological therapies could be developed in the future. At this moment pharmacological treatments in cancer survivors often fall short due to their numerous side-effects. The goal of my PhD is to explore PI in cancer survivors and (chronic) pain in general, followed by a main research interest of PI in breast cancer survivors (BCS).
Pre-trajectory: During the past three-and-a-half years, I investigated PI in pain populations and cancer survivors. This work resulted in the publication of five first authorship papers, including a systematic review on PI in pain populations, an exploration of PI in cancer survivors, an exploration of cognitive-emotional factors (including PI) and healthcare use in BCS, the finetuning of the research protocol for a large multicenter randomized controlled trial (RCT) targeting PI in BCS and an editorial on chronic pain treatment. My track record so far illustrates that next to the Kom op Tegen Kanker-funded project (ANI251, RCT), I have dedicated time to delve deeper into the key factor targeted by the intervention under investigation in the RCT, PI. This was possible due to the unfortunate COVID-19 pandemic during which recruitment for the trial was hampered since it was not allowed to see patients for research purposes at that time, and later still because patients did not feel comfortable to participate right after stringent measures were loosened. Nevertheless, I took all the effort needed to still successfully complete the RCT and just recently, I was able to finalize the recruitment and treatment phase.
Future research and work: To finalize the RCT in time after the peak of the COVID-19 pandemic, I needed to take the extra mile for the project during the last 2 years. Therefore, I have temporarily put the objectives for my personal PhD project aside, which now leaves me with some unanswered research questions for my PhD dissertation, which would make a significant contribution to the field of psychosocial cancer research and can lead to an optimization of care for cancer survivors. Concretely, the extension of my PhD trajectory for an additional year would ensure me to investigate the direct relationship of PI on pain using an innovative analysis method (Directed Acyclic Graph (DAG)) (WP1) and to unravel the connections between important cancer treatment-related (i.e., fatigue, insomnia, and pain) and PI (WP2) in BCS with pain. Not only will this work significantly contribute to the state-of-the-art concerning PI as an important treatment target, it also ensures optimal use of already collected research data from cancer survivors. A concrete valorisation plan for the results is already on point (WP4). I aim to publish both studies in high-impact (Q1) journals, ensuring that this valuable evidence will get the reach it deserves. The proposed research could lead to evidence for the optimization of non-pharmacological care for the sequelae seen after cancer, which could therefore significantly impact the survivors’ quality of life and reduce the socioeconomic burden. Additionally, these new insights will allow me to further develop research plans to contribute to the continuation of our psychosocial cancer research line and this in close collaboration with the cancer survivors themselves (WP5).