Spotlight on EMCR Awardees
In 2021, WHRTN distributed grants to 36 EMCRs to provide funding for flexible and diverse needs to strengthen and bolster the career development of women working across women’s health research or research translation.
Read about three of projects from awardees, Associate Professor Caroline Gurvich, Dr Anna Singleton and Dr Kristie Harper.
A/Prof Caroline Gurvich
Clinical Neuropsychologist at Monash University; Deputy Director of HER Centre Australia, Department of Psychiatry; and, Head of the Cognition and Hormones Research Group
Is cognition affected by surgical menopause prior to the age of natural menopause?
The project is evaluating the subjective experience of cognitive difficulties and objective neuropsychological changes in early menopause (risk reducing bilateral oophorectomy).
“This award has been pivotal in developing my research in the area of cognition and early menopause. I am passionate about this research area and am grateful to have received this funding as well as the opportunity to establish essential collaborations to kickstart this research program.”
Relatively little is known about the short- and long-term consequences of surgical menopause (bilateral oopherectomy (BSO)) in women with a high risk of ovarian cancer. The recent increase in publications on the topic of cognitive changes in menopause, hypothesised links between surgical menopause and Alzheimer’s disease as well as blogs and social media reports on topics such as brain fog in early menopause highlight a need for clear, evidence based information.
There is limited research examining the short-term cognitive effects of risk reducing BSO in premenopausal women. One small (n=35) longitudinal study by Farrag and colleagues reported cognitive decline (reductions in attention and memory) within 6 months of bilateral oophorectomy in premenopausal women, compared to controls. Of the women who had bilateral oophorectomy, a serum estradiol decrease of greater than 50% six months postoperatively was associated with a greater cognitive decline. The underlying mechanism of diminished cognitive functioning is suggested to be the abrupt decline in serum estradiol that occurs after bilateral oophorectomy, although other hormonal mechanisms may be implicated e.g. abrupt increase in gonadotropins.
A recent cross-sectional survey, led by Prof Hickey, explored factors that impact uptake of risk reducing BSO in high-risk women. Of the 66 women who completed the survey, 29 were premenopausal and had been advised to undergo risk reducing BSO. Barriers to uptake of risk reducing BSO including loss of fertility and menopausal symptoms, which included concerns about memory problems (reported in 53% of respondents). Cognitive difficulties can have a substantial impact on quality of life. Better supporting women through provision of information about potential cognitive (e.g. memory and thinking skills) side effects and their management may support their decision-making about risk reducing BSO.
Study design
The study design involved recruitment of two groups of 30 women (total of 60 women) aged 30-44 years
1. Premenopausal and at high familial risk and/ or high inherited risk (BRCA 1/2) of ovarian cancer and planning to have risk-reducing BSO.
2. Premenopausal and at high familial risk and/ or high inherited risk (BRCA 1/2) of ovarian cancer, but not planning to have risk-reducing BSO in the next 24 months.
Participation in this project involves one assessment prior to any surgery (baseline assessment) and three follow up assessments at 3 months, 12 months and 24 months post-BSO surgery. Women who are at a high risk for ovarian cancer but elect not to have surgery will be assessed at the same time points (i.e. baseline, 3 months, 12 months and 24 months). These sessions are roughly 1.5-2 hours and are completed over zoom.
During each session, women complete assessments of subjective cognitive performance (i.e, any perceived cognitive difficulties), objective neuropsychological performance (performance on tasks assessing attention, memory and executive function abilities) and self-report scales to assess mood and menopause symptoms (such as hot flushes, night sweats and sleep disturbance). Semi-structured qualitative interviews are also conducted on a subset of women in the BSO group at the three-month follow up assessment to learn more about their subjective and qualitative experiences of any mental fatigue or brain fog.
There is a lack of objective neuropsychological data regarding potential detrimental cognitive effects of early (surgical) menopause and no evidence on how subjective experiences align with objective neuropsychological changes. This project will complement the WHAM (Women’s Health after surgical Menopause) study, led by Prof Martha Hickey, by providing new data on the subjective/qualitative cognitive experiences of younger high-risk women (aged 30-44 years) who undergo risk reducing BSO. This information will advance knowledge about early, surgical menopause. This knowledge is crucial to help high-risk women in their decision-making and management of menopausal symptoms.
Project Aims
The aim of this research was to determine the effect of risk reducing bilateral salpingo-oophorectomy (RRBSO) in premenopausal women (<45 years) on cognition, specifically examining memory, attention, processing speed, executive function skills, as well as subjective experience cognitive difficulties.
Project Objectives
To determine the short-term effects of early surgical menopause (BSO) on memory, attention, processing speed and executive or ‘higher order’ functions.
To determine how women’s qualitative experiences and subjective cognitive concerns relate to objective cognitive changes.
To explore the contribution of other factors (beyond changes in hormone levels) to the experience of cognitive change in early (surgical) menopause, including mood (depression, anxiety, stress), vasomotor symptoms and sleep disturbance.
Highlights and Breakthroughs
This research has yielded preliminary results that characterise the cognitive experiences of women who experience surgical menopause prior to the age of natural menopause.
Women describe perceived impairments in thinking, memory and attention following early surgical menopause that had an adverse impact on quality of life. The next phase of this project is exploring subjective and objective cognition pre- and post-BSO.
Women also identified a lack of awareness about the potential for cognitive difficulties to occur in the context of surgical menopause. This has led to the development of a “brain fog during early surgical menopause” tip sheet that we are currently seeking consumer feedback on.
Dr Anna Singleton
Early-career researcher (PhD awarded Dec 2021) at the Engagement and Co-design Research Hub (University of Sydney)
Co-design a ‘Cancer Experience Survey’ with cancer survivors. The project is evaluating which heart health support strategies women would like to receive during and after cancer treatment and how we can harness digital health strategies such as text messaging, websites and mobile applications to achieve accessible support services.
“A shining example of how seed grants can have big impacts for our emerging careers, by enabling capacity building to grow our research teams and improve supervisory skills. This grant enabled me to establish new collaborations with Australia’s leading cancer survivorship researchers and lead a multidisciplinary research team of Australian cancer and public health researchers and consumer representatives, which will be critical to my career moving forward. I am passionate about supporting women’s health across Australia and Internationally, and I’m thankful that WHRTN EMCR Award could help me on my journey.”
Project Overview
Over 74,000 women are diagnosed with cancer each year. Due to improvements in cancer treatment (surgery, chemotherapy, radiotherapy) and the proliferation of long-term cancer survivors (75-91% 5-year survival rates), women are more likely to die of heart disease than their cancer. There is limited heart health support for cancer survivors between medical appointments and a co-designed solution was urgently needed.
For my PhD research, I co-designed an evidence-based text message intervention called EMPOWER-SMS with breast cancer survivors, clinicians, and researchers to improve mental and physical health support between appointments. The 6-month EMPOWER-SMS program was tested in a randomised controlled trial (RCT; N=160) and found effective for improving medication adherence. Participants found EMPOWER-SMS useful (91%) and motivating for lifestyle change (67%). The RCT led to a national implementation pilot, which recruited 845 breast cancer survivors through social media and breast cancer networks (e.g. McGrath Foundation and National Breast Cancer Foundation Register4 program). The program had broad reach, with participants registering from all states and territories, ages ranged from 31-87 and 49% resided in low-moderate socioeconomic areas. However, qualitative feedback revealed that women diagnosed with other cancers would like to receive support as well.
Project Aims
To co-design a ‘Cancer Experience Survey’ with cancer survivors.
Evaluate which heart health support strategies women would like to receive during and after cancer treatment and how we can harness digital health strategies such as text messaging, websites and mobile applications to achieve accessible support services.
Project Objectives
To evaluate the current cancer experience for people during and after treatment in terms of their heart health, including physical and mental health.
To receive insights from people living with or beyond cancer to identify new ways to help people improve their heart health during and after cancer treatments.
To use the results to inform co-design of evidence-based heart health text messages for women with ovarian, cervical, colorectal and lung cancers.
Highlights and Breakthroughs
The Cancer Experience Survey was co-designed with 4 consumer representatives (3 breast cancer, 1 colorectal cancer) and a multidisciplinary team of psychology researchers, cancer nurses, breast cancer surgeons/oncologists, physiotherapists, and dietitians.
Study recruitment is complete (467 participants nationally).
Dr Kristie Harper
Early career researcher and occupational therapist ,currently works in the Emergency Department (ED) at Sir Charles Gairdner Hospital (SCGH) and holds a conjoint Researcher Coordinator position with Curtin University
Establishing older women's view on frailty and an Emergency Department evidence-based frailty intervention team (FIT) program.
“This award has been essential for us to engage with older women to ensure our services are better shaped around their needs and preferences. It has been a valuable and appreciated opportunity for me to impact on women’s health and to grow, develop and promote my research.”
Project Overview
Over 900,000 older women, aged 65 years and over, presented to Australian Emergency Departments (ED) in 2020, 12% more than five years ago.(3-6) Older women have higher levels of frailty, when compared to men, resulting in higher rates of disability, more psychological and physical co-morbidity and poorer self-rated health.(1) ED attendances are significant events marking a new paradigm in the life trajectory of an older woman, often coinciding with the onset of frailty. Progression of mild frailty, especially in the early stages, can be delayed through timely evidence based interventions including exercise; high protein caloric supplementation; Vitamin D, and de-prescription of medications.(2) Presentation to an ED is an opportunity for women to engage in preventative strategies improving health outcomes and reducing rates of representations.(7, 8).
The detection of mild frailty and intervention to prevent poor outcomes could improve women’s health. As such it was proposed to integrate frailty assessment and interventions into allied health practice as a ‘Frailty Intervention Team’ (FIT) program. The FIT program consists of frailty screening using the Clinical Frailty Scale (CFS)(9) and tailored interventions consisting of patient and family education; referral for geriatrician assessment; referral for dietician review; linkage to occupational therapy and physiotherapy rehabilitation programs; and review of the home environment and further services if required. The FIT program incorporates key recommendations from the Asia-Pacific Clinical Practice Guidelines for the Management of Frailty,(10) the Royal Australian College of General Practitioners (RACGP) aged care clinical guide (Silver Book)(11), and the Australian College for Emergency Medicine (ACEM) (2020) policy on the care of elderly patients in the ED.(12)
It was anticipated that the FIT program could support older women with mild frailty to increase their frailty awareness and knowledge, support healthy ageing, improve their quality of life and overall reduce frailty. The purpose of this project was to trial the FIT program for a three-month period and evaluate the program, incorporating essential consumer feedback. These pilot data could be utilised to further develop the intervention and services provided in the ED setting.
Project Aims
The primary aim of this research was to use the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework(13, 14) to evaluate the effectiveness of an evidence-based frailty intervention (FIT) tailored to female older adults. A prospective mixed methods approach for a three-month period was utilised.
The secondary aims were to assess the challenges and facilitators regarding the provision of a FIT program in ED setting from the perspectives of patients and staff; to describe how older women view frailty and how this impacts on their health and well-being; and to describe older women’s views on frailty interventions or services that could be delivered through the ED setting.
Project Objectives
The main objective was to determine the feasibility and perceived benefit of implementing an evidence-based frailty intervention (FIT) tailored to female older adults.
Highlights and Breakthroughs
Data collection commenced in September 2021 with a three-month data collection period (concluding in December 2021).
Screening reviewed 1,319 patients in the ED. Eight hundred and ninety-six (67.9%) patients were aged 70 years and over, of which 60% were female. Two hundred thirteen (39.7%) older women were classified as having mild frailty.
Consumer group meeting was held in November 2022 to discuss frailty and frailty interventions.
Sixty consumer interviews concluded in February 2022.
The FIT program was evaluated using the RE-AIM framework in the ED setting and was feasible, well embedded and adopted by staff. All patients were offered interventions to address frailty and 83% of patients accepted the intervention. Gaps were identified in implementation of strategies after discharge.
Consumer feedback highlighted that future efforts are required to understand acceptable ways and language utilised to provide frailty education. This may reduce patient perceived stigma associated with frailty and enhance understanding of the link between the interventions provided and how they impact on frailty reduction.
