Spotlight on Dr Helena Harder
Research Fellow at Sussex Health Outcomes Research & Education in Cancer (SHORE-C)
Previous Research
I did a Higher Professional Education degree in the Netherlands, which is a four-year programme, equivalent to a UK Bachelor’s degree and includes practical training. When I finished I decided to study for a Master degree at Utrecht University. I was very interested in neuropsychology and included a six-month placement in my study at the neuropsychology department of a large teaching hospital. I had an interesting time there and interacted with a wide range of neurological patients. I wanted to combine psychology with medicine and this was a perfect way.
After my graduation I worked in a cancer hospital in the Netherlands investigating the use of a special diagnostic instrument to measure cognition in patients with brain tumours. We secured a four-year grant from the Dutch Cancer Society to examine the cognitive side-effects of intensive cancer treatments. I travelled across the Netherlands to recruit a large group of haematological patients who were having a stem cell or bone marrow transplant. Together with a research assistant I assessed a large group of patients before and at 12 and 20 months after the transplant. We did the same tests at similar time points in a clinical relevant patient control group and compared the results. This was quite novel at the time because no one had published this research before.
Whilst working and raising two young children I produced a PhD thesis with 6 papers based on this research, and all were published in peer-review journals. While I was finishing, my husband, who is British, found a job in Nepal and we decided to move there for three years. I did voluntary work in a local government hospital and also enjoyed a long ‘sabbatical’. Then we both got job offers here in the UK. I worked in the area of stroke research in the NHS and towards the end of my contract secured a position as research fellow here in Sussex at SHORE-C, Sussex Health Outcomes Research and Education in Cancer. Basically, it’s been a full circle, and now I’m working again within cancer research.
Current Research
My research at SHORE-C is pragmatic, patient-centered, and I usually work closely together with other team members. We focus on the psychosocial impact of cancer on patient’s life, we measure Patient-Reported Outcomes or PROs in national and international clinical trials, and we develop and evaluate interventions to help cancer patients cope with symptoms and treatment side-effects. We also look at how information provision and communication about cancer can be improved. Currently, I work part-time and I am involved in several projects.
In one of these projects I developed an app for women who have had breast cancer surgery or radiotherapy to the armpit. Following breast cancer surgery women are advised to do arm and shoulder exercises to prevent problems developing that may limit their range of movement. Most hospitals give patients sheets of paper explaining the exercises and there’s no real follow-up or monitoring on how the patient is managing. The aim of this app bWell is to support women in this rehabilitation process. We asked breast cancer patients directly what they would like from an app. They wanted exercise videos, so together with a physiotherapist we developed and filmed an exercise programme that can be followed through a series of videos. They also wanted reassuring language in the videos so we wrote a film script and trialled this with some patients.
I am also working on a decision support aid for older women with breast cancer to help them decide if they want to have chemotherapy or not. This particular project is part of the Age Gap study and led by the University of Sheffield. They approached us because we had conducted research in older women with breast cancer examining the decision making process about whether or not to have chemotherapy. There is a discrepancy between the treatment and outcomes for older and younger women with breast cancer, and this national trial aims to optimise this and reduce the gap. It’s quite nice to see that some of the results of your previous work are being used in a larger project.
For another international trial we developed a study-specific weekly diary to measure how patients manage chemotherapy-induced diarrhoea. Diarrhoea is a well-known side-effect of cancer treatment and can have a great impact on patient’s well-being. Sometimes the diarrhoea is severe and patients may be reluctant to leave the house. Standard anti-diarrhoea medicines such as loperamide don’t always work, and this randomised trial investigates the use of a prophylactic injection of octreotide in women who receive targeted therapy for advanced breast cancer.
One of the latest projects I am involved in is assessing the biological and psychological effects of supportive interventions for women with breast cancer. There is growing evidence that exercise programmes or make-up workshops can have psychological benefits for people affected by cancer. We are measuring changes in quality of life using PROs, and Dr Melanie Flint and her team at the University of Brighton, who are collaborating on the study, are measuring the stress cortisol levels in the women’s saliva and hair samples before and after the intervention.
I think what excites me about my research is that it is different all the time. Some researchers enjoy working in-depth on something for many years, but I’m not that kind of person. I like to do and juggle different projects at the same time. It does mean that you have to be able to make the switch from one moment to the other, which can be hard if you’re working part-time and trying to fit it all in.
I always hope that patients will have some benefits from my research. For instance take the bWell app, it would be great if women in the future report that they used it and it helped them. Also, it would be great if there is more information out there for the older women with breast cancer, after all we are an ageing population.
The Future
What I am keen to do in the future is to establish international contacts, so I am now looking into contacts in Nepal to see if there are any research possibilities. Working there would probably mean cancer prevention research because it is a developing country. I think that this is something to work on in the coming year, and we’ll see from there. I have never planned that far ahead and am always open for new ventures.
Interview by Alex Aghajanian