She replaces Karen Kayser who served as the school’s first endowed chair for the program and recently retired. BrintzenhofeSzoc shares her personal story that led to her interest in the field, along with how her growing body of research is changing clinical care in this one-on-one with UofL News.

UofL News: How did you become interested in oncology social work?

BrintzenhofeSzoc: I became interested in oncology social work when I was a teenager, even though I didn’t realize it at the time. My mother died of breast cancer when I was 13, and it was devastating to me, to my siblings (there were nine of us), and to our dad, who became our primary caregiver. We were from 6 to 25 years of age. I decided then that I wanted to work with people who were or would experience the death of a family member from cancer. I was thinking about children who had a parent with cancer and thought that if they knew how sick the parent was and could talk to someone about it, they would be more prepared to live without the parent. I wanted to be that person to whom they could talk.

I didn’t know that social workers existed when my mother died. I learned this when I was a senior in college. I took an Introduction to Social Work course as an elective, and by the end of the semester, I knew that was how I could attain my goal of working with families preparing to or grieving the death of a parent due to cancer.

I had two field placements at Virginia Commonwealth University, where I earned a Master of Social Work degree. I was placed at a settlement house in Richmond, Virginia, the first year. I worked with children from the neighborhood and the older adults who attended the daycare center. I discovered that I didn’t like working with children but loved working with older adults. My second placement was at the Johns Hopkins Oncology Center in the outpatient clinic. Here I worked with adults who had cancer, mostly with a terminal disease, and their families. It was exactly what I wanted to do.

UofL News: Your research focuses on the experience of chronic or life-limiting disease on what is known as the BioPsychoSocialSpiritualSexualCulture (BPSSSC) aspects of individuals. Explain this, please. 

BrintzenhofeSzoc: After receiving my MSW, I worked at The Johns Hopkins Hospital on the AIDS inpatient unit. During this time, I was able to apply a core concept from social work to what I was doing on the unit. This was working with individuals and families using the lens of BioPsychoSocial care. This meant that I paid attention to the biological (illness-related), the psychological (emotions, quality of life, adaptation to the illness) and the social (family relationships, social support, communication) domains of each person and not just their diagnosis of AIDS. Through this work, I realized that there was more to the individual that didn’t necessarily fit into the BioPsychoSocial domains. The other domains that I became aware of, over time and with more experience, as they almost always came with when working with people with AIDS, included spirituality and religion, sexuality and cultural issues.

Throughout my career as an academic and as a researcher, I continued to explore how all six domains, rather than just three, were present and how they played a part in moving through the trajectory of the disease. I wanted social workers to include the whole person in their practice and research, so I expanded the concept to include all the domains I had identified and that which was in the literature. So, I expanded the core concept of the BioPsychoSocial domains to the BioPsychoSocialSpiritualSexualCultural (BPSSSC) domains.

I started using the expanded concept in my teaching to highlight the importance of spirituality, sexuality and culture in working with patients and families in medical settings. This was also a way to encourage students and future social workers to include these three additional domains into their assessments, treatment plans, outcomes and research. I wanted them to ask specific questions about these sometimes taboo topics. Over the past five years, I have assembled literature that demonstrates the benefit of including these domains in social work practice. I am currently working on a manuscript presenting the BPSSSC. The importance of expanding the lens of social work has become more evident over the past two years due to the COVID pandemic and the racial unrest we have all experienced.

UofL News: How have your findings translated into clinical care? 

BrintzenhofeSzoc: Following a cancer diagnosis, cancer patients and their family members experience a range of psychosocial distress. I was an integral member of a research team that explored the relationship between distress based on cancer sites, or where the cancer was in the body. We published an article in 2001 with the outcomes of this study. The dataset was made up of 4,496 patients with 14 different cancer diagnoses. This study had the largest sample size at the time and continues to be one of the largest sample sizes used in distress research. The outcome reported was that the prevalence of distress among all patients regardless of cancer site was 35.1%. The prevalence of distress differed by cancer site, ranging from 29.6% among those with gynecological cancer to 43.4% among those with lung cancer.

These findings were translated into clinical practice directly through changes made by the accrediting body of cancer centers, the American College of Surgeons Commission on Cancer. In 2015 the [commission] added the requirement that all new patients seen in a cancer center be screened for distress. The mandate further states that patients who report high distress be offered an appropriate intervention. Further, annual data was to be collected and reported on the number of patients screened, the percent of high distress and the number of those who were offered intervention and accepted it. This is one example of how my findings have translated into clinical care.

I also have developed and tested several measures for use with people with chronic or life-limiting diseases. This included the following measures: Healing Experiences in All Life Stressors, Profile of Adaptation to Life among medically ill populations, Satisfaction with Life Domains Scale for breast cancer and the BSI-18. Clinicians and researchers use these measures to increase our understanding of outcomes across the BPSSSC domains and those amenable to using evidence-based practices that focus on improving these outcomes.

UofL News: You have experience as a clinical social worker at the Johns Hopkins Oncology Center. How did this and other work in the clinical setting influence your future research? 

BrintzenhofeSzoc: When I graduated, there were no jobs at Hopkins Oncology Center, so I applied for and was hired to work on the AIDS unit at the Johns Hopkins Hospital. It was just right for me. I was able to work with adults, mostly young adults, who had a diagnosis of AIDS. Most of the people I worked with died during my two years there. It was amazing to have the honor of working with people who knew they were dying of AIDS. I also worked with their partners, family members and friends. One of the most rewarding aspects of this job was working with the medical residents and fellows who rotated through the unit and being able to help them understand the role that psychosocial issues had on people with AIDS.

I decided the best way to learn more about this expanded lens I was working with was to go back to school for a PhD. I spent the next four years working on my doctorate at The Catholic University of America in the National School of Social Service (NCSSS). During this time, I was exposed to the literature and learned about the spiritual and religious aspects of how people experience events in their lives. Later in my career, I expanded my thinking to include the sexual and cultural domains.

After completing my PhD, I worked at the Johns Hopkins Oncology Center as a clinical social worker, as a researcher in the psychosocial research program and as the social work internship program coordinator. This experience expanded my reach to include research as well as teaching. I was hired to a tenure track position at the NCSSS in 1999 and was there until 2016. I was at the University of Cincinnati from 2016 to 2021. It has been with great excitement that I join Kent School of Social Work and Family Science as a professor and Dr. Renato LaRocca Endowed Chair in Oncology Social Work. I am honored to be here.

UofL News: Describe the emphasis of UofL’s Psychosocial Oncology Social Work program? 

BrintzenhofeSzoc: Social workers make up the largest group of mental health professionals in general, in health care, and in oncology settings. Working with people with cancer, their family members and the health care teams that provide care requires knowledge about the disease, how the diagnosis and treatment negatively influence outcomes in BPSSSC, and skills based on evidence-based interventions that can provide relief. Preparing the next generation of social workers for oncology care is a major emphasis of the Psychosocial Oncology Social Work Program. We prepare social work students to work in oncology settings upon graduation and across their careers.

A second foundational aim of the program is to prepare social workers to be consumers of research and producers of research in psychosocial oncology. We work with students in our PhD program to develop their skills and knowledge in this area. A third objective of the program is to work with the community to identify and support their needs by offering continuing education, collaborating in the evaluation of and research into interventions and developing the next generation of academics in this field. The communities I am talking about include the community of oncology social workers who are at local, regional, national and international levels, people at these same levels who have experienced a diagnosis of cancer themselves or in their families, and health care providers outside of social work.

UofL News: What is your vision for the program? 

BrintzenhofeSzoc: My vision for the Psychosocial Oncology Program is to increase the number of MSW students enrolled in the specialization, which will lead to a stronger and more prepared oncology care workforce. I also want to expand the number of MSW students who, while not necessarily planning to be oncology social workers, will enroll in one or both psychosocial oncology courses.

This part of my vision is based on the knowledge that wherever social workers provide care, some of their clients, patients or residents will be dealing with chronic or life-limiting diseases. Having the background of understanding the interactions between one’s BPSSSC characteristics and health outcomes will improve care to people seen outside of cancer settings. While the courses use the lens of cancer, my goal is to help students translate this knowledge and set of skills to other groups with chronic and life-limiting diseases, disorders and conditions.

Another part of my vision is to recruit and mentor social workers working towards a PhD focusing on psychosocial oncology. Here I want to prepare the next generation of academics and researchers focusing on psychosocial oncology. Finally, I would like the Kent School of Social Work and Family Science to be known as a go-to place for help in evaluating programs and researching the effectiveness of interventions. I want this program to have the reputation of building the workforce and supporting the growth of evidence-based practice.

Li has been conducting research funded by the for the past five years which led him to the connection between activity of a protein expressed in fatty tissue and an increase in breast cancer development. Li and colleagues shared the theory in an invited forum in , a Cell Press journal, published online last week. The article describes Li’s theory that adipose fatty acid binding protein (FABP4), expressed in fatty tissue, is responsible for fueling breast cancer tumor growth.

“Many types of cancer are related to obesity, not only breast cancer. More than 13 types of cancer are clearly associated with obesity and I think the list will go on and on once we have more data,” Li said. “In our research, we found the fatty acid binding protein family, especially one member, FABP4, plays a very critical role in the association of obesity and cancer, most specifically breast cancer. We theorize that FABP4 is responsible for the underlying molecular mechanism which promotes obesity-associated breast cancer development.”

Adipose tissue in the body produces FABP4 within fat cells, where it processes and distributes water-insoluble long-chain fatty acids. A certain amount of FABP4 enters the bloodstream under normal conditions. However, as a higher volume of fat tissue is accumulated, more FABP4 is secreted into circulation.

“When we get obese, this protein is secreted out much more into the circulatory system,” Li said. “Normally these molecules are inside the cells, but when people are obese, the molecules are outside.”

Li’s theory offers two ways in which FABP4 may stimulate growth in breast cancer tumors.

First, within the cells, FABP4 increases in certain tumor-associated macrophages, which accumulate in tumors to promote tumor growth. Li’s research also revealed that when FABP4 is inhibited, tumor growth is reduced in animal models even though the adipose tissue remained.

Second, when elevated levels of FABP4 circulate outside the fat cells in obesity, the protein promotes breast cancer development through direct interaction with breast cancer cells. In animal research, mammary tumor development and growth were reduced in obese animals in which FABP4 was controlled.

In addition, FABP4 in the bloodstream appears to work in multiple mechanisms to fuel interactions between tumor components and fat cells, thereby promoting cancer development.

Moreover, Li’s research group recently published findings in showing that different types of high-fat diets have different effects on tumor development. High-fat diets of either cocoa butter or fish oil both result in fat-induced obesity. However, the cocoa butter diet results in increased mammary tumor growth, while the fish oil diet does not. This study not only confirms the critical role of FABP4 in obesity-associated cancer, but reveals that not all obesity promotes the development of tumors.

Li and his team believe a better understanding of how FABP4 works both within macrophages and in circulation could provide opportunities to prevent certain breast cancers from progressing. It may also lead to the development of treatment methods that target FABP4 with drugs or specific antibodies.

“Now we are trying to generate some antibodies for this protein, which could be a very effective therapy strategy for obesity-associated cancer,” Li said.

“I’m going to fight this cancer beast,” said the breast cancer survivor and Kent School of Social Work student who will soon receive her master’s degree in social work.

The “beast” has claimed Martin’s parents, two siblings and three grandparents. What’s more, in just the past nine months as she began her advanced standing coursework, she lost nine more. Seven of those losses were to cancer.

Martin received her own cancer diagnosis in 2010 but has been cancer-free since 2012. She has an older sister who is also a breast cancer survivor.

“Over and over and over, it was like, bam, bam, bam, bam,” she said of the many cancer diagnoses that targeted her loved ones.

This profound personal experience drew Martin to the Kent School. She wanted to do something to help those who faced cancer. The graduate degree program with a specialization in psychosocial oncology seemed like an ideal fit.

“I thought, ‘Is this the right place for me?’ Then I decided I have to do this for all the people I’ve lost and for those living with cancer – to help them live longer and better,” she said.

Martin’s academic journey began in 2008. She earned an associate’s degree from Ivy Tech Community College of Indiana in 2015 and her UofL undergraduate degree in social work in 2018.

She kept pushing ahead for the master’s degree with the psychosocial oncology specialization.

Martin acknowledges it was tough to stay focused, especially as her cancer losses mounted. But she persevered.

“I kept my eye on the prize,” she said. “The UofL family came around to me and lifted me up when I needed to be lifted up.”

During her studies at the Kent School, Martin discovered a new passion: research.

“Man, I love research,” she said.

She began focusing on psychosocial distress and its impact on those diagnosed with cancer. Her findings underscored the importance of providing people with psychosocial services in the survivorship phase — even after they have stopped receiving treatment — and tapping into complementary and alternative medicine techniques such as acupuncture, yoga, tai chi, reiki and mindfulness to improve health outcomes.

“I spoke with people who were 25 years out (since they had been diagnosed with cancer) who are still experiencing various aspects of bio-psychosocial and spiritual distress related to their cancer journey. And, if these are left unchecked, they translate into negative health care outcomes,” she said.

Martin says she is looking for work and hopes to land a clinical position after commencement where she can pursue her licensed clinical social worker designation with the oncology social work certification and continue her research.

She is an American Cancer Society Ambassador for the society’s new initiative, , which encourages female-led cancer research.

Already a big advocate for the society (completing a 500-hour practicum for the nonprofit organization while working on her master’s degree), Martin plans to explore the possibility of obtaining funding from sources such as ResearcHERS, the National Cancer Institute and the National Institute for Health and Care Excellence for her ongoing work.

As her time at UofL comes to an end, Martin says earning her degree has been an inspiring journey.

“I have a great deal of resilience, so instead of giving in to grief, I began to tap into the energy of extreme loss as I earned this degree to inspire my journey forward in memory of those I’ve lost and in honor of those who have survived,” she said. “My husband, Chris, has worked like a dog to support me throughout the process. Earning the Master of Science in social work with the psychosocial oncology specialization is so validating and I am intrigued by how the next steps in this journey will unfold.”

UofL was the first college in the nation to launch a social work curriculum with a . The Kent School program is under the direction of .

Accreditation by the NAPBC is granted only to those centers that have voluntarily committed to provide the highest level of quality breast care and that undergo a rigorous evaluation process and review of their performance. The Brown Cancer Center first received NAPBC accreditation in 2009.

To earn accreditation, the center must demonstrate compliance with standards established by the NAPBC for treating women who are diagnosed with the full spectrum of breast disease. The standards include proficiency in the areas of center leadership, clinical management, research, community outreach, professional education and quality improvement. 

“A breast center that achieves NAPBC accreditation has demonstrated a firm commitment to offer its patients every significant advantage in their battle against breast disease,” said assistant professor of surgery, UofL Division of Surgical Oncology, who directs the breast cancer program as a surgical oncology specialist with UofL Physicians.

“I am extremely proud of this accomplishment. The breast program at the Brown Cancer Center was the first in Kentucky and remains the longest running NAPBC accredited breast program in our region,” said Beth Riley, MD, deputy director of the James Graham Brown Cancer Center and a breast cancer specialist. “This continued commitment to excellence and quality care is evident among our dedicated team of specialists. Several areas of the program were also nominated for ‘Best Practice’ highlights on a national level which speaks to the high level of care we are able to provide.”

The NAPBC is a consortium of professional organizations dedicated to the improvement of the quality of care and monitoring of outcomes of patients with diseases of the breast. This mission is pursued through standard-setting, scientific validation and patient and professional education. Its board membership includes professionals from 20 national organizations that reflect the full spectrum of breast care. 

The American Cancer Society estimates that more than 232,000 patients are diagnosed with invasive breast cancer in the United States annually. In addition, hundreds of thousands of women who deal with benign breast disease require medical evaluation for treatment options.

Receiving care at a NAPBC-accredited center ensures that a patient has access to:

• Comprehensive care, including a full range of the latest treatment services
• A multidisciplinary team approach to coordinate the best treatment options
• Information about ongoing clinical trials and new treatment options
• Quality breast care close to home

The long-awaited study, presented at the American Society of Clinical Oncology meeting over the weekend in Chicago, confirmed what many breast cancer specialists, including those at the at the University of Louisville, had already believed.

For women with this common type of cancer – early stage estrogen-receptor positive – anti-estrogen treatments alone provide the same benefit as chemotherapy, without the harsh and sometimes devastating side effects. Chemotherapy can cause hair loss, a weakened immune system and heart problems, among other issues. Breast cancer is the most common cancer in women worldwide.

“The name of the study is TAILORx, which is perfect, because what this means is that for a large group, treatment can be truly tailored to a woman’s circumstances,” said Elizabeth Riley, MD, FACP, a breast cancer expert at UofL’s Brown Cancer Center and deputy director of the center. “We now have solid data that chemotherapy is not needed for many in this group and helps validate what many specialists already knew.

“For years, physicians made treatment decisions solely based on a woman’s stage of breast cancer. TAILORx now confirms the biology of the tumor may be more important. This study should reassure a woman with very early stage, estrogen-driven breast cancer that chemotherapy can be avoided without increasing her risk of breast cancer,” Riley said.

The study, published Sunday in the New England Journal of Medicine, analyzed how well a widely-used genetic test called the Oncotype DX Breast Recurrence Score assessed the risk of breast cancer returning. The Oncotype DX test looks at 21 genes linked with a likelihood of recurrence. The test has a range between 0 and 100, and determines whether these genes are turned off or on, or are over expressed.

The study’s lead author, Joseph Sparano MD, associate director for clinical research at the Albert Einstein Cancer Center and Montefiore Health System in New York City, said the data confirms women can be spared “unnecessary treatment if the test indicates chemotherapy is not likely to provide benefit.”

Riley noted there are multiple types of breast cancer, with multiple genes involved in the growth of tumors. She said those patients who will benefit from the study’s findings are estrogen sensitive, test negative for HER2 (human epidermal growth factor receptor 2), a gene that can play a role in the development of breast cancer, and have early-stage tumors below 5 centimeters that have not spread to lymph nodes.

They also have what is considered an intermediate score on the OncotypeDX test, one between 11 and 25.

Riley said that past research has shown women with scores between 0 and 10 could safely forego chemotherapy, while those with scores over 25 were best treated with a combination of chemotherapy and anti-estrogen hormonal treatment, as the cancer recurrence risk in this group was high.

“There have been clear guidelines on treatment for women with a high or low score OncotypeDX score. It was the group in the intermediate range, from 11 to 25, that the degree of benefit of chemotherapy was not well established,” Riley said.

Details of the study

The study followed more than 10,000 women diagnosed with breast cancer between 2006 and 2010. Of those, 6,711 had intermedia scores between 11 and 25. That group was split into two: one receiving hormone therapy and chemotherapy, and the other only hormone therapy.

The women were followed for an average of nine years, and researchers found the outcome in recurrence and survival was virtually the same.

“If you are seen by a doctor tomorrow and have a low to intermediate score on the test, you should expect not to be offered chemotherapy, unless you are under the age of 50,” Riley said.

That is the caveat, she said. Breast cancer in younger women is biologically different, and typically comes with a poorer prognosis. In premenopausal women and those younger than 50, the TAILORx results suggested that hormonal therapy alone may not be enough and chemotherapy may still be needed, she said.

While these patients should discuss their options with their doctor, they would be likely candidates for the more aggressive combination therapy, she said.

“In that case, the treatment decisions are going to depend on more than just the test, such as a thorough analysis of a patient’s particular tumor type. We can’t say that everyone under 50 needs chemotherapy, but future studies may be necessary to interpret the test in this age group,” Riley said.

Breast cancer in younger women is a focus of Riley’s. At the Brown Cancer Center, she also leads the , which addresses the challenges this group faces with regional experts in the management of breast cancer in young women. The program also addresses the impact of treatment on fertility, the patient’s young children, and her career. HER stands for Hope, Empower and Restore.

The Play4Kay Pink Out honors the late Kay Yow, a former University of North Carolina coach who died from cancer in 2009. The Kay Yow Cancer Fund is celebrating its 10^th anniversary of providing funding and support for cancer research.

The at the will be on hand at the game with giveaways and educational materials on the importance of early screening and detection of breast cancer. Louisville Women’s Basketball also will recognize breast cancer survivors on the court during halftime.

Fans are encouraged to wear pink, and representatives of Tom Drexler Plumbing and Remodeling will accept $5 donations for a breast cancer awareness t-shirt in the main concourse of the KFC Yum! Center. Proceeds will benefit Gilda’s Club of Louisville.

Fans also will get to check out the Mustang and Mobile Screening Unit, vehicles that are projects of Horses and Hope, an organization that brings cancer screening, detection and treatment services to workers in the equine industry in Kentucky.

Breast cancer survivors are eligible to receive one free ticket and a discounted ticket for $3 for all guests. Call the Louisville Cardinals’ Ticket office for this offer at 502-852-5151. Other fans can receive discounted tickets for $3 by visiting  and using promo code PLAY4KAY.

The cancer center’s Mobile Screening Unit provides prevention and early detection services for breast and other types of cancers. People with private health insurance, Medicare or Medicaid will incur no additional charges for mobile services, and the cancer center will bill providers on behalf of the patients. Some co-pays may apply.

Services provided by the Mobile Screening Unit are furnished by staff at the cancer center and the Kentucky Cancer Program, the statewide cancer prevention and control program mandated by the Kentucky General Assembly.

For more than 25 years, the mobile unit has reached people wherever they are, first focusing on the provision of mammograms for breast cancer and later adding screening services for other types of cancer.

Business and organizational leaders who want to schedule the unit should contact Vera Hobbs at 502-562-4361, extension 4.

The stats are sobering: Breast cancer is the second most common kind of cancer in women, and about one in eight women born today in the United States will get breast cancer at some point.

You can show support for all that the Brown Cancer Center does to end breast cancer by adding the Facebook profile frame. It’s easy:

From your phone:

1. Click on your profile picture.
2. Click “Add Frame.”
3. In the search function, type in “Brown Cancer Center.”
4. Click “Change Frame.”

From your desktop or laptop:

1. Go to .
2. In the search function type in “Brown Cancer Center.”
3. Once you have found the correct frame, click “Use as Profile Picture” to save.

While you are at it, like the Brown Cancer Center on and follow on to keep up-to-date with the latest news and events.

The event is Tuesday, Oct. 10, at Buckhead Mountain Grill, 707 W. Riverside Dr., Jeffersonville, Indiana. Doors open at 5:30 p.m. and dinner will be served at 6 p.m. Admission is free and open to breast cancer survivors only. Participants must register to attend by calling 502-852-6318.

Attendees are invited to dress for the occasion with prizes for the best Halloween costume and the best “Rocky Horror Picture Show” costume.

Rachel Platt of WHAS11’s “Great Day Live!” will emcee. The nonprofit theater company Acting Against Cancer will present “The Rocky Horror Halloween Party,” marking the fourth consecutive year the company has staged the production for Kentuckiana audiences.

The event is made possible with support from Buckhead Mountain Grill, Anthem BlueCross BlueShield and Rocky’s Italian Grill.

The Kentucky Cancer Program is the state mandated cancer control program jointly administered by the University of Louisville (West Region) and the University of Kentucky (East Region). At UofL, the program is sponsored by the James Graham Brown Cancer Center.

Kentucky African Americans Against Cancer, Horses and Hope, James Graham Brown Cancer Center, KentuckyOne Health and Partnership in Cancer Control have joined with the Kentucky Cancer Program to sponsor the screenings. The program is funded by the WellCare Community Foundation. The screenings will be provided by the Horses and Hope Cancer Screening Van.

The following will be provided from 8:30 a.m. to 3:30 p.m.:

• Mammograms for breast cancer screening
  • For women age 40 and over
  • No cost to women without insurance
  • Advance appointments required by calling 502-776-117
• Colon cancer screenings
  • Take-home stool test (FIT Kits)
  • For all men and women age 50 and over
  • For African-American men and women age 45 and over
  • No appointment needed
• Blood pressure checks, health insurance information and free gifts

For additional information, contact Janikaa Sherrod, Kentucky Cancer Program, 502-852-6318.