PEARL: Exploring More Personalized Prevention, Screening and Treatment

By Contributing Writer - December 08, 2023

The gem that is PEARL sits across from Moffitt Cancer Center’s Magnolia campus clinic, in the research center that housed Moffitt’s first scientific investigations. PEARL researchers welcome clinicians, patients and community members, all working together on better ways to intercede before cancer puts potential future patients in the clinic across the street.

The Population Engagement and Research Laboratory (PEARL), which opened in April 2023, was designed for population science research with a new paradigm in mind. Called precision cancer interception, its goal is to stop cancer and its associated outcomes earlier in the process through personalized prevention, screening and treatment based on a person’s unique biological and behavioral characteristics.

Shelley Tworoger, PhD, associate center director for Population Science, says the three-year process of creating PEARL was a team effort with many Moffitt groups contributing to its success. Planning included a survey of other cancer centers nationwide.

"We’ve learned that changing your physical activity or diet or quitting smoking are each important interventions in their own right. But if we could come up with ways to help people adopt multiple behavior changes at the same time, it could have an even bigger impact."

- Dr. Shelley Tworoger

“There are really only a handful of cancer centers that have all the different components of PEARL in one location,” Tworoger noted. That eliminates a barrier current Moffitt study participants have long encountered — trekking to multiple Moffitt campuses to engage in research studies. It also allows researchers to design studies that test the power of combining different types of interventions simultaneously.

“We’ve learned that changing your physical activity or diet or quitting smoking are each important interventions in their own right,” Tworoger said. “But if we could come up with ways to help people adopt multiple behavior changes at the same time, it could have an even bigger impact.”

PEARL’s facilities are state of the art, starting with human laboratory rooms for smoking and physiological and behavioral studies. Cameras in each room feed into a monitoring station where investigators can observe remotely without influencing a participant’s actions. The rooms are equipped with negative pressure ventilation that literally sucks smoke out of the room. This makes ongoing studies of cigarette smoking safer, Tworoger says, “and it opens up opportunities to study other forms of tobacco product use like hookahs that are highly damaging but relatively understudied, so that we can better determine how to help people stop.”

Moffitt PEARL
PEARL includes a research kitchen and dining area for diet studies, which reflects the growing interest in the role of obesity and metabolism in cancer.

A research kitchen and dining area for diet studies reflect a growing interest in the role of obesity and metabolism in cancer. John Cleveland, PhD, Moffitt’s executive vice president, center director and chief scientific officer, has a vision to elevate metabolism as another pillar of cancer care and treatment on par with surgery, radiation, chemotherapy and immunotherapy. Recruiting cancer metabolism researchers requires facilities to support their work, Tworoger says. “To translate the basic research that’s happening in this space into actuality for patients, we needed some resources we’ve never had before — like the research kitchen and dining area.”

Exercise is another key component of metabolism-related research. PEARL boasts exercise facilities to study both aerobic and strength training. It also includes novel ways to assess participants’ body composition like DEXA (dual energy X-ray absorptiometry), scanning typically used in clinical settings to evaluate bone density. Additional DEXA software allows PEARL researchers to track body fat composition, an important factor driving tumor cell growth. Combined with the exercise and dining areas, tailored DEXA monitoring will foster further research into ways to limit the muscle-wasting effects of treatment or disease that cancer patients often experience.

PEARL also has patient assessment rooms for physical exams and specimen collection, as well as a dedicated lab for specimen processing. It houses two large meeting spaces: a conference room for collaborative work among researchers and a larger meeting space to gather with community partners. It’s here that Tworoger hopes PEARL will help team science to expand and flourish, translating findings from Moffitt’s basic scientists and clinicians into interventions that help people.

“When we designed PEARL, we met with our Basic Science colleagues,” Tworoger explained. “We talked to them about where they saw their research going and how their studies might expand into human populations. That allowed us to intentionally design PEARL with the capacity to do early translational research that will speed new interventions into the community.”

PEARL is already hosting collaborations with community partners such as YMCA of the Suncoast and federally qualified health centers. The conversations center on how Moffitt can support them with education and referral assistance — and how community partners can collaborate on research studies that test interventions and fine-tune them to be culturally appropriate and effective.

“Moffitt’s mission is to contribute to the prevention and cure of cancer,” Tworoger said. “PEARL creates an increased opportunity to foster the prevention and interception part of our mission.”

PEARL HUMAN LABORATORY ROOMS

Meet Dr. Vani Simmons

Dr. Vani Simmons
Dr. Vani Simmons, director of Moffitt's Tobacco Research and Intervention Program

Coping behaviors have always fascinated me — and smoking is a truly maladaptive means to cope with stress. I’ve devoted my career to conducting applied research projects that are designed to help people quit smoking and improve their health. Now as director of Moffitt’s Tobacco Research and Intervention Program (TRIP), I’m very excited to have access to PEARL, its fantastic resources and the opportunities it offers for research.

One exciting feature of the new PEARL lab rooms is a negative pressure ventilation system that allows participants to light up without exposing others to smoke. The rooms also include discrete video cameras linked to a control room where we can record sessions without being obtrusive. Given the stigma attached to smoking, you can imagine how a participant’s behavior could be better observed without someone present.

Now that our TRIP team is on the Magnolia campus, we are closer to more research collaborators, as well as clinicians and patients. As a team, we are working on a large program grant to help cancer patients quit smoking with digital tools like mobile apps. As we develop them, PEARL will allow us to get immediate feedback on whether our new tools are acceptable to patients. PEARL’s large meeting space is perfect for conducting focus groups among community members — important to our studies with diverse populations like Spanish-speaking smokers.

PEARL enables a much more rigorous assessment of smoking behavior, beyond self-reported questionnaires, and offers space for intervention development. Hopefully, that will translate to more effective interventions to help people quit smoking and reduce cancer burden.

PEARL EXERCISE FACILITIES

Meet Dr. Nathan Parker

Dr. Nathan Parker, Moffitt Cancer Center
Dr. Nathan Parker, assistant member of Moffitt's Health Outcomes and Behavior Program

As an avid weightlifter, it’s rewarding to help patients with cancer maintain strength through exercise.

For decades, the mindset was that patients should rest during cancer treatment. But there’s growing evidence that exercise can be hugely beneficial. It’s not just limited to aerobic exercise like walking. Using weights or resistance bands for strength training is also critical — particularly for patients whose cancers or treatments cause muscle loss. That’s why I started the MPROVE Lab (Moffitt Promotes Resilience in Oncology Via Exercise) that is part of PEARL.

Some of our work is based on the concept of exercise prehabilitation or “prehab.” The goal of prehab is to get patients as strong as possible before a treatment like surgery or cellular therapy to improve their recovery process afterward. Expanding upon that, I’m currently studying remote (via Zoom) strength training with patients who are receiving chemotherapy for advanced or metastatic gastrointestinal cancers. Maintaining strength is incredibly important in this population.

The field of exercise oncology is working to quantify how exercise can improve clinical outcomes by boosting patients’ strength and fitness. PEARL provides a setting for studies to observe the impact of exercise on outcome measures like hospital readmissions, complications or disruptions to chemotherapy regimens.

PEARL’s community focus also lends access to diverse populations for possible study participation. We’re already collaborating with YMCA of the Suncoast to develop a pickleball program for cancer survivors, a fun way to keep people moving that hopefully will lead to more and stronger partnerships.

PEARL RESEARCH KITCHEN

Meet Dr. Tiffany Carson

Dr. Tiffany Carson, Moffitt Cancer Center
Dr. Tiffany Carson, research program leader for Moffitt's Health Outcomes and Behavior Program

I’m interested in how diet and physical activity impact weight management — and how to help people make healthier choices that fit their lifestyles and cultural preferences.

Obesity is a risk factor linked to at least 13 different cancers. So, if we’re recommending diet modifications, is there a way to promote changes that lead to both healthier weights and physiological processes that lower cancer risks?

My research studies high-fiber diets to see if they lead to healthier gut microbiomes, what that looks like across different populations and how we can help different types of people achieve those dietary patterns.

In PEARL’s kitchen, we store prepackaged meals made to detailed specifications for participants to pick up. We ask them to eat one meal each day with us in our dining area. It gives us an opportunity to engage with them, learn how the meal consumption is going and build rapport, bolstering participant retention throughout multiweek studies.

One great aspect of PEARL is how different state-of-the-art research spaces are co-located. It allows us as investigators to bump into one another, brainstorm and collaborate across interventions. For instance, our current RESET study participants are cancer-free Black women with obesity and elevated stress levels. We’re studying whether behavioral weight loss programs can be combined with stress management techniques to achieve better outcomes. Based on that study, my next step is to tailor iRESET for Black patients with breast cancer, obesity and elevated stress to possibly improve their survivorship experience.

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