Dr. Wright is Assistant Professor of Nursing. She received a B.S.N. and M.S. from University of Michigan School of Nursing, and a Ph.D. from New Your University College of Nursing.
Fay Wright, PhD, RN, APRN-BC joined the Rory Meyers College of Nursing as an assistant professor in 2015, following a T-32 post-doctoral fellowship in Self and Symptom Management at Yale University School of Nursing. Dr. Wright’s research is focused on identifying profiles of patients at risk for higher levels of symptoms with chronic comorbid conditions including cancer, heart disease and diabetes. By developing risk profiles that incorporate demographic, clinical and genomic characteristics, Dr. Wright plans to develop and test precision interventions to support patients’ self-management of symptoms, and to improve their functional status and quality of life. Dr. Wright has experience conducting clinical research within large urban and community hospital settings using quantitative, biobehavioral and mixed method methodology. Her publications identify characteristics of patients at risk for higher levels of fatigue during chemotherapy.
Prior to joining the faculty at NYU, Dr. Wright the Assistant Director for Evidence-Based Practice and Nursing Research at Northern Westchester Hospital in Mt Kisco NY, a clinical assistant professor at Pace University Lienhard School of Nursing, and NYU College of Nursing.
New York University, PhDNew York University, Post-Master's CertificateUniversity of Michigan School of Nursing, MSUniversity of Michigan School of Nursing, BSN
Honors and awards
Research Pilot Grant International Society of Nurses in Genetics: Daily Diurnal Fatigue Variability and its Association with Genetic Expression of Inflammasome Pathways $2500 (2017)T32 Post-doctoral fellowship, National Institute of Nursing Research (2017)Intramural Research Training Award: Precision Health Boot Camp. National Institute of Nursing (2016)Intramural Research Training Award: Summer genetics Institute. National Institute of Nursing. (2015)Summer Genetics Institute. Intramural Research Training Award National Institute of Nursing Research. (2015)Valedictorian PhD Program New York University College of Nursing (2015)Distinguished PhD Student New York University College of Nursing (2015)Best Dissertation Award New York University College of Nursing (2015)Evidence-Based Practice Excellence Award Maintaining Normothermia in Perioperative Patients Foundation of New York State Nurses Association (2012)Evidence-Based Practice Excellence Award: Developing an Evidence-based Protocol for Sedation in Mechanically Ventilated Critical Care Patients Foundation of New York State Nurses Association (2011)
Eastern Nursing Research Society (Chronic Comorbid Conditions Research Interest Group Co-Chair)Sigma Theta TauOncology Nursing SocietyAmerican Nurses AssociationAssociation of New York State Nurses
Characteristics associated with inter-individual differences in the trajectories of self-reported attentional function in oncology outpatients receiving chemotherapyAbstractPurpose: Between 14 and 85 % of patients report noticeable changes in cognitive function during chemotherapy (CTX). The purposes of this study were to determine which demographic, clinical, and symptom characteristics were associated with inter-individual variability in initial levels of attentional function as well as with changes in the trajectories of attentional function in a sample of oncology patients who received two cycles of CTX. Methods: Oncology outpatients (n = 1329) were recruited from two comprehensive cancer centers, one veteran’s affairs hospital, and four community-based oncology programs. The Attentional Function Index (AFI) was used to assess perceived effectiveness in completing daily tasks that required working memory and attention. Hierarchical linear modeling (HLM) was used to evaluate for inter-individual variability in initial levels and in the trajectories of attentional function. Results: Demographic, clinical, and symptom characteristics associated with inter-individual differences of attentional function at enrollment (i.e., intercept) were as follows: employment status, functional status, trait anxiety, depressive symptoms, sleep disturbance, evening fatigue, and morning energy. Gender was the only characteristic associated with inter-individual differences in the trajectories of attentional function. Morning fatigue was the only characteristic associated with both initial levels and the trajectories of attentional function. Conclusions: Prior to their next dose of CTX, patients reported moderate levels of attentional function that persisted over two cycles of CTX. Many of the clinical and symptom characteristics associated with decrements in attentional function are amenable to interventions. Clinicians need to assess patients for changes in attentional function and associated characteristics and recommend evidence-based interventions.
Common and Distinct Characteristics Associated With Trajectories of Morning and Evening Energy in Oncology Patients Receiving ChemotherapyAbstractAbid, H., Kober, K. M., Smoot, B., Paul, S. M., Hammer, M., Levine, J. D., Lee, K., Wright, F., Cooper, B. A., Conley, Y. P., & Miaskowski, C. (2017). Journal of Pain and Symptom Management. 10.1016/j.jpainsymman.2016.12.339Context: Although energy conservation strategies are recommended in clinical practice guidelines, little is known about changes in energy levels in oncology patients undergoing cancer treatment. Objectives: The objective of this study was to identify variations in the trajectories of morning and evening energy levels and determine which characteristics predicted initial levels and the trajectories of morning and evening energy. Methods: Outpatients receiving chemotherapy (CTX) completed demographic and symptom questionnaires six times over two CTX cycles. Energy was assessed using the Lee Fatigue Scale. Hierarchical linear modeling was used to analyze the data. Results: A large amount of interindividual variability was found in the morning and evening energy trajectories. Patients who lived alone, had childcare responsibilities, had a lower functional status, did not exercise on a regular basis, had lower hemoglobin levels, had lower attentional function, higher trait anxiety, and higher sleep disturbance reported lower morning energy levels at enrollment. Variations in the trajectories of morning energy were associated with a higher body mass index and higher levels of morning energy and higher sleep disturbance scores. For evening energy, patients who were female, white, had lower functional status, and had lower attentional function and higher sleep disturbance reported lower evening energy levels at enrollment. Evening energy levels at enrollment were associated with changes in evening energy over time. Conclusion: Patients undergoing CTX experience decrements in both morning and evening energy. The modifiable characteristics associated with these decrements can be used to design intervention studies to increase energy levels in these patients.
Differences in Symptom Clusters Identified Using Ratings of Symptom Occurrence vs. Severity in Lung Cancer Patients Receiving ChemotherapyAbstractContext: An important question in symptom clusters research is whether the number and types of symptom clusters vary based on the specific dimension of the symptom experience used to create the clusters. Objectives: Given that lung cancer patients undergoing chemotherapy (CTX) report an average of 14 co-occurring symptoms and studies of symptom clusters in these patients are limited, the purpose of this study, in lung cancer patients undergoing CTX (n = 145), was to identify whether the number and types of symptom clusters differed based on whether symptom occurrence rates or symptom severity ratings were used to create the clusters. Methods: A modified version of the Memorial Symptom Assessment Scale was used to assess for the occurrence and severity of 38 symptoms, one week after the administration of CTX. Exploratory factor analysis was used to extract the symptom clusters. Results: Both the number and types of symptom clusters were relatively similar using symptom occurrence rates or symptom severity ratings. Five symptom clusters were identified using both symptom occurrence rates and severity ratings (i.e., sickness behavior, lung cancer specific, psychological, nutritional, and epithelial). Across these two dimensions, the specific symptoms within each of the symptom clusters were relatively similar. Conclusions: Identification of symptom clusters in patients with lung cancer may assist with the development of more targeted symptom management interventions. Future studies are warranted to determine if symptom clusters change over a cycle of CTX in patients with lung cancer.
Differences in symptom occurrence, severity, and distress ratings between patients with gastrointestinal cancers who received chemotherapy alone or chemotherapy with targeted therapyAbstractTantoy, I. Y., Dhruva, A., Cataldo, J., Venook, A., Cooper, B. A., Paul, S. M., Levine, J. D., Conley, Y. P., Cartwright, F., Lee, K., Wright, F., & Miaskowski, C. (2017). Journal of Gastrointestinal Oncology, 8(1), 109-126. 10.21037/jgo.2017.01.09Background: Approximately 28% of patients with gastrointestinal (GI) cancers will receive targeted therapy (TT) because of the associated increases in survival. Only four studies have examined the symptom experience of these patients. To date, no studies have evaluated for differences in symptom occurrence, severity, and distress between patients who received chemotherapy (CTX) alone (n=304) or CTX with TT (n=93). Methods: Patients completed self-report questionnaires, approximately one week after they received CTX. A modified version of the Memorial Symptom Assessment Scale (MSAS) was used to obtain data on symptom occurrence, severity, and distress. Binary logistic regression analyses were used to test for differences in symptom occurrence rates between the two treatment groups. Ordinal logistic regression analyses were used to test for differences in severity and distress ratings between the two treatment groups. Results: Patients who received CTX with TT were significantly younger (P=0.009); were diagnosed with cancer longer (P=0.004); had a higher number of prior treatments (P=0.024); had metastatic disease, specifically to the liver (P < 0.001); had a diagnosis of anal, colon, rectum, or colorectal cancer (CRC) (P < 0.001); and were positive for detection of B-Raf proto-oncogene, serine/threonine kinase (BRAF) and Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations (both P < 0.001). In addition, CTX treatment regimens were significantly different between the two groups (P < 0.001). After controlling for significant covariates, patients who received TT reported lower occurrence rates for lack of energy, cough, feeling drowsy, and difficulty sleeping (all, P < 0.05). Patients who received TT reported lower severity scores for dry mouth (P=0.034) and change in the way food tastes (P=0.035). However, they reported higher severity scores for "I don't look like myself" (P=0.026). No differences in symptom distress scores were found between the two treatment groups. Conclusions: This study is the first to evaluate for differences in the symptom experience of GI cancer patients who received CTX alone or CTX with TT using a multidimensional symptom assessment scale. While between group differences in patients' symptom experiences were identified, both treatment groups warrant ongoing assessments to optimally manage their symptoms.
Differential expression of genes and differentially perturbed pathways associated with very high evening fatigue in oncology patients receiving chemotherapyAbstractPurpose: Fatigue is the most common symptom associated with cancer and its treatment. Investigation of molecular mechanisms associated with fatigue in oncology patients may identify new therapeutic targets. The objectives of this study were to evaluate the relationships between gene expression and perturbations in biological pathways and evening fatigue severity in oncology patients who received chemotherapy (CTX). Methods: The Lee Fatigue Scale (LFS) and latent class analysis were used to identify evening fatigue phenotypes. We measured 47,214 ribonucleic acid transcripts from whole blood collected prior to a cycle of CTX. Perturbations in biological pathways associated with differential gene expression were identified from public data sets (i.e., Kyoto Encyclopedia Gene and Genomes, BioCarta). Results: Patients were classified into Moderate (n = 65, mean LFS score 3.1) or Very High (n = 195, mean LFS score 6.4) evening fatigue groups. Compared to patients with Moderate fatigue, patients with Very High fatigue exhibited differential expression of 29 genes. A number of the perturbed pathways identified validated prior mechanistic hypotheses for fatigue, including alterations in immune function, inflammation, neurotransmission, energy metabolism, and circadian rhythms. Based on our findings, energy metabolism was further divided into alterations in carbohydrate metabolism and skeletal muscle energy. Alterations in renal function-related pathways were identified as a potential new mechanism. Conclusions: This study identified differential gene expression and perturbed biological pathways that provide new insights into the multiple and likely inter-related mechanisms associated with evening fatigue in oncology patients.
Evaluation of Coping as a Mediator of the Relationship Between Stressful Life Events and Cancer-Related DistressAbstractLangford, D. J., Cooper, B., Paul, S., Humphreys, J., Keagy, C., Conley, Y. P., Hammer, M. J., Levine, J. D., Wright, F., Melisko, M., Miaskowski, C., & Dunn, L. B. (2017). Health Psychology. 10.1037/hea0000524Objective: Lifetime stressful life events (SLEs) may predispose oncology patients to cancer-related distress (i.e., intrusive thoughts, hyperarousal, avoidance). Coping may influence cancer-related distress by mediating this relationship. This study sought to (a) determine the prevalence and impact of lifetime SLEs among oncology outpatients receiving chemotherapy and (b) examine the relationship between SLEs and cancer-related distress and the mediating role of coping on this relationship. Method: Patients (n = 957), with breast, gastrointestinal, gynecologic or lung cancer, who were undergoing chemotherapy, completed the Life Stressor Checklist-Revised (LSC-R), a measure of lifetime SLEs. Cancer-related distress was assessed with the Impact of Event Scale-Revised. Coping strategies since beginning chemotherapy were assessed with the Brief COPE; 2 latent variables (engagement and disengagement coping) were identified based on these scores. LSC-R scores (number of SLEs and perceived impact during the prior year) were evaluated in relation to demographic and clinical characteristics. Structural equation modeling was used to evaluate the relationship between LSC-R and Impact of Event Scale-Revised scores and the mediating role of engagement and disengagement coping on this relationship. Results: On average, patients reported 6.1 (SD = 4.0; range = 0-23 out of 30) SLEs. Patients who were not married/partnered, had incomes <$30,000/year, or who had lower functional status or greater comorbidity had higher LSC-R scores. The relationship between more SLEs and more severe cancer-related distress was completely mediated by disengagement coping. Engagement coping did not mediate this relationship. Conclusions: Disengagement coping, including behavioral disengagement, avoidance, and denial, should be targeted to mitigate cancer-related distress. (PsycINFO Database Record
Inflammatory pathway genes associated with inter-individual variability in the trajectories of morning and evening fatigue in patients receiving chemotherapyAbstractWright, F., Hammer, M., Paul, S. M., Aouizerat, B. E., Kober, K. M., Conley, Y. P., Cooper, B. A., Dunn, L. B., Levine, J. D., DEramo Melkus, G., & Miaskowski, C. (2017). Cytokine, 91, 187-210. 10.1016/j.cyto.2016.12.023Fatigue, a highly prevalent and distressing symptom during chemotherapy (CTX), demonstrates diurnal and interindividual variability in severity. Little is known about the associations between variations in genes involved in inflammatory processes and morning and evening fatigue severity during CTX. The purposes of this study, in a sample of oncology patients (N = 543) with breast, gastrointestinal (GI), gynecological (GYN), or lung cancer who received two cycles of CTX, were to determine whether variations in genes involved in inflammatory processes were associated with inter-individual variability in initial levels as well as in the trajectories of morning and evening fatigue. Patients completed the Lee Fatigue Scale to determine morning and evening fatigue severity a total of six times over two cycles of CTX. Using a whole exome array, 309 single nucleotide polymorphisms SNPs among the 64 candidate genes that passed all quality control filters were evaluated using hierarchical linear modeling (HLM). Based on the results of the HLM analyses, the final SNPs were evaluated for their potential impact on protein function using two bioinformational tools. The following inflammatory pathways were represented: chemokines (3 genes); cytokines (12 genes); inflammasome (11 genes); Janus kinase/signal transducers and activators of transcription (JAK/STAT, 10 genes); mitogen-activated protein kinase/jun amino-terminal kinases (MAPK/JNK, 3 genes); nuclear factor-kappa beta (NFkB, 18 genes); and NFkB and MAP/JNK (7 genes). After controlling for self-reported and genomic estimates of race and ethnicity, polymorphisms in six genes from the cytokine (2 genes); inflammasome (2 genes); and NFkB (2 genes) pathways were associated with both morning and evening fatigue. Polymorphisms in six genes from the inflammasome (1 gene); JAK/STAT (1 gene); and NFkB (4 genes) pathways were associated with only morning fatigue. Polymorphisms in three genes from the inflammasome (2 genes) and the NFkB (1 gene) pathways were associated with only evening fatigue. Taken together, these findings add to the growing body of evidence that suggests that morning and evening fatigue are distinct symptoms.
Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapyAbstractMark, S., Cataldo, J., Dhruva, A., Paul, S. M., Chen, L. M., Hammer, M. J., Levine, J. D., Wright, F., Melisko, M., Lee, K., Conley, Y. P., & Miaskowski, C. (2017). Supportive Care in Cancer, 1-10. 10.1007/s00520-017-3655-2Purpose: In a sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer who received at least two cycles of chemotherapy (CTX), the purposes were to evaluate for inter-individual differences in the severity of sleep disturbance and determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of sleep disturbance. Methods: A total of 1331 patients completed study questionnaires in their homes, at six time points over two cycles of CTX (prior to CTX administration, approximately 1 week after CTX administration, and approximately 2 weeks after CTX administration). Questionnaires included demographic, clinical, and symptom assessments (i.e., General Sleep Disturbance Scale, Lee Fatigue Scale, Center for Epidemiological Studies-Depression Scale, Spielberger State-Trait Anxiety Inventories, Attentional Function Index). Hierarchical linear modeling based on full maximum likelihood estimation was performed. Results: Characteristics associated with higher initial levels of sleep disturbance included higher body mass index, poorer functional status, higher trait anxiety, higher depressive symptoms, and higher evening fatigue. Characteristics associated with the worse trajectories of sleep disturbance were higher levels of education and higher sleep disturbance at enrollment. Characteristics associated with both higher initial levels and worse trajectories of sleep disturbance were higher morning fatigue and worse attentional function. Conclusions: A large amount of inter-individual variability exists in sleep disturbance during CTX. The modifiable and non-modifiable characteristics found in this study can be used to identify higher risk patients and provide earlier interventions to reduce sleep disturbance.
Predictors of the multidimensional symptom experience of lung cancer patients receiving chemotherapyAbstractWong, M. L., Paul, S. M., Cooper, B. A., Dunn, L. B., Hammer, M. J., Conley, Y. P., Wright, F., Levine, J. D., Walter, L. C., Cartwright, F., & Miaskowski, C. (2017). Supportive Care in Cancer, 1-9. 10.1007/s00520-017-3593-zPurpose: Few studies have examined interindividual variability in the symptom experience of lung cancer patients. We aimed to identify the most prevalent, severe, and distressing symptoms, and risk factors associated with increased symptom burden. Methods: Lung cancer patients (n = 145) reported occurrence, severity, and distress for 38 symptoms on the Memorial Symptom Assessment Scale 1 week after chemotherapy. Using multidimensional subscales, risk factors for higher global distress, physical, and psychological symptoms were evaluated using simultaneous linear regression. Results: Mean age was 64.0 years and 56.6% were female. Mean Karnofsky Performance Status score was 79.1 (SD 14.6) and mean Self-Administered Comorbidity Questionnaire score was 7.3 (SD 3.9). The most distressing and prevalent symptom was fatigue. Problems with sexual interest/activity had the highest mean severity rating. Patients with lower functional status (p = 0.001) and higher comorbidity (p = 0.02) reported higher global distress. Similarly, lower functional status (p = 0.003) and higher comorbidity (p = 0.04) were associated with a higher physical symptom burden along with lower body mass index (p = 0.02). Higher psychology symptom burden was associated with lower functional status (p = 0.01), younger age (p = 0.02), non-metastatic disease (p = 0.03), higher number of prior treatments (p = 0.04), and income (p = 0.03). Conclusions: Fatigue was the most distressing and prevalent symptom among lung cancer patients receiving chemotherapy. Lower functional status was associated with a higher burden of global distress, physical, and psychological symptoms. Younger age and non-metastatic disease were additional risk factors for increased psychological symptoms. Together, these risk factors can help clinicians identify lung cancer patients at increased need for aggressive symptom management.
Primer in Genetics and Genomics, Article 5—Further Defining the Concepts of Genotype and Phenotype and Exploring Genotype–Phenotype AssociationsAbstractAs nurses begin to incorporate genetic and genomic sciences into clinical practice, education, and research, it is essential that they have a working knowledge of the terms foundational to the science. The first article in this primer series provided brief definitions of the basic terms (e.g., genetics and genomics) and introduced the concept of phenotype during the discussion of Mendelian inheritance. These terms, however, are inconsistently used in publications and conversations, and the linkage between genotype and phenotype requires clarification. The goal of this fifth article in the series is to elucidate these terms, provide an overview of the research methods used to determine genotype–phenotype associations, and discuss their significance to nursing through examples from the current nursing literature.