Faculty

John Merriman headshot

John Merriman

PhD RN

Assistant Professor

1 212 998 5375

433 First Avenue
Room 426
New York, NY 10010
United States

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Professional overview

Dr. Merriman’s research is focused on changes in cognitive function after a diagnosis of cancer.  He is particularly interested in biobehavioral predictors of these cognitive changes, including functional and structural brain markers, genomic markers, and mood.  Prior to his faculty appointment, he was a postdoctoral associate at the University of Pittsburgh School of Nursing and a doctoral student at the University of California, San Francisco School of Nursing.

Education

University of California, San Francisco PhD, Nursing
University of California, San Francisco MS, Nursing
Mississippi College BS, Communication

Honors and awards

University of Pittsburgh Postdoctoral Association Postdoctoral Alumni Award (2016)
Sigma Theta Tau International inductee (2006)
Mortar Board inductee (1993)

Professional membership

Oncology Nursing Society
Sigma Theta Tau International
International Society of Nurses in Genetics

Publications

Publications

Exploratory Study of Associations Between DNA Repair and Oxidative Stress Gene Polymorphisms and Cognitive Problems Reported by Postmenopausal Women With and Without Breast Cancer

Merriman, J., Sereika, S. M., Conley, Y. P., Koleck, T. A., Zhu, Y., Phillips, M. L., Bertocci, M. A., Brufsky, A. M., & Bender, C. M. (2019). Biological Research for Nursing, 21(1), 50-60. 10.1177/1099800418799964
Abstract
Purpose: Women with breast cancer report varying frequencies of cognitive problems during adjuvant systemic therapy. This variability suggests latent subgroups. Therefore, we identified latent subgroups of self-reported cognitive problems among postmenopausal women with and without breast cancer. We explored associations between membership in these subgroups and (a) demographic, clinical, and symptom characteristics and (b) variations in candidate gene polymorphisms. Methods: We evaluated frequency of cognitive problems using the Patient Assessment of Own Functioning Inventory. Growth mixture modeling identified latent subgroups over 18 months of adjuvant systemic therapy and at matched time points for women without cancer (N = 331). We evaluated for differences among subgroups in demographic, clinical, and symptom characteristics and in 41 single nucleotide polymorphisms in 10 candidate genes involved in DNA repair and oxidative stress pathways (n = 199). We modeled associations between genotypes and subgroup membership using multinomial logistic regression. Results: We identified three latent subgroups: more frequent, persistent, and almost never. Receipt of chemotherapy plus anastrozole, depressive symptoms, and baseline neuropathic symptoms increased the odds of belonging to the more frequent subgroup. Anxiety and depressive symptoms increased the odds of belonging to the persistent subgroup. With covariates controlled for, carrying the ERCC5 rs873601 G minor allele increased the odds of reporting more frequent cognitive problems. Conclusions: Chemotherapy plus anastrozole, depressive symptoms, and presence of neuropathic symptoms may predict more frequent cognitive problems during systemic therapy that later resolve. Mood dysregulation before therapy may predict persistent cognitive problems during therapy. ERCC5 genotype may influence frequency of cognitive problems after controlling for these risk factors.

Trajectories of cognitive function and associated phenotypic and genotypic factors in breast cancer

Bender, C. M., Merriman, J., Sereika, S. M., Gentry, A. L., Casillo, F. E., Koleck, T. A., Rosenzweig, M. Q., Brufsky, A. M., McAuliffe, P., Zhu, Y., & Conley, Y. P. (2018). Oncology Nursing Forum, 45(3), 308-326. 10.1188/18.ONF.308-326
Abstract
OBJECTIVES: This study identified women with unique trajectories of executive function, concentration, and visual working memory before and during adjuvant therapy for breast cancer, and examined phenotypic and genotypic predictors associated with subgroups. SAMPLE & SETTING: 399 postmenopausal women, of whom 288 were women with early-stage breast cancer and 111 were women without breast cancer, matched on age and years of education to the women with breast cancer, and all at an urban cancer center. METHODS & VARIABLES: A repeated-measures design was used; assessments occurred before adjuvant therapy and every six months post-therapy initiation. Group-based trajectory modeling determined subgroups. Multinomial logistic regression identified phenotypic and genotypic characteristics. RESULTS: Three executive function and concentration trajectory subgroups were identified: low, moderate, and high; two visual working memory subgroups were identified: low and high. IMPLICATIONS FOR NURSING: Advancing age, greater pretherapy fatigue, and poorer pretherapy cognitive function are associated with the low subgroups. DNA repair and oxidative stress mechanisms may be involved in the cognitive changes that women experience.

Trajectories of self-reported cognitive function in postmenopausal women during adjuvant systemic therapy for breast cancer

Merriman, J., Sereika, S. M., Brufsky, A. M., McAuliffe, P. F., McGuire, K. P., Myers, J. S., Phillips, M. L., Ryan, C. M., Gentry, A. L., Jones, L. D., & Bender, C. M. (2017). Psycho-Oncology, 26(1), 44-52. 10.1002/pon.4009
Abstract
Objective: In a sample of 368 postmenopausal women, we (1) determined within-cohort and between-cohort relationships between adjuvant systemic therapy for breast cancer and self-reported cognitive function during the first 18 months of therapy and (2) evaluated the influence of co-occurring symptoms, neuropsychological function, and other covariates on relationships. Methods: We evaluated self-reported cognitive function, using the Patient Assessment of Own Functioning Inventory (PAOFI), and potential covariates (e.g., co-occurring symptom scores and neuropsychological function z-scores) in 158 women receiving aromatase inhibitor (AI) therapy alone, 104 women receiving chemotherapy followed by AI therapy, and 106 non-cancer controls. Patients were assessed before systemic therapy and then every 6 months, for a total of four assessments over 18 months. Controls were assessed at matched time points. Mixed-effects modeling was used to determine longitudinal relationships. Results: Controlling for covariates, patients enrolled before chemotherapy reported poorer global cognitive function (p < 0.001), memory (p < 0.001), language and communication (p < 0.001), and sensorimotor function (p = 0.002) after chemotherapy. These patients reported poorer higher-level cognitive and intellectual functions from before chemotherapy to 12 months after initiation of AI therapy (p < 0.001). Higher levels of depressive symptoms (p < 0.001), anxiety (p < 0.001), and fatigue (p = 0.040) at enrollment were predictors of poorer cognitive function over time. PAOFI total score was a predictor of executive function (p = 0.048) and visual working memory (p = 0.005) z-scores, controlling for covariates. Conclusions: Findings provide further evidence of poorer self-reported cognitive function after chemotherapy and of relationships between co-occurring symptoms and cognitive changes. AI therapy alone does not have an impact on self-reported cognitive function.

The association between pre-treatment occupational skill level and mood and symptom burden in early-stage, postmenopausal breast cancer survivors during the first year of anastrozole therapy

Nugent, B. D., Sereika, S. M., Rosenzweig, M., McCue, M., Merriman, J., & Bender, C. M. (2016). Supportive Care in Cancer, 24(8), 3401-3409. 10.1007/s00520-016-3161-y
Abstract
Purpose: Previous research has explored occupational activity of breast cancer survivors but has not examined the influence of occupational level on symptoms prospectively. The purpose of this study was to examine the relationship between occupational classification and changes in mood and symptom burden for postmenopausal breast cancer survivors during the first year of anastrozole therapy. Methods: This was an exploratory secondary analysis in 49 postmenopausal women receiving anastrozole therapy for early-stage breast cancer. Participants reported their occupation at baseline and completed self-report questionnaires measuring mood and symptom burden at baseline, 6 months, and 12 months. Occupation was classified according to four major skill levels delineated by the International Standard Classification of Occupations (ISCO). Results: Breast cancer survivors employed at occupational skill levels 1 through 3 reported significantly higher depressive symptoms, fatigue, and total symptoms on average than those employed at ISCO skill level 4. After adjusting for multiple comparisons, this pattern remained for the musculoskeletal, vasomotor, and gastrointestinal symptom subscales. Conclusions: Breast cancer survivors employed at lower skill levels (i.e., ISCO 1–3) reported poorer mood and greater symptom burden than breast cancer survivors employed at a higher skill level (i.e., ISCO 4). Assessing baseline occupation of occupationally active breast cancer survivors may improve understanding of the association between types of occupations and mood and symptom trajectories and may inform development of interventions to mitigate symptom severity in order to help breast cancer survivors maintain optimal occupational function and adherence to therapy.

Gender differences in predictors of quality of life at the initiation of radiation therapy

West, C., Paul, S. M., Dunn, L., Dhruva, A., Merriman, J., & Miaskowski, C. (2015). Oncology Nursing Forum, 42(5), 507-516. 10.1188/15.ONF.507-516
Abstract
Purpose/Objectives: To evaluate gender differences in quality of life (QOL), demographic, clinical, and symptom characteristics. Design: Prospective, observational. Setting: Two radiation oncology departments in northern California. Sample: 185 patients before initiation of radiation therapy (RT). Methods: At their RT simulation visit, patients completed a demographic questionnaire, a measure of QOL, and symptom-specific scales. Backward elimination regression analyses were conducted to determine the significant predictors of QOL. Main Research Variables: QOL, gender, and 20 potential predictors. Findings: In women, depressive symptoms, functional status, age, and having children at home explained 64% of the variance in QOL. In men, depressive symptoms, state anxiety, number of comorbidities, being a member of a racial or ethnic minority, and age explained 70% of the variance in QOL. Conclusions: Predictors of QOL differed by gender. Depressive symptom score was the greatest contributor to QOL in both genders. Implications for Nursing: Nurses need to assess for QOL and depression at the initiation of RT. Knowledge of the different predictors of QOL may be useful in the design of gender-specific interventions to improve QOL.

Patterns of change in cognitive function with anastrozole therapy

Bender, C. M., Merriman, J., Gentry, A. L., Ahrendt, G. M., Berga, S. L., Brufsky, A. M., Casillo, F. E., Dailey, M. M., Erickson, K. I., Kratofil, F. M., McAuliffe, P. F., Rosenzweig, M. Q., Ryan, C. M., & Sereika, S. M. (2015). Cancer, 121(15), 2627-2636. 10.1002/cncr.29393
Abstract
BACKGROUND The purpose of this study was to examine and compare the effects of the first 18 months of anastrozole therapy on cognitive function in women with breast cancer. METHODS This large, longitudinal cohort study was composed of postmenopausal women with early-stage breast cancer who received chemotherapy plus anastrozole (n=114) or anastrozole alone (n=173) and a control group (n=110). Cognitive function was assessed before systemic therapy and 6, 12, and 18 months after therapy initiation and at comparable time points in controls. RESULTS The chemotherapy-anastrozole and anastrozole-alone groups had poorer executive function than the controls at nearly all time points (P<.0001 to P=.09). A pattern of deterioration in working memory and concentration was observed during the first 6 months of anastrozole therapy for the chemotherapy-anastrozole group (P<.0001 and P<.0009, respectively) and the anastrozole-alone group (P=.0008 and P=.0002, respectively). This was followed by improved working memory and concentration from 6 to 12 months in both groups. The anastrozole-alone group had a second decline in working memory and concentration from 12 to 18 months after the initiation of therapy (P<.0001 and P=.02, respectively). CONCLUSIONS Women with breast cancer had poorer executive functioning from the period before therapy through the entire first 18 months of therapy. A pattern of decline in working memory and concentration with initial exposure to anastrozole was observed. Women receiving anastrozole alone had a second deterioration in working memory and concentration from 12 to 18 months after therapy initiation. The longer term effects (>18 months) of anastrozole on cognitive function remain to be determined. Cancer 2015;121:2627-2636.

Trajectories of fear of recurrence in women with breast cancer

Dunn, L. B., Langford, D. J., Paul, S. M., Berman, M. B., Shumay, D. M., Kober, K., Merriman, J., West, C., Neuhaus, J. M., & Miaskowski, C. (2015). Supportive Care in Cancer, 23(7), 2033-2043. 10.1007/s00520-014-2513-8
Abstract
Purpose: Although fear of recurrence (FCR) is common among cancer survivors, it remains unclear what factors predict initial levels (e.g., prior to surgery) or changes in FCR in the post-treatment period. Among women treated for breast cancer, this study evaluated the effects of demographic, clinical, symptom, and psychosocial adjustment characteristics on the initial (preoperative) levels of FCR and trajectories of FCR over 6 months following surgery. Methods: Prior to and for 6 months following breast cancer surgery, 396 women were assessed for demographic and clinical (disease and treatment) characteristics, symptoms, psychological adjustment characteristics, and quality of life (QOL). FCR was assessed using a four-item subscale from the QOL instrument. Hierarchical linear modeling was used to examine changes in FCR scores and to identify predictors of inter-individual differences in preoperative FCR levels and trajectories over 6 months. Results: From before surgery to 6 months post-operatively, women with breast cancer showed a high degree of inter-individual variability in FCR. Preoperatively, women who lived with someone, experienced greater changes in spiritual life, had higher state anxiety, had more difficulty coping, or experienced more distress due to diagnosis or distress to family members reported higher FCR scores. Patients who reported better overall physical health and higher FCR scores at enrollment demonstrated a steeper decrease in FCR scores over time. Conclusions: These findings highlight inter-individual heterogeneity in initial levels and changes in FCR over time among women undergoing breast cancer surgery. Further work is needed to identify and provide interventions for women experiencing FCR during and after breast cancer treatment.

Cancer- and treatment-related cognitive changes: What can we do now? what lies ahead?

Bender, C. M., & Merriman, J. (2014). ONCOLOGY (United States), 28(9).

Cytokine gene variation is associated with depressive symptom trajectories in oncology patients and family caregivers

Dunn, L. B., Aouizerat, B. E., Langford, D. J., Cooper, B. A., Dhruva, A., Cataldo, J. K., Baggott, C. R., Merriman, J. D., Dodd, M., West, C., Paul, S. M., & Miaskowski, C. (2013). European Journal of Oncology Nursing, 17(3), 346-353. 10.1016/j.ejon.2012.10.004
Abstract
Purpose: Depressive symptoms are common in cancer patients and their family caregivers (FCs). While these symptoms are characterized by substantial interindividual variability, the factors that predict this variability remain largely unknown. This study sought to confirm latent classes of oncology patients and FCs with distinct depressive symptom trajectories and to examine differences in phenotypic and genotypic characteristics among these classes. Method: Among 167 oncology outpatients with breast, prostate, lung, or brain cancer and 85 of their FCs, growth mixture modeling (GMM) was used to identify latent classes of individuals based on Center for Epidemiological Studies-Depression (CES-D) scores obtained prior to, during, and for four months following completion of radiation therapy. One hundred four single nucleotide polymorphisms (SNPs) and haplotypes in 15 candidate cytokine genes were interrogated for differences between the two largest latent classes. Multivariate logistic regression analyses assessed effects of phenotypic and genotypic characteristics on class membership. Results: Four latent classes were confirmed: Resilient (56.3%), Subsyndromal (32.5%), Delayed (5.2%), and Peak (6.0%). Participants who were younger, female, non-white, and who reported higher baseline trait and state anxiety were more likely to be in the Subsyndromal, Delayed, or Peak groups. Variation in three cytokine genes (i.e., interleukin 1 receptor 2 [IL1R2], IL10, tumor necrosis factor alpha [TNFA]), age, and performance status predicted membership in the Resilient versus Subsyndromal classes. Conclusions: Findings confirm the four latent classes of depressive symptom trajectories previously identified in a sample of breast cancer patients. Variations in cytokine genes may influence variability in depressive symptom trajectories.

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