Jennifer Hunter, R.N., Ph.D., is an associate professor in the School of Nursing and Health Studies. She recently joined the MUBIG team and shifted her research to basic science approaches. As a nurse anthropologist, she entered the realm basic science through a social science route – beginning with ethnographic research in and around the jungle city of Iquitos, Peru.
Similar to other underdeveloped world regions, the incidence and mortality from cervical cancer is very high. In Iquitos, it was estimated that one in 10 women died of the disease. Very few could afford any treatment. During this research, Hunter encountered one woman who had the resources for radiation treatment, making her one of few that survived cervical cancer in this region, but eight years later she suffered severe pain in her back and legs, and her vagina had adhered closed, save for a small opening through which urine could pass.
Literature and subsequent in-depth interviews with cervical cancer survivors in the United States confirmed the commonality of treatment-related complications causing long-term physical, emotional and relational suffering. Although the treatment for cervical cancer is most often life-saving, the damage to normal tissues can have a significant impact on vaginal/sexual function and can also compromise urinary and bowel functions, causing obstructions, incontinence, fistula formation and chronic pain. Irradiation alters the DNA of cells in a way that interferes with normal inflammatory and wound healing processes. In comparison to a normal wound, healing and scar formation related to a radiation wound does not “turn off” as it should. The process is perpetuated, resulting in a continued inflammatory response and excessive, defective collagen deposition and fibrosis. Tumor necrosis factor (TNF) and transforming growth factor (TGF-β, and TGF-β1) are some of the cytokines that have been identified as playing a key role in the pathogenesis of RT damage. The fibrosis resulting from radiation causes rigidity that can extend through the entire pelvis, creating a “horseshoe fibrosis” pattern and chronic pain. These cervical cancer treatment-related complications have been described for decades and noted in up to 88 percent of patients. There has been little change in the incidence of complications during those years and little to no advancement in treatment options for vaginal and pelvic radiation damage.
Hunter is now pursuing avenues through which to expand her knowledge base in cell and molecular biology, biochemistry, genetics and related laboratory methods in order to study radiation damage to the vagina and surrounding pelvic tissues with the goal of finding ways to intervene to prevent the long term fibrotic changes that result. Although fibrosis can occur in any tissue; she is beginning her study with vaginal epithelial cells (VECs), layers of which overlie the muscle layers that enable vaginal function and flexibility. The epithelial cell layer can be more than 25 cells thick and forms a robust physical barrier that is the first line of defense against trauma. VECs have the ability to recognize pathogens and produce chemokines and cytokines that signal immune responses, and to respond female hormones, which regulate cell functions differently in various stages in the menstrual cycle. This opens potential for expanding MUBIG’s bone – tendon – muscle “crosstalk” line of research to epithelial – extracellular matrix – muscle crosstalk.
Hunter’s lab is currently testing the feasibility of using a 3D model of primary human VECs atop a gel matrix of collagen and fibroblasts to test cell response to nonlethal doses of radiation. Response to injury is being evaluated with gene and protein expression, histology and calcium imaging (with monolayer cultures). Future avenues for intervention include interruption or inhibition of inflammatory response, inhibition of gene transcription, growth factor antagonism, and induction and acceleration of scar degradation. Hunter’s growing knowledge of 3D culture models can also contribute to other MUBIG lines of study where these more physiologic models can be used.
- NIH SBIR Phase I grant. National Institute of Minorities and Health Disparities (Co-PI) School of Nursing and Health Studies Women’s Health Research Fund grants (2). (PI)
- American Society of Cytopathology Patient Advocacy Grant. (Coordinator -community-partnered project) John Templeton Foundation. A HealthCare Chaplaincy Initiative Grant (Co-PI)
- UMKC Faculty Research Grant. (PI)
- NIH R03. National Institute Cancer Institute. (PI)
- UMKC Center for the City Community Research Grant. (PI)
- National Research Service Award for dissertation study. National Institute of Nursing Research (Co-I w Chair) Institute of International Education Nancy Petrie Grant-in-Aid for Study Abroad (PI)
- Univ of Kansas, Latin American Studies Foreign Language and Area Studies (FLAS) Graduate Fellowship (PI)
Kainoa J. Johnson (graduate student, School of Biological Sciences)
Hunter, J. (2014). The impact of cervical cancer treatment on sexual function and intimate relationships: Is anyone listening? Open Journal of Obstetrics and Gynecology (OJOG) 4(8): 479-490. DOI: 10.4236/ojog.2014.48069.
Hunter, J. & Kelly P.J. (2012). Imagined anatomy and other lessons from learner verification interviews with Mexican immigrant women. Journal of Obstetric, Gynecologic & Neonatal Nursing 41(6): E1- E12.
Hunter, J. (2008). Applying constructivism to nursing education toward cultural competence: A course that bears repeating. Journal of Transcultural Nursing 19(4), 354-362.
Hunter, J. (2007). Bereavement: An incomplete rite of passage. Omega: Journal of Death and Dying 56(2), 153-173.
Hunter, J. (2006). Better late than never: Reflections on the delayed prioritization of cervical cancer in international health. Health Care for Women International 27(1), 2-17.
Hunter, J. (2005). Cervical cancer educational pamphlets: Do they miss the mark for Mexican immigrant women’s needs? Cancer Control: Cancer, Culture and Literacy Supplement 12(November suppl.), 42-50.
Hunter, J. (2005). Emelda’s story: Applying ethnographic insights to cultural assessment and cervical cancer control. Journal of Transcultural Nursing 16(4): 322-330.
Hunter, J. (2004). Cervical Cancer In Iquitos, Peru: Local Realities To Guide Prevention Planning. Cadernos de Saude Publica, 20(1), 160-171.
Hunter, J. (2002). Cervical cancer in Iquitos, Peru: A tragedy of postponed priority. Doctoral dissertation, University of Kansas, Lawrence, KS, Dissertation Abstracts International, 63/05:1888, 2002.