Why should an Italian statistician decide to get a PhD in palliative care at NTNU?

Cinzia Brunelli


Cinzia Brunelli (3rd from left) defended her thesis in Milan, Italy 25 November 2016.

There are multiple answers to this odd question, some related to my personal history and some broader ones, related to the role research is playing in palliative care, an exciting and rapidly developing area of science that is destined to have vast impact on the lives of many.

Starting from the beginning, I’ve always liked numbers more than words – and I still do! That’s why I graduated in statistics, economic statistics to be precise, at the University of Padua in 1992. Just after graduation, I started my collaboration with the Psychology Research Unit at the National Cancer Institute of Milan where Dr. Marcello Tamburini was looking for a person with methodological research training to work on his pioneering projects on quality of life and patient reported outcomes in oncology. The Psychology Unit team worked in close collaboration with the Palliative Care Unit directed by Vittorio Ventafridda and indeed the very first scientific paper I co-authored, was focused on pain assessment and was published in 1994. The collaboration with these two units was very fruitful and stimulating for many years.  As a statistician I was a permanent part of the research team, involved in research projects all the way from protocol planning through analysis to interpretation. In this way my contribution could be more than sample size calculation or data analysis. This allowed me to develop professional skills characterized by  the methodological knowledge of applied statisticians, but also by an understanding of the clinical matter deeper than  the average of other methodologists; I dare define myself the «missing link between statistics and clinic», two worlds that may sometimes suffer from difficulties in communication. However, I was the only statistician in the group and this has certainly made me feel «isolated» when I could not share doubts and discuss solutions with «my own kind of statisticians».

Emerging collaboratives and networks

Meanwhile, palliative care was growing in Europe and Italy, and research became an emergent field for national and international collaboratives. In 2000 I started to actively participate in the research congresses of the European Association for Palliative Care Research Network (EAPC RN) where I met other research groups and in particular the palliative care group from St. Olavs Hospital and  NTNU directed by Professor Stein Kaasa. Congresses were also an opportunity for me to meet and share experiences with other statisticians and researchers working primarily in palliative care. But it was in 2007 with a formal involvement within the European Palliative Care Research Collaborative (EPCRC), that I joined an international research collaboration on a regular basis.

The EPCRC project was funded by a grant from the European Union’s 6th Framework and was lead by Stein Kaasa. Within the same project, professor Caraceni, director of the Palliative Care Unit in Milan, was leading a work package on pain treatment and  I was involved in giving my methodological contribution  to the development of evidence based guidelines on the use of opioids for cancer pain. The EPCRC project made me try the true taste of international, multiprofessional, enjoyable and  high quality research experience: we had regular meetings in the different countries of the collaborative, we planned multicentre internationals studies and shared previously collected data for secondary analyses, and we learned to understand each other as different professionals with different cultural backgrounds. The cooperation continued, and still continues, within the framework collaboration established between my institution, the Fondazione IRCCS Istituto Nazionale Tumori in Milan and the PRC in Trondheim through a number of common research projects.

Why? Why not?

Working at an international level opens your mind and you start thinking bigger: you understand that if you have innovative ideas, if you belong to a reliable research network and have adequate research competence and experience, you can actively be purposeful. I was trained as a statistician, a profession which plays an essential part in medical research now, but which is most often destined to cover the role of the follower. I was 46 years old in 2012 when I learned about a new international PhD programme at NTNU. I thought: «Why not? Why not try to become more self-standing as a researcher?» So my personal answer to the initial question is: «I decided to get a PhD to be a driver more than a follower». I believe that freedom and responsibility are the two key words of PhD training experience:  supervisors can be very helpful but they are often busy, which means you have to manage tasks properly within the due time relying on your own resources.

The second part of the question was «Why Norway?» Unfortunately, in Italy we do not have PhD training in palliative care, but I knew that NTNU was welcoming students from abroad. Hence, with the support of my two supervisors Professors Augusto Caraceni and Professor Stein Kaasa I applied for PhD training at NTNU. Thanks to the funding I received from PRC, from my institution  and from the Floriani Foundation, a non-profit private foundation promoting assistance and research in palliative care in Milan (http://www.fondazionefloriani.eu), I could dedicate myself full time to my research project. 25 November 2016 I defended my thesis, «Cancer pain assessment, classification and patient reported outcomes in the evaluation of treatment effect», at a dissertation ceremony arranged by NTNU in Milan.

My PhD experience was very positive.  My supervisors provided outstanding scientific advices and were very supporting with me during these three years. I also appreciated the warm and welcoming atmosphere I found at PRC among other PhD candidates, post-docs and administrative staff always ready to help with both scientific and organizational issues. I have really enjoyed my residency periods in Trondheim, its wonderful summer and fall colors. I admired the scenery when walking along Nidelva or hiking in Bymarka.  I have actually missed the opportunity to learn at least a little Norwegian: everybody speaks English so well that it is actually not needed! I have enjoyed shrimps, bacalao and spelt bread and I have also learned to enjoy Norwegian coffee… the trick is simply not to call it «coffee»!

But I won’t miss all that: the research collaboration between Fondazione IRCCS Istituto Nazionale Tumori  and PRC is still continuing and active! Hopefully in the future other Italian researchers will seize the opportunity to enter the PhD training programme in palliative care to start taking the driving seat of their research careers.