Ashley W-T Wang1, Laura C Bouchard2, Lisa M Gudenkauf3, Devika R Jutagir4, Hannah M Fisher5, Jamie M Jacobs6, Bonnie B Blomberg7, Suzanne C Lechner8, Charles S Carver9, Michael H Antoni10. 1. Department of Psychology, Soochow University, Taipei, Taiwan. 2. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. 3. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States. 4. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Psychology, University of Miami, Coral Gables, FL, United States. 5. Department of Psychology, University of Miami, Coral Gables, FL, United States. 6. Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. 7. Department of Microbiology and Immunology, University of Miami, Miller School of Medicine, Miami, FL, United States; Sylvester Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, United States. 8. Department of Psychology, University of Miami, Coral Gables, FL, United States; Research Advisor, LLC in Hallandale Beach, FL, United States. 9. Department of Psychology, University of Miami, Coral Gables, FL, United States; Sylvester Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, United States. 10. Department of Psychology, University of Miami, Coral Gables, FL, United States; Sylvester Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, United States; Department of Psychiatry and Behavioral Sciences University of Miami, Miller School of Medicine, Miami, FL, United States. Electronic address: mantoni@miami.edu.
Abstract
OBJECTIVE:Cognitive-behavioral stress management (CBSM) improves adaptation to primary treatment for breast cancer (BCa), evidenced as reductions in distress and increases in positive affect. Because not all BCa patients may need psychosocial intervention, identifying those most likely to benefit is important. A secondary analysis of a previous randomized trial tested whether baseline level of cancer-specific distress moderated CBSM effects on adaptation over 12 months. We hypothesized that patients experiencing the greatest cancer-specific distress in the weeks after surgery would show the greatest CBSM-related effects on distress and affect. METHODS:Stages 0-III BCa patients (N = 240) were enrolled 2-8 weeks after surgery and randomized to either a 10-week group CBSM intervention or a 1-day psychoeducational (PE) control group. They completed the Impact of Event Scale (IES) and Affect Balance Scale (ABS) at study entry, and at 6- and 12- month follow-ups. RESULTS: Latent Growth Curve Modeling across the 12-month interval showed that CBSM interacted with initial cancer-related distress to influence distress and affect. Follow-up analyses showed that those with higher initial distress were significantly improved by CBSM compared to control treatment. No differential improvement in affect or intrusive thoughts occurred among low-distress women. CONCLUSION:CBSM decreased negative affect and intrusive thoughts and increases positive affect among post-surgical BCa patients presenting with elevated cancer-specific distress after surgery, but did not show similar effects in women with low levels of cancer-specific distress. Identifying patients most in need of intervention in the period after surgery may optimize cost-effective cancer care.
RCT Entities:
OBJECTIVE:Cognitive-behavioral stress management (CBSM) improves adaptation to primary treatment for breast cancer (BCa), evidenced as reductions in distress and increases in positive affect. Because not all BCapatients may need psychosocial intervention, identifying those most likely to benefit is important. A secondary analysis of a previous randomized trial tested whether baseline level of cancer-specific distress moderated CBSM effects on adaptation over 12 months. We hypothesized that patients experiencing the greatest cancer-specific distress in the weeks after surgery would show the greatest CBSM-related effects on distress and affect. METHODS: Stages 0-III BCapatients (N = 240) were enrolled 2-8 weeks after surgery and randomized to either a 10-week group CBSM intervention or a 1-day psychoeducational (PE) control group. They completed the Impact of Event Scale (IES) and Affect Balance Scale (ABS) at study entry, and at 6- and 12- month follow-ups. RESULTS: Latent Growth Curve Modeling across the 12-month interval showed that CBSM interacted with initial cancer-related distress to influence distress and affect. Follow-up analyses showed that those with higher initial distress were significantly improved by CBSM compared to control treatment. No differential improvement in affect or intrusive thoughts occurred among low-distress women. CONCLUSION: CBSM decreased negative affect and intrusive thoughts and increases positive affect among post-surgical BCapatients presenting with elevated cancer-specific distress after surgery, but did not show similar effects in women with low levels of cancer-specific distress. Identifying patients most in need of intervention in the period after surgery may optimize cost-effective cancer care.
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