Prospective Thinking in Hormone-Responsive Breast Cancer
Condition: Hormone Receptor Positive Malignant Neoplasm of Breast
MeSH terms: Neoplasms; Breast Neoplasms
Study type: Interventional

Summary: 
      One factor that limits the effectiveness of adjuvant hormone therapy for breast cancer is
      medication nonadherence. Adherence to long-term medication regimens requires valuation of
      temporally distant outcomes. Thus, interventions that improve valuation of the future, a
      phenomenon known as delay discounting, may improve medication adherence in breast cancer
      treatment and improve survival. This study will investigate the acute efficacy of a
      prospective thinking intervention (episodic future thinking) for reducing delay discounting
      and improving valuation of future health in breast cancer patients. Patients will engage in
      either episodic future thinking or a control condition during completion of delay discounting
      tasks in which they choose between immediate and delayed outcomes.
    

Detailed description: 
      Globally, breast cancer is the most common cause of cancer death among women. The most common
      pathological subtype is hormone receptor positive breast cancer, which accounts for
      approximately 70% of all diagnoses. Adherence to adjuvant hormone therapy (HT), including
      selective estrogen receptor modulators and aromatase inhibitors, in the treatment of hormone
      responsive breast cancer decreases risk of recurrence and increases overall survival among
      women. Unfortunately, up to half of patients discontinue HT prematurely or administer HT less
      frequently than prescribed, which increases risk of disease recurrence and associated
      mortality. Understanding the mechanisms underlying nonadherence will allow for development of
      targeted interventions to improve breast cancer survival.

      A defining characteristic of adjuvant HT is that it provides no short-term benefits and,
      instead, prevents disease recurrence only after years of sustained adherence. In contrast,
      the benefits of discontinuing HT are relatively immediate (e.g., avoidance of adverse side
      effects, such as hot flashes or arthralgia). Thus, adherence to HT requires one's behavior to
      be guided by temporally distant outcomes, as bias toward immediate gratification narrows the
      temporal window over which future costs and benefits can motivate behavior. Therefore,
      treatment adherence may be understood through the behavioral economic process of delay
      discounting (i.e. devaluation of delayed outcomes), which provides a measure of how
      individuals value the future. Accumulating evidence shows that delay discounting is
      associated with a wide variety of maladaptive health behaviors, including failure to seek
      routine medical screening for cancer and other illnesses. However, no work has yet examined
      associations between delay discounting and adherence to cancer treatment, generally, or
      breast cancer treatment, specifically. This gap in knowledge represents a challenge to the
      understanding of risk factors for cancer-related morbidity and mortality and may limit the
      efficacy of breast cancer treatment.

      Accordingly, the present study will investigate the acute efficacy of an episodic future
      thinking (EFT) intervention for reducing discounting and improving valuation of future health
      in breast cancer patients. EFT is a form of prospection that involves mental simulation of
      events that might occur in one's future. To some extent, EFT is an innate human ability that
      guides decision-making (e.g., simulating the experience of an upcoming job interview or
      social event); however, populations who discount the future rapidly show deficits in this
      ability, considering the future infrequently and demonstrating low-quality EFT content (e.g.,
      fewer contextual and sensory details). Thus, EFT interventions are designed to remediate this
      deficit and reduce bias toward immediate gratification by guiding individuals to both
      generate high-quality EFT content and prompting them to engage in EFT frequently. Prior
      laboratory-based research by the investigative team and others has shown that EFT both
      reduces delay discounting and improves a wide range of maladaptive health behaviors and
      outcomes contributing to the development of cancer and survival following diagnosis and
      treatment, including tobacco use and dietary and weight control. The present study seeks to
      extend these findings by demonstrating that EFT improves laboratory-based measures of delay
      discounting and valuation of future health in breast cancer patients. Demonstrating EFT's
      acute efficacy in the laboratory would suggest that EFT may be adapted in future grant
      proposals as a targeted, remotely delivered intervention to improve HT adherence and
      subsequent breast cancer survival.
    

Intervention name(s): Episodic future thinking; Episodic recent thinking
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Prospective thinking intervention; Sham episodic thinking
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants will be randomly assigned to either an episodic future thinking group or a control group (episodic recent thinking), stratified by menopausal status and baseline level of delay discounting.
Masking: Single (Participant)
Primary purpose: Basic Science