Abstract IA28: Community-based stress management intervention for black breast cancer survivors: A follow up
Authors: Lechner Suzanne C. 
Published: October 2015

Project CARE, an NCI-funded randomized clinical trial, examined whether participation in an adapted cognitive-behavioral stress management (CBSM) and enhanced breast cancer wellness and education (CW) program improved psychological outcomes among a sample of underserved Black breast cancer survivors. Both group-based, 10-week interventions used in the trial were culturally adapted for Black women in the community from evidence-based interventions used in previously successful clinical trials.

Participants were randomly assigned to CBSM or CW. Participants were 114 Black women (mean age = 51.1, 27-77 years) who had completed breast cancer treatment 0-12 months prior to enrollment (all stages of disease, mean time since cancer diagnosis = 14.1mo). Women were assessed at baseline, immediately post-intervention and at a six-month follow-up. We previously reported that there was a remarkable 94% retention rate from baseline to six month follow-up (mean attendance rate = 7.5 sessions, only 9 participants did not attend any intervention sessions). Participants in both conditions showed statistically significant improvement on indices of psychological well-being, including mood (Profile of Mood States-Short Version), quality of life (Functional Assessment of Cancer Therapy-Breast Cancer), intrusive thoughts (Impact of Event Scale-Revised), depressive symptoms (Center for Epidemiologic Studies-Depression), and stress levels (Perceived Stress Scale) over the six-month post-intervention follow-up (all repeated measures ANOVA within subjects time effects: p&lt;.05) but condition x time effects were not statistically significant. Given that women in both conditions showed improvement over the course of the study, we compared our findings to longitudinal, natural history studies of women in the post-treatment re-entry phase after breast cancer treatment. The projected course of distress differed from the Project CARE results.

Next, we examined potential mediators of the change over time to account for the findings. Using quality of life as the main outcome, we explored candidate mechanisms in mediation models (including session attendance, pain, fatigue, sleep, mood, intrusive thoughts about breast cancer, depressive symptoms, burdens of poverty, perceived stress, ability to relax, and stress management skills). None of the potential mediator models met criteria.

Findings suggest that improvements in multiple measures over time may have been due to other, unmeasured factors, such as participation in intervention groups with of individuals from a similar racial background who are undergoing similar stressors or consistent attention from a supportive research team. The wide-reaching implications of this research program include decisions about appropriate control groups and the timing of intervention delivery during the cancer treatment trajectory.

Citation Format: Suzanne C. Lechner. Community-based stress management intervention for black breast cancer survivors: A follow up. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr IA28.