Mindfulness Meditation or Survivorship Education in Improving Behavioral Symptoms in Younger Stage 0-III Breast Cancer Survivors (Pathways to Wellness)

Study Overview
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Brief Summary
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This randomized phase III trial studies how well mindfulness meditation or survivorship education work in improving behavioral symptoms in younger stage 0-III breast cancer survivors. Behavioral interventions, such as mindfulness meditation, use techniques to help patients change the way they react to environmental triggers that may cause a negative reaction. Survivorship education after treatment may reduce stress and improve the well-being and quality of life of patients with breast cancer. Mindfulness meditation or survivorship education may help improve the health behaviors of younger breast cancer survivors.

Detailed Description
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PRIMARY OBJECTIVES: I. To evaluate the efficacy of two different types of group interventions (mindfulness and survivorship education), specifically tailored to the needs of younger female breast cancer survivors, in reducing depressive symptoms, compared to a usual care control group. SECONDARY OBJECTIVES: I. To compare the efficacy of the two interventions relative to a usual care control group on fatigue, sleep disturbance, and vasomotor symptoms. II. To examine the efficacy of the two interventions relative to a usual care control group on circulating and genomic markers of inflammation. III. To explore potential moderators and mediators of intervention efficacy in the two intervention groups. OUTLINE: Patients are randomized to 1 of 3 arms. ARM A (MINDFULNESS AWARENESS PRACTICES [MAPs]): Patients attend a mindfulness meditation class over 2 hours once weekly for 6 weeks. Patients then attend in person booster sessions that include guided meditation, questions, and discussion of how to maintain a mindfulness practice over 1 hour once monthly for 3 months. ARM B (SURVIVORSHIP EDUCATION INTERVENTION [SE]): Patients attend a survivorship education class over 2 hours once weekly for 6 weeks. Patients also receive monthly electronic newsletters with tailored information about topics of interest to younger survivors, including cancer-related events in the community and tips about following through on recommendations for healthy living. ARM C (USUAL CARE/DELAYED TREATMENT CONTROL GROUP): Patients receive usual care for 9 months. Patients are then offered a choice of participating in Arm A or Arm B. After completion of study, patients are followed up at 3 and 6 months.

Official Title
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Improving Outcomes for Younger Breast Cancer Survivors: A Phase III Randomized Trial Targeting Behavioral Symptoms in Younger Breast Cancer Survivors

Conditions
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Cancer Survivor, Early-Stage Breast Carcinoma, Stage 0 Breast Cancer, Stage IA Breast Cancer, Stage IB Breast Cancer, Stage IIA Breast Cancer, Stage IIB Breast Cancer, Stage IIIA Breast Cancer, Stage IIIB Breast Cancer, Stage IIIC Breast Cancer

Intervention / Treatment
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* Other: Educational Intervention
* Other: Laboratory Biomarker Analysis
* Procedure: Meditation Therapy
* Other: Questionnaire Administration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women diagnosed with early stage, resectable breast cancer (Stage 0, I, II, or III) prior to age 50, and are within 5 years of diagnosis Have completed all surgery, radiation, and/or chemotherapy treatments at least 6 months previously; may still be receiving trastuzumab or endocrine adjuvant therapy Ability to complete evaluation surveys in English Have evidence of at least mild clinical depression on a standardized screening questionnaire Exclusion Criteria: Has a breast cancer recurrence, metastasis, or another interval cancer diagnosis following the breast cancer (excluding non-melanoma skin cancer) Unable to commit to intervention schedule (6 weekly group meetings) Actively practicing mindfulness meditation Has another serious or chronic medical or psychiatric condition that contributes to substantial physical or emotional disability that would detract from participating in either of the intervention programs or from the measurement of intervention outcomes

Ages Eligible for Study
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Maximum Age: 49 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Arm A (MAPs)<br>Patients attend a mindfulness meditation class over 2 hours once weekly for 6 weeks. Patients then attend in person booster sessions that include guided meditation, questions, and discussion of how to maintain a mindfulness practice over 1 hour once monthly for 2 months. | Other: Laboratory Biomarker Analysis<br>* Correlative studies<br>Procedure: Meditation Therapy<br>* Attend mindfulness meditation<br>* Other names: Meditation;Other: Questionnaire Administration<br>* Ancillary studies<br>|
| Active Comparator: Arm B (SE)<br>Patients attend a survivorship education class over 2 hours once weekly for 6 weeks. Patients also receive monthly electronic newsletters with tailored information about topics of interest to younger survivors, including cancer-related events in the community and tips about following through on recommendations for healthy living. | Other: Educational Intervention<br>* Attend survivorship education<br>* Other names: Intervention, Educational;Other: Laboratory Biomarker Analysis<br>* Correlative studies<br>Other: Questionnaire Administration<br>* Ancillary studies<br>|
| Active Comparator: Arm C (USUAL CARE/DELAYED TREATMENT CONTROL GROUP)<br>Patients receive usual care for 9 months. Patients are then offered a choice of participating in Arm A or Arm B. | Other: Educational Intervention<br>* Attend survivorship education<br>* Other names: Intervention, Educational;Other: Laboratory Biomarker Analysis<br>* Correlative studies<br>Procedure: Meditation Therapy<br>* Attend mindfulness meditation<br>* Other names: Meditation;Other: Questionnaire Administration<br>* Ancillary studies<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in depressive symptoms measured by Center for Epidemiologic Studies Depression Scale score | The data will be analyzed using linear mixed effects models, with fixed effects for time and condition and random effects for individuals. Differences between conditions in change over time will be examined by testing condition-by-time interaction terms. All tests will be two-sided. The Hochberg procedure will be applied to the two p-values for each intervention to control the familywise error rate at 0.05. | 2 weeks post-intervention to 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in fatigue assessed by Fatigue Symptom Inventory | Will be tested using the mixed modeling approach, and p-values reported both with and without multiplicity adjustment. All tests will be two-sided. | 2 weeks post-intervention to 6 months | 
| Change in hot flashes measured by the vasomotor symptom severity subscale of the BCPT symptom scales questionnaire. | Will be tested using the mixed modeling approach, and p-values reported both with and without multiplicity adjustment. All tests will be two-sided. | 2 weeks post-intervention to 6 months | 
| Change in inflammatory biomarkers will focus on laboratory measurements of Interleukin-6 (IL-6) and high sensitivity C-Reactive Protein (hsCRP) | Will be tested using the mixed modeling approach, and p-values reported both with and without multiplicity adjustment. All tests will be two-sided. | 2 weeks post-intervention to 6 months | 
| Change in sleep disturbance assessed by Insomnia Severity Index | Will be tested using the mixed modeling approach, and p-values reported both with and without multiplicity adjustment. All tests will be two-sided. | 2 weeks post-intervention to 6 months | 
| Mediators of intervention efficacy assessed by questionnaire | Mediators assessed will include self-efficacy, mindfulness, self-kindness, and rumination. | Up to 6 months | 
| Moderators of intervention efficacy assessed by questionnaire | Moderators will include preparedness for survivorship, intervention preference, and childhood adversity. Will be assessed using condition-by-moderator interaction terms in mixed models. | Up to 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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breast cancer, younger women, education, mindfulness meditation, depression, cancer survivor