Cognitive-behavioral Stress Management Improves Treatment and Survival in Women With Breast Cancer

Women who were taught how to manage stress early in their breast cancer treatment showed greater length of survival and longer time until disease recurrence over 8 to 15 years after their original diagnosis. These findings from a randomized trial were published in Breast Cancer Research and Treatment (doi:10.1007/s10549-015-3626-6).

Cognitive-behavioral stress management (CBSM) improves psychological adaptation and lowers distress and inflammatory signaling in circulating cells during breast cancer treatment and long-term follow-ups, according to prior research from this team. Women were taught CBSM techniques including muscle relaxation and deep breathing exercises as well as skills to change negative thoughts and improve coping strategies in 10 weekly group sessions.

This secondary analysis, based on the trial funded by the National Cancer Institute, examined whether patients with breast cancer who attended CBSM sessions in the weeks after surgery had improved survival and a longer disease-free interval until recurrence.

"Our ongoing work is examining whether the effects of stress management on depressive symptoms and inflammatory biomarkers during the first year of treatment are linked to longer-term disease recurrence and survival," said Michael Antoni, PhD, survivorship theme leader of the cancer control research program at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and professor of Psychiatry and Behavioral Sciences, in Florida.

Antoni, who is also professor of Psychology at UM's College of Arts & Sciences, and researchers in the Department of Psychology noted that prior research has showed that distress, negative mood, and heightened inflammation during treatment may all facilitate disease progression and poorer health outcomes, thus the researchers wanted to determine if participating in a program such as CBSM could reduce the risk of disease progression and mortality over the long term.

The researchers are now testing whether disease outcomes up to 15 years later can be predicted by changes in inflammatory gene expression during and after the stress management intervention. They are also developing and testing shorter versions of the stress-management program. They want to see if a 5-week version of the program specifically targeting either relaxation training or cognitive behavioral coping skills are equivalent to the 10-week CBSM program.

The researchers are also testing stress management interventions adapted to meet the needs of specific vulnerable cancer populations, such as African American women, Latina women, or older women of all races and ethnicities.

"Our work is unique in that more than one-third of the participants were of an ethnic minority, compared to mostly non-Hispanic White women studied in prior research, which means that the findings may be generalizable to the larger population of breast cancer patients." Antoni said.

"Our overarching goal is to improve survivorship and health outcomes by reaching patients early in the cancer treatment process and providing them the tools they need to manage current and future challenges on their journey."

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