Community-Based Programs Reduce Stress for Black Breast Cancer Survivors

A team of researchers at the Sylvester Comprehensive Cancer Center has found that a community-based stress management intervention program improved the psychological adaptation of underserved black breast cancer survivors. They also found that an educational program providing post-treatment breast cancer health and wellness information had a similar effect. Their findings have been published in the Journal of the National Cancer Institute Monographs.

The report is the culmination of a five-year study (2009-13) funded by a $4 million grant from the National Institutes of Health. The study began after researchers at Sylvester noticed that very few black women had enrolled in their previous stress-management programs.

“From a research perspective, you never want to have lopsided representation,” said Suzanne C. Lechner, Ph.D., research associate professor of psychiatry and behavioral sciences, and the lead author of the study. “We had meetings with people from the community, and we asked why black women were not participating. They told us that our researchers didn’t understand their needs and that our programs weren’t specific enough to their life experiences. They needed to feel engaged, and that the people running the groups were just like them and from the same neighborhood. And they didn’t want to come to UM; they wanted UM to come to them.”

Out of these meetings, Project CARE (Cope, Adapt, Renew and Empower) was born. Two 10-session programs providing either stress management techniques or breast cancer wellness education were developed and offered in black communities throughout Miami-Dade County. Sessions were led by black women who also were skilled interventionists. The study sought out women who had concluded breast cancer treatment within the previous 12 months. The timing was important, noted Lechner.

“Treatment for breast cancer is usually a long process,” she said. “It can be drawn out for many months, and a patient develops a strong bond with her treatment team. But when treatment ends, they lose that part of their support system. This has strong emotional implications.”

The researchers found that breast cancer wasn’t the only factor affecting the subjects’ emotional well-being.

“These women also tended to have stressors related to poverty and responsibilities in their social network,” said Lechner. “Some were caring for children and for parents or other extended-family adults at the same time. We worked with women who had no air conditioning, or who didn’t turn on the lights because they wouldn’t be able to pay the electric bill. Some actually told us that breast cancer was a lower priority for them than some of these other situations.”

In all, 114 subjects participated in the study. They were randomly assigned to one of the two programs, both of which were culturally adapted for black women. The researchers’ efforts to make cultural connections were rewarded by the study results. First, the retention rate was a remarkable 95 percent; Lechner noted that 60 to 70 percent normally would be considered excellent. Second, no matter which of the two programs they were enrolled in, the subjects showed statistically significant improvement on all indices of psychological well-being, including overall quality of life, intrusive thoughts, depressive symptoms and stress levels over the six-month post-intervention follow-up.

It appears to the researchers that providing post-treatment guidance may have been as important a factor in reducing stress as were the stress-management techniques themselves.

“Many women tell us there is a shift in how they view their lives after breast cancer, and they aren’t sure what to do next,” said Lechner. “Some, for example, want to make changes in their health behaviors, but they don’t know how to begin or where to go for help. Others find their friends and family don’t understand what they have been through, and they need to create a new support network, with new friends. What we tried to do with Project CARE was connect them to the resources they needed, and to offer them a how-to manual about how to re-enter your life when treatment is over and you feel like you can breathe once again.”

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