Journal of Cancer Survivorship

, Volume 2, Issue 3, pp 190–204 | Cite as

Addressing the needs of young breast cancer survivors at the 5 year milestone: can a short-term, low intensity intervention produce change?

  • Joan R. Bloom
  • Susan L. Stewart
  • Carol N. D’Onofrio
  • Judith Luce
  • Priscilla J. Banks



Today, the 5-year relative survival rate for cancer is 65% and there are 10.5 million survivors. The largest group of survivors are those of breast cancer. Reductions in mortality are occurring at a greater rate for women under age 50 at diagnosis than among older women.


Our goal was to design a socio-educational intervention for 5-year survivors aged 50 or younger at diagnosis and test the hypotheses that women in the intervention group would show greater improvement than controls with respect to (1) knowledge of breast cancer, its treatment, and long-term health concerns; (2) lifestyle habits (i.e., exercise and diet); and (3) communication with family and physicians.


Using a randomized controlled trial with a pre-post design, 404 women who were 5 years from diagnosis and cancer-free (response rate 54%) were randomly assigned to an intervention or delayed intervention (control) group and were assessed at pre-test (baseline) and 6 months later (96% retention). The intervention consisted of three 6-h workshops over a 3 month period. Four series of workshops were held at different geographical areas in the greater San Francisco Bay Area. The workshops included activities and information to promote physical, social, emotional, and spiritual well-being. The intervention design was based on findings from focus groups and a survey of 185 cancer-free 5-year survivors that assessed changes since the early months after diagnosis in physical, social, emotional, and spiritual concerns (response rate 73%).


Consistent with our first hypothesis, at post-test, women in the intervention group, on average, had greater knowledge regarding breast cancer, its treatment, and their own future health than did those in the control group (p = 0.015). Hypothesis 2 was partially supported as women in the intervention group were more likely than the control group to report an increased amount of physical activity (p = 0.036), but not significant dietary changes. Social support was related to increased self report of physical activity. With the exception of the last series of workshops, the intervention group did not report improved communications with family, friends, and physicians (hypothesis 3).


A short-term intervention can affect knowledge levels and physical activity but not diet or communication in the family.

Implications for Cancer Survivors

The intervention was related to greater knowledge related to breast cancer, and increased report of physical activity. The program was not related to changes in reported diet or family communication.


Young breast cancer survivors Socio-educational intervention for breast cancer survivors 


  1. 1.
    Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, et al., editors. SEER Cancer Statistics Review, 1975–2004, National Cancer Institute. Bethesda, MD,, based on November 2006 SEER data submission, posted to the SEER web site, 2007.
  2. 2.
    Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL, et al. Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin 2006;56:168–83.PubMedGoogle Scholar
  3. 3.
    Lewis FM, Deal LW. Balancing our lives: a study of the married couple’s experience with breast cancer recurrence. Oncol Nurs Forum 1995;22(6):943–53.PubMedGoogle Scholar
  4. 4.
    Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR. Quality of life in long-term disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst. 2002;94:39–49.PubMedGoogle Scholar
  5. 5.
    Craig TJ, Comstock GW, Geiser PB. The quality of survival in breast cancer: a case control comparison. Cancer 1974;33:1451–7. doi: 10.1002/1097-0142(197405)33:5<1451::AID-CNCR2820330531>3.0.CO;2-G.PubMedCrossRefGoogle Scholar
  6. 6.
    Gotay CC, Muraoka MY. Quality of life in long-term survivors of adult-onset cancers. J Natl Cancer Inst 1998;90(9):656–667. doi: 10.1093/jnci/90.9.656.PubMedCrossRefGoogle Scholar
  7. 7.
    Bloom JR, Stewart SL, Chang S, Banks PJ. Then and now: quality of life of young breast cancer survivors. Psycho-oncol 2004;13:1–14. doi: 10.1002/pon.794.Google Scholar
  8. 8.
    Avis NE, Crawford S, Manuel J. Quality of life among younger women with breast cancer. J Clin Oncol 2005;23(15):3322–3330. doi: 10.1200/JCO.2005.05.130.PubMedCrossRefGoogle Scholar
  9. 9.
    Ganz PA, Hussey MA, Moinpour CM, Unger JM, Hutchins LF, Dakhil SR, et al. Late cardiac effects of adjuvant chemotherapy in breast cancer survivors treated on Southwest Oncology Group protocol s8897. J Clin Oncol 2008;26(8):1223–1230. Jan 28, doi: 10.1200/JCO.2007.11.8877.PubMedCrossRefGoogle Scholar
  10. 10.
    Dorval M, Maunsell E, Deschenes L, Brisson J, Masse B. Long-term quality of life after breast cancer: comparison of 8-year survivors with population controls. J Clin Oncol 1998;16:487–494.PubMedGoogle Scholar
  11. 11.
    Bloom JR, Petersen DM, Kang SH. Multi-dimensional quality of life among long-term (5+years) adult cancer survivors. Psycho-Oncol 2007;16:691–706.CrossRefGoogle Scholar
  12. 12.
    Tomich P, Helgeson V. Five years later: a cross-sectional comparison of breast cancer survivors and healthy women. Psycho-oncol 2002;11:154–169. doi: 10.1002/pon.570.CrossRefGoogle Scholar
  13. 13.
    Greendale GA, Petersen L, Zibecchi L, Ganz PA. Factors related to sexual function in postmenopausal women with a history of breast cancer. Menopause 2001;8(2):111–9. Summer.PubMedCrossRefGoogle Scholar
  14. 14.
    Knobf MT. The influence of endocrine effects of adjuvant therapy on quality of life outcomes in younger breast cancer survivors. Oncologist 2006;11(2):96–110. Feb.PubMedCrossRefGoogle Scholar
  15. 15.
    Meyer L, Aspegren K. Long-term psychological sequelae of mastectomy and breast conserving treatment for breast cancer. Acta Oncol 1989;28:13–18. doi: 10.3109/02841868909111174.PubMedCrossRefGoogle Scholar
  16. 16.
    Omne-Ponten M, Holmberg L, Sjoden PO. Psychosocial adjustment among women with breast cancer Stages I and II: six-year follow-up consecutive patients. J Clin Oncol 1994;12:1778–1782.PubMedGoogle Scholar
  17. 17.
    Sorensen MS. Psychosocial factors in quality of life for long-term survivors of breast cancer and their spouses. Diss Abstr Int (B) 1994;55:607.Google Scholar
  18. 18.
    Halttunen A, Heitanen P, Jallinoja P, Lonnqvist J. Getting free of breast cancer: an eight-year perspective of the relapse-free patients. Acta Oncol 2002;31:307–310. doi: 10.3109/02841869209108177.CrossRefGoogle Scholar
  19. 19.
    Saleeba A, Weitzner MA, Meyers C. Subclinical psychological distress in long-term survivors of breast cancer: a preliminary communication. J Psychosoc Oncol 1996;14:83–93. doi: 10.1300/J077V14N01_05.CrossRefGoogle Scholar
  20. 20.
    Amir M, Ramati A. Post-traumatic symptoms, emotional distress and quality of life in long-term survivors of breast cancer: preliminary research. J Anxiety Disord 2002;16:191–206. doi: 10.1016/S0887-6185(02)00095-6.CrossRefGoogle Scholar
  21. 21.
    Holzner B, Kemmler G, Kopp M, Moschen R, Schweigkofler H, Dunser M, et al. Quality of life in breast cancer patients—not enough attention for long-term survivors. Psychosomatics 2001;43:117–123. doi: 10.1176/appi.psy.42.2.117.CrossRefGoogle Scholar
  22. 22.
    Bloom JR, Stewart SL, Johnston M, Banks P, Fobair P. Sources of support and the physical and mental well-being of young women with breast cancer. Soc Sci Med 2001;53(11):1513–24. doi: 10.1016/S0277-9536(00)00440-8.PubMedCrossRefGoogle Scholar
  23. 23.
    Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK. Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2007;146:511–515.PubMedGoogle Scholar
  24. 24.
    Shapiro CL, Recht A. Late effects of adjuvant therapy for breast cancer. J Natl Cancer Inst Monographs 1994;16:101–12.PubMedGoogle Scholar
  25. 25.
    Quivey J, Luce JM, Stewart SL, Johnston M, Banks PJ, Bloom JR. Younger women with breast cancer: patterns of care in 5 San Francisco Bay Area Counties. In: Proceedings American Society of Clinical Oncology 17. Abstract 1998;643:167a, Atlanta, GA.Google Scholar
  26. 26.
    Osteen RT, Cady B, Friedman M, Kraybill W, Doggett S, Hussey D, et al. Winchester. Patterns of care for younger women with breast cancer. J Natl Cancer Inst Monographs 1994;16:43–46.PubMedGoogle Scholar
  27. 27.
    Ganz PA, Hussey MA, Moinpour CM, Unger JM, Hutchins LF, Dakhil SR, et al. Late cardiac effects of adjuvant chemotherapy in breast cancer survivors treated on Southwest Oncology Group protocol s8897. J Clin Oncol 2008;26(8):1223–1230. Jan 28, doi: 10.1200/JCO.2007.11.8877.PubMedCrossRefGoogle Scholar
  28. 28.
    Theriault RL. Pathophysiology and implications of cancer treatment-induced bone loss. Oncology 2004;18(5, Suppl 3):11–15. Williston Park.PubMedGoogle Scholar
  29. 29.
    Simpson JS, Carlson Le, Beck CA, Patten S. Effects of a brief intervention on social support and psychiatric morbidity in breast cancer patients. Psycho-oncol 2002;11:282–294. doi: 10.1002/pon.565.CrossRefGoogle Scholar
  30. 30.
    Miyashita M. A randomized intervention study for breast cancer survivors in Japan. Cancer Nurs 2005;28:70–78. doi: 10.1097/00002820-200501000-00011.PubMedCrossRefGoogle Scholar
  31. 31.
    Smedslund G, Ringlah GI. Meta-analysis of the effects of psychosocial interventions on survival time in cancer patients. J Psychosom Res. 2004;57(2):123–131. doi: 10.1016/S0022-3999(03)00575-0.PubMedCrossRefGoogle Scholar
  32. 32.
    Pierce JP, Faerber S, Wright F, Newman V, Flatt SW, Kealey S, et al. Greenberg. Feasibility of a randomized trial of a high-vegetable diet to prevent breast cancer recurrence. Nutr Cancer 1997;28:282–288.PubMedCrossRefGoogle Scholar
  33. 33.
    Courneya KS. Exercise in cancer survivors: an overview of research. Med Sci Sports Exerc 2003;35(11):1846–1852. doi: 10.1249/01.MSS.0000093622.41587.B6.PubMedCrossRefGoogle Scholar
  34. 34.
    Pinto BM, Maruyama NC. Exercise in the rehabilitation of breast cancer survivors. Psycho-oncol 1998;8:191–205. 1998. doi: 10.1002/(SICI)1099-1611(199905/06)8:3<191::AID-PON355>3.0.CO;2-T.CrossRefGoogle Scholar
  35. 35.
    Pinto BM, Clark MM, Maruyama NC, Federe SI. Psychological and fitness changes associated with exercise participation among women with breast cancer. Psycho-oncol 2003;12:341–354. doi: 10.1002/pon.618.Google Scholar
  36. 36.
    Schover LR, Jenkins R, Sui D, Adams JH, Marion MS, Jackson KE. Randomized trial of peer counseling on reproductive health in African American breast cancer survivors. J Clin Oncol 2006;24(10):1620–1626. doi: 10.1200/JCO.2005.04.7159.PubMedCrossRefGoogle Scholar
  37. 37.
    Sepucha Kr, Belkova JK, Mutchnick S, Esserman LJ. Consultation planning to help breast cancer patients prepare for medical consultations: effect on communication and satisfaction for patients and physicians. J Clin Oncol 2002;20(11):2695–2700. doi: 10.1200/JCO.2002.10.068.PubMedCrossRefGoogle Scholar
  38. 38.
    Davison BJ, Degner LF. Feasibility of using a computer-assisted intervention to enhance the way women with breast cancer communicate with their physicians. Cancer Nursing 2002;25(6):417–424. doi: 10.1097/00002820-200212000-00001.PubMedCrossRefGoogle Scholar
  39. 39.
    Helgeson VS, Cohn S, Schulz R, Yasko J. Long-term effects of an educational and peer discussion group intervention on adjustment to breast cancer. Health Psychol 2000;20:137–143.Google Scholar
  40. 40.
    Jacobs C, Ross R, Walker I, Stockdale F. Behavior of cancer patients: a randomized study of the effects of education and peer support groups. Am J Clin Oncol 1983;10:342–350.Google Scholar
  41. 41.
    Mallinger JB, Griggs JJ, Shields CG. Family communication and mental health after breast cancer. Eur J Cancer Care 2006;15:355–361. doi: 10.1111/j.1365-2354.2006.00666.x.CrossRefGoogle Scholar
  42. 42.
    Cutrona C, Russel D. Type of social support and specific stress: toward a theory of optimal matching. In: Sarason B, Pierce G, editors. Social support: an interactional view. New York: Wiley; 1990. p. 319–366.Google Scholar
  43. 43.
    Waxler-Morrison N, Hislop TG, Mears B, Jab K. Effects of social relationships on survival for women with breast cancer: a prospective study. Soc Sci Med 1991;33(2):177–183. doi: 10.1016/0277-9536(91)90178-F.PubMedCrossRefGoogle Scholar
  44. 44.
    Berkman LF. Social networks, support and health: taking the next step forward. Am J Epidemiol 1986;123:559–562.PubMedGoogle Scholar
  45. 45.
    Thoits P. Stress, coping and social support processes: where are we? What next? J Health Soc Behav. Extra Issue 1995;53–79.Google Scholar
  46. 46.
    Ganz PA. Advocating for the woman with breast cancer. CA Cancer J Clin 1995;45(2):114–26. doi: 10.3322/canjclin.45.2.114.PubMedCrossRefGoogle Scholar
  47. 47.
    Sarna L. Women with lung cancer: impact on quality of life. Qual Life Res 1993;2(1):13–22. doi: 10.1007/BF00642885.PubMedCrossRefGoogle Scholar
  48. 48.
    Seeman T, Syme SL. Social networks and coronary heart disease: a comparison of the structure and function of social relations as predictors of disease. Psychosom Med. 1987;49:341–354.PubMedGoogle Scholar
  49. 49.
    Levine S. The changing terrain of medical sociology: emergent concern with quality of life. J Health Soc Behav 1987;28(1):1–7. doi: 10.2307/2137136.PubMedCrossRefGoogle Scholar
  50. 50.
    Calman KC. Quality of life of cancer patients—an hypothesis. J Med Ethics 1984;10:124–7.PubMedGoogle Scholar
  51. 51.
    Ganz PA, Hirji K, Sim MS, Schag CAC, Fred C, Polinsky ML. Predicting psychosocial risk in patients with breast cancer. Medical Care 1993;31(5):419–431. doi: 10.1097/00005650-199305000-00004.PubMedCrossRefGoogle Scholar
  52. 52.
    Kurtz ME, Wyatt G, Kurtz JC. Psychological and sexual well-being, philosophical/spiritual views, and health habits of long-term cancer survivors. Health Care Women Int 1995;16(3):253–262.PubMedGoogle Scholar
  53. 53.
    Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989;2:888–891. doi: 10.1016/S0140-6736(89)91551-1.PubMedCrossRefGoogle Scholar
  54. 54.
    Lewis JA, Manne SL, DuHamel KN, Vickburg SM, Boybjerg DH, Currie V, et al. Social support, intrusive thoughts, and quality of life in breast cancer survivors. J Behav Med 2001;24(3):231–245. doi: 10.1023/A:1010714722844.PubMedCrossRefGoogle Scholar
  55. 55.
    Bloom JR. Surviving and thriving. Psycho-oncol 2002;11(2):1–3. editorial, doi: 10.1002/pon.606.Google Scholar
  56. 56.
    Bloom JR. Social support and adjustment to breast cancer. In: Andersen BL, editor. Women and cancer: psychological perspectives. New York: Springer-Verlag; 1986. p. 204–219.Google Scholar
  57. 57.
    Surveillance E, Results E. (SEER) Program ( SEER*Stat Database: incidence—SEER 17 Regs Limited-Use, Nov 2006 Sub (2000–2004), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2007, based on the November 2006 submission. Greater Bay Area Cancer Registry.
  58. 58.
    Bloom JR, D’Onofrio C, Banks P, Stewart SL, Johnston M, Morrow MA. Psychoeducational group intervention for young women with breast cancer: design and process evaluation. Cancer Res Ther Control 1999;8:83–102.Google Scholar
  59. 59.
    Pierce JP, Newman VA, Natarajan L, Flatt SW, Al-Delaimy WK, Caan BJ, et al. Telephone counseling helps maintain long-term adherence to a high-vegetable dietary pattern. J Nutr 2007;137(10):2291–2296.PubMedGoogle Scholar
  60. 60.
    Bloom JR, Gorsky RD, Fobair P, Hoppe R, Cox RS, Varghese A. Physical performance at work and at leisure: validation of a measure of biological energy in a sample of cancer survivors. J Psychosoc Oncol 1990;6(l):49–63.CrossRefGoogle Scholar
  61. 61.
    Block G, Hartman AM, Dresser CM, Carroll JG, Gardner L. A data-based approach to diet questionnaire design and testing. Am J Epidemiol 1986;124:453–469.PubMedGoogle Scholar
  62. 62.
    Block G, Hartman AM, Naughton D. A reduced dietary questionnaire: development and validation. Epidemiology 1990;1:58–64. doi: 10.1097/00001648-199001000-00013.PubMedCrossRefGoogle Scholar
  63. 63.
    Schain, W. Breast cancer problems checklist, unpublished, 1979.Google Scholar
  64. 64.
    Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol 1979;109(2):186–204.PubMedGoogle Scholar
  65. 65.
    Seeman TE, Kaplan GA, Knudsen L, Cohen R, Guralnik J. Social network ties and mortality among the elderly in the Alameda county study. Am J Epidemiol 1987;126(4):714–723.PubMedGoogle Scholar
  66. 66.
    Kroenke CH, Kubzansky LD, Schernhammer ES, Holmes MD, Kawachi I. Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol 2006;24:1105–1111. doi: 10.1200/JCO.2005.04.2846.PubMedCrossRefGoogle Scholar
  67. 67.
    Bloom JR, Stewart SL, Chang S, You M. Effects of a telephone counseling intervention on sisters of young women with breast cancer. Prev Med 2006;43:379–384. doi: 10.1016/j.ypmed.2006.07.002.PubMedCrossRefGoogle Scholar
  68. 68.
    Pierce JP, Newman VA, Flatt SW, Faerber S, Rock CL, Natarajan L, et al. Telephone counseling intervention increases intakes of micronutrient- and phytochemical-rich vegetables, fruit and fiber in breast cancer survivors. J Nutr 2004;134:452–458.PubMedGoogle Scholar
  69. 69.
    Chlebowski RT, Blackburn GL, Thomson CA, Nixon DW, Shapiro A, Hoy MK, et al. Dietary fat reduction and breast cancer outcome: Interim efficacy results from the women’s intervention nutrition study. J Natl Cancer Inst 2006;98(24):1767–1776.PubMedCrossRefGoogle Scholar
  70. 70.
    Feuerstein M. editor. Handbook of cancer survivorship. Springer Science/Business Media, 2007.Google Scholar
  71. 71.
    Bloom JR. Exercise for bone health: young breast cancer survivors, NIH, NCI 5 R01 CA-112273.Google Scholar
  72. 72.
    Golant, M. The wellness community–national,

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Joan R. Bloom
    • 1
  • Susan L. Stewart
    • 2
  • Carol N. D’Onofrio
    • 3
  • Judith Luce
    • 2
  • Priscilla J. Banks
    • 3
  1. 1.University of CaliforniaBerkeleyUSA
  2. 2.University of CaliforniaSan FranciscoUSA
  3. 3.Northern California Cancer CenterFremontUSA

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