Addressing the needs of young breast cancer survivors at the 5 year milestone: can a short-term, low intensity intervention produce change?
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.
KeywordsYoung breast cancer survivors Socio-educational intervention for breast cancer survivors
- 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, http://seer.cancer.gov/csr/1975_2004/, based on November 2006 SEER data submission, posted to the SEER web site, 2007.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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.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
- 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
- 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
- 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.Surveillance E, Results E. (SEER) Program (www.seer.cancer.gov) 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.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
- 63.Schain, W. Breast cancer problems checklist, unpublished, 1979.Google Scholar
- 70.Feuerstein M. editor. Handbook of cancer survivorship. Springer Science/Business Media, 2007.Google Scholar
- 71.Bloom JR. Exercise for bone health: young breast cancer survivors, NIH, NCI 5 R01 CA-112273.Google Scholar
- 72.Golant, M. The wellness community–national, http://www.thewellnesscommunity.org