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Brief relaxation training is associated with long-term endocrine therapy adherence among women with breast cancer: post hoc analysis of a randomized controlled trial

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Abstract

Purpose

Despite life-saving potential, many women struggle to adhere to adjuvant endocrine therapy (AET) for their breast cancer (BCa). Prior research has demonstrated that emotional distress is a barrier to AET adherence. We followed women from a trial to test the long-term effects of two 5-week post-surgical group-based stress management interventions, cognitive behavioral therapy (CBT), and relaxation training versus an attention-matched health education control, on AET adherence.

Methods

We conducted a long-term follow-up (median = 8 years) of women randomized to CBT, relaxation training, or health education after surgery for stage 0–3 BCa. We measured adherence with the Endocrine Therapy Medication Usage Questionnaire (ETMUQ). First, we established factors on the ETMUQ via confirmatory factor analysis. We then used Bayesian structural equation modeling to regress these factors on study arm, controlling for age and treatments received.

Results

Of those who completed long-term follow-up (n = 59, 44.7%), over half (n = 33; 55.9%) reported problems with adherence generally. Women receiving relaxation training (n = 15) had better adherence than those receiving health education (n = 24) on the Forgetfulness/Inconsistency [B(SE) = 0.25(0.14), p = 0.049] and Intentional Nonadherence [B(SE) = 0.31(0.14), p = 0.018] factors of the ETMUQ. Similar results were observed for those receiving relaxation training compared to CBT (n = 20): Forgetfulness/Inconsistency [B(SE) = − 0.47(0.25), p = 0.031]; Intentional Nonadherence [B(SE) = − 0.31(0.15), p = 0.027].

Conclusion

Women receiving relaxation training were less likely to (1) forget to take their AET and (2) intentionally miss doses of AET in the long term compared to women receiving health education or CBT. This is evidence for the need of randomized trials that aim to improve adherence by incorporating theoretically based behavioral change techniques.

Trial registration and dates

Trial 2R01-CA-064710 was registered March 26, 2006.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

The parent study (2R01-CA-064710) and current project (F31CA254148-01) were funded by National Cancer Institute of the National Institutes of Health Grant. Dr. Safren was supported by Grant 9K24DA040489.

Funding

The parent study was funded by National Cancer Institute of the National Institutes of Health Grant 2R01-CA-064710, and the current project was funded by F31CA254148-01 for analyses. Dr. Safren was supported by Grant 9K24DA040489.

Author information

Authors and Affiliations

  1. Department of Psychology, University of Miami, 5665 Ponce de Leon, Coral Gables, FL, 33146, USA

    Molly E. Ream, Emily A. Walsh, Chloe Taub, Steven A. Safren & Michael H. Antoni

  2. Department of Psychiatry, Massachusetts General Hospital, Boston, USA

    Jamie M. Jacobs

  3. Department of Psychiatry, Harvard Medical School, Boston, USA

    Jamie M. Jacobs

  4. Georgetown University, Washington, USA

    Marc Lippman

  5. Department of Medicine, University of Miami, Coral Gables, USA

    Natasha Schaefer-Solle

  6. Sylvester Comprehensive Cancer Center, Miami, USA

    Michael H. Antoni

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  1. Molly E. Ream
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  2. Emily A. Walsh
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  3. Jamie M. Jacobs
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  4. Chloe Taub
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  7. Steven A. Safren
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  8. Michael H. Antoni
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analyses were performed by MER, EAW, CT, and JMJ. The first draft of the manuscript was written by MER and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Molly E. Ream.

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Conflict of interest

Dr. Michael Antoni is an inventor of the intellectual property used in the study. Dr. Antoni is also a compensated consultant for Blue Note Therapeutics and Atlantis Healthcare.

Ethical approval

The parent trial was approved by the Institutional Review Board at the University of Miami and is registered as National Institutes of Health Clinical Trial NCT02103387. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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All women participating in the study completed informed consent procedures.

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Ream, M.E., Walsh, E.A., Jacobs, J.M. et al. Brief relaxation training is associated with long-term endocrine therapy adherence among women with breast cancer: post hoc analysis of a randomized controlled trial. Breast Cancer Res Treat 190, 79–88 (2021). https://doi.org/10.1007/s10549-021-06361-x

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