BREAST CANCER IN YOUNGER WOMEN--IMPROVING LIFE QUALITY

乳腺癌是美国女性最常见的癌症。1992年，

Breast cancer is the most common cancer among women in the U.S. In 1992, 180,000 new cases were diagnosed with 20% of all newly-diagnosed women under 50 years of age. Younger women with breast cancer have particular concerns such as reproduction, long term consequences of premature menopause, and concerns about body image and sexuality. No reported studies have looked at psychosocial issues specific to younger women, yet several have found that younger women have more problems adjusting to breast cancer. While previously tested interventions directed at women with breast cancer have shown varying degrees of effectiveness, most involve group support programs, or intensive health professional involvement. These interventions are costly to implement, and many women do not have access, time, or the inclination to participate in a psychotherapeutic program. Demographic characteristics of support group attenders suggest that low socioeconomic status and minority individuals are underrepresented. The proposed study addresses the shortcomings of previous interventions as well as the specific concerns of younger women with an innovative intervention that is accessible to all women and easily implemented in the community. Building on the extensive experience at the New England Research Institute in developing health-related videotapes for patients and the general public, the proposed intervention is a 30-minute videotape focusing on specific concerns of younger women. The videotape will feature women serving as models to present various solutions to stresses and problems they encountered, as well as to validate common concerns. It will be designed to boost morale, increase self-esteem, and improve coping strategies. The specific aims of the proposed project are: (1) to identify and describe the key issues with respect to the psychosocial (body image, sexuality, reproduction, interpersonal and family relationships), as well as medical and disability related sequelae of breast cancer diagnosis and treatment; (2) to produce a 30 minute videotape focusing on issues of particular concern to younger women; and (3) to evaluate the videotape intervention for women in a randomized trial. The videotape will be evaluated by randomly assigning 250 newly diagnosed breast cancer patients <50 years of age recruited from multiple sites to an intervention or control group. Subjects will receive a baseline interview and after randomization will be followed at 6 wks, 6 mos, and 1-year post baseline. Quality of life is the primary outcome. The proposed videotape provides the following advantages: accessible to most women, women can view it when psychologically ready, can be viewed in the privacy of one's home, can be shown to family members to provide a stimulus for discussion, readily applied in community practice settings, a cost effective intervention; once produced, it is low cost to implement, and can provide immediate psychological benefit.