Facilitating Adjustment in Low-Income Black Women with Breast Cancer

描述（由申请人提供）：我们之前发现，基于小组的认知行为压力管理（CBSM）干预通过减少侵入性想法、焦虑、社会破坏和负面影响，促进了最近接受乳腺癌治疗的女性在辅助治疗后的心理社会适应。干预还减少了身体症状（例如，疲劳、睡眠中断）和压力标记（例如，血清皮质醇水平），以及增加积极的影响，利益发现，和积极的心态在参与者。这种效果在手术后持续了一年。然而，与更大规模的心理肿瘤干预研究一致，干预主要集中在从私人诊所和大学医疗中心招募的白色中产阶级妇女。这项拟议的研究将通过调整我们的CBSM干预措施来解决这一差异，该干预措施适用于南佛罗里达的黑人乳腺癌幸存者，他们在心理社会需求方面严重不足。通过与一个以癌症为重点的社区组织合作，拟议的项目将在社区环境中招募、评估和举办干预小组。入选将限于在6个月内完成治愈性治疗的经组织学证实的乳腺癌（I-III期）的非裔美国女性（n=120，脱落后）。参与者将随机接受为期10周的CBSM干预或注意力时间匹配的增强型乳腺癌教育对照条件。所有妇女（干预组和对照组）将在干预后监测6个月。研究终点包括：（a）非裔美国人乳腺癌幸存者对干预措施的接受程度;（B）对疾病的心理社会适应;（c）身体症状群（例如，疼痛、疲劳、睡眠中断）;（d）经济指标（例如，返回工作，病假）;和（e）压力的客观指标（昼夜唾液皮质醇的斜率）。拟议研究的主要目标是确定一个成功的压力管理干预是否可以在社区环境中有效地实施，并证明它是有效的促进积极适应乳腺癌的非裔美国妇女乳腺癌。 公共卫生相关性本项目将研究压力管理计划对低收入黑人乳腺癌妇女的有效性。这项研究是在雅阁与美国国立卫生研究院的使命，以寻求减轻心理社会的困难后，乳腺癌的诊断经验的黑人妇女在美国。

DESCRIPTION (provided by applicant): We previously found that a group-based, cognitive behavioral stress management (CBSM) intervention facilitated psychosocial adaptation after adjuvant therapy in women recently treated for breast cancer by reducing intrusive thoughts, anxiety, social disruption, and negative affect. The intervention also decreased physical symptoms (e.g., fatigue, sleep disruption) and stress markers (e.g., serum cortisol levels), as well as, increased positive affect, benefit finding, and positive states of mind in participants. Such effects held up to one year after surgery. However, the intervention, as is consistent with the larger body of psycho-oncology intervention research, focused primarily on white, middle class women, recruited from private practices and university-based medical centers. The proposed study will address this disparity by adapting our CBSM intervention for Black breast cancer survivors in South Florida, who are grossly underserved in terms of psychosocial needs. By partnering with a cancer-focused community organization, the proposed project will recruit, assess and hold intervention groups in community-based settings. Inclusion will be limited to African American women (n=120 after attrition), with histologically confirmed breast cancer (Stages I-III) who have completed curative treatment within six months. Participants will be randomized to either a 10-week CBSM intervention or an attention-time matched Enhanced Breast Cancer Education control condition. All women (intervention and control groups) will be monitored for six months after the intervention. Study endpoints include: (a) intervention acceptability among African American breast cancer survivors; (b) psychosocial adaptation to disease; (c) physical symptom clusters (e.g., pain, fatigue, sleep disruption); (d) economic indicators (e.g., return to work, sick days); and, (e) an objective indicator of stress (slope of diurnal salivary cortisol). The primary goal of the proposed study is to determine whether a successful stress-management intervention can be effectively implemented in community settings, and to demonstrate that it is efficacious in facilitating positive adaptation to breast cancer among African American women with breast cancer. PUBLIC HEALTH RELEVANCE This project will examine the effectiveness of a stress management program for low-income Black women with breast cancer. This study is in accord with the National Institutes of Health's mission to seek to attenuate psychosocial difficulties following a breast cancer diagnosis as experienced by Black women in the United States.