Facilitating Adjustment in Low-Income Black Women with Breast Cancer

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Abstract 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. Project Narrative 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.