CBSM effects in postadjuvant breast cancer survivors

乳腺癌幸存者会遇到许多压力源，这些压力源可能导致持久的、改变生活的社会心理、行为和生理后遗症。在整个病程中遇到的压力源包括但不限于生活任务的中断、社会网络的变化、治疗相关的副作用、经济困难以及疾病复发和进展的不确定性。当然，乳腺癌的不良影响已被充分记录，但越来越多的文献显示，一些癌症幸存者也从他们的经历中获得了积极的成长。目前，对于这些可能改变生活的消极和积极的变化是否或如何受到社会心理干预的影响知之甚少。也就是说，如果有的话，心理社会干预是如何缓冲乳腺癌及其治疗的负面影响的？这些干预措施如何促进幸存者的积极成长？此外，干预相关过程如何影响生理变化（即行为、免疫系统功能和神经内分泌功能），而这些生理变化反过来又可能增加或减少乳腺癌复发和进展的风险？这些问题是拟议项目的重点。我们建议在白人、西班牙裔和黑人女性中测试基于群体的认知行为压力管理（CBSM）干预的有效性，这些女性被诊断为原发性、早期到中期乳腺癌（I-III期）并接受了治疗。该项目将在干预后立即、6个月和12个月检查CBSM对各种心理社会过程（即认知评价、自我效能、社会支持和生理唤醒）的影响。具体来说，我们期望这些过程中与干预相关的变化能够促进更快地恢复到诊断前的生活质量水平，并增强积极成长的感觉。我们还将研究这些过程中与干预相关的变化如何与健康行为、免疫系统功能和生殖激素水平的变化相关联，这些变化本身可能与疾病的复发和进展有关。

Breast cancer survivors encounter many stressors that may resulting in lasting, life-altering psychosocial, behavioral, and physiological sequelae. The stressors encountered throughout the course of the disease include, but are not limited to, disruption of life tasks, changes in social network, treatment-related side effects, financial hardship, and uncertainty about disease recurrence and progression. Certainly, the adverse effects of breast cancer have been well documented, but a growing body of literature reveals that some cancer survivors also report positive growth from their experience. At present, little is known about whether or how these potentially life-altering changes negative and positive can be influenced by psychosocial interventions. That is, how, if all, do psychosocial interventions buffer the negative effects of breast cancer and its treatment? How do such interventions enhance positive growth in survivors? Moreover, how do intervention-related processed influence physiological changes (i.e., in behavior, immune system functioning, and neuroendocrine functioning), which in turn, may increased or reduce the risk of breast cancer recurrence and progression? These questions are the focus of the proposed project. We propose to test the effectiveness of our group-based, cognitive behavioral stress management (CBSM intervention among White, Hispanic, and Black women who have been diagnosed with and treated for primary, early- to middle stage breast cancer (Stages I-III). The proposed project will examine the effects of CBSM on a variety of psychosocial processes (i.e., cognitive appraisals, self-efficacy, social support, and physiological arousal) immediately, 6 months, and 12 months after the intervention. Specifically, we expect intervention-related changes in these processes to foster a more rapid return to pre-diagnostic levels of quality of life, as well as enhance a sense of positive growth. We will also examine how intervention-related changes in these processes are associated with changes in health behaviors, immune system functioning, and reproductive hormone levels, which themselves may be related to disease recurrence and progression.