Facilitating Adjustment in Low-Income Black Women with Breast Cancer

摘要 我们以前发现，一个基于群体的认知行为压力管理（CBSM）干预， 在最近接受乳腺癌治疗的女性中， 减少侵入性想法、焦虑、社会干扰和负面影响。干预也减少了 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， 增加参与者的积极影响、利益发现和积极心态。这种影响在一个 手术后一年。然而，这种干预，与更大的心理肿瘤学机构一致， 干预研究，主要集中在白色，中产阶级妇女，从私人诊所招募， 大学医疗中心。拟议的研究将通过调整我们的CBSM来解决这一差异 对南佛罗里达黑人乳腺癌幸存者的干预， 心理社会需求。通过与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。将仅限于非洲国家 美国女性（n=120，脱落后），患有组织学确诊的乳腺癌（I-III期）， 6个月内完成治疗。受试者将随机接受10周CBSM 干预或注意力时间匹配的增强型乳腺癌教育控制条件。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）非裔美国乳腺癌幸存者对干预接受程度;（B）心理社会 对疾病的适应;（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（昼夜唾液分泌的斜率 皮质醇）。这项研究的主要目的是确定一个成功的压力管理 干预措施可以在社区环境中有效实施，并证明它在以下方面是有效的： 促进患有乳腺癌的非裔美国妇女积极适应乳腺癌。项目叙述 该项目将研究低收入黑人妇女的压力管理计划的有效性， 乳腺癌这项研究雅阁美国国立卫生研究院的使命， 美国黑人妇女在乳腺癌诊断后所经历的心理社会困难 States.

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.