Long-term endocrine therapy adherence following stress management for breast cancer

项目总结 背景资料。在美国，每8名女性中就有1人在一生中被诊断出患有乳腺癌，每8人中就有1人被诊断患有乳腺癌 39名妇女死于这种疾病。虽然乳腺癌非常普遍，而且可能是致命的，但在许多情况下，它 是可以治疗的。辅助内分泌治疗(AET)是一种有效的治疗80%的早期妇女 荷尔蒙受体在乳腺癌中表达的疾病。尽管完成比赛的女性 建议的10年AET疗程和持续服药的患者显著减少 为了减少复发的可能性，大约一半的妇女未能完成这一疗程。除了……之外 面对衰弱的更年期相关副作用，乳腺癌患者面临着心理社会障碍 与AET依从性差有关的疾病，包括焦虑、抑郁和社会支持不佳。 重要的是，这些是可修改的构造，可能有助于实现一致性，并且可以作为目标 心理社会干预。研究策略。目前的研究目的是：1)测试两种药物的长期效果 简要的术后心理社会干预、认知行为疗法(CBT)和放松训练 (RT)与注意力匹配的健康教育(HE)对照组(不关注服药依从性)， 基线后7年的AET依从性，2)检查AET试验效果的心理社会中介因素 依从性，以及3)检查试验条件和AET依从性是否与8-14年的复发有关- 自由生存。我有一个独特的机会，可以利用一群 参加为期5周的压力管理的随机对照试验的女性，并增加了 评估他们对AET的依从性和无复发生存率。意义重大。我们之前的工作已经证明 CBT和RT有效地改善了抑郁情绪、情绪幸福感和压力管理技能 干预组与HE对照组比较。鉴于有证据表明心理学 痛苦与较差的AET依从性有关，接受干预的妇女有可能 他们对AET依从性的改善是心理健康改善的下游影响。 这项研究将首次测试手术后提供的压力管理干预是否会对 对AET遵守的长期影响。如果我们可以通过以下方式促进AET在疾病过程的早期坚持 心理干预，我们可能最终会改善长期的健康结果。培训计划。使用 在统计学、心理肿瘤学和坚持科学方面的额外培训和经验，这项研究将为 为我成为一名独立的临床研究人员的目标奠定基础。与NCI的使命一致 提高存活率并帮助人们活得更长、更健康，我的长期目标是阐明 应激对癌症结局影响的行为过程并针对这些过程 通过在临床肿瘤学环境中可行的心理社会干预。

PROJECT SUMMARY Background. In the United States, 1 in 8 women will be diagnosed with breast cancer in their lifetime, with 1 in 39 women dying from the disease. While breast cancer is highly prevalent and can be deadly, in many cases it is treatable. Adjuvant endocrine therapy (AET) is an effective treatment for the 80% of women with early-stage disease who have hormone receptors expressed in their breast cancer. Although women who complete the recommended 10-year course of AET and consistently take the medication have a significantly reduced chance of recurrence, approximately half of women fail to complete this course of treatment. In addition to coping with debilitating menopausal-related side effects, women with breast cancer face psychosocial barriers that have been associated with poor AET adherence, including anxiety, depression, and poor social support. Importantly, these are modifiable constructs that may contribute to adherence and can be targeted by psychosocial interventions. Research Strategy. The current study aims to 1) test the long-term effects of two brief post-surgical psychosocial interventions, cognitive behavioral therapy (CBT) and Relaxation Training (RT), versus an attention-matched Health Education (HE) control (not focused on medication adherence), on AET adherence at 7 years post-baseline, 2) examine psychosocial mediators of trial effects on AET adherence, and 3) examine whether trial condition and AET adherence are related to 8-14-year recurrence- free survival. I have a unique opportunity to take advantage of an ongoing long-term follow-up from a cohort of women who participated in a randomized controlled trial for 5-week stress management and add measures to assess their adherence to AET and recurrence-free survival. Significance. Our prior work has demonstrated that CBT and RT effectively improved depressive affect, emotional well-being, and stress management skills in the intervention groups in comparison to those receiving the HE control. Given evidence that psychological distress relates to worse AET adherence, it is plausible that women receiving the intervention have had improvements in their AET adherence as a downstream effect of improvements in psychological wellbeing. This study will be the first to test whether a stress management intervention delivered post-surgery may have a long-term impact on AET adherence. If we can facilitate AET adherence early in the disease process through psychological intervention, we may ultimately improve long-term health outcomes. Training Plan. With additional training and experience in statistics, psycho-oncology, and adherence science, this study will lay the groundwork for my goal to become an independent clinical researcher. In line with the NCI’s mission of improving survivorship and helping people live longer, healthier lives, my long-term goals are to elucidate the behavioral processes underlying the effects of stress on cancer outcomes and to target these processes through psychosocial interventions that are feasible in clinical oncology settings.