Facilitating Adjustment in Low-Income Black Women with Breast Cancer

描述(申请人提供)：我们之前发现，一种基于群体的认知行为压力管理(CBSM)干预通过减少侵入性思维、焦虑、社交干扰和负面情绪，促进了最近接受乳腺癌辅助治疗的女性患者的心理社会适应。干预还减少了参与者的身体症状(例如疲劳、睡眠障碍)和压力标记物(例如血清皮质醇水平)，以及增加了积极情绪、利益发现和积极心态。这样的影响在手术后一年内保持不变。然而，这种干预与心理肿瘤学干预研究的更大主体是一致的，主要集中在白人中产阶级女性身上，她们是从私人诊所和大学医疗中心招募的。这项拟议的研究将通过调整我们对南佛罗里达州黑人乳腺癌幸存者的CBSM干预措施来解决这种差异，他们在心理社会需求方面严重缺乏服务。通过与一个专注于癌症的社区组织合作，拟议的项目将在社区环境中招募、评估和举行干预小组。纳入范围将仅限于非洲裔美国女性(自然减员后120人)，患有经组织学证实的乳腺癌(I-III期)，她们在6个月内完成了根治治疗。参与者将被随机分配到为期10周的CBSM干预或关注时间匹配的增强型乳腺癌教育控制条件下。所有妇女(干预组和对照组)将在干预后接受为期六个月的监测。研究终点包括：(A)非裔美国人乳腺癌幸存者对干预措施的可接受性；(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(例如重返工作岗位、病假)；以及(E)客观的压力指标(昼夜唾液皮质醇的斜率)。这项拟议的研究的主要目标是确定是否可以在社区环境中有效地实施成功的压力管理干预，并证明它在促进患有乳腺癌的非裔美国女性对乳腺癌的积极适应方面是有效的。 公共卫生相关性这个项目将检验针对患有乳腺癌的低收入黑人女性的压力管理计划的有效性。这项研究与美国国立卫生研究院的使命一致，即寻求减轻美国黑人女性被诊断患有乳腺癌后的心理社交困难。

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.