Lechner Suzanne C, Whitehead Nicole E, Vargas Sara, Annane Debra W, Robertson Belinda R, Carver Charles S, Kobetz Erin, Antoni Michael H
Department of Psychiatry and Behavioral Sciences (SCL, BRR, MHA), Sylvester Comprehensive Cancer Center (SCL, DWA, CSC, EK, MHA), and Department of Public Health Sciences (EK), University of Miami Miller School of Medicine, Miami, FL; Department of Clinical and Health Psychology, University of Florida, Gainesville, FL (NEW); The Miriam Hospital, The Warren Alpert Medical School of Brown University, Providence, RI (SV); Department of Psychology, University of Miami, Coral Gables, FL (MHA, CSC).
J Natl Cancer Inst Monogr. 2014 Nov;2014(50):315-22. doi: 10.1093/jncimonographs/lgu032.
In this randomized trial, Project CARE, we examined whether participation in a cognitive-behavioral stress management and breast cancer wellness and education program improved psychological outcomes among a sample of underserved black breast cancer survivors.
Both complementary medicine interventions were 10-sessions, manualized, group-based, and were culturally adapted for black women in the community from evidence-based interventions. Participants were 114 black women (mean age = 51.1, 27-77 years) who had completed breast cancer treatment 0-12 months before enrollment (stages 0-IV, mean time since cancer diagnosis = 14.1 months). Women were enrolled upon completion of curative treatment (ie, surgical, chemotherapy, radiation oncology) and randomized to receive cognitive-behavioral stress management or cancer wellness and education program.
There was a remarkable 95% retention rate from baseline to 6-month follow-up. Participants in both conditions showed statistically significant improvement on indices of psychological well-being, including overall quality of life (Functional Assessment of Cancer Therapy-Breast), intrusive thoughts (Impact of Event Scale-Revised), depressive symptoms (Center for Epidemiologic Studies-Depression), and stress levels (Perceived Stress Scale) over the 6-month postintervention follow-up (all repeated measures analysis of variance within-subjects time effects: P < .05, except for overall mood; Profile of Mood States-Short Version). Contrary to hypotheses, however, condition × time effects were not statistically significant.
Findings suggest that improvements in multiple measures over time may have been due to intensive training in stress management, extensive provision of breast cancer information, or participation in an ongoing supportive group of individuals from a similar racial background. Implications bear on decisions about appropriate control groups, the timing of intervention delivery during the treatment trajectory, and perceived support from the research team.
在这项名为“关爱计划”的随机试验中，我们研究了参与认知行为压力管理以及乳腺癌健康与教育项目是否能改善服务不足的黑人乳腺癌幸存者样本的心理状况。
两种补充医学干预措施均为基于手册的、为期10节的小组课程，且根据循证干预措施进行了文化调整，以适应社区中的黑人女性。参与者为114名黑人女性（平均年龄 = 51.1岁，年龄范围27 - 77岁），她们在入组前0 - 12个月完成了乳腺癌治疗（0 - IV期，自癌症诊断以来的平均时间 = 14.1个月）。女性在完成根治性治疗（即手术、化疗、放射肿瘤学治疗）后入组，并随机接受认知行为压力管理或癌症健康与教育项目。
从基线到6个月随访期间，保留率高达95%，这一结果非常显著。在干预后的6个月随访中，两种干预组的参与者在心理健康指标上均显示出具有统计学意义的改善，包括总体生活质量（癌症治疗功能评估 - 乳腺癌量表）、侵入性思维（事件影响量表修订版）、抑郁症状（流行病学研究中心抑郁量表）和压力水平（感知压力量表）（所有重复测量方差分析中的组内时间效应：P < 0.05，但总体情绪除外；简版情绪状态剖面图）。然而，与假设相反，干预组与时间的交互作用在统计学上并不显著。
研究结果表明，随着时间推移多项指标的改善可能归因于压力管理方面的强化训练、大量乳腺癌信息的提供，或参与了由具有相似种族背景的个体组成的持续支持小组。这些结果对关于合适对照组的决策、治疗过程中干预实施的时机以及研究团队所提供的感知支持具有启示意义。
