Psychosocial intervention for rural women with breast cancer: The Sierra-Stanford Partnership

Abstract

Objective: This study was initiated by breast cancer survivors living in a rural community in California. They formed a partnership with academic researchers to develop and evaluate a low-cost, community-based Workbook-Journal (WBJ) for improving psychosocial functioning in geographically and economically isolated women with primary breast cancer.

Design: A randomized controlled trial was used to compare the WBJ intervention plus educational materials to educational materials alone (usual care).

Setting: One rural cancer center and several private medical, surgical, and radiation oncology practices in 7 rural counties in the Sierra Nevada Foothills of California.

Participants: One hundred women with primary breast cancer who were either within 3 months of diagnosis or within 3 months of completing treatment.

Intervention: A community-initiated, theoretically-based Workbook-Journal, designed by rural breast cancer survivors and providers as a support group alternative. It included compelling personal stories, local rural resources, coping strategies, and messages of hope.

Results: Community recruiters enrolled 83% of the women referred to the study. Retention at 3-month follow-up was 98%. There were no main effects for the WBJ. However, 3 significant interactions suggested that women who were treated in rural practices reported decreased fighting spirit and increased emotional venting and posttraumatic stress disorder symptoms if they did not receive the WBJ. Among women who receive the WBJ, 74% felt emotionally supported.

Conclusions: This community-based Workbook-Journal may be an effective psychosocial intervention for rural, isolated, and low-income women with breast cancer. Community involvement was essential to the success of this project.

FIGURE 1

Interaction of intervention and months since diagnosis on posttraumatic stress disorder (PTSD). PCL-S, PTSD Checklist-Specific symptoms, where higher scores equal higher PTSD; Workbook, Workbook-Journal group; UC, usual care group.

FIGURE 2

Interaction of intervention and treatment site on fighting spirit from the Mental Adjustment to Cancer Scale (MAC). Workbook, Workbook-Journal group; UC, usual care group; SNCC, Sierra Nevada Memorial Cancer Center; Other, other rural practice.

FIGURE 3

Effect of site on behavioral disengagement from the Coping Operations Preference Enquiry (COPE). A higher value equals higher behavioral disengagement. Workbook, Workbook-Journal group; UC, usual care group; SNCC, Sierra Nevada Memorial Cancer Center; Other, other rural practice.

FIGURE 4

Interaction of intervention and treatment site on emotional venting from the COPE. A higher value equals higher emotional venting. Workbook, Workbook-Journal group; UC, usual care group; SNCC, Sierra Nevada Memorial Cancer Center; Other, other rural practice.