Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer

Abstract

Objective: After surgery for breast cancer, many women experience anxiety relating to the cancer that can adversely affect quality of life and emotional functioning during the year postsurgery. Symptoms such as intrusive thoughts may be ameliorated during this period with a structured, group-based cognitive behavior intervention.

Method: A 10-week group cognitive behavior stress management intervention that included anxiety reduction (relaxation training), cognitive restructuring, and coping skills training was tested among 199 women newly treated for stage 0-III breast cancer. They were then followed for 1 year after recruitment.

Results: The intervention reduced reports of thought intrusion, interviewer ratings of anxiety, and emotional distress across 1 year significantly more than was seen with the control condition. The beneficial effects were maintained well past the completion of adjuvant therapy.

Conclusions: Structured, group-based cognitive behavior stress management may ameliorate cancer-related anxiety during active medical treatment for breast cancer and for 1 year following treatment. Group-based cognitive behavior stress management is a clinically useful adjunct to offer to women treated for breast cancer.

FIGURE 1. Experimental Design and Study Progression of Patients Undergoing Postsurgical Breast Cancer Treatment

FIGURE 2. Structure of Latent Growth-Curves Modeling^a

^a Outcome variables at three assessments (at 6-month intervals) are used to define two latent variables (intercept and slope), with experimental condition (intervention versus control) used to predict those latent variables. M_i is the differential effect of the intervention on the intercept of the growth curves; M_s is the differential effect of the intervention on change over time. ^b In some models tested, this loading was estimated rather than specified as 12.

FIGURE 3. Change in Thought Intrusions, Clinician-Rated Anxiety, and Negative Affect Among Patients Undergoing Postsurgical Breast Cancer Treatment Randomly Assigned to a Stress Management Intervention or a Control Condition^a

^a For thought intrusions, time 3 was estimated as 7.02 months (to yield the best linear relation) rather than 12 months. Means incorporate all observed data and all data estimated using full information maximum likelihood procedures for missing assessments. ^b Group effect on slope: z=3.64, p<0.001; Cohen’s d=1.22. Groups differ at time 2 (z=2.38, p<0.03; Cohen’s d=0.43) and time 3 (z=2.86, p<0.005; Cohen’s d=0.29). ^c Group effect on slope: z=2.71, p<0.003; Cohen’s d=0.74. No significant between-group differences at any time. ^d Group effect on slope: z=2.48, p<0.02; Cohen’s d=0.33. Groups differ at time 3 (z=2.63, p<0.01; Cohen’s d=0.43).