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Randomized Controlled Trial
. 2021 Nov;190(1):79-88.
doi: 10.1007/s10549-021-06361-x. Epub 2021 Aug 19.

Brief relaxation training is associated with long-term endocrine therapy adherence among women with breast cancer: post hoc analysis of a randomized controlled trial

Molly E Ream  1 , Emily A Walsh  2 , Jamie M Jacobs  3   4 , Chloe Taub  2 , Marc Lippman  5 , Natasha Schaefer-Solle  6 , Steven A Safren  2 , Michael H Antoni  2   7
Affiliations
Randomized Controlled Trial

Brief relaxation training is associated with long-term endocrine therapy adherence among women with breast cancer: post hoc analysis of a randomized controlled trial

Molly E Ream et al. Breast Cancer Res Treat. 2021 Nov.

Abstract

Purpose: Despite life-saving potential, many women struggle to adhere to adjuvant endocrine therapy (AET) for their breast cancer (BCa). Prior research has demonstrated that emotional distress is a barrier to AET adherence. We followed women from a trial to test the long-term effects of two 5-week post-surgical group-based stress management interventions, cognitive behavioral therapy (CBT), and relaxation training versus an attention-matched health education control, on AET adherence.

Methods: We conducted a long-term follow-up (median = 8 years) of women randomized to CBT, relaxation training, or health education after surgery for stage 0-3 BCa. We measured adherence with the Endocrine Therapy Medication Usage Questionnaire (ETMUQ). First, we established factors on the ETMUQ via confirmatory factor analysis. We then used Bayesian structural equation modeling to regress these factors on study arm, controlling for age and treatments received.

Results: Of those who completed long-term follow-up (n = 59, 44.7%), over half (n = 33; 55.9%) reported problems with adherence generally. Women receiving relaxation training (n = 15) had better adherence than those receiving health education (n = 24) on the Forgetfulness/Inconsistency [B(SE) = 0.25(0.14), p = 0.049] and Intentional Nonadherence [B(SE) = 0.31(0.14), p = 0.018] factors of the ETMUQ. Similar results were observed for those receiving relaxation training compared to CBT (n = 20): Forgetfulness/Inconsistency [B(SE) = - 0.47(0.25), p = 0.031]; Intentional Nonadherence [B(SE) = - 0.31(0.15), p = 0.027].

Conclusion: Women receiving relaxation training were less likely to (1) forget to take their AET and (2) intentionally miss doses of AET in the long term compared to women receiving health education or CBT. This is evidence for the need of randomized trials that aim to improve adherence by incorporating theoretically based behavioral change techniques.

Trial registration and dates: Trial 2R01-CA-064710 was registered March 26, 2006.

Keywords: Adherence; Behavior change; Breast cancer; Endocrine therapy; Psycho-oncology.

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Conflict of interest statement

Conflicts of Interest/Competing Interests:

Dr. Michael Antoni is an inventor of the intellectual property used in the study. Dr. Antoni is also a compensated consultant for Blue Note Therapeutics and Atlantis Healthcare.

Figures

Fig. 1
Fig. 1
CONSORT Flow Diagram
Fig. 2
Fig. 2
Distributions of self-reported reasons for non-adherence at 8-year follow-up
See this image and copyright information in PMC

References

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