title: A randomized controlled trial of cognitive-behavioral stress management in breast cancer: survival and recurrence at 11-year follow-up.
abstract: Non-metastatic breast cancer patients often experience psychological distress which may influence disease progression and survival. Cognitive-behavioral stress management (CBSM) improves psychological adaptation and lowers distress during breast cancer treatment and long-term follow-ups. We examined whether breast cancer patients randomized to CBSM had improved survival and recurrence 8-15 years post-enrollment. From 1998 to 2005, women (N = 240) 2-10 weeks post-surgery for non-metastatic Stage 0-IIIb breast cancer were randomized to a 10-week, group-based CBSM intervention (n = 120) or a 1-day psychoeducational seminar control (n = 120). In 2013, 8-15 years post-study enrollment (11-year median), recurrence and survival data were collected. Cox Proportional Hazards Models and Weibull Accelerated Failure Time tests were used to assess group differences in all-cause mortality, breast cancer-specific mortality, and disease-free interval, controlling for biomedical confounders. Relative to the control, the CBSM group was found to have a reduced risk of all-cause mortality (HR = 0.21; 95 % CI [0.05, 0.93]; p = .040). Restricting analyses to women with invasive disease revealed significant effects of CBSM on breast cancer-related mortality (p = .006) and disease-free interval (p = .011). CBSM intervention delivered post-surgery may provide long-term clinical benefit for non-metastatic breast cancer patients in addition to previously established psychological benefits. Results should be interpreted with caution; however, the findings contribute to the limited evidence regarding physical benefits of psychosocial intervention post-surgery for non-metastatic breast cancer. Additional research is necessary to confirm these results and investigate potential explanatory mechanisms, including physiological pathways, health behaviors, and treatment adherence changes.
authors.affiliation: The Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey Suite 10B, Boston, MA, 02114, USA. jstagl@mgh.harvard.edu.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Stagl
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Miami, FL, 33136, USA.|Sylvester Cancer Center, University of Miami Miller School of Medicine, 1475 N.W. 12th Avenue, Miami, FL, 33136, USA.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Lechner
authors.affiliation: Sylvester Cancer Center, University of Miami Miller School of Medicine, 1475 N.W. 12th Avenue, Miami, FL, 33136, USA.|Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd, Coral Gables, FL, 33146, USA.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Carver
authors.affiliation: Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd, Coral Gables, FL, 33146, USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Bouchard
authors.affiliation: Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd, Coral Gables, FL, 33146, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Gudenkauf
authors.affiliation: Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd, Coral Gables, FL, 33146, USA.
authors.forename: Devika R
authors.initials: DR
authors.lastname: Jutagir
authors.affiliation: Department of Microbiology and Immunology, University of Miami Miller School of Medicine, 1600 N.W. 10th Avenue, Miami, FL, 33136, USA.
authors.forename: Alain
authors.initials: A
authors.lastname: Diaz
authors.affiliation: Westat, 1600 Research Boulevard, Rockville, MD, 20850, USA.
authors.forename: Qilu
authors.initials: Q
authors.lastname: Yu
authors.affiliation: Sylvester Cancer Center, University of Miami Miller School of Medicine, 1475 N.W. 12th Avenue, Miami, FL, 33136, USA.|Department of Microbiology and Immunology, University of Miami Miller School of Medicine, 1600 N.W. 10th Avenue, Miami, FL, 33136, USA.
authors.forename: Bonnie B
authors.initials: BB
authors.lastname: Blomberg
authors.affiliation: Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd, Coral Gables, FL, 33146, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Ironson
authors.affiliation: Celgene Corporation, Summit, NJ, 07901, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Glück
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Miami, FL, 33136, USA.|Sylvester Cancer Center, University of Miami Miller School of Medicine, 1475 N.W. 12th Avenue, Miami, FL, 33136, USA.|Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd, Coral Gables, FL, 33146, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Antoni
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D002423:Cause of Death; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012307:Risk Factors; D013315:Stress, Psychological / Q000628:therapy*
chemical_list: D014408:Biomarkers, Tumor
keywords: Behavior therapy; Breast cancer; Breast neoplasm; Cognitive therapy; Recurrence; Survival