Behavioral Stress Management Program, Even in Small Doses, May Help Breast Cancer Patients

NCI CAM Annual Report-FY10

Over the past 20 years, Professor Michael Antoni, Ph.D. and his colleagues at the University of Miami have received NCI supportto research and develop the Cognitive Behavioral Stress Management (CBSM) intervention for women recovering from breast cancer. CBSM – a 10-week program that combines cognitive behavioral therapy techniques, relaxation training, and learning interpersonal skills – has proven successful in helping many patients achieve improvements in multiple indicators of psychosocial adaptation after treatment, including better social and psychological functioning and less intrusive thoughts and social disruption.*

These successes have led to the adoption of the CBSM program by the University of Miami Sylvester Comprehensive Cancer Center and by numerous other cancer centers in the United States. However, Dr. Antoni cautions that the full 10-week program – which includes 2-hour sessions each week – can be difficult for some breast cancer patients to participate in, either due to debilitating symptoms from their illness and treatments, scheduling, transportation problems, or other concerns. This has led him and his colleagues to explore whether condensed or alternative formats for delivering CBSM will make the intervention a realistic option for more patients.

With NCI funding**, Dr. Antoni is currently studying two 5-week, partial versions of CBSM. Dr. Antoni reported that “previous research has shown that women who had attended on average 5 of the 10 CBSM sessions did just about as well as did women who attended 8-10 sessions, and did much better than women who only attended 1-2 sessions.”

The investigators also discovered that two components of CBSM provided most of the beneficial effects for breast cancer patients. “One thing from the intervention that seemed to be accounting for most of the positive effects was relaxation training and the patients’ confidence in using relaxation skills,” Dr. Antoni recalled. “One other variable that seemed to drive most of the effects was the amount of time the women were spending each week in expressing their emotions” with cognitive behavioral therapy.

“This suggests that shorter forms of the CBSM intervention – focusing on elements of the full intervention such as cognitive behavioral therapy techniques or on relaxation training skills – might be a cost-effective way to facilitate adaptation among a larger portion of the population of women receiving treatment for breast cancer,” Dr. Antoni said.

As a result, the current study is randomizing women, newly diagnosed with Stages I to III breast cancer, into three groups: 1) cognitive behavioral therapy; 2) relaxation training intervention; or 3) an attention-social support control. Groups of 80 individuals each will run for 5 weeks.

While that study is running, Dr. Antoni is also planning research into new delivery formats – including teleconferencing, videophone, and Internet Skype technologies – to bring CBSM directly to patients’ homes. “A lot of breast cancer patients are suffering side effects during treatment, like fatigue, that might make it hard for them to attend even a 5-week group,” he noted. “We want to be able to reach those patients.”

Dr. Antoni and his colleagues are studying bringing CBSM “to the community for the lower-income minority patients.” They’re currently testing whether CBSM works in women from one lower income African- American community, he said. “We’re running groups in the churches and community health centers that serve these women.”

In addition, Dr. Antoni added, they will delve further into their earlier research findings on the biological impact of CBSM on breast cancer patients. In previous CBSM studies, they collected blood samples from study participants and “found reductions in serum cortisol (a marker of stress) and changes in immune system activity such as increases in lymphocyte proliferative responses and increased Th-1 cytokine production (interferon-gamma and interleukin-2),” he noted. Dr. Antoni and his colleagues are now examining other molecules involved in stress response and seeing how they change following participation in the CBSM program.