OBJECTIVE: Assess impact of a computer‐based patient support system on quality of life in younger women with breast cancer, with particular emphasis on assisting the underserved. DESIGN: Randomized controlled trial conducted between 1995 and 1998. SETTING: Five sites: two teaching hospitals (Madison, Wis, and Chicago, Ill), two nonteaching hospitals (Chicago), and a cancer resource center (Indianapolis, Ill). The latter three sites treat many underserved patients. PARTICIPANTS: Newly diagnosed breast cancer patients (N = 246) under age 60. INTERVENTIONS: Experimental group received Comprehensive Health Enhancement Support System (CHESS), a home‐based computer system providing information, decision‐making, and emotional support. MEASUREMENTS AND MAIN RESULTS: Pretest and two post‐test surveys (at two‐ and five‐month follow‐up) measured aspects of participation in care, social/information support, and quality of life. At two‐month follow‐up, the CHESS group was significantly more competent at seeking information, more comfortable participating in care, and had greater confidence in doctor(s). At five‐month follow‐up, the CHESS group had significantly better social support and also greater information competence. In addition, experimental assignment interacted with several indicators of medical underservice (race, education, and lack of insurance), such that CHESS benefits were greater for the disadvantaged than the advantaged group. CONCLUSIONS: Computer‐based patient support systems such as CHESS may benefit patients by providing information and social support, and increasing their participation in health care. These benefits may be largest for currently underserved populations.

To compare the benefits of the Internet generally versus a focused system of services, 257 breast cancer patients were randomly assigned to a control group, access to the Internet with links to high-quality breast cancer sites, or access to an eHealth system (Comprehensive Health Enhancement Support System, CHESS) that integrated information, support, and decision and analysis tools. The intervention lasted 5 months, and self-report data on quality of life, health-care competence, and social support were collected at pretest and at 2-, 4-, and 9-month posttests. CHESS subjects logged on more overall than Internet subjects and accessed more health resources, but the latter used non health-related sites more. Subjects with access to the Internet alone experienced no better outcomes than controls at any of the 3 time points, compared to pretest levels. Subjects with CHESS experienced greater social support during the intervention period and had higher scores on all 3 outcomes at 9 months, 4 months after the intervention ended. CHESS subjects also scored higher than those with Internet access during the intervention period but not significantly after the intervention ended. Thus, CHESS (with one simple interface and integrated information, communication, and skills services) helped newly diagnosed breast cancer patients even after computers were removed. In contrast, patients received little benefit from Internet access, despite having links to a variety of high-quality sites.Breast cancer affects one in eight women and is the second leading cause of cancer death among women (American Cancer Society, 2007). Earlier detection and improved treatment are reducing mortality from this disease, but its impact on a woman's quality of life remains substantial (Bruckner, Yost, Cashey, Webster, & Cella, 2005). Beginning with diagnosis and continuing at least through the stresses of treatment, breast cancer patients typically NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript experience uncertainties, anxiety, novel and difficult decisions, physical pain, impairment of everyday life functioning, feelings of social isolation, difficulties adjusting and maintaining relationships, and so on (Gustafson, Taylor, Thompson, & Chesney, 1993;Mandelblatt, Figuerido, & Cullen, 2003). Or, in summary, both the initial diagnosis of breast cancer and the subsequent treatment adversely affect a woman's quality of life.Apart from medical treatment, a variety of resources can impact how well a woman deals with the disease. For example, mounting evidence suggests that information produces accurate disease-related expectations (Maly, Leake, & Silliman, 2004), improved health, and even increased longevity among breast cancer patients (Kiecolt-Glaser & Glaser, 1987). Patients satisfied with social support perceive their health more positively and report fewer physical symptoms (Sammarco, 2004). Thus, understanding how quality of life can be buffered against the stresses of breast cancer should allow us to develop and...

BACKGROUND Studies that prospectively and simultaneously evaluate, within the first year of diagnosis, the impact of surgery and chemotherapy on quality of life (QOL) of younger women (60 years or younger) with early stage breast carcinoma are limited. METHODS Quality of life of 103 women who had surgery (lumpectomy, 49; mastectomy, 54) approximately 1 month before the start of the study was evaluated at baseline and again after 5 months. Thirty‐two women received chemotherapy during the study. RESULTS Over time, subjects reported improvement in body image and physical, emotional, and functional well‐being (P < 0.001). They were less bothered by swollen/tender arms and worried less about risk of cancer to family members (P < 0.001). However, satisfaction with sex life, social support, and social/family well‐being declined (P < 0.001). In the period closer to surgery, women with mastectomy reported poorer body image (P = 0.001) and worse functional (P = 0.08) and physical well‐being (P = 0.10). Women with lumpectomy worried more about the effects of stress on their illness (P < 0.01) and had lower emotional well‐being (P = 0.06). By 6 months after surgery, the two groups reported similar QOL scores. Chemotherapy had a negative impact on women's sexual functioning (P = 0.01) and their physical well‐being (P = 0.09). Women who received chemotherapy also reported more shortness of breath (P = 0.07). Post hoc analysis showed that women with breast reconstruction had higher emotional well‐being at baseline than those with lumpectomy (P = 0.001) and mastectomy alone (P < 0.01). CONCLUSIONS Younger women with breast carcinoma could experience a range of adjustment problems at various points in the treatment cycle. Interventions that would help reduce the negative impact of treatment on QOL need to be designed and integrated into routine clinical practice. Cancer 2001;92:1288–98. © 2001 American Cancer Society.

Little is known about the effective elements of Interactive Cancer Communication Systems (ICCSs). A randomized trial explored which types of services of a multifaceted ICCS benefited patients and the nature of the benefit. Women with breast cancer (N=450) were randomized to different types of ICCS services or to a control condition that provided internet access. The Comprehensive Health Enhancement Support System (CHESS), served as the ICCS. ICCS services providing information and support, but not coaching such as cognitive behavior therapy, produced significant benefits in health information competence and emotional processing. Provision of Information and Support ICCS services significantly benefited women with breast cancer. More complex and interactive services designed to train the user had negligible effects.

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