A meta‐analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients

Ye, Mengfei; Du, Kanghui; Zhou, Jingying; Zhou, Quanqian; Shou, Mengna; Hu, Bin; Jiang, Pan-Ruo; Dong, Nan; He, Luying; Liang, Shenglin; Yu, Changhong; Zhang, Jian; Ding, Zhinan; Liu, Zheng

doi:10.1002/pon.4687

Cited by 98 publications

(81 citation statements)

References 51 publications

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“…A qualitative study of ET use found several patients reported difficulty remembering their medication, and those who were adherent described the use of a routine time for taking medication and reminders (such as alarms or pill‐boxes) as a facilitator . Importantly, studies examining racial difference in ET utilization have described racial differences in perceptions of tradeoffs as well as resource barriers, but have generally not described significant differences by age and race in habit formation , which we observe is nearly as large as the other, more commonly described, barriers.…”

Section: Discussioncontrasting

confidence: 53%

Factors Associated with Endocrine Therapy Non‐Adherence in Breast Cancer Survivors

et al. 2020

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Background: For women with hormone receptor positive breast cancer, long-term endocrine therapy (ET) can greatly reduce the risk of recurrence, yet adherence is low-particularly among traditionally underserved populations. Methods:The Carolina Breast Cancer Study oversampled Black and young women (<50 years of age). Participants answered an ET-specific medication adherence questionnaire assessing reasons for non-adherence. We used principal factor analysis to identify latent factors describing ET non-adherence. We then performed multivariable regression to determine clinical and demographic characteristics associated with each ET non-adherence factor.Results: 1,231 women were included in analysis, 59% reported at least one barrier to ET adherence. We identified three latent factors which we defined as: habit -challenges developing medication-taking behavior; tradeoffs -high perceived side effect burden and medication safety concerns; and resource barriers -challenges related to cost or accessibility. Older age (50+) was associated with less reporting of habit (Adjusted Risk Ratio (aRR) 0.54[95% CI: 0.43-0.69] and resource barriers (aRR 0.66 [0.43-0.997]), but was not associated with tradeoff barriers. Medicaid-insured women were more likely than privately-insured to report tradeoff (aRR:1.53 [1.10-2.13]) or resource barriers ). Black race was associated with increased reporting of all factors (habit: aRR 1.29[1.09-1.53]; tradeoffs: 1.32 [1.09-1.60], resources: 1.65[1.18-2.30]).Conclusion: Barriers to ET adherence were described by three distinct factors, and strongly associated with sociodemographic characteristics. Barriers to ET adherence appear inadequately addressed for younger, Black, and publicly-insured breast cancer survivors. These findings underscore the importance of developing multi-faceted, patient-centered interventions that address a diverse range of barriers to ET adherence.

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Section: Discussioncontrasting

confidence: 53%

Factors Associated with Endocrine Therapy Non‐Adherence in Breast Cancer Survivors

et al. 2020

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“…The efficacy of Internet delivery of cognitive-behavioral techniques (CBT) is supported [19], as is CBT to reduce depression and stress in women with breast cancer [20]. Unguided Internet CBT psychosocial interventions also show promise [21][22][23].…”

Section: Introductionmentioning

confidence: 99%

CaringGuidance™ after breast cancer diagnosis eHealth psychoeducational intervention to reduce early post-diagnosis distress

Lally

Kupzyk

Bellavia

et al. 2019

Support Care Cancer

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Purpose Significant cancer-related distress affects 30-60% of women diagnosed with breast cancer. Fewer than 30% of distressed patients receive psychosocial care. Unaddressed distress is associated with poor treatment adherence, reduced quality of life, and increased healthcare costs. This study aimed to evaluate the preliminary efficacy of a new web-based, psychoeducational distress self-management program, CaringGuidance™ After Breast Cancer Diagnosis, on newly diagnosed women's reported distress.Methods One-hundred women, in five states, diagnosed with breast cancer within the prior 3 months, were randomized to 12 weeks of independent use of CaringGuidance™ plus usual care or usual care alone. The primary multidimensional outcome, distress, was measured with the Distress Thermometer (DT), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Impact of Events Scale (IES) at baseline and months 1, 2, and 3. Intervention usage was continually monitored by the data analytic system imbedded within CaringGuidance™. Results Although multilevel models showed no significant overall effects, post hoc analysis showed significant group differences in slopes occurring between study months 2 and 3 on distress (F(1,70) = 4.91, p = .03, η 2 = .065) measured by the DT, and depressive symptoms (F(1, 76) = 4.25, p = .043, η 2 = .053) favoring the intervention. Conclusions Results provide preliminary support for the potential efficacy of CaringGuidance™ plus usual care over usual care alone on distress in women newly diagnosed with breast cancer. This analysis supports and informs future study of this selfmanagement program aimed at filling gaps in clinical distress management.

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“…National Comprehensive Cancer Network Distress Management Guidelines support the use of psychosocial interventions that include cognitive behavioral techniques (CBT) and psychoeducation to reduce mild to moderate cancer‐related distress early in the course of care. A recent meta‐analysis of multimodal CBT, using a range of techniques, recommended CBT for women with breast cancer to reduce depression, anxiety, and stress . Greater uptake of such interventions by patients with cancer has been demonstrated when delivered early after diagnosis and remotely (eg, phone) rather than in person .…”

Section: Introductionmentioning

confidence: 99%

“…A recent meta-analysis of multimodal CBT, using a range of techniques, recommended CBT for women with breast cancer to reduce depression, anxiety, and stress. 13 Greater uptake of such interventions by patients with cancer has been demonstrated when delivered early after diagnosis and remotely (eg, phone) rather than in person. 14 As technology moves forward, web-based delivery of interventions for stress reduction, including "low-intensity" CBT, 15 are increasing 16 and have shown efficacy whether clinically guided or self-managed by their intended users.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and acceptance of the CaringGuidance web‐based, distress self‐management, psychoeducational program initiated within 12 weeks of breast cancer diagnosis

et al. 2019

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Objective Limited clinical resources create barriers to quality management of cancer‐related distress. CaringGuidance After Breast Cancer Diagnosis is a web‐based, patient‐controlled, psychoeducational program of cognitive‐behavioral, coping and problem‐solving strategies aimed at early post‐diagnosis distress reduction without clinical resources. This study evaluated the feasibility of recruiting and retaining newly diagnosed women to 12 weeks of CaringGuidance and program acceptance. Methods Women with stage 0 to II breast cancer diagnosed within the prior 3 months were recruited from clinics and communities in four states, from 2013 to 2015 and randomized to 12 weeks of CaringGuidance plus usual care (n = 57) or usual care alone (n = 43). Recruitment, retention, and program use were tracked. Using standard and study‐derived measures, demographic and psychological variables were assessed at baseline and monthly and program satisfaction at 12 weeks. Results Of 139 women screened, 100 enrolled, five withdrew, and 12 were lost to follow‐up (83% retention rate). Total program engagement was positively associated with greater baseline intrusive/avoidant thoughts. Intervention participants (92%) believed CaringGuidance would benefit future women and was easy to use. Sixty‐six percent believed CaringGuidance helped them cope. Women used program content to change thoughts (49%) or behaviors (40%). Stress in the previous year was positively associated with reports that CaringGuidance was reassuring and helpful. Conclusions Feasibility and acceptance of CaringGuidance was demonstrated pointing to the program's potential as a cancer‐distress self‐management intervention. Future research will explore program feasibility and acceptability in other regions of the United States, leading to clinical implementation trials.

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A meta‐analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients

Abstract: Cognitive behavior therapy is an effective therapy for psychological symptoms of cancer survivors and patients, with meaningfully clinical effect sizes. These findings suggested that CBT should be used as the intervention for breast cancer survivors and patients when possible.

Cited by 98 publications

References 51 publications

Factors Associated with Endocrine Therapy Non‐Adherence in Breast Cancer Survivors

Factors Associated with Endocrine Therapy Non‐Adherence in Breast Cancer Survivors

CaringGuidance™ after breast cancer diagnosis eHealth psychoeducational intervention to reduce early post-diagnosis distress

Feasibility and acceptance of the CaringGuidance web‐based, distress self‐management, psychoeducational program initiated within 12 weeks of breast cancer diagnosis

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