Nuevo Amanecer‐II: Results of a randomized controlled trial of a community‐based participatory, peer‐delivered stress management intervention for rural Latina breast cancer survivors

Abstract

Objective: We report results of a community-based multisite, randomized controlled trial of Nuevo Amanecer (NA-II), a 10-week stress management program for rural, low literacy Latina breast cancer survivors. Methods: Trained peers delivered NA-II to Spanish-speaking Latinas with nonmetastatic breast cancer in three rural communities. Women were randomized to receive the program immediately or wait 6 months. Assessments were conducted at baseline, 3 months, and 6 months. Primary outcomes were breast cancer-specific quality of life domains; secondary outcomes included general distress symptoms and stress management skills. Intention-to-treat analyses using repeated-measures linear regression models estimated changes in slope between groups. Results: Of 153 participants (76 randomized to intervention, 77 to control group), 92% were retained at 6 months. Mean age was 54.8 years (SD = 10.5); 80% had less than high school education. There were no statistically significant treatment × time effects on quality of life. Compared to women in the control group, intervention group women reported greater improvements in anxiety at 6 months (−0.20 vs −0.02, P = .049; range 0-4) as well as three stress management skills: relaxation at 3 months (+0.98 vs −0.07, P < .0001; range 0-4) and 6 months (+0.82 vs +0.04, P < .001), awareness of tension at 3 months (+0.31 vs −0.19, P < .01; range 0-4) and 6 months (+0.29 vs −0.11, P < .05), and coping confidence at 3 months (+0.12 vs −0.23, P < .01; range 0-4). Conclusions: Stress management programs delivered by trained peers in rural community settings can reduce anxiety and improve stress management skills among Latina breast cancer survivors. Trial registration: http://www.ClinicalTrials.gov identifier NCT02931552.

Using Behavioral Science to Address COVID-19 Vaccine Hesitancy Among Cancer Survivors: Communication Strategies and Research Opportunities

“…Health behavior is also heavily influenced by perceived social norms, particularly norms that are held by members of a person’s in-group (or individuals with whom they share an identity) (Van Bavel et al, 2020 ). Prior behavioral interventions have successfully leveraged peer cancer survivors to increase physical activity (Pinto et al, 2015 ), improve stress management (Nápoles et al, 2020 ), and enhance well-being (Giese-Davis et al, 2016 ) among cancer survivors, suggesting that peer influence might be especially effective in encouraging the adoption of health-promoting actions. Although vaccination behaviors may be unique in certain respects (e.g., vaccination is a discrete rather than long-term behavior and may be more affected by misinformation), the use of peer models could still be a promising strategy, and research suggests that survivors may be willing to serve as vaccine advocates, especially when they believe vaccines are safe (Shelal et al, 2020 ).…”

Management of Distress in Patients with Cancer—Are We Doing the Right Thing?

“…Many patient-level interventions designed to ameliorate distress are effective [ 21 ]. Examples of patient-level intervention approaches that produced significant reductions in distress within randomized controlled trials include cognitive-behavioral therapy [ 22 ], mindfulness [ 23 ], and supportive-expressive psychotherapy [ 24 ]. While effective, few patient-level interventions have been evaluated as part of routine cancer care delivery across multiple settings.…”

Sharing research results with Latina breast cancer survivors who participated in a community-engaged behavioral RCT study: a descriptive cross-sectional survey study

“…The first RCT ( n = 151) was conducted between 2011 and 2014 in five urban Northern California counties in the San Francisco Bay Area [ 22 ]. The second RCT ( n = 153) was conducted between 2016 and 2018 in rural areas of Imperial, Tulare, and Santa Cruz/Monterey counties [ 23 ]. Participants in both trials were Spanish-speaking Latina survivors of non-metastatic breast cancer, tended to be of low socioeconomic status, and mostly of Mexican descent.…”