Managing Uncertainty in Older Breast Cancer Survivors
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Summary of Findings Uncertainty Management Intervention for Older Breast Cancer Survivors Grant # 1RO1CA 78955 Funding Agency: NCI P.I. Merle Mishel, Co-P.I. Barbara Germino, Co-Investigator. Karen Gil. Funding Dates: 1998-2004 In a randomized controlled design, this study tested the efficacy of a theoretically based uncertainty management intervention delivered to older long-term breast cancer survivors. The sample included 509 recurrence-free women (360 Caucasian, 149 African American) with a mean age of 64 years. (SD=8.9 years) who were 5-9 years post treated for breast cancer. Women were randomly assigned to either the intervention or usual care control condition. Most of the women had stage 1 (49%) or stage 2 (36%) breast cancer at diagnosis. The intervention and control groups were compared on demographics at baseline and there were no significant differences between the groups. The intervention was packaged and delivered to each woman along with a tape player. Orientation to the intervention was provided during four weekly telephone sessions, in which study nurses guided cancer survivors in the use of audio taped cognitive-behavioral strategies to manage uncertainty about cancer recurrence. A self-help manual was also included to help women understand and manage long-term treatment side-effects and other symptoms. Treatment outcomes measures were gathered at baseline (pre-intervention) 10months afterward and 20 months from baseliner. Findings
The most frequent triggers about recurrence were news of someone’s cancer, new aches and pains, environmental smells, information from the media and annual medical examination. Women averaged two triggers per month so that across the 8 months of follow-up the number of triggers was about 16. The most common symptoms were fatigue, joint stiffness and pain. Over 50% reported symptoms of lymphedema and hormone or sexual problems. Results
The MANOVA for uncertainty management variables revealed significance differences over time for the intervention groups. Women in the intervention groups reported an increase in cognitive reframing from baseline to 20month follow-up whreas the control condition declined. Gains in cancer knowledge from baseline to 20 months later were reported for all women in the intervention groups as contrasted with the controls. For patient-provider communication, there was a significant difference for treatment by ethnic group on “how much the patient tells the nurse”. From baseline to 10 months there was an increase in communication with the nurse for African American women in the treatment group as compared with controls. However this gain did not continue to 20 month. Similarly Caucasian women in the treatment group had improvements in satisfaction with social support from baseline to 10months, but this was not present at 20 months. The MANOVA for coping variables indicated significant difference between intervention and control groups. Follow-up analysis indicated the difference was treatment by ethnicity. For Caucasian women in the intervention, there was an increase in cognitive self-statements and an increase in behavioral activities from baseline to 10 months and in diverting attention from baseline to 20 months. For African-American women in the treatment group there was a significant decrease in catastrophizing from baseliner to 10 months. A major treatments effect was found for the amount and helpfulness of information sought by these women. This included cognitive information, lymphedema information and symptom information. Lastly, we examined whether the intervention would improved levels of personal growth in these long –term survivors. We found that African-American women gained in greater flexibility, and in a new view of life. It was evident from the findings that women who received the uncertainty management intervention gained and maintained a range of benefits over time when compared to a randomly assigned control group. Specifically finding gains 20 months post intervention is rare and supports the strength of the skills that these women learned and continued to use.
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