The effects of Pythagorean Self-Awareness Intervention on breast cancer patients undergoing adjuvant therapy: A pilot randomized controlled trial

Maria Charalampopoulou, Flora Bacopoulou, Konstantinos N Syrigos, Evaggelos Filopoulos, George P Chrousos, Christina Darviri, Maria Charalampopoulou, Flora Bacopoulou, Konstantinos N Syrigos, Evaggelos Filopoulos, George P Chrousos, Christina Darviri

Abstract

Introduction: Breast cancer patients undergo extended treatments that affect their psychological state and quality of life. There is a lack of studies examining the effects of holistic stress management interventions (that combine stress perception, cognitive and lifestyle interventions) on mental health and biological indices (e.g. cortisol concentrations) of breast cancer patients.

Materials and methods: This pilot randomized controlled trial provided the first assessment of the effects of a novel, cognitive-based intervention, the Pythagorean Self-Awareness Intervention (PSAI), on psychological symptoms, quality of life, sleep quality and lifestyle as well as on stress-related biological measures of breast cancer patients undergoing adjuvant therapy. Standardized questionnaires were administered at baseline and 8-weeksafter the intervention to evaluate quality of life, stress, depression, and anxiety (primary outcomes). Sleep quality, lifestyle and hair cortisol concentrations were also assessed (secondary outcomes).

Results: Forty-five breast cancer patients undergoing adjuvant therapy were randomly assigned to the PSAI group (n = 25) or the control group (n = 20).Women in the PSAI group reported significant improvements post-intervention in total Quality of Life, specific aspects of Quality of Life [Physical well-being, Social well-being, Emotional well-being, Functional well-being, Breast cancer concerns] as well as Perceived stress, depression, anxiety and stress. Improvements in secondary outcomes included increase in sleep quality, empowerment for healthy lifestyle and reduction of hair cortisol concentrations.

Conclusions: The PSAI was beneficial as complementary therapy in the women studied. Larger randomized controlled trials with longer follow-up are needed to ascertain these findings.

Keywords: Adjuvant therapy; Breast cancer; Cognitive interventions; Hair cortisol; Management; Quality of life; Stress.

Conflict of interest statement

Declaration of competing interest None.

Copyright © 2019 Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Flow Diagram of the study.

References

    1. Bray F., Ferlay J., Soerjomataram I., Siegel R.L., Torre L.A., Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA A Cancer J Clin. 2018;68:394–424. doi: 10.3322/caac.21492.
    1. Pinquart M., Fröhlich C., Silbereisen R.K. Cancer patients’ perceptions of positive and negative illness-related changes. J Health Psychol. 2007;12(6):907–921. doi: 10.1177/1359105307082454.
    1. Hewitt M., Herdman R., Holland J. The National Academies Press; Washington, DC: 2004. Meeting psychosocial needs of women with breast cancer.
    1. Prates A.C.L., Freitas-Junior R., Prates M.F.O. Influence of body image in women undergoing treatment for breast cancer. Rev Bras Ginecol Obstet. 2017;39:175–183. doi: 10.1055/s-0037-1601453.
    1. Keesing S., Rosenwax L., McNamara B. The implications of women’s activity limitations and role disruptions during breast cancer survivorship. Women’s Health. 2018 doi: 10.1177/1745505718756381. 1745505718756381.
    1. Burgess C., Cornelius V., Love S., Graham J., Richards M., Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. Br Med J. 2005;330:702–705. doi: 10.1136/bmj.38343.670868.D3.
    1. Dunn L.B., Langford D.J., Paul S.M., Berman M.B., Shumay D.M., Kober K. Trajectories of fear of recurrence in women with breast cancer. Support Care Cancer. 2015;23(7):2033–2043. doi: 10.1007/s00520-014-2513-8.
    1. Pasquini M., Biondi M. Depression in cancer patients: a critical review. Clin Pract Epidemiol Ment Health. 2007;3:2. doi: 10.1186/1745-0179-3-2.
    1. Kang D.H., Park N.J., McArdle T. Cancer-specific stress and mood disturbance: implications for symptom perception, quality of life, and immune response in women shortly after diagnosis of breast cancer. ISRN Nurs. 2012 doi: 10.5402/2012/608039.
    1. Fann J.R., Thomas-Rich A.M., Katon W.J. Major depression after breast cancer: a review of epidemiology and treatment. Gen Hosp Psychiatry. 2008;30:112–126. doi: 10.1016/j.genhosppsych.2007.10.008.
    1. Perry S., Kowalski T.L., Chang C.H. Quality of life assessment in women with breast cancer: benefits, acceptability and utilization. Health Qual Life Outcomes. 2007;5(1):24. doi: 10.1186/1477-7525-5-24.
    1. Phillips S.M., Dodd K.W., Steeves J., McClain J., Alfano C.M., McAuley E. Physical activity and sedentary behavior in breast cancer survivors: new insight into activity patterns and potential intervention targets. Gynecol Oncol. 2015;138(2):398–404. doi: 10.1016/j.ygyno.2015.05.026.
    1. Goodwin P.J., Pritchard K.I. Obesity and hormone therapy in breast cancer: an unfinished puzzle. J Clin Oncol. 2010:3405–3407. doi: 10.1200/JCO.2010.29.5113.
    1. Sephton S.E., Sapolsky R.M., Kraemer H.C., Spiegel D. Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst. 2000;21(12):994–1000. doi: 10.1093/jnci/92.12.994. 92.
    1. Obradović M.M., Hamelin B., Manevski N., Couto J.P., Sethi A., Coissieux M.M. Glucocorticoids promote breast cancer metastasis. Nature. 2019;567(7749):540. doi: 10.1038/s41586-019-1019-4.
    1. Hamilton N.A., Kitzman H., Guyotte S. Enhancing health and emotion: mindfulness as a missing link between cognitive therapy and positive psychology. J Cogn Psychother. 2006;20(2):123–134. doi: 10.1891/jcop.20.2.123.
    1. Greenberg M.A. Cognitive processing of traumas: the role of intrusive thoughts and reappraisals. J Appl Soc Psychol. 1995;25:1262–1296. doi: 10.1111/j.1559-1816.1995.tb02618.x.
    1. Dupont A., Bower J.E., Stanton A.L., Ganz P.A. Cancer-related intrusive thoughts predict behavioral symptoms following breast cancer treatment. Health Psychol. 2014;33(2):155. doi: 10.1037/a0031131.
    1. Wicklund R.A. vol 8. Academic Press; 1975. pp. 233–275. (Objective self-awareness. Advances in experimental social psychology).
    1. Goleman D. Bloomsbury Publishing; London: 1995. Emotional intelligence.
    1. Hartman D., Zimberoff D. Higher stages of human development. J Heart-Centred Ther. 2008;11(2):3–95.
    1. American Cancer Society Breast cancer.
    1. Canadian cancer society, [accessed 10 December 2019].
    1. Bodai B.I., Tuso P. Breast cancer survivorship: a comprehensive review of long-term medical issues and lifestyle recommendations. Perm J. 2015;19(2):48. doi: 10.7812/TPP/14-241.
    1. Hamer J., Warner E. Lifestyle modifications for patients with breast cancer to improve prognosis and optimize overall health. CMAJ (Can Med Assoc J) 2017;189(7):E268–E274. doi: 10.1503/cmaj.160464.
    1. Zhang M., Huang L., Feng Z., Shao L., Chen L. Effects of cognitive behavioral therapy on quality of life and stress for breast cancer survivors: a meta-analysis. Minerva Med. 2017:84–93. doi: 10.23736/S0026-4806.16.04528-6.
    1. Zhang Q., Zhao H., Zheng Y. Effectiveness of mindfulness-based stress reduction (MBSR) on symptom variables and health-related quality of life in breast cancer patients—a systematic review and meta-analysis Support Care. Cancer. 2019;27:771. doi: 10.1007/s00520-018-4570-x.
    1. Simos D.S., Kokkinos A., Tentolouris N., Dimosthenopoulos C., Mantzou E., Artemiadis A. Pythagorean self awareness intervention (PSAI): a novel cognitive stress management technique for body weight control. Eur J Clin Investig. 2019:e13164. doi: 10.1111/eci.13164.
    1. Darviri C., Zavitsanou C., Delikou A., Giotaki A., Artemiadis A., Terentiou A. A novel non-pharmaceutical treatment for patients with mild cognitive impairment. Psychology. 2016;7:678–686. doi: 10.4236/psych.2016.75070.
    1. Darviri C., Zavitsanou C., Delikou A., Giotaki A., Artemiadis A., Anagnostouli M. Pythagorean self-awareness serves successfully as a new cognitive behavioral based technique in multiple sclerosis physical and psychosocial well-being and quality of life. Psychology. 2016;7:572. doi: 10.4236/psych.2016.74059. 04.
    1. Chatzikonstantinou F., Miskedaki A., Antoniou C., Chatzikonstantinou M., Chrousos G., Darviri C. A novel cognitive stress management technique for acne vulgaris: a short report of a pilot experimental study. Int J Dermatol. 2019;58(2):218–220. doi: 10.1111/ijd.14227.
    1. Tsoli S., Vasdekis S., Tigani X., Artemiadis A., Chrousos G., Darviri C. A novel cognitive behavioral treatment for patients with chronic insomnia: a pilot experimental study. Complement Ther Med. 2018;37:61–63. doi: 10.1016/j.ctim.2018.01.015.
    1. Cohen S., Kamarck T., Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–396. doi: 10.2307/2136404.
    1. Andreou E., Alexopoulos E.C., Lionis C., Varvogli L., Gnardellis C., Chrousos G.P. Perceived stress scale: reliability and validity study in Greece. Int J Environ Res Public Health. 2011;8:3287–3298. doi: 10.3390/ijerph8083287.
    1. Lovibond S.H., Lovibond P.F. 2nd.Ed. Psychology Foundation; Sydney: 1995. Manual for the depression anxiety stress scales.
    1. Lyrakos G.N., Arvaniti C., Smyrnioti M., Kostopanagiotou G. Translation and validation study of the depression anxiety stress scale in the Greek general population and in a psychiatric patient’s sample. Eur Psychiatry. 2011;26:1731. doi: 10.1016/S0924-9338(11)73435-6.
    1. Brady M.J., Cella D.F., Mo F., Bonomi A.E., Tulsky D.S., Lloyd S.R. Reliability and validity of the functional assessment of cancer therapy-breast quality –of-life instrument. J Clin Oncol. 1997;15(3):974–986. doi: 10.1200/JCO.1997.15.3.974.
    1. Kotronoulas G.C., Papadopoulou C.N., Papapetrou A., Patiraki E. Psychometric evaluation and feasibility of the Greek Pittsburgh Sleep Quality Index (GR-PSQI) in patients with cancer receiving chemotherapy. Support Care Cancer. 2011;19(11):1831–1840. doi: 10.1007/s00520-010-1025-4.
    1. Buysse D.J., Reynolds C.F., Monk T.H., Berman S.R., Kupfer D.J. The Pittsburghsleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. doi: 10.1016/0165-781(89)90047-4.
    1. Darviri C., Alexopoulos E.C., Artemiadi A.K., Tigani X., Kraniotou C., Darvyri P. The Healthy Lifestyle and Personal Control Questionnaire (HLPCQ): a novel tool for assessing self-empowerment through a constellation of daily activities. BMC Public Health. 2014;14:995. doi: 10.1186/1471-2458-14-995.
    1. Wester V.L., Van Rossum E.F. Clinical applications of cortisol measurements in hair. Eur J Endocrinol. 2015;173(4) doi: 10.1530/EJE-15-0313. M1-10.
    1. Wennig R. Potential problems with the interpretation of hair analysis results Forensic. Sci Int. 2000;107:5–12. doi: 10.1016/S0379-0738(99)00146-2.
    1. The golden verses of Pythagoras. . [accessed 10 December 2019].
    1. William Keith Chambers Guthrie . Cambridge University Press; Cambridge: 1978. A history of Greek philosophy, the earlier Presocratics and the Pythagoreans.
    1. Kabat-Zinn, Full J. Bantam Dell; New York: 2013. Catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness.
    1. Creswell J.D. Mindfulness interventions. Annu Rev Psychol. 2017;68:491–516. doi: 10.1146/annurev-psych-042716-051139.
    1. Walsh Roger, Shapiro Shauna L. The meeting of meditative disciplines and western psychology: a mutually enriching dialogue. Am Psychol. 2006;61(3):227–239. doi: 10.1037/0003-066X.61.3.227.
    1. Buckner R.L., Andrews-Hanna J.R., Schacter D.L. The brain’s default network: anatomy, function, and relevance to disease. Ann N Y Acad Sci. 2008;1124(1):1–38. doi: 10.1196/annals.1440.011.
    1. Marchand W.R. Neural mechanisms of mindfulness and meditation: evidence from neuroimaging studies. World J Radiol. 2014;6(7):471. doi: 10.4329/wjr.v6.i7.471.
    1. Shapira-Lichter I., Oren N., Jacob Y., Gruberger M., Hendler T. Portraying the unique contribution of the default mode network to internally driven mnemonic processes. Proc Natl Acad Sci. 2013;110(13):4950–4955. doi: 10.1073/pnas.1209888110.
    1. Basten U., Christine S., Christian J.F. Trait anxiety and the neural efficiency of manipulation in working memory. Cognit Affect Behav Neurosci. 2012;12(3):571–588. doi: 10.3758/s13415-012-0100-3.
    1. Ford E.S., Bergmann M.M., Kröger J., Schienkiewitz A., Weikert C., Boeing H. Healthy living is the best revenge: findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam study. Arch Intern Med. 2009;169(15):1355–1362. doi: 10.1001/archinternmed.2009.237.
    1. Lee I.M., Shiroma E.J., Kamada M., Bassett D.R., Matthews C.E., Buring J.E. Association of step volume and intensity with all-cause mortality in older women. J Am Intern Med. 2019 doi: 10.1001/jamainternmed.2019.0899.
    1. Klarsfeld A., Serge B., François R. L’horlogecircadienne à l’heure Nobel-PrixNobel de Médecine 2017: jeffrey C. Hall, Michael Rosbashet Michael W.Young. M-S (Med Sci) 2018;34(5):480–484. doi: 10.1051/medsci/20183405023.
    1. Circadian rhythms. .[accessed 10 December 2019].
    1. Baird B., Smallwood J., Gorgolewski K.J., Margulies D.S. Medial and lateral networks in anterior prefrontal cortex support metacognitive ability for memory and perception. J Neurosci. 2013;33(42):16657–16665. doi: 10.1523/JNEUROSCI.0786-13.2013.
    1. Tagini A., Antonino R. The ‘I’ and the ‘Me’ in self-referential awareness: aneurocognitive hypothesis. Cogn Process. 2010;11(1):9–20. doi: 10.1007/s10339-009-0336-1.
    1. World Health Organization WHO Library Cataloguing in Publication Data Pacific physical activity guidelines for adults: framework for accelerating the communication of physical activity guidelines. 2008. SBN 978 92 9061 394 7.
    1. NationalSleepFoundation. [accessed 10 December 2019].
    1. Ye M., Du K., Zhou J., Zhou Q., Shou M., Hu B. A meta analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients. Psycho Oncol. 2018;27:1695–1703. doi: 10.1002/pon.4687.
    1. Antoni M.H., Lechner S.C., Kazi A., Wimberly S.R., Sifre T., Urcuyo K.R. How stress management improves quality of life after treatment for breast cancer. J Consult Clin Psychol. 2006;74(6):1143. doi: 10.1037/0022-006X.74.6.1152.
    1. Pelekasis P., Zisi G., Koumarianou A., Marioli A., Chrousos G., Syrigos K. Forming a stress management and health promotion program for women undergoing chemotherapy for breast cancer: a pilot randomized controlled trial. Integr Cancer Ther. 2016;15(2):165–174. doi: 10.1177/1534735415598225.
    1. Lehrer S., Green S., Ramanathan L., Rosenzweig K.E. Insufficient sleep associated with increased breast cancer mortality. Sleep Med. 2013;14:469. doi: 10.1016/j.sleep.2012.10.012.
    1. Loh S.Y., Quek K.F. Cancer-behavior-coping in women with breast cancer: effect of a cancer self-management program. Intern J Appl Basic Med Res. 2011;1(2):84. doi: 10.4103/2229-516X.91150.
    1. Rottmann N., Dalton S.O., Christensen J., Frederiksen K., Johansen C. Self-efficacy, adjustment style and well-being in breast cancer patients: a longitudinal study. Qual Life Res. 2010;19:827. doi: 10.1007/s11136-010-9653-1.
    1. Ibrahim E.M., A-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2011;28:753–765. doi: 10.1007/s12032-010-9536-x.
    1. Dandamudi A., Tommie J., Nommsen-Rivers L., Couch S. Dietary patterns and breast cancer risk: a systematic review. Anticancer Res. 2018;38(6):3209–3222. doi: 10.21873/anticanres.12586.
    1. Antoni M., Lutgendorf S., Cole S.W., Dhabhar F.S., Sephton S.E., McDonald P.G. The influence of bio-behavioural factors on tumour biology: pathways and mechanisms. Nat Rev Cancer. 2006;6:240–248. doi: 10.1038/nrc1820.
    1. Russell E., Koren G., Rieder M., Van Uum S. Hair cortisol as a biological marker of chronic stress: current status, future directions and unanswered questions. Psychoneuroendocrinology. 2012;37(5):58901. doi: 10.1016/j.psyneuen.2011.09.009.

Source: PubMed

3
구독하다