Lemons to lemonade: Effects of a biobehavioral intervention for cancer patients on later life changes

Abstract

Objective: The sustainment of gains for cancer patients provided psychosocial interventions is unclear. Furthermore, it is unknown whether interventions also yield long-term positive changes. The present study experimentally tests if an intervention delivered at cancer diagnosis could yield broad, long-term, changes in domains such as relationships, worldview, priorities, and goals. It was hypothesized that the intervention group would report more positive and fewer negative life changes during survivorship versus the control group.

Method: Patients with Stage II/III breast cancer were randomized to biobehavioral intervention (BBI) or assessment only. At randomization, patients completed measures of cancer stress (Impact of Events Scale [IES]) and depressive symptoms (Center for Epidemiological Studies Depression scale [CES-D]). At the 24-month follow-up, survivors (N = 160) completed a thought listing task with 7 prompts (e.g., "relationships"). Patients listed thoughts about change since diagnosis and rated each for valence. Groups were compared on the frequency of positive/negative thoughts across prompts. Listed thoughts were content analyzed.

Results: BBI survivors reported significantly more positive changes (p < .05), controlling for IES and CES-D. Groups did not differ on negative changes. Patients with higher IES/CES-D scores reported more negative changes at 24 months (ps < .05). Content analysis revealed a predominance (13/23) of positive thought categories.

Conclusions: Adding support for efficacy, BBI survivors reported significantly more positive life changes since diagnosis than survivors not receiving BBI. More generally, heightened stress/depressive symptoms at diagnosis foretold survivors' reporting of more negative changes. Thought listing is a strategy to obtain personalized accounts of life changes after breast cancer. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT03578627.

Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to report.

Figures

Figure 1.

Study flow for a RCT accruing and assessing Stage II/III breast cancer patients postsurgery and prior to adjuvant therapy with subsequent randomization to Biobehavioral Intervention and assessment versus Assessment only arms. Non-cumulative frequency and reasons for attrition are provided.

Figure 2.

Mean number of positive, negative, and neutral changes reported on a thought listing task at the 24-month follow up for RCT arms. The Biobehavioral Intervention arm survivors reported significantly more positive changes since diagnosis in contrast to Assessment only survivors. Study arms did not differ on negative change or neutral change reports.

Figure 3.

Content of cancer survivors (N=160) reports of life changes (n=998) since diagnosis by content area. For each category, the percentage of total thoughts is provided.

Figure 4.

Content of cancer survivors (N=160) reports of life changes (n=998) since diagnosis by content area. The percentage of positive (white), neutral (grey), and negative (black) ratings for each topic is displayed, listed in order of percentage positive, from highest (left) to lowest (right).