Stress Management Improved Quality of Life for Breast Cancer Patients

Women who received cognitive behavioral stress management after surgery for early breast cancer reported better quality of life and lower symptoms of depression.

Women who received cognitive behavioral stress management (CBSM) after surgery for early-stage breast cancer reported better quality of life and lower symptoms of depression for as long as 15 years after treatment.

These results, which were published in the journal Cancer, suggest that the early implementation of stress management techniques can positively influence the long-term mental health of breast cancer survivors.

Jamie M. Stagl, MS, of Massachusetts General Hospital and Harvard Medical School, Michael H. Antoni, PhD, of the department of psychology at the University of Miami, and colleagues randomized 100 women with stage 0 to stage IIIb breast cancer 2 to 10 weeks post-surgery to a 10-week CBSM intervention or a 1-day psychoeducational control group. The women, 51 in the CBSM group and 49 in the control group, were then contacted 8 to 15 years later for a follow-up evaluation.

According to Stagl, the stress management techniques helped the women to better cope with the stress of primary breast cancer treatment, as well as the uncertainty of potential recurrence or disease progression.

The women in the CBSM group had a significantly lower incidence of depression symptoms and better quality of life.

“Since depressive symptoms are prevalent during cancer treatment, our prior work showing that CBSM reduces depressive symptoms over the first year of treatment is significant,” said Antoni. “Since persisting depressive symptoms into survivorship are also common, these new findings that women receiving CBSM during primary treatment show beneficial effects out to 15 years suggests a real impact on their quality of life well into survivorship.”

CBSM included progressive muscle relaxation and deep breathing techniques, as well as modifying negative feelings such as self-defeating and irrational thoughts through a procedure called “cognitive restructuring.” These techniques can be learned and applied to daily life and to breast cancer–specific stressors, and have been shown to improve regulation of cortisol in women undergoing treatment for breast cancer, said Antoni.

Patients in the study were all randomized at the University of Miami between 1998 and 2005. At follow-up, the breast cancer survivors were, on average, 62.5 years old. Seventy percent were Caucasian, 21% were Hispanic, 5% were black, and 3% were Asian. The self-administered Functional Assessment of Cancer Therapy–Breast was used to assess quality of life. Those who received CBSM reported better overall physical well-being and emotional well-being compared with the control group.

Because about one-third of the participants were part of a minority group, the results from this study are more generalized to the broad breast cancer survivor population, noted the study authors. Still, because the quality-of-life measures were self-reported, there may be self-report bias in the data collected.

While advances in surgery and treatment have boosted and extended survivorship, side effects from therapy and emotional issues continue after therapy ends. Prior studies have reported difficulties with both physical and psychological aspects of survivors’ quality of life. Physical symptoms include pain, fatigue, swelling, and the onset of menopause. Psychological stresses include the worry of recurrence and mild to moderate depression. Psychosocial interventions have been shown in meta-analyses to improve the quality of life of survivors in the short term, but data on long-term effects are missing.

According to Antoni, recently released data from the American Psychosomatic Society Annual Meeting show that depressive symptoms during breast cancer treatment could predict greater odds of mortality over the subsequent 8 to 15 years. “It’s plausible that these CBSM effects on long-term depressive symptoms may have implications for survival. Finally, since depressive symptoms relate to greater signs of inflammation in breast cancer patients and inflammation promotes cancer disease progression via effects on angiogenesis, invasion, and metastasis, then managing depressive symptoms during and after active treatment for breast cancer could have effects on health outcomes via lower inflammation,” he noted.