Facilitated Intervention Can Improve Quality of Life for Breast Cancer Survivors

Taking the focus off pain management and specific post-treatment symptoms, and putting it on quality of life defined as "active engagement," a team from Dartmouth's Norris Cotton Cancer Center, led by Mark T. Hegel, PhD with first-author Kathleen D. Lyons, ScD, established and tested a new paradigm for working with breast cancer survivors. Published in the Journal of Psychosocial Oncology, "Development and Initial Evaluation of a Telephone-Delivered Behavioral Activation and Problem-solving Treatment Program to Address Functional Goals of Breast Cancer Survivors," covers two studies looking at feasibility and potential efficacy.

"Most breast cancer survivors bounce back well after treatment, but anywhere from a quarter to a third of them might benefit from rehabilitation interventions that help them accelerate recovery by finding and applying ways to engage in productive and health-promoting activities," explained Lyons. "It was a complete pleasure and privilege to work with the study participants and give them a structure and some support while they found ways to create healthy and productive routines and lifestyles."

Almost one-third of breast cancer survivors experience difficulty after treatment when trying to resume previous levels of work, leisure, physical, and social activities. This is particularly true of women in young to middle adulthood. For them, cancer diagnosis comes at a time of high demands for peak performance at work and home, and correspondingly less flexibility in time and schedule.

The Dartmouth group's rehabilitation intervention was designed to help women find ways to accelerate recovery and engage in health-promoting activities. The study considered feasibility, acceptability to survivors, and efficacy in helping women to meet their goals.

Women were highly satisfied with the telephone-delivered intervention and primarily used the program to set weekly goals regarding exercise, work, better nutrition, taking care of themselves and their homes, managing stress, and social activities. The women met 71% of their weekly goals and showed improvements in quality of life, active coping, planning, and reframing.

A second paper published in OTJR: Occupation, Participation, and Health, titled, "A Content Analysis of Functional Recovery Strategies of Breast Cancer Survivors," takes a closer look at goals the study participants set for themselves and their success in achieving them.

The study team used Dartmouth's Biostatistics Shared Resource, which is open to outside investigators by arrangement, to design their studies and analyze data.

Looking forward, Hegel and Lyons continue to study the intervention with a larger sample size to attempt to replicate their findings and plan to work with nurse practitioners at Dartmouth-Hitchcock's Norris Cotton Cancer Center to study the feasibility of integrating the problem-solving and action-planning structure into survivorship care.

Mark Hegel is Professor of Psychiatry, and of Community & Family Medicine at Dartmouth's Geisel School of Medicine where Kathleen Lyons is Assistant Professor of Psychiatry. Both are members of Dartmouth's Norris Cotton Cancer Center's Cancer Control Research Program.

This work was supported by the Alliance for Clinical Trials in Oncology Foundation grant 70804, and the National Cancer Institute grant R21 CA140849-01. Lyons is supported by the American Cancer Society's MRSG-12-113-01-CPPB, which is a Mentored Research Scholar Grant in Applied and Clinical Research.

About Dartmouth-Hitchcock Norris Cotton Cancer CenterNorris Cotton Cancer Center combines advanced cancer research at Dartmouth and the Geisel School of Medicine with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center in Lebanon, NH, at Dartmouth-Hitchcock regional locations in Manchester, Nashua, and Keene, NH, and St. Johnsbury, VT, and at 12 partner hospitals throughout New Hampshire and Vermont. It is one of 41 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at cancer.dartmouth.edu.