Long-Term Effect of the Self-Management, Comprehensive Coping Strategy Program on Quality of Life in Patients with Advanced Breast Cancer Treated with High Dose Chemotherapy

Wednesday, 1 August 2012: 4:10 PM

Fannie Gaston-Johansson, PhD, RN, FAAN
Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD

Learning Objective 1: describe the benefit of a multi-modal coping strategies approach to affecting long term quaity of life among breast cancer survivors.

Learning Objective 2: describe the apporaches to empower women with breast cancer to manage stress and symptoms during survivorship.

Purpose: Due to treatment advances, women with breast cancer have improved survival rates.  Longer survival has created a need for coping interventions to assist stress reduction and long term symptoms and improve quality of life (QOL). Prior coping research has been conducted during treatment with one to two coping strategies rather than a comprehensive coping self-management approach. The purpose of this study was to determine differences between QOL in a Comprehensive Coping Strategy Program (CCSP) treated and control group of breast cancer patients one year after treatment. The significance is that the CCSP is expected to reduce stress and improves QOL.

Methods: This was a prospective, randomized, experimental study guided by Stress, Appraisal and Coping Theory. Breast cancer patients (n = 73; CCSP 38, control 35) scheduled for chemotherapy treatment were randomized to CCSP treatment or control group. The CCSP intervention (education, cognitive restructuring, coping skills enhancement, and relaxation/ imagery) was administered 2 weeks before admission and reinforced over 5 time points. Variables included QOL, psychological distress, coping strategies, and CCSP benefits. Data were collected at baseline and one year follow-up. Analyses examined descriptive statistics, correlations, hierarchical regression and used analysis of covariance.

Results: The CCSP group had significant improvement in overall QOL (p<.01), health and functioning (p<.05), socioeconomic (p<.05), and psychological/ spiritual well-being (p<.01) compared to control group. Patients used the CCSP to manage psychological (51%) and sleep problems (60%).

Conclusions: CCSP improved QOL for patients at one year follow-up. CCSP has potential as a self-management program for breast cancer survivors. The study represents one of the few controlled trials of a comprehensive breast cancer intervention to empower survivors when coping with symptoms and stress. Potential areas for research include customizing CCSP for caregivers affected by high levels of stress and health disparities populations, their co-morbidities, and disabilities.