Interventions for breast cancer patients show benefits based on women’s stress levels

Jun 2 2016

Is a couples' support group or an enhanced couples' group therapy intervention with skill instruction more effective for helping women diagnosed with early stage breast cancer? According to research from an investigator at Rutgers Cancer Institute of New Jersey and colleagues from other facilities across the country, neither intervention is more dominant, but each has its own benefits depending on the stress level of the patient. Rutgers Cancer Institute Associate Director for Cancer Prevention, Control and Population Science Sharon Manne, PhD, who is also a professor of medicine at Rutgers Robert Wood Johnson Medical School, is the lead author of the work published in the June online issue of Journal of Consulting and Clinical Psychology. She shares more about the work.

Q: Why is this topic important to explore?
A: Women diagnosed with early-stage breast cancer may have numerous emotional concerns including making medical treatment decisions and managing post-surgical recovery and treatment side effects such as nausea, hair loss, and weight gain. Patients may experience distress related to cancer's impact on daily life (career, social life, household/family responsibilities, and relationships). One way women manage this stressful experience is to turn to a spouse or significant other for emotional and practical support. Because of the importance of the marital relationship in a couples' adjustment to this life-changing experience, a number of couple-focused interventions have been developed and evaluated. Previous work from our team evaluated a six-session, couple-focused group intervention for this population which targeted relationship communication and coping skills using skill-based instruction. Results from our earlier research showed lower depressive symptoms at the six-month follow up for participants. In this new study, we wanted to compare this method to traditional support group therapy in which couples attend the group session together and both receive emotional support and validation from group members.

Q: How was this latest study structured?
A: Participants were 302 women with early stage breast cancer and their significant others (including two female spouses), who were recruited from the outpatient clinics of oncologists practicing in three comprehensive cancer centers in the Northeastern United States, as well as community hospital oncology practices. Patients had to be at least 18 years old and had to have a primary diagnosis of early stage breast cancer within the last 12 months but could be active in treatment. Of the 302 couples, half were assigned to the traditional support group therapy sessions, which were each 90 minutes long and encouraged participants to express their emotions and share their experiences about their cancer journey. The other half was assigned to the couple-focused, enhanced skill-based intervention, which focused on constructive communication skills, learning how to cope with cancer-related emotions as a couple, problem solving as a couple, handling changes in intimacy as a result of cancer, and managing survivorship changes and concerns. Participants were asked to practice these skills during the sessions and at home. Most couples attended at least six of the eight sessions. Participants were asked to fill out a survey prior to taking part in the interventions, upon conclusion of the group sessions, and six months and 12 months post-group.

Q: What did you and your colleagues learn?
A: We found that depression, anxiety and cancer distress declined and well-being improved for couples enrolled in both interventions - that is, neither treatment was superior to the other. Each group intervention was more effective for patients depending on their personal and relationship characteristics. For instance, those patients who reported high levels of cancer-related stress prior to starting the intervention experienced less anxiety and depression and better well-being at the one-year follow up if they were part of the traditional couples' support group. Conversely, when cancer-related stress was low prior to taking part in the sessions, participants in the couple-focused, enhanced skill-based couples' group intervention reported lower anxiety and depression and better well-being one year following the intervention.

Q: What is the implication of these findings?
A: Women who experience more distress may benefit more from the traditional couples' group therapy, whereas women with less distress may benefit from the enhanced skill-based couples group intervention. Our research shows that all couples handle the cancer experience differently, thus it is important to target different types of group therapy to patients and partners with different levels of stress.

Q: What about future studies or applications?
A: The make-up of our sample was primarily Caucasian, relatively well-educated and primarily heterosexual couples. Future studies may want to focus on different, less-educated, and more racially-diverse samples. Because patients were women and the majority of spouses were men, future research should examine treatment effects for these couple-focused group interventions among a patient population that is comprised of mixed sex (for example: colon cancer, where patients would be both women and men).