Nuevo Amanecer: Results of a Randomized Controlled Trial of a Community-Based, Peer-Delivered Stress Management Intervention to Improve Quality of Life in Latinas With Breast Cancer

摘要

Objectives. We evaluated a community-based, translational stress management program to improve health-related quality of life in Spanish-speaking Latinas with breast cancer. Methods. We adapted a cognitive–behavioral stress management program integrating evidence-based and community best practices to address the needs of Latinas with breast cancer. Spanish-speaking Latinas with breast cancer were randomly assigned to an intervention or usual-care control group. Trained peers delivered the 8-week intervention between February 2011 and February 2014. Primary outcomes were breast cancer–specific quality of life and distress, and general symptoms of distress. Results. Of 151 participants, 95% were retained at 6 months (between May 2011 and May 2014). Improvements in quality of life from baseline to 6 months were greater for the intervention than the control group on physical well-being, emotional well-being, breast cancer concerns, and overall quality of life. Decreases from baseline to 6 months were greater for the intervention group on depression and somatization. Conclusions. Results suggest that translation of evidence-based programs can reduce psychosocial health disparities in Latinas with breast cancer. Integration of this program into community-based organizations enhances its dissemination potential. Latinos are the fastest growing US racial/ethnic group. With a population growth rate 4 times that of the total US population (24.3% vs 6.1%), they accounted for half of the nation’s growth between 2000 and 2006. 1 Breast cancer is the most frequently occurring cancer and leading cause of cancer death among Latinas. 2 Latinas experience worse breast-cancer-recurrence-free survival than White women. 3 Latinas are at higher risk for psychosocial and physical sequelae of breast cancer than White women and report higher rates of anxiety, depression, fear of recurrence, fatigue, and pain and worse health-related quality of life (HRQOL). 4–9 Limited English proficiency, employment, and insurance coverage; lack of transportation; and problems paying for treatment increase their risk of distress. 6 Anxiety among Spanish-speaking patients is common because they often do not understand the diagnosis or treatment and are less involved in patient-centered decision-making. 10 These factors can chronically elevate stress levels among Latinas after breast cancer. In fact, disparities in HRQOL between Latinas and non-Latinas with breast cancer have been partially explained by higher stress levels. 5 Higher levels of chronic stress and fatigue can cause hypothalamic–pituitary–adrenal axis dysregulation and inflammatory responses. 3,11,12 Among breast cancer survivors, stress management interventions improve HRQOL, including increased positive affect and lifestyle changes; decreased anxiety, stress, emotional distress, and thought intrusion 13–18 ; and improved sleep quality. 14,19 These interventions may also produce beneficial changes in biomarkers of the hypothalamic–pituitary–adrenal axis 14 and immune functioning. 18 However, such studies are lacking among Latinas with breast cancer. Translation of evidence-based stress management interventions could help address this gap and reduce ethnic disparities in psychosocial health of Latinas with breast cancer. We present results of a randomized controlled trial of a peer-delivered cognitive–behavioral stress management (CBSM) program called Nuevo Amanecer (“a new dawn”) for Spanish-speaking Latinas with breast cancer. The program was developed using community-based participatory research methods for translating evidence-based interventions for underserved populations 20 through a collaboration between the University of California, San Francisco; Círculo de Vida Cancer Support and Resource Center; and a coalition of community-based organizations and clinical partners. 21,22.