Funded by the NCI: R44 CA106154

Transcription

1 Kelly Carpenter, PhD, Talaria, Inc. Bonnie McGregor, PhD, Fred Hutchison Cancer Research Center KrisAnn Schmitz, MSW, Talaria, Inc. Ardith Doorenbos, PhD, University of Washington School of Nursing Seattle, WA Funded by the NCI: R44 CA106154

2 Mild Distress Diagnosable Psychological Disorders

3 10 to 16 week group interventions Includes: CBT-based cognitive skills training Relaxation and meditation practice Emotional expression Social support Communication skills training Motivational enhancement for treatment adherence

4 CBSM for breast cancer patients is effective DECREASES Anxiety/depression Intrusive thoughts Cancer-related stress INCREASES Positive adjustment Personal growth Perceived social support Treatment adherence Immune functioning

5 CBSM interventions are not widely available Primarily offered in large urban areas Participation is difficult, especially for women with multiple demands on their time Often not covered by insurance

6 Internet interventions can be: Self-administered/self-paced Convenient and private Lower cost Easily distributed and revised As effective as face-to-face

7 10 week intervention Content similar to existing CBSM interventions Addition of journaling and a discussion group Interactive CBT exercises MP3s of guided relaxation and meditation exercises Video-based narration and patient stories

8 123 women with early stage breast cancer Screened for distress Randomly assigned to the 10- week intervention or to a wait-list control Assessed at baseline, 11 weeks and 22 weeks Outcomes include depression, anxiety, quality of life, benefit finding, negative mood regulation and self-efficacy for coping with cancer

9 Women were recruited via Army of Women blast Participants screened by phone Online consent and questionnaire data collected online Bi-weekly phone check-ins for both groups (collected distress ratings) Weekly check-in forms for intervention group (collected sleep and stress ratings) Follow-up phone interview and debriefing

10 Inclusion Criteria: Diagnosis of stage 0, I, II or III breast cancer within 18 mos. Rating of 5 or higher on the Distress Thermometer OR 6 or higher on the 4-item Perceived Stress Scale OR 7 or higher on the Mini POMS. Access to a computer with internet connection, telephone and account. Exclusion Criteria: Cancer recurrence. Schizophrenia or use of anti psychotic meds. Bipolar disorder without use of mood stabilizing medication.

11 N =123 Age: M = SD = 9.84, Range: 28 to 73 69% Married 8% Hispanic 88% White, 7.5% African American, 7% other 90% had at least some college.

12 Age at diagnosis 50.3 (9.7) Months since diagnosis 8.5 (4.9) Stage (%) I 37.9 II 32.6 III 10.6 Had chemotherapy 59% Had radiation therapy 64%

13

14 F(3,112) = 2.38, p <.05 * *controlling for ever diagnosed w/ depression

15 F(3,111) = 4.69, p <.05 * *controlling for stage, ever diagnosed w/ depression

16 F(3,110), p =.02* * Controlling ever diagnosed w/ depression

17 F(2,113) = 3.62, p =.06 *CESD, GAD7, POMS neg affect mean Z scores

18 F(2,110) = 5.04, p <.05

19 F(3,15) = 12.16, p =.001 * *controlling for ever diagnosed w/ depression

20 F(5,109) = 4.30, p =.04 * *controlling for age, age at dx, educ

21 Intervention participants reported significantly improved: Anxiety Depression Mental confusion Self-efficacy for coping with cancer Self-efficacy for negative mood regulation No difference in health-related quality of life (FACT-B). Intervention received high satisfaction and acceptance ratings. The discussion board was under-utilized

22 Directly compare the online intervention to the face-to-face CBSM group. Young Survivors Stress Management project Dissemination Challenges for a demo: kcarpenter@talariainc.com

23 Mike Antoni, PhD, University of Miami Barbara Andersen, PhD, Ohio State Robin Adler, MSW, Private Practice, Seattle, WA John Wynn, MD, Swedish Medical Center Elana Rosenbaum, LICSW, UMass Medical School Leah Wilcox, MPH, Army of Women Talaria, Inc. s graphics and multimedia team All of our participants who patiently answered hundreds of questions without complaint.