Long-Term Effect of a Nonrandomized Psychosocial Mindfulness-Based Intervention in Hispanic/Latina Breast Cancer Survivors

Background: There is a paucity of research on the long-term impact of stress-reduction in Hispanic/Latina breast cancer (BC) survivors, a growing minority. In this article, we assess the long-term efficacy of an 8-week training program in mindfulness-based stress reduction (MBSR) on quality of life (QoL) in Hispanic BC survivors. Methods: Hispanic BC survivors, within the first 5 years of diagnosis, stages I to III BC, were recruited. Participants were enrolled in bilingual, 8-week intensive group training in MBSR and were asked to practice a- home, daily. They were also provided with audio recordings and a book on mindfulness practices. Patient-reported outcomes for QoL and distress were evaluated at baseline, and every 3 months, for 24 months. Results: Thirty-three self-identified Hispanic women with BC completed the MBSR program and were followed at 24 months. Statistically significant reduction was noted for the Generalized Anxiety Disorder measure (mean change −2.39, P=0.04); and Patient Health Questionnaire (mean change −2.27, P=0.04), at 24 months, compared with baseline. Improvement was noted in the Short-Form 36 Health-related QoL Mental Component Summary with an increase of 4.07 (95% confidence interval = 0.48-7.66, P=0.03). However, there was no significant change in the Physical Component Summary. Conclusions: Hispanic BC survivors who participated in an 8-week MBSR–based survivorship program reported persistent benefits with reduced anxiety, depression, and improved mental health QoL over 24 months of follow-up. Stress reduction programs are beneficial and can be implemented as part of a comprehensive survivorship care in BC patients.

A survivorship program to improve quality of life of Hispanic/Latino breast cancer (BC) survivors

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Background: We sought to determine whether Hispanic BC survivors in El Paso, TX would benefit from participating in a comprehensive multidisciplinary cancer survivorship program, by improvement of performance using the validated questionnaires: 1) Patient Health Questionnaire 9(PHQ9), 2) General Anxiety Disorder 7 (GAD 7), and SF36 Health related quality of life (HRQOL) questionnaires. Methods: After IRB approval, we recruited consecutive patients within the first 5 years post-diagnosis with Stages I-III BC and have completed active therapy. The program was staffed by an oncologist, a nurse practitioner, a nutritionist and a clinical psychologist. Survivors were seen every 3 months and questionnaires obtained. They were provided with a personalized treatment summary, dietary advices, in-depth one on one psychological assessment and interventions and an 8 week course based on Mindfulness Based Stress Reduction (MBSR). Results: 94 patients were recruited, 60 completed 12 months follow ups, and 33 completed 2 years follow ups. 91% were Hispanics. Mean age 55 years. 31% of participants were younger than 50 years. Stage 1 BC 38%, Stage 2 43% and stage 3 19%.75% received chemotherapy; and 74% received endocrine therapy. At baseline, PSC representing the mean for the SF-36 QOL Physical Health was 45.75, and the MSC for Mental Health was 43.7, both below the population norm (50.0). Mean scores for GAD7 was 7.3 and for PHQ9 7.62, both abnormal (< 5). At 12 months PSC 46.02, MSC 46.1, GAD7 was 4.92; and PHQ9 was 5. At 24 months, PSC 45.65; MSC 47.02; GAD7 4.88; and PHQ9 4.52. Patients older than 50 years who attended the MBSR courses showed the most improvement in MSC and PHQ scores. Conclusions: BC survivors, predominantly Hispanics, benefited from participating in this program with improved mental SF36- HRQOL, a significant and long - lasting improvement in anxiety and depression at 12months and 24 months. Future efforts should focus on programs targeting younger cancer survivors who did not appear to derive a significant benefit overall. Also, additional efforts are needed to address physical -health related quality of life in cancer survivorship programs by introducing, as an example, exercise and pain control interventions.

Abstract P1-09-14: Improved outcome of breast cancer survivors participating in a multidisciplinary cancer survivorship program at Texas Tech University Health Sciences in El Paso, TX

Introduction: Breast Cancer (BC) survivors in El Paso, TX include a majority of Hispanics. We have previously reported that these survivors have decreased mental and physical health related Quality of Life (QOL). We sought to determine whether BC survivors would benefit from participating in a comprehensive multidisciplinary BC Survivorship Program at the Garbar Breast Care Center (GBCC), as determined by improvement of performance on the following validated questionnaires: 1) Patient Health Questionnaire 9(PHQ9), 2) General Anxiety Disorder 7 (GAD 7), and SF36 QOL questionnaires. Methods: After IRB approval, we recruited consecutive patients at our institution over 6 months starting October, 2013, and who are within the first 5 years post-diagnosis with Stages I-III BC and have completed surgery, chemotherapy and/or radiation therapy. Survivors were enrolled in the survivorship program staffed by an oncologist, a nurse practitioner, a nutritionist and a clinical psychologist. They participate in individual as well as group sessions. Survivors are initially screened for depression and generalized anxiety disorder using PHQ9 and GAD 7, in addition to assessing the patient’s QOL at baseline, and every 3 months. Survivors are provided with a personalized summary of all received treatment and follow up care plans; dietary counselling and individual meal plans, in addition to in-depth psychological assessment and an intervention using Mindfulness Based Stress Reduction. Results: 47 patients have been recruited so far and all but one completed baseline questionnaires;17 and 7 respectively had 3 and 6 months follow up visits. 94% were Hispanics. Mean age 54 years. 38% of participants were younger than 50 years of age; Stage 1 BC (36%), Stage 2 (36%), and stage 3 (28%) . 80% received chemotherapy ; and 68% had hormone receptor positive BC and received endocrine therapy. The scores at baseline were : PCS representing the mean for the SF-36 QOL Physical Health was 46.0, and the MCS for Mental Health was 44.0, both below the population norm (50.0). Mean scores for GAD 7 was 7.54 and for PHQ 9 7.33, both abnormal (&lt;5 on PHQ9 and GAD 7 are considered normal scores). At 3 months the scores were as follows: PCS 49.71, MCS 45.34, both improved (the higher the better); GAD7 5.18; and PHQ9 6.82 (both improved, the lower the better). At 6 months, same favorable trend continues: PCS 50.07 [SD 5.54, 44.29-53.35]; MCS 49.66 [SD 7.73, 38.93-62.41]; GAD7 5.00 (SD 3.70); and PHQ9 4.57 (SD 3.64).

Conclusion: BC survivors are benefiting from participating in the new BC Survivorship Program launched at Texas Tech in El Paso, TX. They have experienced improved mental and physical health related QOL, improved anxiety and depression by GAD7, and PHQ9, with scores reaching near normal values at 6 months into the program which continues to enroll BC survivors. This program represents a culturally appropriate model for Hispanic BC survivors. It is expected to continue to improve the quality of life of these patients, empower them in their transition from cancer treatment to survivorship and lead to improved psychosocial adjustment and normal social functioning with significant implication not only on survivors, but also on their families and the community.

Citation Format: Zeina Nahleh, Rebecca Pasillas, Alok Dwivedi, Azadeh Nasrazadani, Rosalinda Heydarian, Luis Sanchez, Indika Mallawaarachchi, Cecilia Ochoa, Edward Saltzstein. Improved outcome of breast cancer survivors participating in a multidisciplinary cancer survivorship program at Texas Tech University Health Sciences in El Paso, TX [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-14.