Although considerable research attention has addressed the psychosocial concerns of breast cancer patients, little is known about the transition from active treatment to survivorship. Clinical experience and limited data suggest that this period can be particularly stressful. In this competing continuation, the investigators propose to develop and evaluate a relatively low-cost psycho-educational preparatory intervention to facilitate this transition. The proposed study builds on their prior research program in quality of life and breast cancer. In this multi-center study, the investigators will register 1260 newly-diagnosed breast cancer patients from Los Angeles, Washington, D.C., and Kansas City, Kansas, one month after definitive surgery, and prospectively recruit them for participation in a randomized controlled trial (RCT) designed to test and evaluate three different intervention approaches for improving post-treatment patient outcomes. The interventions will occur after the completion of primary/adjuvant therapy. They expect to consent and randomize at least 630 women to one of 3 groups: (A) CONTROL CONDITION: standard written information (NCI publication """"""""Facing Forward""""""""); (B) MINIMAL INTERVENTION: control + videotape that models coping and addresses the transition from patient to survivor; and HIGH INTENSITY INTERVENTION: minimal intervention + brief counseling (one in-person session with follow-up telephone call) + additional written materials. They hypothesize that a brief, preparatory intervention that includes counseling will be the most effective strategy for improving quality of life during the transition for patient to survivor.
The specific aims of this application are: (1) to measure the impact of the three preparatory interventions on subsequent cognitive adaptation, and emotional, physical and interpersonal functioning, 2 and 6 months after the intervention; (2) to evaluate a model derived from self-regulation and stress and coping theories which postulates that promotion of realistic expectancies regarding the treatment transition and of specific approach-oriented coping strategies will serve as mediators of the intervention's effectiveness on adaptive outcomes; (3) to conduct an economic evaluation of the RCT strategies, and to calculate the incremental costs per unit change in specific dimensions of quality of life.
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