Jamie Stagl worries that women with breast cancer don’t get enough help coping with their diagnosis. Cancer upends a woman’s daily routine, her sense of her body, her vision of the future. There’s almost nothing more stressful.
So Stagl, now a clinical fellow at Massachusetts General Hospital, helped study a University of Miami program that taught 240 breast-cancer patients relaxation techniques and coping strategies.
The program worked. The women who took the 10-week stress-management class shortly after surgery reported feeling better and having fewer depressive symptoms such as anxiety than those who took a one-day, breast-cancer education session.
The women felt better one year after the course, five years later, and — according to a new study published last month in the journal Cancer — an average of 11 years later. (Stagl and her colleagues tracked down 100 of the original participants; another 30 had died; and 110 couldn’t be found or didn’t want to participate.)
The positive results surprised even Stagl. “It’s quite amazing,” she said.
Stagl doesn’t know whether the women are still using the techniques they were taught — which include mindfulness, deep breathing, visual imagery, cognitive behavioral therapy, and learning how to ask for help from friends and family. But the study suggests that they have internalized the strategies.
Women may be particularly receptive to these approaches when they’re coping with a cancer diagnosis, said Laura S. Porter, an associate professor at Duke University Medical Center. “This is really a teachable moment.”
The skills taught in the course are useful at many stressful moments, Porter said, not just when cancer is diagnosed. But most people aren’t explicitly trained how to cope with stressful events.
“These are really good life skills,” Porter said. “While I certainly wouldn’t say that anyone could take a 10-week course and be set for life, I think anyone could take a 10-week course and be much better at coping with stress.”
Next, the study team, led by Michael Antoni of the University of Miami, hopes to show that an easier-to-manage five-week group class works as well as the 10-week one.
And researchers want to know whether relaxation actually reduces the recurrence of breast cancer. It makes biological sense, Stagl said. Stress drives up levels of the hormone cortisol, which is known to weaken the immune system. If a woman’s stress level remains high indefinitely after diagnosis, she may have a worse outcome than if she can bring it back down, Stagl said.
The story discusses a recent paper in the journal Cancer, which states that patients who participated in a 10-week stress management group after treatment for breast cancer reported a higher quality of life eight to 15 years later. The story emphasizes the positive impact that stress management training can have on the long-term physical and emotional well-being of breast cancer survivors. However, the story could have done more to highlight the limitations of the study and to consider the cost and feasibility of the group program.
According to the CDC, breast cancer is the most common form of cancer among women in the United States, with more than 220,000 women diagnosed in 2011 alone. More women are survivors of breast cancer than of any other cancer. And studies show that breast cancer survivors have higher rates of depression than the general public — with a 2005 U.K. study reporting that 15 percent of survivors have depression five years after treatment. The fact that breast cancer is so common, and that depression can have a significant impact on the quality of life of breast cancer survivors, means that a better understanding of how to mitigate depression in breast cancer survivors is an important issue.
The story does not address costs at all. It is not clear whether the type of group-based cognitive-behavioral stress management program discussed in the study is free for most patients, whether it is likely to be covered by insurance, or whether it would require a significant out-of-pocket expense for breast cancer patients.
The story says that patients who participated in the group therapy sessions after treatment reported “feeling better and having fewer depressive symptoms such as anxiety.” However, it doesn’t quantify these results. The story doesn’t tell us how much better the study participants felt and whether that improvement represents a meaningful difference.
The story doesn’t discuss possible harms associated with participating in this stress management program, although the harms are likely to be minimal. In theory, the program could have heightened anxiety about the breast cancer diagnosis by focusing on it frequently over the 10 weeks of the group. We’ll rate this Not Applicable.
The study could have done more to explain the strengths and limitations of this study. The original study that was conducted 11 years ago was a randomized controlled trial, the most reliable form of scientific evidence. But this follow-up study included only 42 percent of the original participants, and as the study authors point out in the paper, “the fact that women who participated in the follow-up were older and reported fewer depressive symptoms and greater well-being at the time of diagnosis than women who did not participate should be considered when these findings are generalized to all breast cancer survivors.” In other words, unlike the original randomized study, which theoretically had a balanced mix of confounding factors in both the treatment and control groups, this follow-up study was susceptible to a self-reporting bias, where patients experiencing depressive symptoms or lower quality of life may have chosen not to participate. That’s an important limitation, and the story would have been better if it had mentioned it.
Breast cancer is all too common, and has a profound impact on patients and their loved ones. The story does not overstate how traumatic the experience can be. However, the story would have been better if it had avoided the hyperbole in the lead that “there’s almost nothing more stressful.” Comparing the difficulties associated with a breast cancer diagnosis to any number of other, awful life events adds little to the story.
The story includes quotes from at least one independent source and clearly identifies quotes from researchers associated with the recent study.
The story discusses stress management in broad terms, referring to it as teaching patients “relaxation techniques and coping strategies.” It does not discuss other possible treatment options for dealing with stress or depression following serious illness, such as professional counseling or medications.
Many breast cancer treatment providers can offer patients information about programs to help patients deal with stress, anxiety, and other depressive symptoms associated with a cancer diagnosis. However, the story does not make clear how widely available such programs are, and how much existing programs resemble the study intervention.
The story notes that the recent study is a follow-up to a previous study on depressive symptoms among breast cancer survivors. But it doesn’t put the research into any larger context. Long-term studies of women’s quality of life — not just survival — 10 or more years after a breast cancer diagnosis are relatively few. The story could have emphasized more the value of the study in contributing to what is known.
The reporter went beyond the material in the news release.