Incorporating Stress Interventions Into Breast Cancer Management
Debi Fischer, MSW, BSN, BA, LCSW, RN
Debi Fischer is a nurse at the University of Miami surgical oncology step down unit. Prior to that she worked in orthopedics and neurology for many years. In addition to her nursing experience, she has earned a master’s degree in social work. Becoming a Licensed Clinical Social Worker was a lon-sought-after goal which she finally attained. She is a caregiver for her family and her dogs as well.
An 11-year study showed that patients with nonmetastatic breast cancer who learned to manage their stress with cognitive behavioral interventions had less depression and a better quality of life.
I recently attended the 35th Annual Florida Society of Oncology Social Workers (FSOSW) Conference in Miami, Florida. I sat in on the plenary speaker event given by Michael H. Antoni, PhD, a professor of psychiatry and behavioral science at the University of Miami, where he gave an overview of research on stress management and relaxation in relation to patients with breast cancer. He described a randomized-controlled trial—published in Breast Cancer Research and Treatment—designed to evaluate cognitive-behavioral stress management (CBSM) in breast cancer and its effect on survival and recurrence at 11-year follow-up.1
In the study, 240 women with nonmetastatic breast cancer were randomized to either a 10-week, group-based CBSM intervention or a 1-day psychoeducational seminar control. Relaxation techniques, altering negative thinking, and ways to deal with stress were incorporated into the CBSM intervention. This study showed that over a period of 11 years, the participants had less depression and a better quality of life.
Although this conference was geared toward oncology social workers, the takeaway message from Antoni’s lecture for me as an RN and LCSW was that the body’s response to stress can have an effect on the patient from a physiological and cognitive standpoint. Specifically, he explained that stress affects cortisol levels. Our response to stressors in our lives can cause cancer to metastasize. When used to decrease stress levels, CBSM can decrease the patient’s cortisol level, which was the modality used by Antoni in the fight against breast cancer. Helping manage stress is therefore crucial for people who are newly diagnosed with breast cancer as well as those in remission.
Another key point that Antoni explained was that reducing depression also had an impact on long-term survival rates in patients with breast cancer who were alive 8 to 15 years after their diagnosis. He stressed that implementing stress reduction techniques early on can influence the progression of this killer disease. Even a short course of CBSM over a 5-week span can impact this disease.
Antoni’s presentation underscored the importance of creatively attacking breast cancer with non-traditional modalities. His research really delivered a very understandable and cogent argument about the value of social workers in the delivery of CBSM in the fight against breast cancer at any stage of the disease. Oncology nurses caring can certainly learn from this research, and be sure to incorporate discussions about stress management with their patients.
- Stagl JM, Lechner SC, Carver CS, et al. A randomized controlled trial of cognitive-behavioral stress management in breast cancer: survival and recurrence at 11-year follow-up. Breast Cancer Res Treat. 2015;154:319. doi: 10.1007/s10549-015-3626-6.