Breast Cancer & Stress

Breast Cancer Stress Release Programme

Funding this proposal will help in evaluating component parts of CREATE as a treatment plan for breast cancer patients using a chronologically structured Program of combining therapies including breathing pattern retraining (BPR), meditation (M), mindfulness-based stress reduction (MBSR), and progressive muscle relaxation training (PMRT).

General introduction

This proposed research study will provide the CREATE Programme to persons with breast cancer, and focus on stress reduction outcomes.  Relaxation / meditation techniques are widely used amongst patients with advanced breast cancer (Shen, Andersen, Albert et al 2002). There is evidence that meditation might be useful for alleviation of pain and anxiety in cancer patients (Ernst 2001),and that the use of PMRT considerably decreased the duration of nausea and vomiting (Molassiotis, Yung, Yam et al 2002). There is also evidence that relaxation training reduces treatment related symptoms, anxiety and depression (Luebbert, Dahme and Hasenbring 2001), and that mindfulness based therapy is helpful in cancer patients (Smith et al 2004).


Background

CREATE combines various therapies including therapies similar to BPR, M, MBSR, and PMRT in easy-to-use methods that can be practised at home for 40 minutes daily by listening to a CD to re-programme mental responses to stress triggers.

It has been shown anecdotally that CREATE can help reduce symptoms of cancer and associated conditions such as stress, chemotherapy side effects, nausea, pain, fear, emotions, sleep, energy levels, breathing difficulties, anxiety, and vomiting.  All these may support breast cancer management.


Research results may lead to proposals to

  • Modify CREATE specifically for breast cancer patients
  • Assess efficacy of CREATE in alleviating breast cancer symptoms
  • Assess CREATE’s efficacy in alleviating conventional treatment’s side effects
  • Demonstrate the feasibility of CREATE to these patients


Suggested study design

The study will be in two phases: pilot and research.  Phase one, the pilot phase (10 patients), would attempt to show potential positive effects for CREATE and fine-tune intervention and assessment. 

Phase two, research, may consist of 75 participants (25 in each arm).  Due to limited research in this area, a power calculation will be conducted on the results of the pilot. Patients will be randomised to either 1) intervention arm, 2) control or 3) normal care.

Patients allocated to the intervention arm will be asked to attend 2-weeks of residential or at home sessions for tuition and motivation.  After, at home, they will listen to a custom made CD of therapies they found most powerful and healing for 40 minutes daily for three months.  Personal silent timers provide practice reminders.

The control group’s ‘quiet time’ will follow the intervention arm’s timing to control for placebo. Both groups will keep a diary to measure programme compliance.  Usual care is provided alongside the programme enabling assessment of the alleviation of side effect symptomatology.

Survey instruments may include e.g. Hamilton Anxiety and Depression Rating Scales, MYMOP (Paterson & Britten, 2000), and QOL tool, EORTC QLQ-C30 (Aaronson et al 1993), to be administered at baseline, completion of intervention (3 months), and 6 months after intervention (9/12) to detect any enduring effects.


References

Benor, D. 1993. Healing Research. (4 vols.) Helix Verlag, Munich.

Ernst E. A primer of complementary and alternative medicine commonly used by cancer patients. Medical Journal of Australia. Vol. 174(2)(pp 88-92), 2001.

Luebbert K. Dahme B. Hasenbring M., The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: A meta-analytical review.  Psycho-Oncology. Vol. 10(6) (pp 490-502), 2001. M. Hasenbring, Department of Medical Psychology, Medical Faculty, Ruhr-University of Bochum, Univesitatsstr. 150/Geb. MA 0/145, D-44789 Bochum; Germany.

Molassiotis A, Yung HP, Yam BM, Chan FY, Mok TS., The effectiveness of progressive muscle relaxation training in managing chemotherapy-induced nausea and vomiting in Chinese breast cancer patients: a randomised controlled trial. Support Care Cancer. 2002 Apr;10(3):237-46. Epub 2001 Dec 18, University of Nottingham, School of Nursing, A Floor, Medical School, Queen’s Medical Centre, Nottingham, NG7 2UH, UK.

Shen J, Andersen R, Albert PS, at al. Use of complementary/ alternative therapies by women with advanced-stage breast cancer, BMC Complementary and Alternative Medicine 2002, 2:8.

Smith JE, Richardson J, Hoffman C, Pilkington K. Mindfulness-based stress reduction as supportive therapy in cancer care: a systematic review. Journal of advanced nursing care 52: 315-327, 2005.

Sweeney A., Goble M., SHADES: Study of Hyperactivity and Attention Deficit using Energy Systems, The International Journal of Healing and Caring – On Line, Vol. 6 No. 2., May 2006, 1-21.