Promoting resilience in stress management within patients with early stage breast cancer.

Abstract

12109 Background: Women with breast cancer often experience persistent psychological distress, including fear of recurrence, which can be exacerbated in marginalized populations. Promoting Resilience In Stress Management (PRISM) is an intervention initially developed for adolescents and young adults with serious illness that builds resilience utilizing skills-based coaching, which may be able to be adapted and deployed to address psychological needs of women with breast cancer. Methods: This pilot study examined PRISM’s feasibility and preliminary effects in women with early-stage breast cancer undergoing chemotherapy. Six PRISM sessions were delivered individually by trained coaches, targeted getting to know participants, stress-management, goal setting, cognitive-reframing, meaning making, and family integration. Feasibility, the primary outcome, was defined as 70% of participants completing the PRISM intervention, baseline, and follow-up surveys. Secondary outcomes were measured using the Acceptability of Intervention Measure, Intervention Appropriateness Measure, Feasibility of Intervention Measure, PROMIS-Global Quality of Life, Post-Traumatic Growth Inventory, Connor-Davidson Resilience scale, Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being, Fear of Cancer Recurrence Inventory, Patient Health Questionnaire Depression Scale, General Anxiety Disorder–Anxiety Scale, and Patient Activation Measure. Pre- and post- results were analyzed using paired t-tests for continuous measures and McNemar’s test for categorical measures. Effect sizes were calculated using Cohen's d and Cramer’s V. Results: From February to September 2024, 30 patients participated in the PRISM intervention pilot. The study population had a median age of 51 years (IQR 47-59), were predominantly Black (57%) and unemployed at the start of the study (37%). Two patients died, two withdrew, and one patient was lost to follow-up, resulting in a completion rate of 83%, meeting the primary feasibility endpoint. Patients reported that the sessions were acceptable (mean 4.6 [SD 0.7]), appropriate (mean 4.5 [SD 0.9]), and feasible (mean 4.6 [SD 0.4]).The largest effect was observed in participants’ resilience (mean 4-point increase; d = 0.6). There was also a mean 14-point increase of patient growth and self-improvement (d = 0.5). Modest effect sizes were observed for improvements in overall spiritual well-being and reductions in fear of cancer recurrence (both d = 0.4). Small effects were observed for depression, anxiety symptoms, patient activation, global health, physical health, and mental health (d = range 0.1 to 0.2). Conclusions: The PRISM intervention was feasible amongst a diverse group of women with early-stage breast cancer and effect sizes suggest potential benefit, warranting further investigation in a future randomized control trial. Clinical trial information: NCT06133348 .