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Distress during the transition from treatment to survivorship and its impact on response to new symptoms
Improved methods of early detection and treatment of breast cancer have led to rising numbers of women surviving and living with the disease for longer periods of time. The special needs of this population have been the focus of considerable research, but little has been done to examine the transition from treatment to life as a survivor. Although the completion of treatment is a welcome milestone for patients, this transition may represent an especially challenging period. Crisis theory posits that the completion of treatment can shatter the tentative equilibrium that patients re-establish during treatment. This is because the completion of treatment entails a loss of the reassurance of monitoring for symptoms of recurrence by health care providers due to the reduced frequency of visits and the loss of the “safety net” of treatment fighting the cancer. Thus, the first goal of the proposed research is a detailed examination of patients’ experience and distress during the transition from treatment to survivorship. This examination will include a special focus on the most pressing concern of breast cancer survivors: fear of recurrence. According to the Self-Regulation Model, this fear during the transition phase, when patients assume responsibility for self-monitoring for symptoms, will make patients more likely to interpret new ambiguous symptoms (e.g., headache) as a recurrence and to utilize strategies to reduce the perceived threat (e.g., complementary and alternative medicine (CAM), screening tests). The second goal of the proposed research is to test these predictions of the Self-Regulation Model. Early stage breast cancer patients at multiple hospitals in the Dana-Farber/Partners CancerCare system will complete an extensive survey during treatment, at the end of treatment and 3 and 6 months post-treatment to examine the time course, prevalence, severity and determinants of their distress. Monthly phone interviews will assess fear of recurrence, interpretation of new symptoms, new CAM use and health care utilization. The results of this research will determine whether psychological interventions are needed to aid patients during this transition period, the issues that ought to be targeted by such interventions, and will facilitate the identification of “at-risk” patients. These interventions can reduce the significant distress that patients experience and potentially their use of unnecessary and costly CAM and health care services as well.
With the increasing number of breast cancer survivors in the U.S., the need for efforts to understand and address the issues that they face has never been so great. The completion of treatment is a welcome milestone for patients, but preliminary evidence and anecdotes indicate that it also represents a very difficult period emotionally. This is because the completion of treatment entails a loss of the reassurance of monitoring for symptoms of recurrence by health care providers due to the reduced frequency of visits and the loss of the “safety net” of treatment fighting the cancer. However, the emotional challenge of this transition period and its potential consequences have been underappreciated by the medical community and understudied by researchers. Thus, the first goal of the proposed research is to conduct an in-depth examination of patients’ experience and distress during this transition period. This examination also requires a special focus on the greatest concern of breast cancer patients following treatment: fear of recurrence. Psychological theory indicates that this fear can lead patients – who are now responsible for self-monitoring for symptoms of recurrence – to interpret new, ambiguous symptoms (e.g., headache) as an indication of recurrence. If every new headache, period of fatigue or ache and pain is interpreted as a recurrence, patients may be experiencing frequent, significant distress and may utilize unnecessary, risky health care services (e.g., unnecessary biopsies, complementary and alternative therapies) for reassurance that their cancer has not returned or will not return. Therefore, the second goal of this research is to examine the impact of patients’ fear of recurrence during this transition period on their response to new, ambiguous symptoms. These goals will be explored in early stage breast cancer patients in the Dana-Farber/Partners CancerCare system during their transition from treatment to survivorship. Patients will complete surveys and phone interviews from treatment until several months post-treatment. The results of this study will fill a critical gap in knowledge about breast cancer survivors and will inform the need for psychological interventions to assist patients during this time in the course of their disease. Such interventions would more directly and safely address patients’ distress than would their use of CAM therapies or health care services, which may which carry risks.