PROJECT SUMMARY
Background. In the United States, 1 in 8 women will be diagnosed with breast cancer in their lifetime, with 1 in
39 women dying from the disease. While breast cancer is highly prevalent and can be deadly, in many cases it
is treatable. Adjuvant endocrine therapy (AET) is an effective treatment for the 80% of women with early-stage
disease who have hormone receptors expressed in their breast cancer. Although women who complete the
recommended 10-year course of AET and consistently take the medication have a significantly reduced
chance of recurrence, approximately half of women fail to complete this course of treatment. In addition to
coping with debilitating menopausal-related side effects, women with breast cancer face psychosocial barriers
that have been associated with poor AET adherence, including anxiety, depression, and poor social support.
Importantly, these are modifiable constructs that may contribute to adherence and can be targeted by
psychosocial interventions. Research Strategy. The current study aims to 1) test the long-term effects of two
brief post-surgical psychosocial interventions, cognitive behavioral therapy (CBT) and Relaxation Training
(RT), versus an attention-matched Health Education (HE) control (not focused on medication adherence), on
AET adherence at 7 years post-baseline, 2) examine psychosocial mediators of trial effects on AET
adherence, and 3) examine whether trial condition and AET adherence are related to 8-14-year recurrence-
free survival. I have a unique opportunity to take advantage of an ongoing long-term follow-up from a cohort of
women who participated in a randomized controlled trial for 5-week stress management and add measures to
assess their adherence to AET and recurrence-free survival. Significance. Our prior work has demonstrated
that CBT and RT effectively improved depressive affect, emotional well-being, and stress management skills in
the intervention groups in comparison to those receiving the HE control. Given evidence that psychological
distress relates to worse AET adherence, it is plausible that women receiving the intervention have had
improvements in their AET adherence as a downstream effect of improvements in psychological wellbeing.
This study will be the first to test whether a stress management intervention delivered post-surgery may have a
long-term impact on AET adherence. If we can facilitate AET adherence early in the disease process through
psychological intervention, we may ultimately improve long-term health outcomes. Training Plan. With
additional training and experience in statistics, psycho-oncology, and adherence science, this study will lay the
groundwork for my goal to become an independent clinical researcher. In line with the NCI’s mission of
improving survivorship and helping people live longer, healthier lives, my long-term goals are to elucidate the
behavioral processes underlying the effects of stress on cancer outcomes and to target these processes
through psychosocial interventions that are feasible in clinical oncology settings.