Short-term and long-term intervention effects on distress, cognitive functioning, and inflammation in older women with breast cancer - PROJECT SUMMARY Background and Significance. An estimated 75% of women diagnosed with breast cancer (BCa) who receive treatment experience cancer-related cognitive impairment (CRCI)1,2. Further, the presence of CRCI in the subsequent months or years after treatment remains present in up to 35% of these women2. One important modifiable factor, psychological distress, has been shown to be associated with CRCI in women with BCa2,5, and dysregulation in immune functioning (e.g., inflammation) has similarly been linked to CRCI in this population2,18, however, the mechanisms involved are still not well understood6. Given that the majority of women diagnosed with BCa transition into survivorship22, it is imperative to understand how BCa exacerbates cognitive decline for older women, particularly in the context of normal aging. Previous research has examined interventions, such as cognitive behavioral therapy (CBT)8,9 and relaxation training10,11 for improving cognitive functioning, but none have tested the effectiveness of an intervention that encompasses both of these elements. Cognitive-behavioral stress management (CBSM) is an empirically validated 10-week group-based intervention that blends CBT and relaxation training and has been shown to be efficacious in reducing distress (e.g., decreased negative affect, depression, and anxiety)12,13 and pro-inflammatory markers14, and in improving QoL13,15 among women with BCa. This work has evolved to the development and testing of remotely-delivered (R-CBSM) interventions, which have been shown to be feasible and acceptable in this population. Research Strategy. The proposed study aims to 1) assess the efficacy of the R-CBSM intervention on subjective cognitive functioning in older women with BCa, 2) examine specific mediators (e.g., inflammation and distress) of R-CBSM intervention effects on cognitive functioning, 3) examine the mediating effects of perceived stress management skills (PSMS) on distress and inflammation, and 4) associate the effects of the R-CBSM intervention-related changes in distress and inflammation with longer-term (36-72 months) subjective and objective cognitive functioning. Training Plan. Expanding my knowledge base and competencies in areas including quantitative analytic skills, psycho-oncology, aging, and cognitive functioning in cancer populations, in addition to enhancing professional development and research dissemination skills (including presentations and publications), will help me achieve my long-term goal to become an independent researcher in the field of health psychology. Overall, I aspire to explore the underlying mechanisms of patient distress to better inform, develop, and implement scalable interventions for improving biopsychosocial health outcomes (e.g., cognitive functioning) for patients with cancer and other chronic conditions.
