Innovative Care: Meeting a Woman's Needs
The method by which research results are communicated and breast cancer therapies are delivered can dictate how sucessful they are. Innovative models of care research projects are finding the best ways to deliver the most advanced treatments to all women, but particularly to those who are often left out of the mainstream health care system.
Research Conclusions
A project (Group Intervention for Women at High Risk for Breast Cancer) undertaken by David K. Wellisch, Ph.D. at the University of California, Los Angeles was an IDEA grant designed to test the feasibility of a new group model (combining aspects of the educational/cognitive behavior and of the dynamic, social support models) for interventionof women at high risk for breast cancer. He concluded that the basic group model appears feasible to implement with this population with some limitations. The model appears feasible to teach basic nutritional concepts and to reduce some psychological symptoms such as feelings of depression and current anxiety. Some modes of coping can be increased, but the enhancement of venting of emotions appears to require a longer group experience with more total sessions. Grief resolution, a critical issue for this population, appears to also require more group sessions to successfully occur in some key areas. The model appears unfeasible as presently designed to effectively facilitate teaching of appropriate personal risk assessment. With a more intensive, longer group intervention, the majority of the project goals appear feasible, with a substantial reduction in emotional suffering and an increased ability to cope with high risk status possible for this population.
Research in Progress
Dr. Karyn L. Angell, with a Postdoctoral Fellowship Award at Stanford University, is investigating the role of social stress and social support on a woman's delay in seeking treatment for symptoms of breast cancer. Thus far, 25 women have been interviewed and efforts are underway to recruit Latina and Asian women. The results of this study will assist health care workers in identifying and assisting women who are at risk of delaying seeking health care for symptoms of breast cancer.
In another study entitled Determinants of Breast-Conserving Surgery and Survival, Dr. Cyllene R. Morris at California Public Health Foundation is seeking to determine the reasons for the apparent underutilization of breast-conserving surgery in California. Breast-conserving surgery (i.e., lumpectomy as opposed to mastectomy)with radiation therapy is an equally effective alternative to mastectomy, and was recommended for most women with stage I or II breast cancer by the 1990 National Institutes of Health Consensus Conference. Nevertheless, fewer than 50% of women who are eligible receive breast-conserving surgery in California, even though mastectomies may have profound emotional consequences and do not improve survival rates in women with small tumors. Preliminary findings show that there is a clear trend towards the use of breast-conserving surgery in California. In 1988, breast-conserving surgery was performed in only 31% of women with early stage breast cancer, compared to 54% of women in 1994. The data are also indicating that, in general, women living in poorly educated or in low income neighborhoods are significantly less likely to receive breast-conserving surgery. Further data collection and analysis are underway.
Dr. Janine E. Giese-Davis is receiving postdoctoral training with Dr. David Spiegel at Stanford University. In her project entitled Does change in emotional expression mediate breast cancer survival?, she is trying to determine the specific therapeutic component linking participation in supportive/expressive group therapy to observed differences in disease progression in women with metastatic breast cancer. Past research with supportive/expressive group therapy has shown that survival was extended in metastatic breast cancer patients by 18 months, doubling the survival time of a matched control group (Spiegel et al, 1989). In this project, each woman's emotional expression and talk-time are being coded from videotape as they participate over time in a supportive/expressive intervention for metastatic breast cancer. These measures are being related to survival, physiological, and psychological functioning. The results will help us understand the elements of psychological therapy that can impact a woman's survival with breast cancer.
Recently Initiated Research
In 1997, three new grants were awarded to study innovative methods to deliver care to women with, or at risk for, breast cancer. Two studies focus on developing and delivering interventions to provide critical psychosocial and educational support to groups of women who have difficulty accessing such services rural women and low-income women. A third study is comparing two different ways to deliver screening, diagnosis, and treatment services to underserved populations usual public health system care and care delivered through an integrated, multidisciplinary breast center.
