DEVELOPMENT, FEASIBILITY, AND ACCEPTABILITY OF A BEHAVIORAL WEIGHT AND SYMPTOM MANAGEMENT INTERVENTION FOR BREAST CANCER SURVIVORS AND INTIMATE PARTNERS.
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2022-01
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Abstract
Background
Weight gain is common for breast cancer survivors and associated with disease progression, recurrence, and mortality. Traditional behavioral programs fail to address symptoms (i.e., pain, fatigue, distress) experienced by breast cancer survivors that may interfere with weight loss and fail to capitalize on the concordance in weight-related health behaviors of couples. This study aimed to develop and examine the feasibility and acceptability of a behavioral weight and symptom management intervention for breast cancer survivors and their intimate partners.Materials and methods
Interviews were conducted with N=14 couples with overweight/obesity to develop the intervention. Intervention feasibility and acceptability were examined through a single-arm pilot trial (N=12 couples). Patterns of change in intervention targets were examined for survivors and partners.Results
Themes derived from interviews were used to develop the 12-session couple-based intervention, which included components from traditional behavioral weight management interventions, appetite awareness training, and cognitive and behavioral symptom management protocols. Couples also worked together to set goals, create plans for health behavior change, and adjust systemic and relationship barriers to weight loss. Examples were tailored to the experiences and symptom management needs of breast cancer survivors and partners. The intervention demonstrated feasibility (attrition: 8%; session completion: 88%) and acceptability (satisfaction). Survivors and partners experienced reductions in weight and improvements in physical activity, eating behaviors, emotional distress, and self-efficacy. Survivors evidenced improvements in fatigue and pain.Conclusions
A behavioral weight and symptom management intervention for breast cancer survivors and partners is feasible, acceptable, and is potentially efficacious.Type
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Dorfman, Caroline S, Tamara J Somers, Rebecca A Shelby, Joseph G Winger, Michele L Patel, Gretchen Kimmick, Linda Craighead, Francis J Keefe, et al. (2022). DEVELOPMENT, FEASIBILITY, AND ACCEPTABILITY OF A BEHAVIORAL WEIGHT AND SYMPTOM MANAGEMENT INTERVENTION FOR BREAST CANCER SURVIVORS AND INTIMATE PARTNERS. Journal of cancer rehabilitation, 5. pp. 7–16. 10.48252/jcr57 Retrieved from https://hdl.handle.net/10161/27275.
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Scholars@Duke
Caroline Susan Dorfman
Caroline Dorfman, Ph.D. is an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Duke University. Dr. Dorfman is a member of the Pain Prevention and Treatment Research Program and the Cancer Symptom Management and Support Program within the Duke Department of Psychiatry and Behavioral Sciences. She is also a member of the Duke Cancer Institute where she serves as the Director of Research and Behavioral Medicine for the Duke Teen and Young Adult Oncology Program. Dr. Dorfman completed her graduate training in clinical psychology at the Ohio State University and her clinical internship at Duke University Medical Center. Her research focuses on developing, implementing, and evaluating psychosocial and behavioral interventions designed to meet the needs of cancer survivors and their partners/families. She is particularly interested in conducting research to address the unique needs of adolescent and young adult cancer survivors.
Tamara J. Somers
Tamara J. Somers, PhD, is a Clinical Psychologist and Faculty Member in the Department of Psychiatry and Behavioral Sciences. Dr. Somers conducts research developing, testing, and implementing behavioral interventions for pain and other symptoms in patients with chronic disease (e.g., cancer, arthritis). She is particularly interested in developing behavioral interventions that are personalized to the needs of individual patients and using innovative delivery methods to deliver the interventions. Grant awards from the NIH, American Cancer Society, and other funding agencies support her research. Dr. Somers also co-directs a clinical psychology training program at the Duke Cancer Institute (DCI) that trains graduate students, clinical psychology interns, and post-doctoral fellows in psychosocial and behavioral symptom management interventions.
Rebecca A Shelby
Rebecca Shelby, Ph.D. is an Associate Professor with Tenure in the Department of Psychiatry and Behavioral Sciences at Duke University and the Director of Education and Training for the Duke Cancer Patient Support Program. Dr. Shelby is a member of the Duke Pain Prevention and Treatment Research Program and the Duke Cancer Control and Population Sciences Program. Dr. Shelby completed her graduate training in clinical psychology at the Ohio State University and her clinical internship and postdoctoral fellowship at Duke University Medical Center. Her research focuses on developing and evaluating behavioral interventions for cancer patients, management of cancer pain and treatment side effects, and improving adherence to recommended care. Dr. Shelby serves on the Duke clinical psychology internship faculty and supervises clinical psychology fellows, interns, and clinical psychology graduate practicum students completing clinical rotations as part of the Duke Cancer Patient Support Program.
Joseph G Winger
Joseph G. Winger, PhD, is a licensed clinical psychologist and an Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. Dr. Winger's research focuses on developing and testing novel psychosocial interventions for patients facing life-limiting illnesses. His work emphasizes addressing spiritual and existential aspects of coping with debilitating symptoms, particularly maintaining a sense of meaning and purpose in life. His research has been supported by grants from the National Cancer Institute (R01CA291768), American Cancer Society (RSG-22-072-01-CTPS; PF-17-054-01-PCSM), and National Palliative Care Research Center (Kornfeld Scholar Award). Dr. Winger also serves as co-director of the Cognitive Behaviorally Informed Skills Training (CBIST) Program for Physical and Occupational Therapists. The CBIST program trains non-behavioral health specialists to integrate evidence-based cognitive and behavioral skills into their clinical practice to improve quality of care and patient outcomes.
Gretchen Genevieve Kimmick
Breast cancer; treatment of breast cancer; management of menopausal symptoms in breast cancer survivors; survivorship issues after breast cancer; supportive care in managment of cancer patients; breast cancer and treatment of cancer in older persons; diagnosis and management of cancer in underserved populations.
Francis Joseph Keefe
I am Director of the Duke Pain Prevention and Treatment Research Program, an active NIH funded clinical research program focused on developing new and more effective ways of assessing and treating patients having acute and persistent pain. I have been active in nationally and internationally in shaping the pain research agenda. For the past 10 years I served as Editor in Chief of PAIN the premier journal in pain research. I also have served as the Chair of a number of NIH Study Sections. Finally, I was a member of the Institute of Medicine committee that published a report in 2011 (Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research) that has played a key role in shaping national policies in pain research and pain care.
Over my career, I have played a key role in the development of clinical pain services and pain research programs at Duke Medical Center. For over 20 years, I directed the Duke Pain Management Program and was a leader in the development of Duke Medical Center's multidisciplinary pain programs (both out-patient and in-patient.) I collaborate actively with investigators in other countries (e.g. United Kingdom, South Africa, China, and Australia).
Over the course of my career, I have collaborated closely with investigators both in and outside my lab. Together we have developed and refined a number of treatment protocols for persistent pain conditions (e.g. pain in patients with advanced cancer; sickle cell disease, and persistent joint pain due to osteo- and rheumatoid arthritis) including partner and caregiver-assisted pain coping skills training interventions. We have conducted a number of NIH- and foundation- funded randomized clinical trials testing the efficacy of these and other behavioral interventions (e.g. aerobic exercise protocols, yoga based interventions, mindfulness-based interventions, forgiveness-based interventions, loving kindness meditation, and emotional disclosure).
I currently serve as a Co-Investigator on a number of NIH grants, a number of which are funded by the HEAL Initiative. Many of these grants are testing novel strategies for delivering training in pain coping skills (e.g. video over internet, web-based training, virtual reality interventions, and apps for mobile devices). Along these lines, I collaborated with Dr. Chris Rini to develop an internet-based program for training in pain coping skills called painTRAINER (available at mypaintrainer.org). This program is free to any individuals or health professionals who wish to use it. I have a keen interest in exploring the efficacy of these and other strategies (e.g. training physical therapists, social workers, and nurses) promise to increase access to behavioral pain management interventions making them more widely available to the large population of patients and caregivers who might benefit from them.I have published over 490 papers on topics ranging from pain coping strategies used during mammography to behavioral approaches to managing acute pain and pain at end of life. I have a longstanding interest in mentoring students and early career professionals interested in developing, testing, and disseminating novel protocols for managing pain, stress, and medical symptoms.
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