A randomized controlled trial of cognitive-behavioral stress management in breast cancer: survival and recurrence at 11-year follow-up

Jamie M. Stagl, Suzanne C. Lechner, Charles S. Carver, Laura C. Bouchard, Lisa M. Gudenkauf, Devika R. Jutagir, Alain Diaz, Qilu Yu, Bonnie B. Blomberg, Gail Ironson, Stefan Glück, Michael H. Antoni

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Non-metastatic breast cancer patients often experience psychological distress which may influence disease progression and survival. Cognitive-behavioral stress management (CBSM) improves psychological adaptation and lowers distress during breast cancer treatment and long-term follow-ups. We examined whether breast cancer patients randomized to CBSM had improved survival and recurrence 8–15 years post-enrollment. From 1998 to 2005, women (N = 240) 2–10 weeks post-surgery for non-metastatic Stage 0–IIIb breast cancer were randomized to a 10-week, group-based CBSM intervention (n = 120) or a 1-day psychoeducational seminar control (n = 120). In 2013, 8–15 years post-study enrollment (11-year median), recurrence and survival data were collected. Cox Proportional Hazards Models and Weibull Accelerated Failure Time tests were used to assess group differences in all-cause mortality, breast cancer-specific mortality, and disease-free interval, controlling for biomedical confounders. Relative to the control, the CBSM group was found to have a reduced risk of all-cause mortality (HR = 0.21; 95 % CI [0.05, 0.93]; p = .040). Restricting analyses to women with invasive disease revealed significant effects of CBSM on breast cancer-related mortality (p =.006) and disease-free interval (p = .011). CBSM intervention delivered post-surgery may provide long-term clinical benefit for non-metastatic breast cancer patients in addition to previously established psychological benefits. Results should be interpreted with caution; however, the findings contribute to the limited evidence regarding physical benefits of psychosocial intervention post-surgery for non-metastatic breast cancer. Additional research is necessary to confirm these results and investigate potential explanatory mechanisms, including physiological pathways, health behaviors, and treatment adherence changes.

Original languageEnglish (US)
Pages (from-to)319-328
Number of pages10
JournalBreast cancer research and treatment
Issue number2
StatePublished - Nov 1 2015


  • Behavior therapy
  • Breast cancer
  • Breast neoplasm
  • Cognitive therapy
  • Recurrence
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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