Correlates of quality of life-related outcomes in breast cancer patients participating in the Pathfinders pilot study

Authors

  • Sophia K. Smith,

    1. Duke Comprehensive Cancer Center, Duke University Medical Center (DUMC), Durham, NC, USA
    2. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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  • James E. Herndon,

    1. Duke Comprehensive Cancer Center, Duke University Medical Center (DUMC), Durham, NC, USA
    2. Department of Biostatistics and Bioinformatics, DUMC, Durham, NC, USA
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  • H. Kim Lyerly,

    1. Duke Comprehensive Cancer Center, Duke University Medical Center (DUMC), Durham, NC, USA
    2. Department of Surgery, DUMC, Durham, NC, USA
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  • April Coan,

    1. Duke Comprehensive Cancer Center, Duke University Medical Center (DUMC), Durham, NC, USA
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  • Jane L. Wheeler,

    1. Department of Medicine, Division of Medical Oncology, DUMC, Durham, NC, USA
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  • Tina Staley,

    1. Duke Comprehensive Cancer Center, Duke University Medical Center (DUMC), Durham, NC, USA
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  • Amy P. Abernethy

    Corresponding author
    1. Duke Comprehensive Cancer Center, Duke University Medical Center (DUMC), Durham, NC, USA
    2. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
    3. Department of Medicine, Division of Medical Oncology, DUMC, Durham, NC, USA
    • Duke University Medical Center, Box 3436, Durham, NC 27710, USA
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Abstract

Objective: In a pilot study, participation in the Pathfinders program was associated with reductions in distress and despair and improvements in quality of life (QOL) among advanced breast cancer patients. This study explores the relationship between psychosocial resources invoked through the Pathfinders intervention and outcomes.

Methods: Advanced breast cancer patients were enrolled in a prospective, single-arm, pilot study of the Pathfinders psychosocial program. Participants met at least monthly with a licensed clinical social worker who administered the Pathfinders intervention, which focused on strengthening adaptive coping skills, identifying inner strengths, and developing a self-care plan. Longitudinal assessments over 6 months used validated instruments to assess changes in Pathfinders targets (coping, social support, self-efficacy, spirituality, and optimism) and outcomes (distress, despair, QOL, and fatigue). Multiple linear regression models examined the joint effect of average changes in target subscales on average outcome changes, adjusted for baseline outcome scores and patient characteristics.

Results: Participants (n=44) were: mean age 51 (SD, 12), 20% non-Caucasian, 50% college degree, and 75% married. Improvements in active coping skills, self-efficacy, and spiritual meaning/peace significantly correlated with an improvement in despair after adjustment for demographic characteristics (all P<0.05). Improvements in social support significantly correlated with positive changes in distress (P<0.05). Gains in learned optimism independently correlated with an increase in overall QOL (P<0.01).

Conclusions: In this pilot assessment, changes in pre-defined Pathfinders targets such as coping skills, social support, self-efficacy, spirituality, and optimism correlated with improvements in patient-reported outcomes. Copyright © 2010 John Wiley & Sons, Ltd.

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