Stress Management Intervention Designed for Cancer "Curvivors" Also Benefits "Metavivors"
Key findings
- This study compared the experience of 156 "curvivors" (cancer survivors who completed treatment with curative intent) and 32 "metavivors" (cancer survivors living with chronic, incurable cancer) in an eight-week resiliency training program
- Metavivors began the Stress Management and Resiliency Training: Relaxation Response Resiliency Program with more resilient health behaviors and less depression than curvivors did, yet their attendance rates were similar
- Curvivors and metavivors demonstrated statistically comparable rates of change in resiliency, anxiety and worry throughout the program, although metavivors experienced significantly smaller reductions in depression
- Heterogenous samples of cancer survivors may engage with and benefit from group-based resiliency interventions
More people than ever are completing cancer treatment that has curative intent and transition into life as "curvivors," as the Institute of Medicine terms them. A small group of women living with metastatic breast cancer coined the term "metavivors," and that term can be extended to people living with any chronic, incurable cancer.
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Most survivorship interventions have been tested only for patients with early-stage cancers treated with curative intent. Researchers now report the Stress Management and Resiliency Training: Relaxation Response Resiliency Program (SMART-3RP), an established psychosocial support program offered at Massachusetts General Hospital, appears to be useful for metavivors as well.
Lucy Finkelstein-Fox, PhD, a psychologist in the Health Promotion and Resiliency Intervention Research Program (HPRIR) and Center for Psychiatric Oncology and Behavioral Sciences, Elyse R. Park, PhD, MPH, director of the HPRIR and director of behavioral research for the Tobacco Research and Treatment Center, the Benson–Henry Institute for Mind Body Medicine and the Cancer Survivorship Program, and colleagues describe the outcomes in Supportive Care in Cancer.
Methods
The SMART-3RP comprises eight weekly group sessions led by a clinical psychologist or psychiatrist. Sessions emphasize stress-awareness, stress-coping, and stress-buffering skills grounded in mind–body techniques (i.e., meditation, breath awareness), positive psychology (i.e., shifting focus to positive experiences) and cognitive behavioral therapy.
The program was designed to support cancer patients with "re-entry" to daily life once the structure of curative treatment ended. As time went on, patients living with cancer as a chronic illness who indicated interest were welcomed to join the same groups.
192 survivors completed online surveys before and/or after participating in a SMART-3RP group between 2017 and 2021. A medical oncologist reviewed their records and was able to determine the status of 188 patients: 156 (83%) were curvivors and 32 (17%) were metavivors.
The survey measures included:
- The 23-item Current Experiences Scale, which examines six domains of resiliency: appreciation for life, health behaviors, new perspectives, personal strength, relating to others and spiritual connection
- The 7-item Generalized Anxiety Disorder assessment
- The 8-item Patient Health Questionnaire (PHQ-8) about depressive symptoms
- Three items from the Penn State Worry Questionnaire
Part of the study period fell during the COVID-19 pandemic, and thus 35% of participants attended at least some virtual sessions.
Results
At baseline, metavivors had significantly less depression than curvivors (β = −2.42; P=0.04) and more resilient health behaviors (β=0.99; P=0.03). There were no other significant between-group differences in distress or resiliency.
Over the course of the program, curvivors reported a significant average within-person reduction of depression (1.72 points on the PHQ-8; P<0.001) and metavivors experienced a non-significant average increase (0.40 points; P=0.62). Individuals with greater distress have been shown to benefit more from intervention, so metavivors may have had less room for improvement.
The two groups demonstrated statistically comparable change in all other survey measures.
Neither the number of sessions attended nor the delivery modality (virtual vs. in-person) affected the strength of symptom change.
A Hypothesis-generating Study
The analyses in this study were exploratory, intended to guide hypothesis testing in future work. The finding that curvivors experienced significantly greater reductions in depression will inform a more nuanced consideration of curvivor–metavivor differences in stressors that precipitate and perpetuate depressive symptoms.
The finding that participants who attended sessions via videoconference were at no significant disadvantage compared to those who attended only in-person meetings has exciting implications for wider dissemination of the SMART-3RP.
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