Carolina Nursing News

Managing Uncertainty in Cancer Patients (MUIC)and Breast Cancer: A Successful Nursing Intervention A Need for Chewing Gum to Further the Research Study. About 178,500 women in the United States were diagnosed with breast cancer in 2007; of this group, approximately 25 percent will be under 50 years of age. In the first four years following treatment, pre-menopausal women under 50 have a high recurrence rate and an increased likelihood of a second primary tumor. The fear of recurrence for younger breast cancer survivors results in a pervasive sense of a less controllable world. Indeed, the frequent and unpredictable intrusion of thoughts of uncertainty about cancer recurrence may constitute a form of chronic stress. Individuals under chronic stress have been shown to have decreased cortisol reactivity which is related to adverse health outcomes. Most pre-menopausal women also experience an intense response to treatment-induced premature menopause, including debilitating hot flashes, mood and sleep impairment, memory impairment, sexual dysfunction, and fatigue, yet little information from physicians is offered to help them with these treatment issues. Uncertainty about how to interpret and handle symptoms leads to excessive worry, avoidance of symptoms or somatic vigilance. There has been little research on young survivors during the period of extended survival. Therefore, it is important to test interventions to help these women control their symptoms and manage the uncertainty about recurrence, and improve their quality of life. There is some evidence that the impact of a breast cancer diagnosis is greater on African-American survivors and they experience more energy loss, sensory and sleep problems, pain and mental distress. African-American breast cancer survivors have rarely been included in intervention studies.

MUIC Intervention. MUIC has designed and tested a successful intervention (UMI) for older breast cancer survivors (mean 64 years of age) who were 5-9 years post treatment. The UMI consisted of audiotapes of cognitive coping skills to manage the triggers of intrusive thoughts about the uncertainty of recurrence, along with a manual containing strategies for managing long-term treatment side effects found among survivors. This is currently being distributed by the National Cancer Institute as a model intervention program.http://rtips.cancer.gov/rtips/rtips_details.do?programid=82&topicid=12&co=n&cg=
The link will go to “RTIPs Program Use Agreement” Please click accept button below to continue. Click on the “Product” image to download documents or to order a CD.

Given the prevalence of intrusive thoughts about recurrence with these women, we will place a greater focus on calming self-statements and cognitive restructuring to enhance the benefits of the intervention for this group. We will also include a new component on skills in communication with the health care provider. The cognitive behavioral strategies will again be primarily taught through a series of audiotapes that will be practiced by women on their own at home, and the revised manual will continue to be a self-help guide that women use on an as-needed basis.

Need: Chewing Gum for Study Subjects. The chewing gum is necessary for the cortisol collection part of the study. Cortisol in saliva is used as an indicator of stress levels. Chewing gum helps subjects produce saliva for the samples. Subjects are given one piece of gum for each saliva set required with two additional pieces for practice. Each subject sample requires 38 pieces of gum. MUIC needs to run 240 subjects, requiring about 9,120 pieces of gum. We are seeking a charitable gift from a donor to provide a tax-deductible contribution of $500 to enable the School of Nursing to purchase the gum for the study. MUIC is currently using Trident Original flavor. Any gum other than Trident Brand Original Flavor must be pre-approved by Brant Nix at the University of North Carolina at Chapel Hill School of Nursing Biobehavioral Laboratory to determine if additives or food coloring will affect the lab work.

Contact: Norma Hawthorne, Director of Advancement, UNC Chapel Hill School of Nursing, CB 7460Chapel Hill, NC 27599-7460. Norma_Hawthorne@unc.edu or call (919) 966-4619.