Cadbury Adams, the manufacturers of Trident Gum, made a gift of 31 boxes of Trident Original flavor — that’s 9,120 pieces of gum — to help nursing researchers at the University of North Carolina at Chapel Hill School of Nursing understand more about managing uncertainty in younger breast cancer survivors. “The chewing gum is necessary for the cortisol collection part of the study,” said Merle Mishel, PhD, RN, FAAN, the principal investigator for the National Institute of Nursing Research study. “Chewing gum helps subjects produce saliva for the samples.”
Why are samples of cortisol needed? Individuals under chronic stress have been shown to have decreased cortisol reactivity which is related to adverse health outcomes. The Carolina SON research team is studying how the fear of recurrence for younger breast cancer survivors results in a pervasive sense of a less controllable world, thereby, potentially increasing their uncertainty about cancer recurrence, which may constitute a form of chronic stress. Chronic stress is known to weaken the immune system.
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. 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. This study, however, includes a significant sample of this group.
The Managing Uncertainty in Cancer Patients (MUIC) team has designed and tested a succesful intervention for older breast cancer survivors (mean 64 years of age) who were 5-9 years post treatment. This is currently being distributed by the National Cancer Institute as a model intervention program. The link is: http://rtips.cancer.gov/rtips/rtips_details.do?programid=82&topicid=12&co=n&cg=
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Most pre-menopausal women also experience an intense reponse 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. The nursing intervention developed by MUIC places a greater focus on calming self-statements and cognitive restructuring to enhance the benefits of the intervention, which can be practiced by women on their own at home, with a self-help guide manual that can be used on as as-needed basis.