A randomized controlled trial of cognitive-behavioral stress management in breast cancer: survival and recurrence at 11-year follow-up
Open accessAbstract
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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Randomized clinical trials of CBSM and Cancer Recovery have shown impressive impact of psychological treatment on quality of life in breast cancer survivors.
“Randomized clinical trials of Cognitive Behavioral Stress Management (CBSM; Antoni) and Cancer Recovery (Anderson) have showed impressive impact of psychological treatment on depression and anxiety symptoms and quality of life in breast cancer survivors.”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [12]
The Introduction reports that women randomized to CBSM had fewer depressive symptoms and better emotional and physical well-being at follow-up; the Discussion also reports reduced anxiety and depressive mood and improved quality of life. The paper discusses Andersen’s intervention in relation to survival and recurrence, but does not establish the claimed psychological or quality-of-life effects for Cancer Recovery. Page numbers are not available in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredParticipation in a CBSM group during cancer treatment is associated with lower incidence of breast cancer mortality compared to patients provided only a brief, educational session during cancer treatment.
“Stagl and Antoni’s group found that participation in a CBSM group during cancer treatment was associated with lower incidence of breast cancer mortality and greater disease-free interval than patients provided only a brief, educational session during cancer treatment [12].”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [12]
The Results (Effects in invasive cancer subsample; page unavailable) report lower breast cancer mortality and a greater disease-free interval for the CBSM group than for the psychoeducational control group. The citing sentence omits that these significant findings were restricted to women with invasive Stage I–IIIb disease; in the full sample, the corresponding results were only trends. (LLM, conf=0.88)
Experimental — accuracy not yet measuredParticipation in a CBSM group during cancer treatment is associated with greater disease-free interval compared to patients provided only a brief, educational session during cancer treatment.
“Stagl and Antoni’s group found that participation in a CBSM group during cancer treatment was associated with lower incidence of breast cancer mortality and greater disease-free interval than patients provided only a brief, educational session during cancer treatment [12].”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [12]
The Results (Effects in invasive cancer subsample; page unavailable) report a greater disease-free interval for the CBSM group than for the control group, which received a one-day psychoeducational seminar. The citing sentence omits the restriction to women with invasive breast cancer: in the full sample, the Results describe only a tendency toward a greater disease-free interval (p = .083). (LLM, conf=0.87)
Experimental — accuracy not yet measuredRandomized clinical trials of CBSM and Cancer Recovery have shown impressive impact of psychological treatment on depression and anxiety symptoms in breast cancer survivors.
“Randomized clinical trials of Cognitive Behavioral Stress Management (CBSM; Antoni) and Cancer Recovery (Anderson) have showed impressive impact of psychological treatment on depression and anxiety symptoms and quality of life in breast cancer survivors.”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [12]
Women with Stage 0-IIIb breast cancer who were randomly assigned to a 10-week CBSM intervention, 2-10 weeks post-surgery, had longer survival up to 11-years post-enrollment compared to those in the control group, while accounting for disease relevant characteristics.
“Their analysis found that women with Stage 0–IIIb breast cancer who were randomly assigned to a 10-week CBSM intervention, 2–10 weeks post-surgery, had longer survival, up to 11-years post-enrollment, compared to those in the control group, while accounting for disease relevant characteristics.”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [12]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Regression Models and Life-Tables
Cox, D. R. (1972) · Journal of the Royal Statistical Society Series B: Statistical Methodology · doi:10.1111/j.2517-6161.1972.tb00899.x · Cited by 39,793 · see citing works
Regression Models and Life-Tables
Cox, D. R. (1992) · Springer Series in Statistics · doi:10.1007/978-1-4612-4380-9_37 · Cited by 26,297 · see citing works
Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008
Ferlay, J., Shin, H., Bray, F., Forman, D., Mathers, C. D., & Parkin, D. M. (2010) · International Journal of Cancer · doi:10.1002/ijc.25516 · Cited by 21,271 · see citing works
TNM Classification of Malignant Tumors
Carter, D. (1998) · The American Journal of Surgical Pathology · doi:10.1097/00000478-199810000-00016 · Cited by 6,354 · see citing works
EFFECT OF PSYCHOSOCIAL TREATMENT ON SURVIVAL OF PATIENTS WITH METASTATIC BREAST CANCER
Spiegel, D., Kraemer, H., Bloom, J., & Gottheil, E. (1989) · The Lancet · doi:10.1016/s0140-6736(89)91551-1 · Cited by 2,353 · see citing works
Babyak, M. A. (2004) · Psychosomatic Medicine · doi:10.1097/01.psy.0000127692.23278.a9 · Cited by 2,061 · see citing works
Cancer survival in five continents: a worldwide population-based study (CONCORD)
Coleman, M. P., Quaresma, M., Berrino, F., Lutz, J.-M., Angelis, R. D., Capocaccia, R., Baili, P., Rachet, B., Gatta, G., Hakulinen, T. R., et al. (2008) · The Lancet Oncology · doi:10.1016/s1470-2045(08)70179-7 · Cited by 1,473 · see citing works
Danaei, G., Hoorn, S. V., López, A. D., Murray, C. J. L., & Ezzati, M. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67725-2 · Cited by 1,368 · see citing works
Hershman, D. L., Kushi, L. H., Shao, T. H., Buono, D. L., Kershenbaum, A., Tsai, W., Fehrenbacher, L., Gomez, S. L., Miles, S. Q., & Neugut, A. I. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.25.9655 · Cited by 834 · see citing works
Psychologic intervention improves survival for breast cancer patients
Andersen, B. L., Yang, H., Farrar, W. B., Golden‐Kreutz, D. M., Emery, C. F., Thornton, L. M., Young, D. C., & Carson, W. E. (2008) · Cancer · doi:10.1002/cncr.23969 · Cited by 495 · see citing works
Giese-Davis, J., Collie, K., Rancourt, K. M. S., Neri, E., Kraemer, H. C., & Spiegel, D. (2011) · Journal of Clinical Oncology · doi:10.1200/jco.2010.28.4455 · Cited by 458 · see citing works
How Stress Management Improves Quality of Life After Treatment for Breast Cancer.
Antoni, M. H., Lechner, S. C., Kazi, A., Wimberly, S. R., Sifre, T., Urcuyo, K. R., Phillips, K. K., Glück, S., & Carver, C. S. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.6.1152 · Cited by 350 · see citing works
Self-citationHerschbach, P., Keller, M., Knight, L., Brandl, T., Huber, B., Henrich, G., & Marten-Mittag, B. (2004) · British Journal of Cancer · doi:10.1038/sj.bjc.6601986 · Cited by 260 · see citing works
Cognitive-Behavioral Stress Management Reverses Anxiety-Related Leukocyte Transcriptional Dynamics
Antoni, M. H., Lutgendorf, S. K., Blomberg, B., Carver, C. S., Lechner, S., Diaz, A., Stagl, J., Arevalo, J. M. G., & Cole, S. W. (2012) · Biological Psychiatry · doi:10.1016/j.biopsych.2011.10.007 · Cited by 251 · see citing works
Self-citationPsychological interventions for women with metastatic breast cancer
Mustafa, M., Carson-Stevens, A., Gillespie, D., & Edwards, A. G. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004253.pub4 · Cited by 244 · see citing works
Host Factors and Cancer Progression: Biobehavioral Signaling Pathways and Interventions
Lutgendorf, S. K., Sood, A. K., & Antoni, M. H. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.26.9357 · Cited by 238 · see citing works
Self-citationAntoni, M. H., Wimberly, S. R., Lechner, S. C., Kazi, A., Sifre, T., Urcuyo, K. R., Phillips, K. K., Smith, R. G., Petronis, V. M., Guellati, S., et al. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.10.1791 · Cited by 236 · see citing works
Self-citationDepression as a Prognostic Factor for Breast Cancer Mortality
Hjerl, K., Andersen, E. W., Keiding, N., Mouridsen, H. T., Mortensen, P. B., & Jørgensen, T. (2003) · Psychosomatics · doi:10.1176/appi.psy.44.1.24 · Cited by 223 · see citing works
Survival Analysis Part IV: Further concepts and methods in survival analysis
Clark, T. G., Bradburn, M. J., Love, S., & Altman, D. G. (2003) · British Journal of Cancer · doi:10.1038/sj.bjc.6601117 · Cited by 187 · see citing works
Stagl, J. M., Bouchard, L. C., Lechner, S. C., Blomberg, B. B., Gudenkauf, L. M., Jutagir, D. R., Glück, S., Derhagopian, R. P., Carver, C. S., & Antoni, M. H. (2015) · Cancer · doi:10.1002/cncr.29076 · Cited by 174 · see citing works
Self-citationRoss, L., Boesen, E. H., Dalton, S. O., & Johansen, C. (2002) · European Journal of Cancer · doi:10.1016/s0959-8049(02)00126-0 · Cited by 155 · see citing works
Stress management intervention for women with breast cancer.
Antoni, M. H. (2003) · doi:10.1037/10488-000 · Cited by 148 · see citing works
Self-citationKissane, D. (2009) · Psycho-Oncology · doi:10.1002/pon.1493 · Cited by 136 · see citing works
A Nonproportional Hazards Weibull Accelerated Failure Time Regression Model
Anderson, K. M. (1991) · Biometrics · doi:10.2307/2532512 · Cited by 76 · see citing works
Cognitive Appraisals, Coping and Depressive Symptoms in Breast Cancer Patients
Bigatti, S. M., Steiner, J. L., & Miller, K. D. (2012) · Stress and Health · doi:10.1002/smi.2444 · Cited by 74 · see citing works
Lauzier, S., Maunsell, E., Lévesque, P., Mondor, M., Robert, J., Robidoux, A., & Provencher, L. (2009) · Breast Cancer Research and Treatment · doi:10.1007/s10549-009-0477-z · Cited by 68 · see citing works
Vargas, S., Antoni, M. H., Carver, C. S., Lechner, S. C., Wohlgemuth, W., Llabre, M., Blomberg, B. B., Glück, S., & DerHagopian, R. P. (2014) · International Journal of Behavioral Medicine · doi:10.1007/s12529-013-9374-2 · Cited by 64 · see citing works
Self-citationStagl, J. M., Antoni, M. H., Lechner, S. C., Bouchard, L. C., Blomberg, B. B., Glück, S., Derhagopian, R. P., & Carver, C. S. (2015) · Health Psychology · doi:10.1037/hea0000125 · Cited by 55 · see citing works
Self-citationPhillips, K. M., Antoni, M. H., Carver, C. S., Lechner, S. C., Penedo, F. J., McCullough, M. E., Glück, S., Derhagopian, R. P., & Blomberg, B. B. (2011) · Cognitive Therapy and Research · doi:10.1007/s10608-011-9398-3 · Cited by 30 · see citing works
Self-citationPhillips, K. M., Jim, H., Small, B. J., Tanvetyanon, T., Roberts, W. S., & Jacobsen, P. B. (2012) · Stress and Health · doi:10.1002/smi.2450 · Cited by 20 · see citing works
Stress management for women with breast cancer.
Antoni, M. H. (2004) · American Psychological Association eBooks · doi:10.1037/10488-001 · Cited by 8 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Stress and cancer: mechanisms, significance and future directions
Eckerling, A., Ricon-Becker, I., Sorski, L., Sandbank, E., & Ben-Eliyahu, S. (2021) · Nature Reviews Cancer · doi:10.1038/s41568-021-00395-5 · Cited by 348 · see citing works
Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update
Andersen, B. L., Lacchetti, C., Ashing, K., Berek, J. S., Berman, B. S., Bolte, S., Dizon, D. S., Given, B., Nekhlyudov, L., Pirl, W., et al. (2023) · Journal of Clinical Oncology · doi:10.1200/jco.23.00293 · Cited by 318 · see citing works
Mind‐body interventions for fear of cancer recurrence: A systematic review and meta‐analysis
Hall, D. L., Luberto, C. M., Philpotts, L. L., Song, R., Park, E. R., & Yeh, G. Y. (2018) · Psycho-Oncology · doi:10.1002/pon.4757 · Cited by 159 · see citing works
Antoni, M. H., Moreno, P. I., & Penedo, F. J. (2023) · Annual Review of Psychology · doi:10.1146/annurev-psych-030122-124119 · Cited by 132 · see citing works
Self-citationUrech, C., Grossert, A., Alder, J., Scherer, S., Handschin, B., Kasenda, B., Borislavova, B., Degen, S., Erb, J., Faessler, A., et al. (2018) · Journal of Clinical Oncology · doi:10.1200/jco.2017.74.8491 · Cited by 98 · see citing works
“Diagnosis of cancer elicits high levels of distress in a majority of patients,(1) which is associated with decreased quality of life as well as diminished treatment tolerance(2,3) and potentially worse disease course.(4,5) Psychosocial support for patients with cancer is effective in alleviating distress and improving…”
BackgroundStress and coping in women with breast cancer:unravelling the mechanisms to improve resilience
Borgi, M., Collacchi, B., Ortona, E., & Cirulli, F. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.10.011 · Cited by 90 · see citing works
Antoni, M. H., Bouchard, L. C., Jacobs, J. M., Lechner, S. C., Jutagir, D. R., Gudenkauf, L. M., Carver, C. S., Lutgendorf, S., Cole, S. W., Lippman, M., et al. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.09.012 · Cited by 89 · see citing works
Self-citationPsychosocial interventions in breast cancer survivorship care
Gudenkauf, L. M., & Ehlers, S. L. (2018) · The Breast · doi:10.1016/j.breast.2017.11.005 · Cited by 67 · see citing works
Self-citationReis, J. C., Antoni, M. H., & Travado, L. (2020) · CNS Spectrums · doi:10.1017/s1092852918001621 · Cited by 44 · see citing works
Self-citationPsychological Intervention and Breast Cancer
Ashton, K., & Oney, K. (2024) · Current Breast Cancer Reports · doi:10.1007/s12609-024-00559-w · Cited by 21 · see citing works
“Interventions range from 5 weeks of group therapy to 26 sessions over one year [12–14].”
Widiasih, R., Ermiati, Jayanti, T. N., & Rais, Y. (2019) · IOP Conference Series Earth and Environmental Science · doi:10.1088/1755-1315/248/1/012056 · Cited by 4 · see citing works
- Authors
- Stagl, J. M., Lechner, S. C., Carver, C. S., Bouchard, L. C., Gudenkauf, L. M., Jutagir, D. R., Diaz, A., Yu, Q., Blomberg, B. B., Ironson, G., Glück, S., & Antoni, M. H.
- Affiliations
- Massachusetts General Hospital (US)
- University of Miami (US)
- Westat (United States) (US)
- Celgene (United States) (US)
- Corresponding author
- Stagl, Jamie M.
- ORCID
- Venue
- Breast Cancer Research and Treatment
- Published
- 2015-10-30
- Volume
- 154
- Issue
- 2
- Pages
- 319-328
- ISSN
- 0167-6806 (ISSN-L)
- 1573-7217
- PMC
- PMC5752103
- OpenAlex
- W1906194972
- Cited by
- 141
- References
- 31
- Citations by year
- 2026: 11 · 2025: 15 · 2024: 16 · 2023: 11 · 2022: 14 · 2021: 14 · 2020: 22 · 2019: 14 · 2018: 9 · 2017: 9 · 2016: 6
- FWCI
- 3.49
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Breast Cancer Research and Treatment (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (HHSN261200800001E, R01-CA-064710)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- cognitive-behavioral stress management, breast cancer, psychological distress, psychosocial interventions, breast cancer-specific mortality, all-cause mortality, disease-free interval, tumor recurrence, long-term follow-up, non-metastatic breast cancer
- MeSH terms
- Adaptation, Psychological, Adult, Breast Neoplasms, Cause of Death, Cognition, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Risk Factors, Stress, Psychological, Biomarkers, Tumor, Cognitive Behavioral Therapy, Proportional Hazards Models, Disease Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
