Effects of the CALM intervention on resilience in Chinese patients with early breast cancer: a randomized trial - PubMed

Randomized Controlled Trial

doi: 10.1007/s00432-023-05498-0. Epub 2023 Nov 18.

Objective: Resilience is an important regulating factor for anxiety and depression in breast cancer. The Managing Cancer and Living Meaningfully (CALM) intervention has been confirmed to improve anxiety and depression in patients, but the role of resilience is still unclear. This study explores this issue.

Methods: In this study, a cohort of 124 patients diagnosed with breast cancer was recruited and randomly assigned to either the intervention group (IG) or the control group (CG). In addition, we enrolled a group of cancer-free women (regular control group) and assessed their resilience. All patients were evaluated using the Connor-Davidson Resilience Scale (CD-RISC), Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy (FACT-B) and Perceived Stress Scale (PSS) at different time points. The primary outcomes were resilience, quality of life, anxiety, depression, and perceived stress. A repeated measures ANOVA was used to compare the scores of the IG and CG groups. The relationship between resilience and quality of life was analyzed using Pearson's correlation test. The paired-sample t-test was used to compare the changes in each score at different time points.

Results: The intervention group showed significant differences in resilience, adamancy, optimism, tenacity, anxiety, depression, perceived stress and QOL scores before and after 6, 12, and 24 weeks (F = 17.411, F = 226.55, F = 29.096, F = 50.67, F = 82.662, F = 105.39, F = 62.66, F = 72.43, F = 34.561, respectively; P < 0.001). Compared to the control group, the intervention group demonstrated significant improvement in resilience and quality of life (t = -11.517, p < 0.001; t = - 4.929, p < 0.001), as well as a significant reduction in anxiety, depression, and perceived stress scores (t = 5.891, p < 0.001; t = 2.654, p < 0.001; t = 4.932, p < 0.001). In the intervention group, a significant positive correlation was observed between resilience in breast cancer survivors and quality of life (QOL) scores. (before CALM treatment: r = 0.3204, P = 0.0111; after 6 weeks: r = 0.3619, P = 0.0038; after 12 weeks: r = 0.3355, P = 0.0077; after 24 weeks: r = 0.2801, P = 0.0274).

Conclusions: A positive impact of the CALM intervention can be seen in improved resilience and reduced anxiety and depression, supporting its use as an effective psychological management tool and intervention strategy in the early stages of long-term breast cancer recovery.

1. 1. Alizadeh AM, Heydari Z, Rahimi M, Bazgir B, Shirvani H, Alipour S, Heidarian Y, Khalighfard S, Isanejad A (2018) Oxytocin mediates the beneficial effects of the exercise training on breast cancer. Exp Physiol 103:222–235 - PubMed - DOI
2. 1. Bezjak A, Ng P, Taylor K, MacDonald K, Depetrillo AD (1997) A preliminary survey of oncologists’ perceptions of quality of life information. Psychooncology 6:107–113 - PubMed - DOI
3. 1. Bonanno GA, Diminich ED (2013) Annual research review: positive adjustment to adversity–trajectories of minimal-impact resilience and emergent resilience. J Child Psychol Psychiatry 54:378–401 - PubMed - DOI
4. 1. Bonanno GA, Westphal M, Mancini AD (2011) Resilience to loss and potential trauma. Annu Rev Clin Psychol 7:511–535 - PubMed - DOI
5. 1. Borgi M, Collacchi B, Ortona E, Cirulli F (2020) Stress and coping in women with breast cancer:unravelling the mechanisms to improve resilience. Neurosci Biobehav Rev 119:406–421 - PubMed - DOI