Intervention-Related Changes in Coping Ability Drives Improvements in Mood and Quality of Life for Patients Taking Adjuvant Endocrine Therapy

ObjectiveA recent randomized trial of a group psychosocial telehealth intervention (STRIDE) improved anxiety, depression, quality of life (QOL), symptom distress, coping, and self-efficacy to manage symptoms related to taking adjuvant endocrine therapy (AET) in women with non-metastatic hormone receptor-positive breast cancer. This study examined whether changes in coping and self-efficacy mediated intervention effects on anxiety, depression, QOL, and symptom distress.MethodWomen (N = 100) were recruited between 10/2019-06/2021 from Massachusetts General Hospital and were randomized to STRIDE or to the medication monitoring control group. Participants completed self-report measures of anxiety and depression (Hospital Anxiety and Depression Scale), QOL (Functional Assessment of Cancer Therapy-Breast Cancer scale), symptom distress (Breast Cancer Prevention Trial Symptom Scale), coping (Measure of Current Status-Part A), and self-efficacy (Self Efficacy for Managing AET Symptoms) at baseline and 24-week follow-up. Mediated regression models tested whether changes in coping ability and self-efficacy mediated the intervention effects on anxiety, depression, QOL, and symptom distress, controlling for key variables.ResultsImprovements in coping across the 24-week study period mediated the effect of STRIDE on anxiety symptoms (indirect effect, B = -0.61, SE = 0.28, 95% CI: -1.28, -0.17), depressive symptoms (indirect effect, B = -0.50, SE = 0.21, 95% CI: -0.97, -0.15), and QOL (indirect effect, B = 3.80, SE = 1.25, 95% CI: 1.54, 6.49), but not symptom distress. Changes in self-efficacy did not mediate improvements in any of the proposed outcomes.ConclusionCoping is an essential component of a brief group psychosocial intervention that drives improvements in mood and QOL for women with non-metastatic hormone receptor-positive breast cancer taking AET.Clinical trial registrationNCT03837496.