Optimizing Expectations About Endocrine Treatment for Breast Cancer: Results of the Randomized Controlled PSY-BREAST Trial

Authors

  • Meike C. Shedden-Mora
    Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Clinical Psychology and Psychotherapy, Hamburg University, Hamburg, Germany
  • Yiqi Pan
    Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  • Sarah R. Heisig
    Department of Clinical Psychology and Psychotherapy, Hamburg University, Hamburg, Germany
  • Pia von Blanckenburg
    Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
  • Winfried Rief
    Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
  • Isabell Witzel
    Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  • Ute-Susann Albert
    Department of Gynecology, University Medical Center Würzburg, Würzburg, Germany
  • Yvonne Nestoriuc
    Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Clinical Psychology and Psychotherapy, Hamburg University, Hamburg, Germany; Department of Clinical Psychology, Helmut Schmidt University Hamburg, Hamburg, Germany

Abstract

Background: Medication side effects are strongly determined by non-pharmacological, nocebo mechanisms, particularly patients’ expectations. Optimizing expectations could minimize side effect burden. This study evaluated whether brief psychological expectation management training (EXPECT) optimizes medication-related expectations in women starting adjuvant endocrine therapy (AET) for breast cancer.
Method: In a multisite randomized controlled design, 197 women were randomized to EXPECT, supportive therapy (SUPPORT), or treatment as usual (TAU). The three-session cognitive-behavioral EXPECT employs psychoeducation, guided imagery, and side effect management training. Outcomes were necessity-concern beliefs about AET, expected side effects, expected coping ability, treatment control expectations, and adherence intention.
Results: Both interventions were well accepted and feasible. Patients’ necessity-concern beliefs were optimized in EXPECT compared to both TAU and SUPPORT, d = .41, p < .001; d = .40, p < .001. Expected coping ability and treatment control expectations were optimized compared to TAU, d = .35, p = .02; d = .42, p < 001, but not to SUPPORT. Adherence intention was optimized compared to SUPPORT, d = .29, p = .02, but not to TAU. Expected side effects did not change significantly.
Conclusion: Expectation management effectively and partly specifically (compared to SUPPORT) modified medication-related expectations in women starting AET. Given the influence of expectations on long-term treatment outcome, psychological interventions like EXPECT might provide potential pathways to reduce side effect burden and improve quality of life during medication intake.