First study to look at needs of women with Triple Negative breast cancer

When an aggressive form of breast cancer strikes a young woman, what kind of stress, anxiety and other psychological and social challenges does she face?

That question hasn't been answered in the published psychological cancer literature, but a new pilot study just launched is gathering data to change that, according to psychologist Georita M. Frierson at Southern Methodist University, Dallas, Texas (SMU).

The two-year study will survey up to 60 women recently diagnosed with an aggressive form of breast cancer that typically strikes younger women under 40, mostly African-American or Hispanic, or those who test positive for a mutation of the human gene that suppresses tumours, BRCA1.

Known as Triple Negative Breast Cancer, this unconventional subtype categorised as "nonhormonal" strikes 10 to 20% of women diagnosed with breast cancer.

The study is probing patients' stress, anxiety and concerns about the psychological and social hurdles they face, said Frierson, principal investigator. SMU is collaborating on the Triple Negative study with the University of Texas Southwestern Simmons Cancer Centre, a National Cancer Institute-designated cancer centre.

"We don't know anything about this population psychologically," said Frierson, an expert in behavioural health psychology and an assistant professor in the SMU Department of Psychology. "But based on this study, for any of their concerns we could tailor a psychological intervention to help other women like the women in my pilot. These women will be our pioneers in the psychological area to help their sisters that may have Triple Negative in the future."

For younger, minority women: Different cancer, different challenges

Triple Negative patients face far different challenges than women with traditional hormonal-type breast cancer, whose psychological and social challenges have been widely examined in the published psychological cancer literature, Frierson said. Traditional hormonal-type patients are typically over age 50, in a later career phase, raising their families, and probably have peers who may be struggling with a chronic illness.

In contrast, a Triple Negative patient is young, maybe mid-career, may not have started a family, and her peers are largely healthy and active. Because Triple Negative is a very aggressive cancer, Triple Negative patients can have lower survival rates and higher recurrence rates, and the medical treatment is different from hormonal-type cancer, Frierson said. For example, while chemotherapy can be an effective treatment for the Triple Negative patient, it can lead to short-term menopause, which may or may not be reversible, she said.

Breast cancer is the second leading cause of cancer death among women after lung cancer. In 2010, there were more than 192 300 new breast cancer cases in the United States, with more than 40 000 deaths.

The subtype is called Triple Negative because it tests negative for all three of the hormone receptors that fuel many types of breast cancer: oestrogen, progesterone and human epidermal receptor 2. Some traditional breast cancer hormonal treatment therapy drugs, such as Tamoxifen, aren't effective against Triple Negative Breast Cancer.

Results will establish protocol to develop interventions

Health care providers, social workers and others can use the study data to develop programs to reduce and manage stressors in the lives of Triple Negative patients, Frierson said.

"We want to fill a gap that needs to be addressed," she said. "The information from this pilot can help us develop programs and support groups to ease the burden on Triple Negative survivors. When we talk about breast cancer, many people think about the woman in her 50s. However, these are young cancer survivors. Really understanding those differences is important."

Health providers who have agreed to refer patients with medical approval by their physicians include U.T. Southwestern and Parkland Hospital in Dallas, and Moncrief Cancer Institute in Fort Worth. As a partner in the study, The Cooper Institute in Dallas will provide participants with fitness testing. The survey is also online, so a woman outside the Dallas-Fort Worth area can answer a one-time questionnaire and participate in the study.

The survey, which takes 45 minutes to an hour to answer, asks questions about physical activity, diet, nutrition, compliance with doctor appointments, stress levels, body image, quality of life, relationships, friendships, fertility, depression, anxiety, sleep and fatigue.

Source: Southern Methodist University