Translating a stress management intervention for rural Latina breast cancer survivors: The Nuevo Amanecer-II

Autoři: Jasmine Santoyo-Olsson aff001;  Anita L. Stewart aff002;  Cathy Samayoa aff004;  Helen Palomino aff005;  Aday Urias aff005;  Nayeli Gonzalez aff005;  Alma Torres-Nguyen aff006;  LaVerne Coleman aff007;  Cristian Escalera aff008;  Vicken Y. Totten aff006;  Carmen Ortiz aff009;  Anna Maria Nápoles aff008
Působiště autorů: Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America aff001;  Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, California, United States of America aff002;  Institute for Health and Aging, University of California San Francisco, San Francisco, California, United States of America aff003;  Health Equity Research Lab, Department of Biology, San Francisco State University, San Francisco, California, United States of America aff004;  Cancer Resource Center of the Desert, El Centro, California, United States of America aff005;  Kaweah Delta Health Care District, Visalia, California, United States of America aff006;  WomenCARE/Entre Nosotras, Family Service Agency of the Central Coast, Soquel, California, United States of America aff007;  National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, United States of America aff008;  Círculo de Vida Cancer Support and Resource Center, San Francisco, California, United States of America aff009
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224068



Adapt a cognitive-behavioral stress management program (Nuevo Amanecer or NA) to be generalizable to rural, low literacy Spanish-speaking Latinas with breast cancer survivors at all phases of survivorship.


Apply the Transcreation Framework, a community-engaged translational model, to develop the adapted program (Nuevo Amanecer or NA-II), design a randomized controlled trial for community settings, identify recruiters and interventionists, and recruit participants into the trial.


Adaptations included expanding the program from eight to ten weeks, simplifying materials, and increasing skills practice. We added stress management videos, healthy lifestyles information, and survivorship information. Interventionists were trained Latina breast cancer survivors. All core components of NA were retained in NA-II including managing the impact of cancer, information on breast cancer and its treatment, finding cancer information, getting support, managing thoughts, stress management techniques, and setting goals. Participants receive a program manual. Each session includes a review of that week’s content using the manual, practicing a stress-management skill, setting a specific goal, and reviewing videos. Spanish-speaking Latinas with non-metastatic breast cancer were recruited by community recruiters. Of 231 women approached, 24% refused, 10% were ineligible, and 153 (66%) were randomized to the intervention or a wait-list control group. The sample was vulnerable: 69% had < high school education, more than half had only Medicaid or no insurance, 91% was foreign born, and 48% reported financial hardship in the past year.


Applying the Transcreation Framework to engage stakeholders in designing community-based RCTs enhanced congruence with community contexts and recruitment of this vulnerable population.

Klíčová slova:

Breast cancer – Breathing – Cancer detection and diagnosis – Cancer treatment – Mental health and psychiatry – Oncology – Psychological stress – Relaxation (psychology)


1. Charlton M, Schlichting J, Chioreso C, Ward M, Vikas P. Challenges of rural cancer care in the United States. Oncology (Williston Park). 2015;29:633–40. 26384798

2. Weaver KE, Geiger AM, Lu L, Case LD. Rural-urban disparities in health status among US cancer survivors. Cancer. 2013;119:1050–7. doi: 10.1002/cncr.27840 23096263

3. Henley SJ, Anderson RN, Thomas CC, Massetti GM, Peaker B, Richardson LC. Invasive cancer incidence, 2004–2013, and deaths, 2006–2015, in nonmetropolitan and metropolitan counties—United States. MMWR Surveill Summ. 2017;66:1–13. doi: 10.15585/mmwr.ss6614a1 28683054

4. Reid-Arndt SA, Cox CR. Does rurality affect quality of life following treatment for breast cancer? J Rural Health. 2010;26:402–5. doi: 10.1111/j.1748-0361.2010.00295.x 21029176

5. Pedro LW. Quality of life for long-term survivors of cancer: influencing variables. Cancer Nurs. 2001;24:1–11. 11219417

6. Bettencourt BA, Schlegel RJ, Talley AE, Molix LA. The breast cancer experience of rural women: a literature review. Psychooncology. 2007;16:875–87. doi: 10.1002/pon.1235 17611958

7. Butow PN, Phillips F, Schweder J, White K, Underhill C, Goldstein D. Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review. Support Care Cancer. 2012;20:1–22. doi: 10.1007/s00520-011-1270-1 21956760

8. Angell KL, Kreshka MA, McCoy R, Donnelly P, Turner-Cobb JM, Graddy K, et al. Psychosocial intervention for rural women with breast cancer: the Sierra-Stanford partnership. J Gen Intern Med. 2003;18:499–507. doi: 10.1046/j.1525-1497.2003.20316.x 12848832

9. Graves KD, Jensen RE, Canar J, Perret-Gentil M, Leventhal KG, Gonzalez F, et al. Through the lens of culture: quality of life among Latina breast cancer survivors. Breast Cancer Res Treat. 2012;136:603–13. doi: 10.1007/s10549-012-2291-2 23085764

10. Yanez B, Thompson EH, Stanton AL. Quality of life among Latina breast cancer patients: a systematic review of the literature. J Cancer Surviv. 2011;5:191–207. doi: 10.1007/s11764-011-0171-0 21274649

11. Costas-Muniz R, Hunter-Hernandez M, Garduno-Ortega O, Morales-Cruz J, Gany F. Ethnic differences in psychosocial service use among non-Latina white and Latina breast cancer survivors. J Psychosoc Oncol. 2017;35:424–37. doi: 10.1080/07347332.2017.1310167 28332946

12. Apollo AJ, Crew KD, Campbell J, Greenlee H, Jacobson JS, Grann V, et al. High rates of psychosocial stress among Hispanic breast cancer survivors. J Clin Oncol. 2007;Vol 25 (Jun 20 Supplement)(No. 18S):9113. {cited 2019 Apr 19}. Available from: Subscription required

13. Bowen DJ, Alfano CM, McGregor BA, Kuniyuki A, Bernstein L, Meeske K, et al. Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors. Breast Cancer Res Treat. 2007;106:85–95. doi: 10.1007/s10549-006-9479-2 17260096

14. Mukhtar RA, Moore AP, Nseyo O, Baehner FL, Au A, Moore DH, et al. Elevated PCNA+ tumor-associated macrophages in breast cancer are associated with early recurrence and non-Caucasian ethnicity. Breast Cancer Res Treat. 2011;130:635–44. doi: 10.1007/s10549-011-1646-4 21717106

15. Antoni MH, Wimberly SR, Lechner SC, Kazi A, Sifre T, Urcuyo KR, et al. Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer. Am J Psychiatry. 2006;163:1791–7. doi: 10.1176/ajp.2006.163.10.1791 17012691

16. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004;29:448–74. doi: 10.1016/s0306-4530(03)00054-4 14749092

17. Henderson VP, Clemow L, Massion AO, Hurley TG, Druker S, Hebert JR. The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: a randomized trial. Breast Cancer Res Treat. 2012;131:99–109. doi: 10.1007/s10549-011-1738-1 21901389

18. Loprinzi CE, Prasad K, Schroeder DR, Sood A. Stress management and resilience training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: a pilot randomized clinical trial. Clin Breast Cancer. 2011;11:364–8. doi: 10.1016/j.clbc.2011.06.008 21831722

19. Savard J, Simard S, Ivers H, Morin CM. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part II: immunologic effects. J Clin Oncol. 2005;23:6097–106. doi: 10.1200/JCO.2005.12.513 16135476

20. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22:969–81. doi: 10.1016/j.bbi.2008.01.012 18359186

21. Antoni MH, Lutgendorf SK, Cole SW, Dhabhar FS, Sephton SE, McDonald PG, et al. The influence of bio-behavioural factors on tumour biology: pathways and mechanisms. Nat Rev Cancer. 2006;6:240–8. doi: 10.1038/nrc1820 16498446

22. Zhou ES, Partridge AH, Blackmon JE, Morgan E, Recklitis CJ. A pilot videoconference group stress management program in cancer survivors: lessons learned. Rural Remote Health. 2016;16:3863. 27303955

23. Giese-Davis J, Bliss-Isberg C, Carson K, Star P, Donaghy J, Cordova MJ, et al. The effect of peer counseling on quality of life following diagnosis of breast cancer: an observational study. Psychooncology. 2006;15:1014–22. doi: 10.1002/pon.1037 16555366

24. Schover LR, Jenkins R, Sui D, Adams JH, Marion MS, Jackson KE. Randomized trial of peer counseling on reproductive health in African American breast cancer survivors. J Clin Oncol. 2006;24:1620–6. doi: 10.1200/JCO.2005.04.7159 16575013

25. Banas JR, Victorson D, Gutierrez S, Cordero E, Guitleman J, Haas N. Developing a peer-to-peer mHealth application to connect Hispanic cancer patients. J Cancer Educ. 2017;32:158–65. doi: 10.1007/s13187-016-1066-6 27364905

26. Napoles-Springer AM, Ortiz C, O'Brien H, Diaz-Mendez M. Developing a culturally competent peer support intervention for Spanish-speaking Latinas with breast cancer. J Immigr Minor Health. 2009;11:268–80. doi: 10.1007/s10903-008-9128-4 18340533

27. Sheppard VB, Figueiredo M, Canar J, Goodman M, Caicedo L, Kaufman A, et al. Latina a Latina: developing a breast cancer decision support intervention. Psychooncology. 2008;17:383–91. doi: 10.1002/pon.1239 17628037

28. Allen JD, Perez JE, Tom L, Leyva B, Diaz D, Idali Torres M. A pilot test of a church-based intervention to promote multiple cancer-screening behaviors among Latinas. J Cancer Educ. 2014;29:136–43. doi: 10.1007/s13187-013-0560-3 24132541

29. Corrigan PW, Torres A, Lara JL, Sheehan L, Larson JE. The healthcare needs of Latinos with serious mental illness and the potential of peer navigators. Adm Policy Ment Health. 2017;44:547–57. doi: 10.1007/s10488-016-0737-2 27236458

30. Napoles AM, Santoyo-Olsson J, Ortiz C, Gregorich S, Lee HE, Duron Y, et al. Randomized controlled trial of Nuevo Amanecer: a peer-delivered stress management intervention for Spanish-speaking Latinas with breast cancer. Clin Trials. 2014;11:230–8. doi: 10.1177/1740774514521906 24577971

31. Napoles AM, Ortiz C, Santoyo-Olsson J, Stewart AL, Gregorich S, Lee HE, et al. Nuevo Amanecer: results of a randomized controlled trial of a community-based, peer-delivered stress management intervention to improve quality of life in latinas with breast cancer. Am J Public Health. 2015;105 Suppl 3:e55–63. doi: 10.2105/AJPH.2015.302598 25905829

32. Napoles AM, Santoyo-Olsson J, Stewart AL, Ortiz C, Garcia-Jimenez M. Evaluating the implementation of a translational peer-delivered stress management program for Spanish-speaking Latina breast cancer survivors. J Cancer Educ. 2018;33:875–84. doi: 10.1007/s13187-017-1202-y 28275966

33. Napoles AM, Stewart AL. Transcreation: an implementation science framework for community-engaged behavioral interventions to reduce health disparities. BMC Health Serv Res. 2018;18:710. doi: 10.1186/s12913-018-3521-z 30208873

34. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, NJ: Prentice Hall; 1986.

35. Arizona Breast Cancer Resource Guide. Understanding breast cancer—Arizona Breast Cancer Resource Guide (ABCRG) {online videos}; 2014. {cited 2019 Apr 19}. Available from:

36. Graves KD, Carter CL, Anderson ES, Winett RA. Quality of life pilot intervention for breast cancer patients: use of social cognitive theory. Palliat Support Care. 2003;1:121–34. 16594274

37. Helgeson VS, Cohen S., Schulz R. & Yasko J. Group support interventions for women with breast cancer: who benefits from what? Health Psychol. 2000;19:107–14 10762094

38. Richardson MA, Post-White J, Grimm EA, Moye LA, Singletary SE, Justice B. Coping, life attitudes, and immune responses to imagery and group support after breast cancer treatment. Altern Ther Health Med. 1997;3:62–70. 9287446

39. Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol. 1997;15:974–86. doi: 10.1200/JCO.1997.15.3.974 9060536

40. Cella D, Hernandez L, Bonomi AE, Corona M, Vaquero M, Shiomoto G, et al. Spanish language translation and initial validation of the functional assessment of cancer therapy quality-of-life instrument. Med Care. 1998;36:1407–18. doi: 10.1097/00005650-199809000-00012 9749663

41. Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med. 1983;13:595–605. 6622612

42. Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114:163–73. doi: 10.1016/j.jad.2008.06.026 18752852

43. Merz EL, Malcarne VL, Roesch SC, Riley N, Sadler GR. A multigroup confirmatory factor analysis of the Patient Health Questionnaire-9 among English- and Spanish-speaking Latinas. Cultur Divers Ethnic Minor Psychol. 2011;17:309–16. doi: 10.1037/a0023883 21787063

44. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96. 6668417

45. Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Sparapan W, Oskamp S, editors. The social psychology of health. Newbury Park, CA: Sage Publishers; 1988

46. Perera MJ, Brintz CE, Birnbaum-Weitzman O, Penedo FJ, Gallo LC, Gonzalez P, et al. Factor structure of the Perceived Stress Scale-10 (PSS) across English and Spanish language responders in the HCHS/SOL Sociocultural Ancillary Study. Psychol Assess. 2017;29:320–8. doi: 10.1037/pas0000336 27280744

47. SOL Sociocultural Ancillary Study. Study procedures manual. 2010 Jan 12. (cited 2019 Apr 19). Available from:

48. Antoni MH, Lechner SC, Kazi A, Wimberly SR, Sifre T, Urcuyo KR, et al. How stress management improves quality of life after treatment for breast cancer. J Consult Clin Psychol. 2006;74:1143–52. doi: 10.1037/0022-006X.74.6.1152 17154743

49. Anderson EE. CIRTification: training in human research protections for community-engaged research partners. Prog Community Health Partnersh. 2015;9:283–8. doi: 10.1353/cpr.2015.0044 26412769

50. De las Nueces D, Hacker K, DiGirolamo A, Hicks LS. A systematic review of community-based participatory research to enhance clinical trials in racial and ethnic minority groups. Health Serv Res. 2012;47:1363–86. doi: 10.1111/j.1475-6773.2012.01386.x 22353031

Článek vyšel v časopise


2019 Číslo 10