Grant Number:	5U01CA197282-05 Interpret this number
Primary Investigator:	Spiegel, David
Organization:	Stanford University
Project Title:	Impact of Affect Reactivity and Regulation on Breast Cancer Treatment Decisions
Fiscal Year:	2019

 DESCRIPTION (provided by applicant): Women diagnosed with breast cancer are choosing bilateral mastectomy (BLM) at increasing rates, currently 14.3%, and 33% of those under 40. This is happening despite evidence that there is no survival benefit from BLM, along with surgical complications and other serious medical and personal costs, compared with more conservative approaches. Women's anxiety about recurrence is critical to this decision, so their choice may in large part reflect the way they experience and regulate affect. To understand the neurobiological and affective determinants of the choice of BLM, and thereby identify future opportunities for new interventions, we propose to examine the relationship between affect reactivity and regulation and women's decisions regarding BLM after initial diagnosis of breast cancer. We will also examine the impact of affect management and treatment decisions on subsequent psychosocial functioning. The study will involve recruiting a sample of 150 women recently diagnosed with breast cancer after their decision about treatment (75 who have elected BLM and 75 demographically and medically similar women who have decided not to have BLM), as well as a matched control group of 50 women without breast cancer. Affective reactivity to negative non-cancer and cancer- related stimuli will be studied using functional magnetic resonance imagining (fMRI). Likewise, affective regulation will be assessed with fMRI probes of both explicit (i.e. conscious, deliberate) and implicit (i.e. nonconscious, automatic) regulation o negative non-cancer and cancer-related stimuli. Psychosocial functioning will be assessed using self-report measures of anxiety, depression, well-being and functional status at 6, 12, and 18 months post-decision. Informational (e.g. awareness of influential people who have undergone BLM), and demographic variables (age, race, SES) will also be assessed. A physiological stress response measure, diurnal salivary cortisol slope, will be obtained at baseline and all follow-ups. This measure has been shown be associated with expression of negative affect, and to predict breast cancer progression. Our Specific Aims are to: 1) Examine affect reactivity and regulation among women with a recent diagnosis of breast cancer in comparison to healthy controls; 2) Relate affect reactivity and regulation to choice of BLM; and 3) Assess long term functional consequences of BLM decision and affect reactivity and regulation. This study will provide an empirical basis for better assisting patients in making difficult but important choices regarding breast cancer treatment alternatives.




Emotional Reactivity and Regulation Relate to Surgical Treatment Decision Making Among Newly Diagnosed Women With Breast Cancer.
Authors: Benedict C. , Nouriani B. , Neri E. , Miller K. , Kurian A.W. , Gross J.J. , Spiegel D. .
Source: Cancer Medicine, 2024 Dec; 13(23), p. e70357.
PMID: 39653041
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Emotion regulation and choice of bilateral mastectomy for the treatment of unilateral breast cancer.
Authors: Zhang J.X. , Kurian A.W. , Jo B. , Nouriani B. , Neri E. , Gross J.J. , Spiegel D. .
Source: Cancer Medicine, 2023-04-21 00:00:00.0; , .
EPub date: 2023-04-21 00:00:00.0.
PMID: 37083300
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Racial and Ethnic Disparities in Cancer Survival: The Contribution of Tumor, Sociodemographic, Institutional, and Neighborhood Characteristics.
Authors: Ellis L. , Canchola A.J. , Spiegel D. , Ladabaum U. , Haile R. , Gomez S.L. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2018-01-01 00:00:00.0; 36(1), p. 25-33.
EPub date: 2017-10-16 00:00:00.0.
PMID: 29035642
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Physical Activity and Survival in Women With Advanced Breast Cancer.
Authors: Palesh O. , Kamen C. , Sharp S. , Golden A. , Neri E. , Spiegel D. , Koopman C. .
Source: Cancer Nursing, 2017-07-19 00:00:00.0; , .
EPub date: 2017-07-19 00:00:00.0.
PMID: 28727578
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Trends in Reoperation After Initial Lumpectomy for Breast Cancer: Addressing Overtreatment in Surgical Management.
Authors: Morrow M. , Abrahamse P. , Hofer T.P. , Ward K.C. , Hamilton A.S. , Kurian A.W. , Katz S.J. , Jagsi R. .
Source: Jama Oncology, 2017-06-05 00:00:00.0; , .
EPub date: 2017-06-05 00:00:00.0.
PMID: 28586788
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Gaps in Incorporating Germline Genetic Testing Into Treatment Decision-Making for Early-Stage Breast Cancer.
Authors: Kurian A.W. , Li Y. , Hamilton A.S. , Ward K.C. , Hawley S.T. , Morrow M. , McLeod M.C. , Jagsi R. , Katz S.J. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2017-04-12 00:00:00.0; , p. JCO2016716480.
EPub date: 2017-04-12 00:00:00.0.
PMID: 28402748
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Post-traumatic stress disorder and cancer.
Authors: Cordova M.J. , Riba M.B. , Spiegel D. .
Source: The Lancet. Psychiatry, 2017 Apr; 4(4), p. 330-338.
EPub date: 2017-01-19 00:00:00.0.
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Contralateral Prophylactic Mastectomy Decisions In A Population-based Sample Of Patients With Early-stage Breast Cancer
Authors: Jagsi R. , Hawley S.T. , Griffith K.A. , Janz N.K. , Kurian A.W. , Ward K.C. , Hamilton A.S. , Morrow M. , Katz S.J. .
Source: Jama Surgery, 2017-03-01 00:00:00.0; 152(3), p. 274-282.
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The Impact Of Doctor-patient Communication On Patients' Perceptions Of Their Risk Of Breast Cancer Recurrence
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Source: Breast Cancer Research And Treatment, 2017 Feb; 161(3), p. 525-535.
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Advancing psychosocial care in cancer patients.
Authors: Grassi L. , Spiegel D. , Riba M. .
Source: F1000research, 2017; 6, p. 2083.
EPub date: 2017-12-04 00:00:00.0.
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Recurrence Risk Perception And Quality Of Life Following Treatment Of Breast Cancer
Authors: Hawley S.T. , Janz N.K. , Griffith K.A. , Jagsi R. , Friese C.R. , Kurian A.W. , Hamilton A.S. , Ward K.C. , Morrow M. , Wallner L.P. , et al. .
Source: Breast Cancer Research And Treatment, 2016-12-21 00:00:00.0; , .
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Rising Bilateral Mastectomy Rates Among Neoadjuvant Chemotherapy Recipients in California From 1998 to 2012.
Authors: Wapnir I.L. , Kurian A.W. , Lichtensztajn D.Y. , Clarke C.A. , Gomez S.L. .
Source: Annals Of Surgery, 2016-09-08 00:00:00.0; , .
EPub date: 2016-09-08 00:00:00.0.
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Aberrant Nocturnal Cortisol And Disease Progression In Women With Breast Cancer
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Source: Breast Cancer Research And Treatment, 2016 Jul; 158(1), p. 43-50.
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Higher Vagal Activity As Related To Survival In Patients With Advanced Breast Cancer: An Analysis Of Autonomic Dysregulation
Authors: Giese-Davis J. , Wilhelm F.H. , Tamagawa R. , Palesh O. , Neri E. , Taylor C.B. , Kraemer H.C. , Spiegel D. .
Source: Psychosomatic Medicine, 2015 May; 77(4), p. 346-55.
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Posttraumatic Growth And Diurnal Cortisol Slope Among Women With Metastatic Breast Cancer
Authors: Diaz M. , Aldridge-Gerry A. , Spiegel D. .
Source: Psychoneuroendocrinology, 2014 Jun; 44, p. 83-7.
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Bedtime Misalignment And Progression Of Breast Cancer
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Source: Chronobiology International, 2014 Mar; 31(2), p. 214-21.
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Correspondence Of Plasma And Salivary Cortisol Patterns In Women With Breast Cancer
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Source: Neuroendocrinology, 2014; 100(2-3), p. 153-61.
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Psychosocial Correlates Of Sleep Quality And Architecture In Women With Metastatic Breast Cancer
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Source: Sleep Medicine, 2013 Nov; 14(11), p. 1178-86.
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Mind Matters In Cancer Survival
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Source: Psycho-oncology, 2012 Jun; 21(6), p. 588-93.
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