The broad aim of this research is to evaluate whether a brief and cost-effective value affirmation writing
intervention reduces physical symptoms, stress and medication non-adherence among breast cancer patients
taking aromatase inhibitors (AIs). The majority of postmenopausal women diagnosed with breast cancer will be
prescribed an AI; and while effective, these medications lead to toxic physical symptom side effect profiles and
poor adherence. Interventions that target these side effects and the stress they cause may lead to improved
medication adherence and therefore improved survival rates for breast cancer patients taking AIs. In pilot work
from our group and others, thinking or writing about important personal values in value affirmation interventions
have been linked to fewer physical symptoms, decreased stress, and improved medication adherence. While
promising, these initial studies had small samples or were cross sectional in nature, and did not evaluate
potential neurobiological mechanisms for intervention effects. The proposed study will be a randomized
controlled trial (RCT) comparing a 6-month, portable value affirmation writing intervention (N=125) to a
control writing intervention (N=125) in breast cancer patients taking aromatase inhibitors. Participants will
complete self-reported measures of physical symptoms, adherence and stress at baseline, post-intervention, and
6-month follow-up. Medication adherence will also be assessed via electronic pill bottle reporting and refill
latency during the study period. As an exploratory mechanistic aim, a subsample of AI patients from the parent
RCT (N=120, 60 per intervention arm) will complete their mid-intervention value affirmation or control writing
task while undergoing functional MRI. Thus, the proposed study will test two specific aims and an exploratory
aim to determine: if value affirmation writing reduces physical symptoms and stress (Aim 1), improves
medication adherence (Aim 2), and if neural reward activation during value affirmation is a neurobiological
mechanism for these benefits (Exploratory Aim 1). The proposed RCT has the potential to identify a powerful,
cost-effective, and easy-to-implement value affirmation intervention for reducing symptoms, stress, and
medication non-adherence in breast cancer patients taking AIs.
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