OBJECTIVE:We modeled changes in both engagement versus nonengagement and frequency of engagement in moderate to vigorous physical activity (MVPA) in women with breast cancer (BC) participating in a trial of cognitive behavioral stress management (CBSM) intervention during the first year of treatment. METHOD:We recruited 240 women with Stage 0-III BC 2-8 weeks postsurgery and randomly assigned them to either a 10-week group CBSM intervention or 1-day psychoeducational (PE) control before they began adjuvant therapy. A brief version of the Seven-Day Physical Activity (PA) Report measured frequency of MVPA, and a measure of perceived stress management skills assessed stress awareness, relaxation skills, and coping confidence in participants at baseline (T1), 6 months (T2), and 12 months (T3) after randomization. We used a two-part latent growth to model change in both engagement versus nonengagement and frequency of engagement in MVPA. RESULTS:The unconditional model showed significant changes in frequency of engagement in MVPA over time (β = 0.11, p < .01) and significant increase in the likelihood of becoming engaged in MVPA over time (β = 1.40, p < .001). In a fully adjusted model, assignment to CBSM was associated with a greater likelihood of becoming engaged in MVPA over time (β = 0.45, p = .02) compared with PE control, although CBSM did not affect MVPA frequency. Those in CBSM revealed greater increases in confidence in relaxation skills (p < .001) but neither stress awareness nor coping skills versus PE controls. Although greater increases in perceived stress awareness, relaxation skills, and coping confidence over time related to MVPA engagement across the entire sample, they did not mediate the effects of CBSM on changes in MVPA engagement (p > .05). CONCLUSIONS:CBSM increased the likelihood of MVPA engagement during primary treatment for BC. However, contrary to hypotheses, perceived stress management skills did not mediate this relationship. Further research should explore additional pathways to better understand how CBSM may have supported physical activity engagement during or after cancer treatment. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Living in a disadvantaged neighborhood is linked to higher mortality rates and poorer quality of life (QoL) among patients with breast cancer (BC). Subjective socioeconomic status (SSS), reflecting one’s perceived socioeconomic “rank” or social standing relative to others, may be associated with differences in the relationship between objective neighborhood disadvantage and QoL. Therefore, we sought to evaluate whether SSS moderated the association between objective neighborhood disadvantage and QoL in middle- and older-aged women undergoing BC treatment. Women (≥ 50yrs) diagnosed with non-metastatic BC participating in a stress management trial completed a baseline assessment of SSS (MacArthur Network Sociodemographic Questionnaire) and QoL (Functional Assessment of Cancer Therapy-Breast) in the weeks after surgery. The Area Deprivation Index (ADI), which ranks the degree of neighborhood disadvantage via participants’ addresses, measured objective neighborhood disadvantage. Multivariate linear regressions related ADI, SSS, and QoL, adjusting for age, cancer stage, and race/ethnicity. Greater SSS relative to the community (B = 3.60, SE = 1.12, p=.002) and the USA (B = 3.01, SE = 1.09, p=.006) related to better QoL. Also, SSS USA interacted with ADI in predicting QoL (B = 0.95, SE = 0.45, p=.038), such that greater ADI related to poorer QoL in women with lower but not higher SSS. Greater SSS relative to one’s community and the USA population related to better QoL in women treated for BC. Conversely, greater objective neighborhood disadvantage related to poorer QoL but not among those with greater SSS. Future work could examine whether SSS is a modifiable intervention target through coping effectiveness training, or by enhancing community and social engagement.

BACKGROUND:Shared decision-making (SDM) emphasizes informed, value-aligned choices, yet affect has not been a primary focus and is rarely addressed explicitly in cancer contexts. Among men with low-to intermediate-risk prostate cancer (LIRPC), active treatment and active surveillance each involve distinct affective challenges that may influence risk perception, decisional uncertainty, and treatment satisfaction. Despite prior work in affect and decision making literature, its integration into cancer contexts remains limited. AIMS:To address the gap, this study examined how affect, alongside cognition and psychosocial factors, was reflected in men's accounts of LIRPC treatment decision making, guided by SDM and affective science frameworks. METHODS:We conducted semi-structured interviews with 28 men with LIRPC across three treatment pathways: AS, AT, and AS-AT transition. Interviews were theory-informed and explored (a) how participants learned and interpreted diagnostic information; (b) how thoughts, emotions, and relationships were experienced in decision-making; and (c) how men reflected on preferred roles. Participants also completed the Control Preferences Scale. RESULTS:Eleven themes emerged across domains. Understanding of information depended on both the clarity of medical communication and its relational context. Participants described strong affective responses at diagnosis, awaiting test results, and shortly before surgery. Decision-making was often deliberative, with men weighing options alongside personal values and priorities, physician trust, and family support. Post-treatment reflections emphasized autonomy and value alignment, with coping used to manage affect and maintain a sense of control. CONCLUSIONS:In LIRPC decision-making, affect appeared to vary across contexts and time points. Although decisions were often described as deliberative, affect seemed embedded in how men interpreted information, navigated relationships, and defined what mattered (including quality of life, anticipated treatment outcomes, and autonomy), which influenced how options were weighed. Incorporating affect into decision support, particularly around key moments, may strengthen SDM and treatment satisfaction.

Introduction: Despite evidence for stress-reducing effects of psychosocial interventions in cancer patients, there is insufficient research on the psychological and physiological effects of interventions that utilize music-based avenues to address distress in this population. Method: Women with nonmetastatic breast cancer (N = 10; M age = 50.25) participated in an exploratory study of effects of Bonny Method of Guided Imagery and Music (GIM; a depth approach to music psychotherapy) sessions on distress, psychological impact of cancer, quality of life, and relevant neuroendocrine markers melatonin and cortisol. Participants completed the Profile of Mood States, Hassles Scale, Impact of Events Scale, and Functional Assessment of Cancer Therapy - Breast Cancer and provided 15 cc of blood before (T1), at midpoint (T2), after the 13-week intervention (T3), and again at 6-week follow-up (T4). Results: Repeated measures analyses showed that after six bi-weekly sessions, participants reported significant pre-post decreases in depressed mood (eta 2p = 0.54) and total mood disturbance (eta 2p = .53), increased well-being (eta 2p = 0.44; all ps < .05), significantly decreased levels of fatigue by follow-up (eta 2p = 0.34; p < .05), and significant pre-post decreases in perceived distress, which remained at follow-up (p < .05). While no significant change was found in serum levels of cortisol or melatonin for this small sample, a large effect was found at follow-up for pre-post increased melatonin (eta 2p = 1.09) and a small-to-medium effect was found for the pre-post decrease in cortisol (eta 2p = 0.43). Discussion: These findings contribute to the growing evidence for GIM as an efficacious intervention for both reducing distress and normalizing stress physiology and provide support for further study.

Across cognitive behavioral treatments for stress management, individuals' ability to effectively learn intervention components is necessary for improved outcomes. The Management of Current Stress (MOCS)-Part A, formerly known as the Measure of Current Status-Part A, captures the uptake of such "active ingredients" or perceived stress management abilities. The MOCS-A is widely used, yet its psychometric properties are not well-established. Little is known about its generalizability across populations. In the current study, we sought to test the MOCS-A reliability among cancer survivors, examine measurement invariance across sex and language (English/Spanish), and verify the measurement structure. We aggregated participants from six randomized controlled trials of stress management interventions, which ran from 1999 to 2024 and enrolled males with prostate cancer (n=649) and females with breast cancer (n=517). Five trials administered the English MOCS-A, and one administered the measure in Spanish. The MOCS-A consists of a total score and four subscales: ability to relax, awareness of bodily tension, assertiveness, and coping confidence. Depending on model assumptions, we calculated omega or alpha reliability estimates. Confirmatory factor analysis tested measurement invariance through incremental constraints added across subgroups. We compared unidimensional, four-factor, second-order, and bifactor models for best fit. The total measure (ω=.93, α=.91) and four subscales (ω=.75-.91; α=.75-.90) demonstrated acceptable reliability. Strong scalar invariance existed between males and females and Spanish and English versions. The bifactor model best fit the measure structure. The MOCS-A is internally consistent, statistically independent, appropriately scored in their current form, and may be implemented across sexes and languages.

Background: To evaluate the impact of Hispanic ethnic enclaves (EE) on the relationship between neighborhood disadvantage and overall survival (OS) in breast cancer (BCa) patients. Methods: Data from BCa patients with stage I-IV disease diagnosed between 2005-2017 was used to analyze the effects of Area Deprivation Index (ADI) scores, a measure of neighborhood disadvantage, and census-tract level Hispanic density, a measure of EE, on OS using mixed-effects Cox regression models. The final model included the following individual-level factors (age, income, race, Hispanic/Latino origin, nativity, insurance status, and comorbidities (hypertension, diabetes, and body mass index) and clinical factors (National Comprehensive Cancer Network guideline-concordant treatment, stage, and receptor subtype). Results: 5,387 patients were analyzed. 52% resided in Hispanic EE. Enclave residents were predominantly White (93%), with Cubans the predominant subgroup (37%). Overall, there were 1,040 deaths within the cohort. Patients residing in highly disadvantaged neighborhoods (ADI Tertile 3 [ADIT3]) within Hispanic EE experienced reduced HR compared to those outside of EE, evidenced by the interaction effect [EE x ADIT3 - HR (95% CI): 0.66 (0.44, 0.98)]. Conclusions: Hispanic EE may protect against mortality in BCa patients, suggesting positive social factors help combat negative effects of neighborhood disadvantage for patients. Understanding protective attributes of EE can help create effective cancer interventions and promote more equitable outcomes in minority populations. Impact: This study found that EE may protect against mortality in BCa patients, suggesting positive social factors may help mitigate the negative effects caused by the neighborhood.

Objective: Cancer- and cancer treatment-related cognitive impairment (CRCI) is reported by many women with breast cancer (BC). Distress tolerance (DT) refers to both the perceived capacity and behavioral act of withstanding uncomfortable/aversive/negative emotional and/or physical experiences. Poor DT has been associated with worse cognitive performance, including executive dysfunction. Importantly, DT can be improved through psychological interventions. However, DT research in cancer has been limited. This study aimed to examine the relationship between DT and CRCI in women with BC. Method: Women with nonmetastatic BC (n = 107, age >= 50 years) were recruited between 2016 and 2023, post BC surgery (54.2% lumpectomy and 38.3% mastectomy) but prior to adjuvant therapy, completed the Distress Tolerance Scale and the Functional Assessment of Cancer Therapy-Cognitive Scale, self-report measures of DT and CRCI, respectively. Hierarchical linear regression was used to test the associations between the DTS-Total Score (DTS-T) and CRCI on the Functional Assessment of Cancer Therapy-Cognitive subscales. Results: DTS-T was significantly associated with perceived cognitive impairment (CogPCI, p = .015), perceived cognitive abilities (CogPCA, p < .001), and quality of life impact (CogQOL, p = .010), after controlling for age and days since surgery. DTS-T explained 12%, 27%, and 12% of the variance in CogPCI, CogPCA, and CogQOL, respectively. Conclusion: Women with BC with greater ability to tolerate distress reported less CRCI, including less CogPCI, less CogQOL, and better CogPCA. Future directions should involve the use of objective measures of CRCI and longitudinal testing of its association with DT.

Women residing in disadvantaged neighborhoods experience disparities in breast cancer (BC) survival which persist when accounting for individual-level socioeconomic/treatment factors. The chronic stress of living in a disadvantaged neighborhood may compound the stress of a new cancer diagnosis, leading to neuroendocrine dysregulation. Cognitive Behavioral Stress Management (CBSM) has shown efficacy at reducing distress and modulating neuroendocrine functioning, but it is unknown whether it is efficacious in this population. This is a secondary analysis of a randomized trial of 10-week group-based CBSM (versus a psycho-educational control) in women with nonmetastatic BC. The Area Deprivation Index (ADI) was calculated, and women were categorized as living in low (n = 175) versus high disadvantage (n = 50). Women completed a measure of cancer-related distress (Impact of Events Scale-Intrusions) and underwent blood draws to collect PM cortisol at baseline, 6 months, and 12 months. Hierarchical linear modeling tested whether condition predicted the slope of outcomes, and whether ADI moderated these relationships. CBSM was associated with greater reductions in cancer-specific distress and cortisol, though these effects were not found to be moderated by ADI. Exploratory simple slope analyses showed that CBSM was associated with decreased cancer-related distress across ADI categories, while CBSM resulted in decreased cortisol among low ADI women only. CBSM reduced cancer-related distress across neighborhoods, but this was only accompanied by cortisol changes among those in advantaged neighborhoods. Neighborhood disadvantage may represent a particularly salient stressor that is distinct from cancer-specific distress. Future interventions targeting this population should consider modifications to increase relevance and accessibility.

Background:Allogeneic hematopoietic stem cell transplantation (allo-SCT) is an effective treatment for various hematologic cancers, though it often results in severe side effects and psychological distress, which can negatively impact health outcomes. Integrative therapies like mindfulness-based stress reduction (MBSR), mindfulness meditation (MM), and music therapy (MT) yield promising results in enhancing both psychosocial outcomes (eg, reducing anxiety and depression) and physiological adaptation (eg, decreasing inflammation) in cancer patients. Objective:We developed and refined, using focus groups and environmental and field testing, an eHealth-delivered mindfulness-based music therapy (eMBMT) intervention aimed at improving health-related quality of life, symptom burden (ie, pain, fatigue, and sleep), disease activity (ie, chronic graft-versus-host disease, cytomegalovirus activation, and infections) and psychosocial (ie, depression, anxiety, and cancer-specific distress) and physiological adaptation (ie, inflammation and immune reconstitution) tailored to adults receiving allo-SCT. Methods:eMBMT intervention content is grounded in MT, MM, and MBSR, developed by a multidisciplinary team, and adapted for adults undergoing allo-SCT. eMBMT content was refined through focus groups and usability and field testing. Focus groups used a semistructured interview guide, while field testing used the "think aloud" method. Usability was evaluated using the 30-item Usefulness, Satisfaction, and Ease of Use (USE) questionnaire. Descriptive statistics analyzed the USE questionnaire and participant characteristics, while rapid qualitative analysis was applied to focus groups and field-testing sessions. Survivors eligible to participate in the focus groups and usability and field testing were adults (>18 years old) who received an allo-SCT (<36 months) for myelodysplastic syndrome, acute myeloid leukemia, or chronic myeloid leukemia, and were in remission for greater than 3 months. Results:During the focus groups, participants (n=11; mean age 43.6, SD 17.8 years) provided qualitative feedback highlighting the shock of diagnosis, challenges during hospitalization, and coping strategies posttreatment. The eMBMT platform received positive evaluations for usefulness (mean 6.47, SD 0.29), ease of use (mean 6.92, SD 0.60), and satisfaction (mean 6.16, SD 0.82). Key themes from field testing highlighted the significance of social support, hope, and maintaining an active lifestyle. Suggestions for improvement included incorporating more representative content, reducing text, enhancing guidance, offering diverse music options, and streamlining blood sample collection. Conclusions:The eMBMT intervention is a comprehensive, user-friendly eHealth tool tailored to the unique needs of allo-SCT patients. The positive feedback and identified areas for improvement underscore its potential to enhance well-being, symptom management, and overall quality of life for cancer survivors. A future pilot randomized controlled trial will further evaluate the feasibility, acceptability, and preliminary efficacy of the eMBMT intervention in improving health-related quality of life, symptom burden, disease activity, and psychosocial and physiological adaptation.