An Early Stress-Reduction Intervention in Patients With Newly Diagnosed Breast Cancer

Study Groups:

If you agree to take part in this study, you will be randomly assigned (as in the flip of a
coin) to 1 of 2 groups. You will have an equal chance of being in either group:

- If you are in Group 1, you will be asked to do daily mind-body exercises for 14 days,
beginning before you start receiving chemotherapy. The exercises are short, about 10
minutes per day. The exercises are presented on an online application ("app") that runs
on your personal electronic device (such as a mobile phone or tablet). You will be
required to install the application on your personal device and to create an account.
The study staff will tell you how to perform the exercises, install the application, and
create an account. During the 14 days, you will receive automated daily reminders to do
the exercises. After you have finished the 14 days of mind-body exercises, you may
continue to use the application free of charge for the remainder of the year. After the
first year, if you want to keep using the application, you will have to pay for it.

- If you are in Group 2, you will not perform the mind-body exercises. You will be offered
one year of free access to the application described above at your last study visit.

Study Visits - All Participants:

Before you start chemotherapy:

- You will complete 10 questionnaires about your stress, mood, physical symptoms, and
personality. It should take about 45 minutes to complete all of the questionnaires. You
can decide to complete some of the questionnaires from home on a personal computer.

- Information about you (such as age and race) and the disease will be collected from your
medical record.

- Blood (about 1 tablespoon) will be drawn for testing of genes and biomarkers that may be
related to physical symptoms and mood. Biomarkers are found in the blood and tissue and
may help researchers measure the effects of the daily mind-body exercises.

- A hair sample will be taken to measure hormones that are commonly released during times
of stress. A lock of hair about the width of a pencil lead will be cut close to your
scalp.

- You may be asked to complete a computer task in which you press buttons multiple times
in a set time limit. You will receive written instructions on how to complete the task.
It should take 15 minutes to complete this task.

At about 15 days after you started the study:

°You will complete one question about your stress. You can complete this question in the
clinic or from home on a personal computer.

During chemotherapy:

At about the third month and the sixth month of chemotherapy:

- You will complete 6 questionnaires about your stress, mood, and physical symptoms. It
should take about 30 minutes to complete the questionnaires. You can decide to complete
these questionnaires from home on a personal computer.

- If your schedule allows for it and you agree, blood (about 1 tablespoon) will be drawn
for biomarker testing. If you do not have time to complete this blood draw, it will not
affect your participation in this study.

About 6 months after you finish receiving chemotherapy:

- You will complete 8 questionnaires about your stress, mood, and physical symptoms. It
should take about 30 minutes to complete the questionnaires.

- Blood (about 1 tablespoon) will be drawn for biomarker testing.

- You may be asked to complete the computer task described above.

Length of Study:

Your participation on this study will be over about 6 months after your last cycle of
chemotherapy. If chemotherapy will not be the first treatment you receive for your diagnosis,
then your participation on this study will be over at 2 weeks after the start of the study.

Inclusion Criteria:

1. Women with stage I-III breast cancer who are followed by the Department of Breast
Medical Oncology and are recommended for neoadjuvant chemotherapy, any regimen. If
chemotherapy is received in an outside facility, patients are eligible if they are
scheduled to return to MD Anderson after completion of chemotherapy.

2. Patients = or > 18 years old

3. Patients who speak English

4. Patients who are willing and able to review, understand, and provide written consent

5. Patients who agree to comply with all study procedures

6. Patients who have access to a mobile phone, tablet, or personal computer, that
supports the Headspace application

Exclusion Criteria:

1. Patients with a documented diagnosis of a formal thought disorder (e.g.,
schizophrenia)

2. Patients who are currently or have been in the past three months actively engaged in
meditation-related exercises for at least one hour a week

3. Patients who are currently receiving psychotherapy

4. Patients with pre-existing diagnosis of an inflammatory autoimmune disease such as
rheumatoid arthritis, systemic lupus erythematosus, or multiple sclerosis

5. Patients who are currently taking adrenergic receptor antagonist (e.g., propranolol)
or corticosteroids (e.g., dexamethasone, methylprednisolone)