Prospective Thinking in Hormone-Responsive Breast Cancer
| Status: | Recruiting |
|---|---|
| Conditions: | Breast Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - 80 |
| Updated: | 2/17/2019 |
| Start Date: | August 1, 2018 |
| End Date: | June 30, 2019 |
| Contact: | Jeff S Stein, PhD |
| Email: | jstein1@vtc.vt.edu |
| Phone: | 540-526-2124 |
Effects of a Prospective Thinking Intervention on Delay Discounting in Patients With Hormone-Responsive Breast Cancer
One factor that limits the effectiveness of adjuvant hormone therapy for breast cancer is
medication nonadherence. Adherence to long-term medication regimens requires valuation of
temporally distant outcomes. Thus, interventions that improve valuation of the future, a
phenomenon known as delay discounting, may improve medication adherence in breast cancer
treatment and improve survival. This study will investigate the acute efficacy of a
prospective thinking intervention (episodic future thinking) for reducing delay discounting
and improving valuation of future health in breast cancer patients. Patients will engage in
either episodic future thinking or a control condition during completion of delay discounting
tasks in which they choose between immediate and delayed outcomes.
medication nonadherence. Adherence to long-term medication regimens requires valuation of
temporally distant outcomes. Thus, interventions that improve valuation of the future, a
phenomenon known as delay discounting, may improve medication adherence in breast cancer
treatment and improve survival. This study will investigate the acute efficacy of a
prospective thinking intervention (episodic future thinking) for reducing delay discounting
and improving valuation of future health in breast cancer patients. Patients will engage in
either episodic future thinking or a control condition during completion of delay discounting
tasks in which they choose between immediate and delayed outcomes.
Globally, breast cancer is the most common cause of cancer death among women. The most common
pathological subtype is hormone receptor positive breast cancer, which accounts for
approximately 70% of all diagnoses. Adherence to adjuvant hormone therapy (HT), including
selective estrogen receptor modulators and aromatase inhibitors, in the treatment of hormone
responsive breast cancer decreases risk of recurrence and increases overall survival among
women. Unfortunately, up to half of patients discontinue HT prematurely or administer HT less
frequently than prescribed, which increases risk of disease recurrence and associated
mortality. Understanding the mechanisms underlying nonadherence will allow for development of
targeted interventions to improve breast cancer survival.
A defining characteristic of adjuvant HT is that it provides no short-term benefits and,
instead, prevents disease recurrence only after years of sustained adherence. In contrast,
the benefits of discontinuing HT are relatively immediate (e.g., avoidance of adverse side
effects, such as hot flashes or arthralgia). Thus, adherence to HT requires one's behavior to
be guided by temporally distant outcomes, as bias toward immediate gratification narrows the
temporal window over which future costs and benefits can motivate behavior. Therefore,
treatment adherence may be understood through the behavioral economic process of delay
discounting (i.e. devaluation of delayed outcomes), which provides a measure of how
individuals value the future. Accumulating evidence shows that delay discounting is
associated with a wide variety of maladaptive health behaviors, including failure to seek
routine medical screening for cancer and other illnesses. However, no work has yet examined
associations between delay discounting and adherence to cancer treatment, generally, or
breast cancer treatment, specifically. This gap in knowledge represents a challenge to the
understanding of risk factors for cancer-related morbidity and mortality and may limit the
efficacy of breast cancer treatment.
Accordingly, the present study will investigate the acute efficacy of an episodic future
thinking (EFT) intervention for reducing discounting and improving valuation of future health
in breast cancer patients. EFT is a form of prospection that involves mental simulation of
events that might occur in one's future. To some extent, EFT is an innate human ability that
guides decision-making (e.g., simulating the experience of an upcoming job interview or
social event); however, populations who discount the future rapidly show deficits in this
ability, considering the future infrequently and demonstrating low-quality EFT content (e.g.,
fewer contextual and sensory details). Thus, EFT interventions are designed to remediate this
deficit and reduce bias toward immediate gratification by guiding individuals to both
generate high-quality EFT content and prompting them to engage in EFT frequently. Prior
laboratory-based research by the investigative team and others has shown that EFT both
reduces delay discounting and improves a wide range of maladaptive health behaviors and
outcomes contributing to the development of cancer and survival following diagnosis and
treatment, including tobacco use and dietary and weight control. The present study seeks to
extend these findings by demonstrating that EFT improves laboratory-based measures of delay
discounting and valuation of future health in breast cancer patients. Demonstrating EFT's
acute efficacy in the laboratory would suggest that EFT may be adapted in future grant
proposals as a targeted, remotely delivered intervention to improve HT adherence and
subsequent breast cancer survival.
pathological subtype is hormone receptor positive breast cancer, which accounts for
approximately 70% of all diagnoses. Adherence to adjuvant hormone therapy (HT), including
selective estrogen receptor modulators and aromatase inhibitors, in the treatment of hormone
responsive breast cancer decreases risk of recurrence and increases overall survival among
women. Unfortunately, up to half of patients discontinue HT prematurely or administer HT less
frequently than prescribed, which increases risk of disease recurrence and associated
mortality. Understanding the mechanisms underlying nonadherence will allow for development of
targeted interventions to improve breast cancer survival.
A defining characteristic of adjuvant HT is that it provides no short-term benefits and,
instead, prevents disease recurrence only after years of sustained adherence. In contrast,
the benefits of discontinuing HT are relatively immediate (e.g., avoidance of adverse side
effects, such as hot flashes or arthralgia). Thus, adherence to HT requires one's behavior to
be guided by temporally distant outcomes, as bias toward immediate gratification narrows the
temporal window over which future costs and benefits can motivate behavior. Therefore,
treatment adherence may be understood through the behavioral economic process of delay
discounting (i.e. devaluation of delayed outcomes), which provides a measure of how
individuals value the future. Accumulating evidence shows that delay discounting is
associated with a wide variety of maladaptive health behaviors, including failure to seek
routine medical screening for cancer and other illnesses. However, no work has yet examined
associations between delay discounting and adherence to cancer treatment, generally, or
breast cancer treatment, specifically. This gap in knowledge represents a challenge to the
understanding of risk factors for cancer-related morbidity and mortality and may limit the
efficacy of breast cancer treatment.
Accordingly, the present study will investigate the acute efficacy of an episodic future
thinking (EFT) intervention for reducing discounting and improving valuation of future health
in breast cancer patients. EFT is a form of prospection that involves mental simulation of
events that might occur in one's future. To some extent, EFT is an innate human ability that
guides decision-making (e.g., simulating the experience of an upcoming job interview or
social event); however, populations who discount the future rapidly show deficits in this
ability, considering the future infrequently and demonstrating low-quality EFT content (e.g.,
fewer contextual and sensory details). Thus, EFT interventions are designed to remediate this
deficit and reduce bias toward immediate gratification by guiding individuals to both
generate high-quality EFT content and prompting them to engage in EFT frequently. Prior
laboratory-based research by the investigative team and others has shown that EFT both
reduces delay discounting and improves a wide range of maladaptive health behaviors and
outcomes contributing to the development of cancer and survival following diagnosis and
treatment, including tobacco use and dietary and weight control. The present study seeks to
extend these findings by demonstrating that EFT improves laboratory-based measures of delay
discounting and valuation of future health in breast cancer patients. Demonstrating EFT's
acute efficacy in the laboratory would suggest that EFT may be adapted in future grant
proposals as a targeted, remotely delivered intervention to improve HT adherence and
subsequent breast cancer survival.
Inclusion Criteria:
- Age 18-80 years
- Female
- Must have a history of hormone responsive breast cancer treated with curative intent
and have been recommended/prescribed adjuvant HT (tamoxifen, anastrozole, letrozole or
exemestane) by their physician.
Exclusion Criteria:
- Recurrent breast cancer
- Adjuvant hormone therapy is no longer medically appropriate/advisable
- Incapable/ without capacity to provide personal consent
- Suffers from cognitive or physical impairments which interfere with medication self-
administration and/or participation in episodic thinking
- Receiving HT for metastatic disease
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