Feature

Air Force Lt. Col. Beth Moore had a stressful year in 2001. She was traveling extensively for work, her mother died and then in November 2001, she was diagnosed with stage I invasive breast cancer. "The breast cancer diagnosis just kind of topped off my year," Moore says.

As she grappled with the sense of loss she felt, Moore wondered how the diagnosis would affect her career in the military and who would care for her if she had a recurrence. The 44-year-old found comfort and ways to deal with her concerns in a psychosocial model of treatment for breast cancer patients and their partners offered at Walter Reed Army Medical Center.

The new program is being developed and led by Lt. Col. Debra Dunivin, PhD, Walter Reed's deputy chief of the department of psychology and director of training for the clinical psychology residency program. She is collaborating with Geoffrey M. Reed, PhD, assistant executive director for professional development in APA's Practice Directorate.

The program is modeled after an earlier collaborative effort between the Practice Directorate and Blue Cross/Blue Shield of Massachusetts, and combines supportive-expressive group therapy, relaxation training and psychoeducation. The eight-week program, which meets one day a week for two hours, helps women cope with their diagnosis, prognosis and treatment options. A six-week session for partners--mostly the husbands of breast cancer patients--is a unique component of the model.

Dunivin and Reed adapted the Practice Directorate's program for the military population, and the model was incorporated into Walter Reed's Clinical Breast Care Project in April 2002. Its integration into patients' medical treatment will help showcase psychosocial care as a core aspect of breast cancer treatment within med-ical centers, Reed says. "It does exist [at other centers]," he says, "but it is not routine at this point."

Reed hopes the collaboration between the Practice Directorate and Walter Reed will help to change that. "If we create a model that has good outcomes, it will be more valued...and we will have something to show to other health-care systems," he says.

The women's groups for Walter Reed's breast cancer patients provide a venue for patients to talk about any intimate details and concerns related to their illness, such as fears of death and the effect on body image, relationships and priorities in life.

"It really is a trauma," Dunivin says. "They have a diagnosis that is potentially life-threatening and often affects family relationships. We try to normalize their feelings and show them they are not going through it alone."

During one session, women bring in childhood photos. "This gives them a chance to know each other as individuals, not only through their cancer stories," Dunivin says.

For the past five years, Walter Reed has included a psychologist on its team of medical staff that meets with women shortly after they are diagnosed to discuss treatment options. They've taken the psychosocial aspect of breast cancer care a step further with the group sessions that enable patients to discuss common concerns that are often difficult to address, such as dealing with hair loss, decreased sexual libido and the threat to their mortality, says Col. Craig Shriver, MD, director and principal investigator of the Clinical Breast Care Project at Walter Reed. "They are not alone," Shriver says. "These are very common issues among women [diagnosed with breast cancer]. Setting up a support system allows them to address these concerns."

A unique component

However, the project also takes into account the affect a breast cancer diagnosis can have on a woman's partner. The partners' group provides a place for husbands to feel support and address their concerns and fears over their wives' diagnoses. Many of the men in the program have served in combat roles in the military and tend not to be as apt to express emotions and vulnerability, Reed says.

The six-week session is modeled after one developed and tested by Barry Bultz, PhD, director of the department of psychosocial resources at the Tom Baker Cancer Center in Calgary, Alberta. The first two sessions contain structured activities that Bultz used in his program. During the first session, Dunivin and Reed showed a news program that featured husbands talking about their feelings openly so the men would have a model to follow and see the value in sharing with others. At the second session, a medical oncologist joined the group to provide information about cancer staging and treatment options, and to answer questions.

Before conducting the group, Dunivin and Reed had speculated that these husbands--who most likely had never been in psychotherapy before--would have difficulty in this setting. But the men were willing to share. Some said they felt guilty when they gave any care or attention to themselves. For instance, one man expressed guilt when he left his wife to go for a jog during the day.

While the participants tended to be motivated to support their wives through their treatment, they were not always sure how to provide that support as well as manage their own emotions, Reed says.

Steve Mackinnon, a former military officer, received a phone call about the new group shortly after his wife was diagnosed with stage I breast cancer last spring. "I decided to get involved to see if there is something I could learn to help my wife," he says. "But what I got out of it were coping skills and how to deal with the emotional turmoil I was going through."

Looking to the future

To bring the program to others, Dunivin and Reed worked with Lynn Bufka, PhD, the Practice Directorate's director of professional development demonstrations projects, to develop a training program in breast cancer psychosocial interventions for therapists within the military. The first training was conducted in December, and additional groups at Walter Reed and other military sites are slated to begin soon. They are also working on an educational video that includes participants talking about their experiences. The video is for health-care professionals as well as patients.

While some women recognize a formal group is not for everyone, many feel it's an option they want to have. That's why Dunivin and Reed hope other centers will follow suit to incorporate this type of psychosocial care into their programs. By doing so, they would be acknowledging that "psychosocial care is an integral part of the treatment with breast cancer patients and does involve the family," Dunivin says. And studies back up psychosocial programs' effectiveness. "The research is unequivocal--it helps people do better when they have psychosocial support," Dunivin says. "This needs to be an integral part of treatment."

Certainly, breast cancer patient Beth Moore can attest to that. Moore completed radiation treatment in March and was part of the first group of patients to attend the sessions in April. She says she liked the small group size--which usually ranges between six and 10--because it gave ample time for everyone to speak. The group also fostered bonds among participants, and after the sessions ended, some women have remained in contact.

Today, Moore says she feels great--both physically and emotionally. "[The group] definitely met my needs," Moore says. "It's a great group for any breast cancer patient--no matter where they are in the disease process. It benefited me personally and is truly expressive and supportive in format."