The authors tested effects of a 10-week group cognitive-behavioral stress management intervention among 100 women newly treated for Stage 0-II breast cancer. The intervention reduced prevalence of moderate depression (which remained relatively stable in the control condition) but did not affect other measures of emotional distress. The intervention also increased participants' reports that having breast cancer had made positive contributions to their lives, and it increased generalized optimism. Both remained significantly elevated at a 3-month follow-up of the intervention. Further analysis revealed that the intervention had its greatest impact on these 2 variables among women who were lowest in optimism at baseline. Discussion centers on the importance of examining positive responses to traumatic events--growth, appreciation of life, shift in priorities, and positive affect-as well as negative responses.

SUMMARYThis study examined coping and distress in African American (n=8), Hispanic (n=53), and non-Hispanic White (n=70) women with early stage breast cancer. The participants were studied prospectively across a year beginning at the time of surgery. African American women reported the lowest levels of distress (particularly before surgery) and depression symptoms. Hispanic women reported the highest levels of self-distraction as a coping response, nonHispanic Whites reported the highest use of humor. Hispanics reported the highest levels of venting, African Americans reported the lowest levels. African American and Hispanic women reported more religious coping than non-Hispanic Whites. The data also provided evidence of a maladaptive spiral of distress and avoidant coping over time. Although some ethnic differences were identified, findings also point to a great many similarities across groups.

Relatively little is known about how members of minority groups cope with experiences such as diagnosis and treatment of breast cancer -in particular, whether coping patterns among minorities differ from that of the majority. This study adds to the existing knowledge base using a cross-sectional sample of middle-class African-American (n ¼ 26), Hispanic (n ¼ 59), and non-Hispanic White women (n ¼ 151) who had been treated for early stage breast cancer in the past year. We tested for differences in coping responses per se and also for the possibility that coping would relate to distress differently in different groups. There were only two differences in coping (controlling for medical variables, education, and distress): compared to non-Hispanic White women, the other two groups both reported using humor-based coping less, and religion-based coping more. There was one difference in how coping related to distress: venting related more strongly to elevated distress among Hispanic than among non-Hispanics. Discussion centers on a growing consensus on ethnic differences in religious and humor-based coping, and on the relative absence of other coping differences among these populations.

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Clinical trials can help inform clinical decision making by quantifying the likelihood of benefit vs. harm. Integrating such data with individual patient circumstances, values, and preferences can help optimize treatment choices.