A predictive tool to help women bounce back from cancer
Coping with and surviving breast cancer is not just a matter of benefitting from the best and most suitable treatment option. It’s also a question of personal resilience, which involves complex factors such as biology, lifestyle, optimism, interpersonal connections or even spirituality. But while resilience studies do exist, most of them focus on emotional distress and functional impairment resulting from diagnosis and treatment. What gives patients strength, on the other hand, remains a grey area. “A strength-based perspective can improve our understanding of protective factors and the role they play in diagnosis and treatment outcomes. But to get there, we need a multidimensional approach,” says Paula Poikonen-Saksela, clinical lecturer at Helsinki University Hospital’s Comprehensive Cancer Center and coordinator of the BOUNCE (Predicting Effective Adaptation to Breast Cancer to Help Women to BOUNCE Back) project. BOUNCE attempts to conceptualise and assess resilience over a long period of time. The project uses a multimethod and multitrait conceptualisation of resilience that considers it either: as a trait or potential; as a process or trajectory; or as a quality-of-life outcome in long-term follow-up. The project team compiled a battery of scales and questionnaires which was then refined and condensed by a group of expert psychologists. The questionnaires were circulated to patients in different languages. “This was a time-consuming process which took longer than expected. We had to keep patients motivated to remain in the study and answer all our questions for the entire 18-month follow-up period, which was made even more complicated by the COVID-19 pandemic. Thanks to coordinated efforts from study physicians and research assistants, we eventually managed to reach the projected number of 600 patients who provided 1 year of follow-up data,” Poikonen-Saksela explains.
Psychological support
With this work completed, the project team proceeded to develop a dedicated clinical model. This will help practitioners identify the trajectories of resilience-related outcomes (such as quality of life) over time, as well the major variables that can predict these trajectories. Eventually, the model will be turned into a prediction tool that will help health professionals predict future levels of resilience-related outcomes based on patients’ status and scores for certain crucial variables. The tool will also come with basic clinical recommendations to facilitate informed decision-making. “A spin-off clinical study is currently under way in Helsinki and Milan,” Poikonen-Saksela adds. “It will examine basic aspects of the clinical model and the applicability of a clinical workflow involving our upcoming decision support tool. In Helsinki, we collect information about patients’ compliance, their actual need for resilience measurement, and the usefulness of digital interventions. In Milan, the main objective is to test the feasibility of the resilience predictor tool in clinical practice. Resilience scores will be measured at baseline, during and after targeted psychological interventions to detect any changes during treatment. We will closely observe which variables are affected by a psychological intervention.” The project is scheduled for completion in April 2022. The remaining time will be used for further data collection and improvement of the statistical models, as well as to conduct a cost-benefit analysis for the decision support module in clinical settings. Big benefits would considerably change clinical practice, enabling practitioners to provide personalised recommendations for the psychological support given to their patients.
Keywords
BOUNCE, breast cancer, psychological, resilience, optimism, lifestyle, decision support
