A Culturally Adapted Cognitive Behaviour Therapy based intervention – Moving on After Breast Cancer Plus – for Pakistani depressed/anxious women with breast cancer
Breast cancer (BC) is the 2nd most common cancer globally and most prevalent cancer among women with an estimated 1.67 million new cases diagnosed in 2012 (25% of all cancers) (WHO, 2012). It is the most common cancer in women both in high and low income countries with slightly high prevalence in low income countries. In Pakistan every ninth woman has a chance of developing breast cancer, which is the highest rate in Asia. The estimated incidence rate of breast cancer in Pakistan is 50/100,000. Diagnosis as well as early treatment of breast cancer is associated with distress. Breast cancer survivors may experience difficulties with sleeping, eating, low mood and feelings of worry, which can last up to 4-10 years after their last cancer treatment. Feelings of low mood and anxiety may stop a person from living life the way they want to and this in turn can prevent them achieving full recovery. Research found that the lack of breast health awareness, modesty and taboos related to breasts, and lack of national breast cancer screening program were major hurdles in increasing survival rates from breast cancer in Pakistan.
As work on prevalence of associated depression with breast cancer is limited in a developing country, hence no work has been done so far on developing interventions to treat the associated conditions. Therefore, we want to assess the feasibility, acceptability and effectiveness of programme called ‘Moving on After Breast Cancer’ (ABC) combined with Cognitive Behaviour Therapy (CBT) (culturally adapted group talking treatment). The combined programme is called ‘Moving on ABC plus’ and will teach mindfulness, relaxation techniques and how to manage low mood and anxiety symptoms. Women are being recruited from Oncology clinics, GP surgeries and voluntary organisations across 4 cities in Pakistan (Karachi, Lahore, Multan, Rawalpindi). The target sample size is 354 breast cancer survivors. All participants are being assessed at baseline using the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder scale (GAD-7), Rosenberg Self Esteem Scale, The Functional Assessment of Cancer Therapy – Breast (FACT-B), EuroQoL EQ-5D, Intrusive Thoughts Scale, and Multidimensional Scale of Perceived Social Support: (MSPSS) at baseline, 4th month (completion of intervention) and 6 month. Participants are being assigned to either intervention arm or routine treatment. As part of this project we will also explore the views of health professionals and service users and their carers on the treatment available and barriers to accessing treatment.