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Effectiveness of Self-Management Training, “EDUDARA”, on Psychological Wellbeing and Cortisol Levels in Breast Cancer Patients during the COVID-19 Pandemic

*Lilik Supriati scopus  -  Department of Nursing, Faculty of Health Sciences, Universitas Brawijaya, Indonesia
Renny Nova  -  Department of Nursing, Faculty of Health Sciences, Universitas Brawijaya, Indonesia
Muhammad Rodli  -  Institute of Science,Technology and Health, Rumah Sakit Dr. Soepraoen, Indonesia
Ahsan Ahsan  -  Department of Nursing, Faculty of Health Sciences, Universitas Brawijaya, Indonesia
Nur Hidaayah  -  Department of Nursing, Faculty of Nursing, Universitas Nahdlatul Ulama, Indonesia
I Dewa Ayu Rismayanti  -  Doctor in Nursing, Nursing Program, Sekolah Tinggi Ilmu Kesehatan Buleleng, Indonesia
Open Access Copyright (c) 2024 by the Authors, Published by Department of Nursing, Faculty of Medicine, Universitas Diponegoro
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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Abstract

Background: Women diagnosed with breast cancer often experience emotional distress, leading to a decrease in psychological well-being. Online self-management training during the COVID-19 pandemic is crucial for maintaining psychological well-being, as it is closely related to stress hormone cortisol levels, which play a vital role in boosting the body’s immune system. However, research on self-management strategies for breast cancer patients, particularly regarding psychological aspect and its relationship to cortisol levels during the COVID-19 pandemic, remains limited.

Purpose: The purpose of this study was to measure the effectiveness of self-management training on psychological well-being and salivary cortisol levels in breast cancer patients.

Methods: This study used a pre-post-test quasi-experimental design with a control group. The participants included 70 breast cancer patients undergoing chemotherapy at a hospital in Malang City, East Java, Indonesia, recruited using simple random sampling. Self-management training using the EDUDARA (Edukasi Kanker Payudara) was administered to the participants in the intervention group for six weeks. Data on wellbeing were collected using the Ryff Psychological Wellbeing Questionnaire, while salivary cortisol levels were measured with the DBD cortisol kit using the competitive ELISA method. SPSS with t-tests was used to analyze the data.

Results: The average post-test psychological well-being score in the intervention group was 90.3, while in the control group, it was 82.69. The results of statistical tests showed a significant difference in psychological well-being between the two groups, with the intervention group showing greater improvement after the training. Additionally, the mean salivary cortisol level post-training was 4.531 in the intervention group and 6.169 in the control group (p=0.001). This indicates a greater reduction in cortisol levels in the intervention group after training, showing that participants’ psychological condition following the “EDUDARA” training was better than that of the control group.

Conclusion: Self-management training had a positive effect on increasing psychological well-being and decreasing salivary cortisol levels among breast cancer patients. Therefore, structured self-management training for these patients can be used for nursing intervention

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Keywords: self- management; psychological well – being; cortisol level; breast cancer

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  1. Ahmadzadeh, I., Abdekhoda, M., & Bejani, M. (2021). Improving self-care management in patients with breast cancer through health literacy promotion. Ethiopian Journal of Health Sciences, 31(1), 85–90. https://doi.org/10.4314/ejhs.v31i1.10
  2. Alhazmi, L. S. S., Bawadood, M. A. A., Aljohani, A. M. S., Alzahrani, A. A. R., Moshref, L., Trabulsi, N., & Moshref, R. (2021). Pain management in breast cancer patients: A multidisciplinary approach. Cureus, 13(6). https://doi.org/10.7759/cureus.15994
  3. Arambasic, J., Sherman, K. A., & Elder, E. (2019). Attachment styles, self-compassion, and psychological adjustment in long-term breast cancer survivors. Psycho-Oncology, 28(5), 1134–1141. https://doi.org/10.1002/pon.5068
  4. Badana, A. N. S., Marino, V. R., Templeman, M. E., Mcmillan, S. C., Tofthagen, C. S., Small, B. J., & Haley, W. E. (2019). Understanding the roles of patient symptoms and subjective appraisals in well-being among breast cancer patients. Support Care Cancer, 27(11), 4245-4252. https:doi.org/10.1007/s00520-019-04707-2
  5. Bò, M. C., Merlo, A., Ligabue, M. B., Bassi, M. C., Lusuardi, M., & Campanini, I. (2023). Self-managed physical activity in breast cancer survivors: A scoping review. PLoS ONE, 18(4), e0284807. https://doi.org/10.1371/journal.pone.0284807
  6. Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68(6), 394–424. https://doi.org/10.3322/caac.21492
  7. Chen, X., Wang, M., Yu, K., Xu, S., Qiu, P., Lyu, Z., Zhang, X., & Xu, Y. (2023). Chronic stress-induced immune dysregulation in breast cancer: Implications of psychosocial factors. Journal of Translational Internal Medicine, 11(3), 226–233. https://doi.org/10.2478/jtim-2021-0050
  8. de la Torre-Luque, A., Cerezo, M. V., López, E., & Sibole, J. V. (2020). Emotional distress among long-term breast cancer survivors: The role of insomnia and worry. Behavioral Psychology/ Psicologia Conductual, 28(3), 533–549
  9. Durosini, I., Triberti, S., Savioni, L., Sebri, V., & Pravettoni, G. (2022). The Role of emotion-related abilities in the quality of life of breast cancer survivors: A Systematic review. International Journal of Environmental Research and Public Health, 19(19), 12704. https://doi.org/10.3390/ijerph191912704
  10. Endang, N. H, Nursalam, N., Chong, M. C., Taat, P. S, & Hidayat, A. (2019). Change of stress and cortisol levels in patients with breast cancer given psychospiritual care. International Journal of Caring Sciences, 12(3), 1796–1805
  11. Frausto, V. M. R., Ortega, L. C., Chiapas, J. M. R., González, M. A. H., Sabanero, G. B., & Rocha, G. M. (2020). Correlation between stress, cortisol levels and coping strategies in cancer patients undergoing treatment. Enfermeria Global, 19(4), 196–219. https://doi.org/10.6018/eglobal.410951
  12. Guan W, Liang W, Zhao Y, Liang H, Chen Z, Li Y, Liu X, Chen R, Guan, W. J., Liang, W. H., Zhao, Y., Liang, H. R., Chen, Z. Z. S., Li, Y. M., Liu, X. Q., Chen, R. C., Tang, C. L., Wang, T., Ou, C. Q., … Chen R. (2020). Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. The European Respiratory Journal, 55(5), 2000547. https://doi.org/10.1183/13993003.00547-2020
  13. Hernandez, R., Bassett, S. M., Boughton, S. W., Schuette, S. A., Shiu, E. W., & Moskowitz, J. T. Psychological well-being and physical health: Associations, mechanisms, and future directions. Emotion Review, 10(1), 18-29. https://doi.org/10.1177/1754073917697824
  14. Herrera, R. A., Deshpande, K., Martirosian, V., Saatian, B., Julian, A., Eisenbarth, R., Das, D., Iyer, M., & Neman, J. (2022). Cortisol promotes breast-to-brain metastasis through the blood-cerebrospinal fluid barrier. Cancer Reports, 5(4), 1–11. https://doi.org/10.1002/cnr2.1351
  15. Iddon, J. E., Taylor, P. J., Unwin, J., & Dickson, J. M. (2019). The role of positive goal engagement in increased mental well-being among individuals with chronic non-cancer pain. British Journal of Pain, 13(4), 230-238. https://doi.org/10.1177/2049463718824857
  16. Koinig, K. A., Arnold, C., Lehmann, J., Giesinger, J., Köck, S., Willenbacher, W., Weger, R., Holzner, B., Ganswindt, U., Wolf, D., & Stauder, R. (2021). The cancer patient’s perspective of COVID-19-induced distress—A cross-sectional study and a longitudinal comparison of HRQOL assessed before and during the pandemic. Cancer Medicine, 10(12), 3928–3937. https://doi.org/10.1002/cam4.3950
  17. Kong, H., Liu, Y., Wu, K., Cui, S., Bai, J., & Fan, X. (2022). Pain and self-management status among Chinese patients with cancer during the COVID-19 pandemic. Pain Management Nursing, 23(1), 26–30. https://doi.org/10.1016/j.pmn.2021.09.004
  18. Lally, R. M., Bellavia, G., Gallo, S., Kupzyk, K., Helgeson, V., Brooks, C., Erwin, D., & Brown, J. (2019). Feasibility and acceptance of the CaringGuidance web-based, distress self-management, psychoeducational program initiated within 12 weeks of breast cancer diagnosis. Psycho-Oncology, 28(4), 888–895. https://doi.org/10.1002/pon.5038
  19. Larasati, D., A., Nugroho, F. A., & Marlina, T. M. (2020). Self care management activities untuk meningkatkan psychological serenity pasien kanker [Self care management activities to increase psychological serenity in cancer patients]. Jurnal Keperawatan Jiwa, 8(3), 337–352
  20. Luo, X., Chen, Y., Chen, J., Zhang, Y., Li, M., Xiong, C., & Yan, J. (2022). Effectiveness of mobile health-based self-management interventions in breast cancer patients: A meta-analysis. Supportive Care in Cancer, 30(3), 2853–2876. https://doi.org/10.1007/s00520-021-06568-0
  21. Maculaitis, M. C., Liu, X., Berk, A., Massa, A., Weiss, M. C., Kurosky, S. K., Li, B., & McRoy, L. (2023). Psychosocial wellbeing among patients with breast cancer during COVID-19. Current Oncology, 30(4), 3886–3900. https://doi.org/10.3390/curroncol30040294
  22. Mahendradhata, Y., Lestari, T., & Djalante, R. (2022). Strengthening government’s response to COVID-19 in Indonesia: A modified Delphi study of medical and health academics. PLoS ONE, 17(9), e0275153. https://doi.org/10.1371/journal.pone.0275153
  23. McBride, E., Arden, M. A., Chater, A., & Chilcot, J. (2021). The impact of COVID-19 on health behaviour, well-being, and long-term physical health. British Journal of Health Psychology, 26(2), 259–270. https://doi.org/10.1111/bjhp.12520
  24. Mészáros-Crow, E., López-Gigosos, R., Mariscal-López, E., Agredano-Sanchez, M., García-Casares, N., Mariscal, A., & Gutiérrez-Bedmar, M. (2023). Psychosocial interventions reduce cortisol in breast cancer patients: Systematic review and meta-analysis. Frontiers in Psychology, 14, 1148805. https://doi.org/10.3389/fpsyg.2023.1148805
  25. Ministry of Health Republic of Indonesia. (2023). Perkembangan situasi penyakit infeksi emerging minggu epidemiologi ke-17 tahun 2023 (23-29 April 2023) [Development of the emerging infectious disease situation 17th epidemiological week 2023 23-29 April 2023]. Ministry of Health Republic of Indonesia. https://infeksiemerging.kemkes.go.id/document/download/LQv
  26. Mohammadzadeh, Z., Eghtedar, S., Ayatollahi, H., & Jebraeily, M. (2022). Effectiveness of a self-management mobile app on the quality of life of women with breast cancer: A study in a developing country. BMC Women’s Health, 22(1), 1–12. https://doi.org/10.1186/s12905-022-02020-5
  27. Muttaqin, D. (2022). Internal structure evaluation on the Indonesian version of psychological well-being scales. Psympathic: Jurnal Ilmiah Psikologi, 9(1), 1–16. https://doi.org/10.15575/psy.v9i1.10710
  28. Nihayati, H. E., Nurhanifah, L., & Krisnana, I. (2021). The effect of psychoeducation on self-efficacy and motivation for taking treatment in breast cancer patients (Ca Mammae). Jurnal Ners, 16(1), 96–100. https://doi.org/10.20473/jn.v16i1.22560
  29. Novarisa, N., Helda, H., & Mulyadi, R. (2023). Indonesia’s COVID-19 trend after the end of a public health emergency of international concern: Preparation for an endemic. Kesmas: Jurnal Kesehatan Masyarakat Nasional, 18(1), 25-30. https://doi.org/10.21109/kesmas.v18isp1.7018
  30. Ortega, L. C., Alicia, M., González, H., & Sabanero, G. B. (2020). Correlation between stress, cortisol levels and coping strategies in cancer patients undergoing treatment. Enfermeria Global. 208–219. https://doi.org/10.6018/eglobal.410951
  31. Pace, T. W. W., Badger, T. A., Segrin, C., Sikorskii, A., & Crane, T. E. (2021). The relationship between health-related quality of life and saliva C-reactive protein and diurnal cortisol rhythm in Latina breast cancer survivors and their informal caregivers: A pilot study. Journal of Transcultural Nursing, 32(4), 326–335. https://doi.org/10.1177/1043659620926537
  32. Pugh, T. M., Squarize, F., & Kiser, A. L. (2021). A comprehensive strategy to pain management for cancer patients in an inpatient rehabilitation facility. Frontiers in Pain Research, 2, 688511. https://doi.org/10.3389/fpain.2021.688511
  33. Ramírez-Expósito, M. J., Dueñas-Rodríguez, B., Carrera-González, M. P., Navarro-Cecilia, J., & Martínez-Martos, J. M. (2021). Circulating levels of β-endorphin and cortisol in breast cancer. Comprehensive Psychoneuroendocrinology, 5, 100028. https://doi.org/10.1016/j.cpnec.2021.100028
  34. Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069. https://psycnet.apa.org/doi/10.1037/0022-3514.57.6.1069
  35. Sephton, S. E., Lush, E., Dedert, E. A., Floyd, A. R., Rebholz, W. N., Dhabhar, F. S., Spiegel, D., & Salmon, P. (2013). Diurnal cortisol rhythm as a predictor of lung cancer survival. Brain, Behavior, and Immunity, 30, S163-S170. https://doi.org/10.1016/j.bbi.2012.07.019
  36. Smith, A. “Ben,” Bamgboje-Ayodele, A., Butow, P., Klein, B., Turner, J., Sharpe, L., Fardell, J., Beatty, L., Pearce, A., Thewes, B., Beith, J., & Girgis, A. (2020). Development and usability evaluation of an online self-management intervention for fear of cancer recurrence (iConquerFear). Psycho-Oncology, 29(1), 98–106. https://doi.org/10.1002/pon.5218
  37. Soetrisno, Cahyanto, E. B., Mulyani, S., Nugraheni, A., Nurinasari, H., & Tjiang, R. E. (2020). The cortisol level, depression anxiety stress score, and quality of life in patient with advance stage cervical cancer after two years of psychorative intervention. Bali Medical Journal, 9(1), 6–12. https://doi.org/10.15562/bmj.v9i1.1636
  38. Supriati, L., Sudiana, I. K., Nihayati, H. E., Ahsan, Rodli, M., & Kapti, R. E. (2022). Perspective of uncertainty and emotional responses in breast cancer patients during the COVID-19 pandemic. SAGE Open Nursing, 8, 1-7. https://doi.org/10.1177/23779608221124294
  39. Supriati, L., Sudiana, I. K., Nihayati, H. E., Ahsan, Rodli, M., & Kapti, R. E. (2023). Patient and illness factors influencing fear of recurrence in breast cancer women. Journal of the Pakistan Medical Association, 73(2), S26–S29. https://doi.org/10.47391/JPMA.Ind-S2-6
  40. Surendra, H., Paramita, D., Arista, N. N., Putri, A. I., Siregar, A. A., Puspaningrum, E., Rosylin, L., Gardera, D., Girianna, M., & Elyazar, I. R. (2023). Geographical variations and district-level factors associated with COVID-19 mortality in Indonesia: a nationwide ecological study. BMC Public Health, 23(1), 103. https://doi.org/10.1186%2Fs12889-023-15015-0
  41. Vanni, G., Materazzo, M., Pellicciaro, M., Ingallinella, S., Rho, M., Santori, F., Cotesta, M., Caspi, J., Makarova, A., Pistolese, C. A., & Buonomo, O. C. (2020). Breast cancer and COVID - 19: The effect of fear on patients’ decision-making process. In Vivo, 34, 1651–1659. https://doi.org/10.21873/invivo.11957
  42. Verma, R., Kilgour, H. M., & Haase, K. R. (2022). The psychosocial impact of COVID-19 on older adults with cancer: A rapid review. Current Oncology, 29(2), 589–601. https://doi.org/10.3390/curroncol29020053
  43. Viale, G., Licata, L., Sica, L., Zambelli, S., Zucchinelli, P., Rognone, A., Aldrighetti, D., Di Micco, R., Zuber, V., Pasetti, M., Di Muzio, N., Rodighiero, M., Panizza, P., Sassi, I., Petrella, G., Cascinu, S., Gentilini, O. D., & Bianchini, G. (2020). Personalized risk–benefit ratio adaptation of breast cancer care at the epicenter of COVID-19 outbreak. The Oncologist, 25(7), e1013–e1020. https://doi.org/10.1634/theoncologist.2020-0316
  44. Villarosa, J., & Ganotice, F. (2018). Construct validation of Ryff’s Psychological Well-being Scale: Evidence from Filipino teachers in the Philippines. Philippine Journal of Psychology, 51(1), 1–20. https://doi.org/10.31710/pjp/0051.01.01

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