This is a two-arm randomized controlled trial (RCT) to determine the feasibility of a larger, fully powered trial in younger ER+ BCS undergoing endocrine therapy in the Deep South and to evaluate preliminary effectiveness of a breath-based group intervention- Breath-Body-Mind (BBM), a trauma-informed program emphasizing slow-paced coherent resonance breathing on psychological and physiological outcomes. The second arm, a survivorship education program (SEP), will serve as an attention-control to match contact time and group setting to control for placebo effects. This project will use multi-source and multimodal data to generate foundational insights into a stress-targeted intervention for an understudied survivorship population. Outcome measures will be assessed across all arms and will include self-reported measures, fMRI, neuro-endocrine-immune blood markers, multi-omics analyses, and physiological measures through a wrist-worn wearable device (GENEActiv).
Primary outcomes:
1\) Feasibility of study as measured by rates of enrollment, randomization, retention, and study completion. We will also develop a data collection system and evaluate its usefulness and ability to scale for a future trial.
Secondary outcomes:
1\) Change in psychological distress (Impact of Event Scale-Revised, IES-R) related to cancer diagnosis and treatment between baseline and 6 months after workshop.
Exploratory outcomes:
1. Fatigue using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F)
2. Sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and the GENEActive device
3. Pain using the Brief Pain Index (BPI),
4. Anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS)
5. Medication adherence using the Morisky Medication Adherence Scale
6. Interoceptive awareness using the Multidimensional Assessment of Interoceptive Awareness (MAIA)
7. Perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS)
8. Neurocognitive function (attention, working memory, processing speed, and executive functioning) using NIH toolbox
9. Overall quality of life will be measured using the Whole Person Health Index (WPHI).
10. Additional cancer-related outcomes will include the Functional Assessment of Cancer Therapy-Endocrine Symptoms (FACT-ES) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Breast 23 (EORTC QLQ-BR23) body image subscale.
11. The Adverse Childhood Experiences Questionnaire (ACE-Q) and the Big Five Inventory-2 Short Form (BFI-2-S) will be used to assess early life stress and personality traits that may moderate response to the intervention.
12. Peripheral biomarkers will be measured, including inflammatory cytokines (IL-6, TNF-α), neurotrophic factors (BDNF), neuroendocrine hormones (cortisol, oxytocin), fasting cardiometabolic markers (glucose, insulin), and blood pressure.
13. Examine neurobiological mechanisms using resting-state fMRI (brain connectivity changes), and multi-omics profiling (epigenomics, transcriptomics, proteomics, metabolomics).