Nuevo Amanecer: Results of a Randomized Controlled Trial of a Community-Based, Peer-Delivered Stress Management Intervention to Improve Quality of Life in Latinas with Breast Cancer

Contact Name: 
Anna Napoles, PhD, MPH
Publication Author(s): 
Carmen Ortiz, PhD, Jasmine Santoyo-Olsson, MS, Anita L. Stewart, PhD, Steven Gregorich, PhD, Howard E. Lee, MD, MPH, Ysabel Duron, BA, Peggy McGuire, MA, and Judith Luce, MD
Barriers to Care Access
Quality of Life
Target Population: 
Hispanic or Latino
Cancer Site: 
Setting Description: 

Trained peers called compañeras (companions) delivered the stress management intervention, Nuevo Amanecer (New Beginnings), in participants' homes for eight weeks. Each week, a 90-minute module was presented to participants using visual aids and hands-on exercises to teach concepts and skills. Compañeras were bilingual or Spanish-monolingual Latina breast cancer survivors who completed active treatment and had participated in three consecutive eight-hour training sessions.  


Project Description: 

To address the high rates of emotional distress and poor quality of life experienced by Spanish-speaking Latinas with breast cancer, we developed a stress management program with input from Latina breast cancer survivors, health care professionals and researchers.

Nuevo Amanecer is an individualized Spanish-language eight-week intervention cognitive-behavioral therapeutic intervention in which compañeras (breast cancer survivors who have received training to deliver the program) teach Latinas who have breast cancer coping skills to manage stress and emotions related to breast cancer survivorship.  

In a randomized controlled trial (RCT), Nuevo Amanecer improved self-reported physical well-being, emotional well-being, breast cancer concerns and overall quality of life, and reduced depressive and body symptoms over a period of six months, as compared with a group of Spanish-speaking Latinas with breast cancer who received usual care while waiting to receive the Nuevo Amanecer intervention at a later time. One of the greatest improvements occurred in somatization, or "distress arising from perceptions of bodily dysfunction" (Napoles et al., 2015), as measured using the Somatization subscale of the Brief Symptom Inventory (Derogatis, 1983).

Results suggest that translation of evidence-based programs from clinical settings into community settings can reduce psychological health disparities in Latinas with breast cancer. 


Significance of Findings: 

To our knowledge, this is the first successful RCT demonstrating that breast cancer survivors can be trained to deliver effectively cognitive-behavioral stress management programs (CBSM) that usually are delivered by health care professionals in cancer centers.

Key Takeaways or Implications for Patients or Caregivers: 
Cognitive-behavioral stress management interventions can be delivered effectively by trained peers in community settings, increasing access to such programs among underserved communities. Delivering CBSM programs via community-based, trained peer support counselors can be a strategy to address shortages of culturally appropriate psycho-oncology services for the growing population of limited English-proficient cancer patients. Delivery of these programs by community organizations may enhance their cultural sensitivity, sustainability and reach.
Key Takeaways for Practice: 
A short stress management program is feasible and acceptable for use among recently diagnosed Spanish-speaking Latinas with breast cancer, a vulnerable group who has disproportionately higher risk of psychosocial morbidity following breast cancer, compared to white women. Implementing peer-delivered, evidence-based programs offers culturally relevant approaches that may help reduce disparities in distress related to breast cancer among Latinas.
Opportunities for Future Research or Takeaways for Other Researchers: 
There is potential for future research that evaluates peer-led CBSM with longer longitudinal outcomes (e.g. one year and beyond), in different populations (e.g. Latinas in different settings; other racial/ethnic minorities) and as compared with different approaches (e.g. other approaches for managing distress like mindfulness). Integrating evidence-based programs that are culturally and linguistically appropriate into community-based organizations enhances their translation potential.
Patient, Caregiver and/or Communities Research Engagement: 
This was a community-based participatory research project in which community organization representatives and breast cancer survivors were involved in all phases of the study.

This research was supported by the California Breast Cancer Research Grants Program Office of the University of California (15BB-1300 and 15BB-1301), National Cancer Institute (1U54CA153511), and National Institute on Aging (1 P30 AG15272). This trial is registered with (NCT01383174).