Clinic Methodology

The Healing with Basketball clinics are conducted once a month and combine these distinct five objectives to allow participants to:

1. Share their recovery goals and bond with other survivors
2. Improve existing overall strength and endurance
3. Recover upper body range of motion in arms, chest, and back
4. Relate to others via peak performance instead of via illness
5. Use the metaphor of basketball and the emphasis on play and teamwork

Specific clinic activities incorporate these five aspects in this way:

Sharing and bonding is promoted during the first thirty minutes of each three-hour clinic. All participants sit around the center circle in the gym on a mat or a towel. The sharing is conducted by a trained group psychotherapist and breast cancer survivor. Using the format of a “go-round,” each member shares briefly her experience of breast cancer, her challenge and success with physical activity, and sets an individual goal for that day’s clinic. The group is facilitated to offer support and feedback. This important first aspect of the clinic helps to fulfill the benefits shown from earlier studies of survivorship using group therapy. Most of the studies conducted in the past twenty years show a significant relationship between psychosocial factors and survival with breast cancer patients.

A study by Dr. David Spiegel (1989) from Stanford University, found that group psychotherapy for women with metastatic breast cancer improved survival. Spiegel found that women who received group therapy for one year were more likely to be alive eight months after diagnosis compared to a group of patients who received no therapy. Four subsequent studies had similar results. A follow up study, by Spiegel et al. (2007) found that patients with metastatic breast cancer who took part in weekly group psychotherapy had similar survival rates as those given literature-based patient education. However, the same study found that women with estrogen receptor (ER) negative tumors (the hardest to treat post-operatively) showed survival benefit and that group therapy improved quality of life (QOL).

Strength building and range of motion happens during the next hour of the clinic. The trainer helps participants warm up with structured stretching. They move next to exercises and drills that focus on improvement of upper body range of motion, full body strength building, and developing better balance.

This part of the clinic helps survivors develop muscle and aerobic strength over time. The use of drills helps to foster team-building and makes the clinic less isolating for members. Unlike a yoga class where participants rarely interact, the trainer uses this time to help participants interact. Participants try to best themselves using a timer and are encouraged to cheer each other on as they accomplish stressful strength building drills. The trainer breaks down each component of the drill so that they can be accomplished safely and customizes each activity to each participant's level of ability.

Research suggests that with the incorporation of vigorous, continual physical exercise, women improve breast cancer survival and reduce recurrence by rates of 20-50% (Holmes, Chen, Feskanich, Kroenke & Colditz, 2005). Increased physical activity after cancer is consistently related to better physical functioning, reduced fatigue, and bodily pain, underscoring the need for physical activity among survivors.

Despite such strong evidence, only 32% (Irwin et al., 2004)of breast cancer survivors engage in vigorous physical activity such as running, aerobics, or strength-training to build muscle. The lack of physical exercise is especially prevalent in women of color. Leitzmann (2008) suggests that differences in physical activity level may contribute poorer survival experienced by some breast cancer survivors.

Relating to others via peak performance rather than relating via a “victim mentality” is an important aspect of the clinic. Too often, breast cancer support groups and chat boards focus on the illness, as opposed to peak survivorship. At the clinics, survivorship is tied to physical achievement. Each month, women are encouraged to notice how they are improving in the quality of their health and their game.

As one survivor recently expressed:

I've been a part of Lynn Grodzki's group of basketball practices.  I can tell you from personal experience that I've quickly progressed from a person who would curl into a fetal position if a ball (of any shape or size) was thrown my way.  I'm now re-inventing myself as an athlete-- or progressing towards one!  I've not been very physically fit in the past.  The 3 hours of training push me to my limits and I find I can do even more than I dreamed.  I also am not in pain afterwards.  The trainer schedules the time so we are not over-taxing ourselves and helps us work with our own goals.  I've learned to dribble, to block, to walk on tip toes, I've done a few push-ups, and I've even shot balls in baskets!  And, I had a lot of fun.

Using the metaphor of basketball makes the clinic unique. Unlike other sports, basketball is an accessible, familiar sport for most cultures and classes in American society. It is also an easy sport to learn to play.

The second half of each clinic is focused on learning to play. The trainer teaches the fundamentals of basketball, which each survivor can practice at her own level of competence. Even without prior basketball experience, survivors easily learn to dribble, pass, and eventually shoot. In our clinics, we teach basic stretching, simple basketball drills (passing, shooting, etc.) and strength-building, aerobic exercises as we practice defense, offense, and running.

Basketball is a team sport and teaches the importance of reliance on others and shared effort to achieve points. In the clinic, the emphasis is on fun and play, not on winning or competition. As survivors pass and shoot, the workout provides a wonderful upper body and aerobic workout, regardless of one’s level of physical ability. As such, it is ideal exercise for breast-cancer survivors.

Participants enter the clinic feeling out of shape and out-of-sorts. They leave with a sense of confidence and excitement. Using our tailored program of building up under-developed muscles and exposing survivors to teamwork and ball handling, participants find themselves learning together, laughing together, and over time, becoming a loving team of stronger, more determined survivors.

 References:

• Alfano, C., et al. (2007). Physical activity, long-term symptoms and physical health-related quality of life among breast cancer survivors: A prospective analysis. Journal of Cancer Survey.

• Andrykowski, M.A. and Manne,M.L. (2006). Are psychological interventions effective and accepted by cancer patients? I. standards and levels of evidence. Ann Behav Med, 32, 93-97.

• Barraclough, J., Osmond , C. Taylor, I., Perry, M., Collins ,P. (1993). Life events and breast cancer prognosis. BMJ, (307), 325.

• Beresford, T.P., Alfers, J., Mangum, L., Clapp, L., Martin, B. (2006). Cancer survival probability as a function of ego defense (adaptive) mechanisms versus depressive symptoms. Psychosomatics, 47, 247-253.

• Buddeberg, C., Sieber, M., Wolf, C., Landolt-Ritter, C., Richter, D., Steiner, R. (1996). Are coping strategies related to disease outcome in early breast cancer? J Psychom Res, 40, 255-264.

• Butow, P.N., Coates, A.S., Dunn, S.M. (1999). Psychosocial predictors of survival in metastatic melanoma. J Clin Oncol, 17, 2256-2263.

• Butow, P.N., Coates, A.S., Dunn, S.M. (2000). Psychosocial predictors of survival: Metastatic breast cancer. Ann Oncol, 11, 469-474.

• Cassileth,R., Walsh, W.P., Lusk, E.J.. (1988). Psychosocial correlates of cancer survival: A subsequent report 3 to 8 years after cancer diagnosis. Journal of Clinical Oncology, 6, 1753-1759.

• Coyne J.C., Lepore, S.J., Palmer, S.C. (2006). Efficacy of psychosocial interventions in cancer care: Evidence is weaker than it first looks. Ann Behav Med, 32, 104-110.

• Cunningham, A.J., Edmonds, C.V., Jenkins, G.P., Pollack, H., Lockwood, G.A., Warr, D. (1998). A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer. Psychooncology, 7, 508-1517.

• DeBrabander, B., Gerits, P. (1999). Chronic and acute stress as predictors of relapse in primary breast cancer patients. Patient Educ Couns, 37, 265-266, 267-272.

• Derogatis, L.R., Abeloff, M.D., Melisaratos, N. (1979). Psychological coping mechanisms and survival time in metastatic breast cancer. JAMA, 202, 1504-1508.

• Gellert, G.A., Maxwell, R.M., Siegel, B.S. (1993). Survival of breast cancer patients receiving adjunctive psychosocial support therapy: A 10-year follow-up study. J Clin Oncol, 11, 66-69.

• Goodwin, P.J., Ennis, M., Bordeleau, L.J., Pritchard, K.I., Trudeau, M.E., Koo, J., et al. (2004). Health-related quality of life and psychosocial status in breast cancer prognosis: Analysis of multiple variables. J Clin Oncol, 22, 4184-4192.

• Goodwin, P.J., Leszcz, M., Ennis, M., Koopmans, J., Vincent, L., Guther, H., et al. (2001). The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med, 345, 1719-1726.

• Graham, J., Ramirez, A., Love, S., Richards, M., Burgess, C. (2002). Stressful life experiences and risk of relapse of breast cancer: Observational cohort study. BMJ, (324), 1420.

• Greer, S., Morris, T., Pettingale, K.W. (1979). Psychological response to breast cancer: Effect on outcome. Lancet, 2, 785-786.

• Hislop TG, Waxler NE, Coldman AJ, Elwood JM, Kan L. (1987). The prognostic significance of psychosocial factors in women with breast cancer. J Chronic Dis, 40, 729-735.

• Hjerl, K., Andersen, E.W., Keiding, N., Mouridsen, H.T., Mortensen, P.B., Jorgensen, T. (2003). Depression as a prognostic factor for breast cancer mortality. Psychosomatics, 44, 24-30.

• Irwin, M.L. and Ainsworth, B.E. (2004). Physical activity interventions following cancer diagnosis: Methodologic challenges to delivery and assessment. Cancer Investigation, 22(1), 30-50.

• Irwin, M.L., Crumley, D., McTiernan, A, Bernstein, L., Baumgartner, R., Gilliland, F.D., et al. (2003). Physical activity levels before and after a diagnosis of breast carcinoma: The health, eating, activity, and lifestyle (HEAL) study. Cancer, 97(7), 1746-1757.

• Irwin, M.L., McTiernan, A., Bernstein, L., Gilliland, F.D., Baumgartner, R., Baumgartner, K., and Ballard-Barbash, R. (2004). Physical activity levels among breast cancer survivors. Medicine & Science in Sports & Exercise, 36(9), 1484-1491.

• Jamison, R.N., Burish, T.G., Wallston, K.A. (1987). Psychogenic factors in predicting survival of breast cancer patients. J Clin Onc, 5, 768-769, 770, 771, 772.

• Jensen, M.R. (1987). Psychobiological factors predicting the course of breast cancer. J Pers, 55, 317-342.

• Kreitler, S., Kreitler, H., Chaitnic, S., Shaked, S. (1997). Psychological and medical predictors of disease course in breast cancer: A prospective study. Eur J Personality, 11, 383-400.

• Kroenke, C.H., Kubzansky, L.D., Schernhammer, E.S., Holmes, M.D., Kawachi, I. (2006). Social networks, social support, and survival after breast cancer diagnosis. J Clin Oncol, 24, 1105-1111.

• Lehto, U.S., Ojanen, M., Dyba, T., Aromaa, A., Kellokumpu-Lehtinen, P. (2006). Baseline psychosocial predictors of survival in localised breast cancer. Br J Cancer, 94, 1245-1252.

• Lemieux, J., Topp, A., Chappell, H., Ennis, M., Goodwin, P.J. (2006). Economic analysis of psychosocial group therapy in women with metastatic breast cancer. Breast Cancer Res Treat, 100-190.

• Levy, S.M., Lee, J., Bagley, C., Lippman, M. (1988). Survival hazards analysis in first recurrent breast cancer patients: Seven-year follow-up. Psychom Med, 50, 520-528.

• Marshall, F. D. (1883). Social environment and breast cancer. A cohort analysis of patient survival. Cancer, 52, 1546-1550.

• Hoffman, M.  (2008). Exercise for cancer patients: Fitness after treatment. Retrieved October 15th, 2008 from http://www.webmd.com/cancer/features/exercise-cancer-patients.

• Irwin, M. (2006). Ivanhoe interview. Archives of Internal Medicine, 166, 2478-2483.

• Holmes, M.D., Chen, W.Y., Feskanich, D., Kroenke, C.H., Colditz, G.A. (2005). Physical activity and survival after breast cancer diagnosis. JAMA, 293, 2479-2486.

• Osborne, C., Ostir, G.V., Du, X., Peek, M.K., Goodwin, J.S. (2005). The influence of marital status on the stage at diagnosis, treatment, and survival of older women with breast cancer. Breast Cancer Res Treat, 93, 41-47.

• Osborne, R.H., Sali, A., Aaronson, N.K., Elsworth, G.R., Mdzewski, B., Sinclair, A.J.. (2004). Immune function and adjustment style: Do they predict survival in breast cancer?. Psychooncology, 13, 199-210.

• Petticrew, M., Bel,l R., Hunter, D. (2002). Influence of psychological coping on survival and recurrence in people with cancer: Systematic review. BMJ, 325, 1066.

• Ramirez,,A.J., Craig, T.K., Watson, J.P., Fentiman, I.S., North, W.R., Rubens, D. (1989). Stress and relapse of breast cancer. BMJ, 298, 291-293.

• Reynolds, P., Boyd, P.T., Blacklow, R.S., Jackson, J.S., Greenberg, R.S., Austin,. D.F., Chen, V.W., Edwards, B.K. (1994). The relationship between social ties and survival among black and white breast cancer patients. national cancer institute Black/White cancer survival study group. Cancer Epidemiol Biomarkers Prev, 3, 253-259.

• Reynolds, P., Hurley, S., Torres, M., Jackson, J., Boyd, P., Chen, V.W. (2000). Use of coping strategies and breast cancer survival: Results from the Black/White cancer survival study. Am J Epidemiol, 152, 940-949.

• Soler-Vila, H., Kasl, S.V., Jones, B.A. (2005). Cancer-specific beliefs and survival: A population - based study of african-american and white breast cancer patients. Cancer Causes Control,168,105-114.

• Soler-Vila H, Kasl SV, Jones BA. (2003). Prognostic significance of psychosocial factors in african-american and white breast cancer patients: A population-based study. Cancer, 98, 1299-1308.

• Spiegel, D., Butler, L.D., Giese-Davis, J., Koopman, C., Miller, E., DiMicelis, S., et al. (2007). Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: A randomized prospective trial. Cancer.

• Spiegel, D., Bloom, J.R., Kraemer, H.C., Gottheil, E. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, 2, 888- 891.

• Tominaga, K., Andow, J., Koyama, Y., Numao, S., Kurokawa, E., Ojima, M., Nagai, M. (1998). Family environment, hobbies and habits as psychosocial predictors of survival for surgically treated patients with breast cancer. Jpn J Clin Oncol, 28, 36-41.

• Tross, S., Herndon, J., Korzun, A., Kornblith, A.B., Cella, D.F., Holland, J.F., et al. (1996). Psychological symptoms and disease-free and overall survival in women with stage II breast cancer. cancer and leukemia group B. J Natl Can Inst, 88, 661-667.

• Watson, M., Haviland, J.S., Greer, S., Davidson, J., Bliss J.M.. (1999). Influence of psychological response on survival in breast cancer: A population-based cohort study. Lancet, 354, 1331-1336.

• Weihs, K.L., Enright, T.M., Siemens, S.J., Reiss, D. (2000). Negative affectivity, restriction of emotions, and site of metastases predict mortality in recurrent breast cancer. J Psychosom Res, 49, 59-68.

• Weihs, K.L., Simmens, S.J., Mizrahi, J., Enright, T.M., Hunt, M.E., Siegel, R.S. (2005). Dependable social relationships predict overall survival in stages II and III breast carcinoma patients. J Psychosom Res, 59, 299-306.