Remotely-Delivered Cognitive Behavioral Stress Management Effects on Cancer-Accelerated Aging in Older, Distressed Breast Cancer Survivors

The study will enroll 192 breast cancer survivors (BCS) who completed initial treatment 3-12 months prior, are on adjuvant endocrine therapy (AET), distressed, mid-older aged (>50yrs), post-menopausal, and diagnosed with Stage I-III HR+, Her2neu- breast cancer. Participants will undergo a run-in period for screening, followed by baseline assessments including REDCAP questionnaires, saliva collection for cortisol, Empatica wristband for heart rate variability (HRV), and an in-person blood draw. Participants will be block randomized to either Remotely-delivered Cognitive Behavioral Stress Management (R-CBSM) + Survivorship Care Planning (SCP) (n=96) or SCP-only control (n=96). The R-CBSM+SCP group will receive 10 weekly group R-CBSM sessions via ZOOM and access to a website with educational materials. Weekly changes in intervention processes (stress, mood, perceived stress management skills, emotion regulation) will be monitored via ecological momentary assessment (EMA) to mobile phones or paper diaries. Follow-up assessments at 6 and 12 months will include RedCap questionnaires, saliva (cortisol), wristbands (HRV), and blood (immune measures). Physical and mental health (depression, quality of life) will be assessed at 0, 6, 12, and 24 months through questionnaires/interviews (remote or in-person) and blood draws, totaling 4 visits (T1: 0m, T2: 6m, T3:12m, T4: 24m) plus remote intercurrent monitoring.