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Bergerot CD, Philip EJ, Bergerot PG, Siddiq N, Tinianov S, Lustberg M. Fear of Cancer Recurrence or Progression: What Is It and What Can We Do About It? Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35561298 DOI: 10.1200/edbk_100031] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with cancer face a trajectory marked by emotional and physical distress that can be associated with both diagnosis and treatment. Fear of cancer recurrence or progression has been considered one of the most common unmet needs reported by patients diagnosed with both localized and metastatic disease. Fear of cancer recurrence or progression has been defined as the "fear, worry, or concern relating to the possibility that cancer will come back or progress." Often overlooked by health care teams, fear of cancer recurrence or progression has been associated with impaired quality of life and psychosocial adjustment, elevated emotional distress, and a range of physical symptoms. Several interventions for fear of cancer recurrence or progression are currently under investigation. Early recognition, support, and validation of feelings associated with fear of cancer recurrence or progression, and appropriate referrals to psychosocial oncology, can be beneficial for many patients. Assessing patients early in their cancer trajectory, and at important milestones, including a change in therapies, at the end of active treatment, and during follow-up visits, can help identify individuals at risk and help individuals engage in supportive programs.
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Affiliation(s)
| | - Errol J Philip
- University of California San Francisco, San Francisco, CA
| | - Paulo Gustavo Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasília, DF, Brazil
| | - Namrah Siddiq
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
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Dietrich N, Estradé A, Antonio Cruzado J. Efficacy of Meaning-Centered Psychotherapy in adult patients with advanced cancer: A systematic review and meta-analysis. PSICOONCOLOGIA 2021. [DOI: 10.5209/psic.77752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: We conducted a PRISMA-compliant systematic review of clinical trials, and a meta-analysis of randomised clinical trials (RCTs) of manualised Meaning-Centered Psychotherapy (MCP) interventions for adult advanced cancer patients. We searched seven databases for trials published in English and Spanish, until March 27, 2021. Results: Seven trials were included in the systematic review, and four in the meta-analysis. The systematic review favoured the effectiveness of MCP for the improvement of spiritual well-being, quality of life (QoL), sense of meaning and psychological distress, although inconsistencies between the trials were found. In pre-post meta-analytic estimates, MCP had a superior therapeutic effect than control conditions for spiritual well-being (d=0.52, p<0.001), QoL (d=0.60, p<0.001), anxiety symptoms (d=-0.47, p<0.001), depressive symptoms (d=-0.50, p<0.001) and desire for hastened death (d=-0.28, p<0.001). No differences were observed in between-group comparisons. MCP was not associated with an increased risk of abandonment at post-treatment (OR=0.86, p=0.57). Conclusion: Manualised MCP interventions are a promising treatment for the improvement of spiritual well-being and quality of life and the reduction of psychological distress in adult patients with advanced cancer. The evidence base is still in an emerging state and should be expanded by higher methodological quality studies.
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Ben-Arye E, Elly M, Gressel O, Reshef A, Shani Md M, Stein N, Saliba W, Samuels N. Exploring the effectiveness of a patient-tailored integrative oncology program on emotional distress during chemotherapy for localized cancer. Psychooncology 2021; 31:207-218. [PMID: 34435403 DOI: 10.1002/pon.5794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/25/2021] [Accepted: 08/11/2021] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVE There is a need to explore how patient-tailored integrative oncology (IO) programs reduce emotional distress. This study set out to bridge the IO research gap between non-specific, quality of life-related and specific emotional-related concerns in chemotherapy-treated patients. METHODS This pragmatic, prospective and preference-controlled study examined patients attending an integrative-physician consultation and weekly IO treatments during adjuvant/neo-adjuvant chemotherapy for localized cancer. Patients choosing to attend ≥4 IO sessions (highly adherent to integrative care, AIC) were compared to low AIC patients using the ESAS (Edmonton Symptom Assessment Scale) anxiety, depression and sleep; and the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) emotional functioning scale, at baseline, 6 and 12 weeks. Emotional distress was assessed by ESAS anxiety and depression, considered as the primary study outcomes. RESULTS Of 439 participants, 260 (59%) were high-AIC and 179 low-AIC, both with similar baseline demographic and cancer-related characteristics. At 6 weeks, high-AIC patients reported greater improvement on ESAS sleep (p = 0.044); within-group improvement on ESAS anxiety and; and EORTC emotional functioning. Compared with low-AIC, high-AIC patients showed greater improvement on ESAS depression (p = 0.022) and sleep (p = 0.015) in those with high baseline ESAS anxiety scores (≥7); and ESAS anxiety (p = 0.049) for patients moderately anxious (4-6) at baseline. CONCLUSIONS High-AIC was associated with significantly reduced anxiety, depression and sleep severity at 6 weeks, especially those with high-to-moderate baseline anxiety levels. These findings reduce the research gap, suggesting specific emotional-related effects of IO.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Maya Elly
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Lin, Carmel, and Zebulun Medical Centers, Clalit Health Services, Haifa, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Alon Reshef
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Psychiatry Department, Ha'Emek Medical Center, Haifa, Israel
| | - Michal Shani Md
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Family Medicine, Clalit Health Service, Rehovot, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Walid Saliba
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Noah Samuels
- The Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Reflecting on meaning in an existential-reorientation group psychotherapy approach for cancer patients: A qualitative thematic analysis. Palliat Support Care 2021; 20:313-320. [PMID: 34275498 DOI: 10.1017/s1478951521000936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objectives of this study were to evaluate, in the Italian cultural context, breast cancer patients' main meaning themes related to the experience of the disease, on the one side, and to be part of an existentially oriented group intervention, on the other. METHOD A short reorientation-existential (RET) group intervention, structured by using some tools and background from cognitive analytic therapy (CAT) and based on the meaning-centered psychotherapy (MCP) existential framework, was delivered to 29 breast cancer patients. The sessions were audio-recorded and transcribed verbatim, with the narratives from reflective exercises (meaning of the journey cancer, meaning of the journey of intervention) uploaded to computer software NVivo 11. Analysis of the transcripts emerged from reflective exercises on the personal meaning of cancer and the letters of meaning (goodbye letter) written by the patients to express the meaning of their experience in the group was conducted through the interpretative phenomenological analysis (IPA) framework. RESULTS Four superordinate themes were identified in the exercise meaning of the experience of cancer, namely "sense of stigma and loneliness (the foreigner)," "guilt (unjust guilt and anticipatory guilt)," "reconsidering one's own life and nostalgia," and "rebirth (a new life, life after life)." Three superordinate themes were found in the meaning of the group experience in the letters, namely "togetherness and gratitude," "legacy," and "acceptance." SIGNIFICANCE OF RESULTS The study confirmed that a short group intervention, based on the existentially oriented framework and delivered in a public clinical healthcare setting, was enriched by focusing on the personal meaning of cancer. Some themes, such as loneliness, nostalgia, and rebirth, emerged during reflection giving, in written letters to participants, the sense of the group therapeutic experience.
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Enhancing Self-Esteem and Body Image of Breast Cancer Women through Interventions: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041640. [PMID: 33572137 PMCID: PMC7914971 DOI: 10.3390/ijerph18041640] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/12/2022]
Abstract
Breast Cancer (BC) is the most common neoplasm in women worldwide, considered a global public health problem. Among BC women, some of the most common psychological symptoms in the adaptation to the disease are reduction in self-esteem and distorted body image (BI). Although there are numerous studies with the goal of promoting different psychological variables, BI and self-esteem are often separately observed despite their relationship and their importance in the process of the illness. Moreover, there have been no reviews that have synthesized the findings related to interventions aimed at enhancing both self-esteem and BI in BC women. Therefore, the objective of this review was to identify and examine the implemented interventions aimed at boosting both variables in this population. For this purpose, a systematic review was implemented following the PRISMA statement. A thorough search was performed on the following databases: Web of Science, PubMed, PsychInfo, PsychArticles, and Scopus. Among 287 records, only eight articles met the eligibility criteria. Interventions were grouped into three types according to their characteristics: Group therapies, Physical activity therapies, and Cosmetic and beauty treatments. The levels of effectiveness of the different interventions varied between them, and within each, in their impact on self-esteem and BI. More interventions focused on developing BI and self-esteem in this population are needed due to their ability to predict psychological functioning and quality of life of women with breast cancer.
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Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Dignity and Psychotherapeutic Considerations in End-of-Life Care. J Palliat Care 2019. [DOI: 10.1177/082585970402000303] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Harvey Max Chochinov
- Department of Psychiatry, University of Manitoba; Manitoba Palliative Care Research Unit and Department of Psychosocial Oncology, CancerCare Manitoba; Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; and Edith Cowan University, Perth, Australia
| | - Thomas Hack
- Department of Psychosocial Oncology, CancerCare Manitoba, and Faculty of Nursing, University of Manitoba
| | - Thomas Hassard
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Susan McClement
- Manitoba Palliative Care Research Unit, CancerCare Manitoba, and Faculty of Nursing, University of Manitoba
| | - Mike Harlos
- St. Boniface General Hospital, Winnipeg, Manitoba, Canada
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Vehling S, Kissane DW. Existential distress in cancer: Alleviating suffering from fundamental loss and change. Psychooncology 2018; 27:2525-2530. [DOI: 10.1002/pon.4872] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/26/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Sigrun Vehling
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - David W. Kissane
- University of Notre Dame; Sydney Australia
- Cunningham Centre; St Vincent's Hospital; Sydney Australia
- Szalmuk Family Psycho-Oncology Research Unit; Cabrini Health and Monash Partner's Comprehensive Cancer Centre; Melbourne Australia
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Tomei C, Lebel S, Maheu C, Lefebvre M, Harris C. Examining the preliminary efficacy of an intervention for fear of cancer recurrence in female cancer survivors: a randomized controlled clinical trial pilot study. Support Care Cancer 2018; 26:2751-2762. [PMID: 29500582 DOI: 10.1007/s00520-018-4097-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 02/07/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Among cancer survivors, fear of cancer recurrence (FCR) is the most frequently reported unmet need. Despite this, research on psychosocial interventions that target FCR is limited. To address this gap, an individual cognitive-existential psychotherapy intervention for FCR was pilot tested via small-scale RCT. METHODS Participants were recruited via study posters, healthcare professionals' referrals, and an electronic hospital database. Twenty-five female cancer survivors were randomized to experimental or wait-list control groups. Sessions included cognitive restructuring techniques, behavioral experiments, discussion of existential concerns, and relaxation exercises. Nineteen women completed the 6-week intervention and completed questionnaire packages at various time points. All participants completed self-administered questionnaires at pre-intervention (T1), post-intervention (T2), and at 3-month follow-up (T3). Participants in the control group also completed the same questionnaires, including at baseline (T0). RESULTS Statistically significant results of between-within ANOVAs included time by condition interactions in the primary outcome measure of FCR and, for the experimental group participants, time by condition interactions in the secondary outcome measures of cancer-specific distress and uncertainty in illness. Statistically significant results of repeated measures ANOVAs included reductions in FCR, cancer-specific distress, uncertainty in illness, reassurance seeking, cognitive avoidance, and intolerance of uncertainty, as well as improvements in positive reinterpretation and growth, emotional coping, and quality of life (improved mental health), when compared to the control group. Most changes were maintained at 3-month follow-up. CONCLUSIONS This intervention responds to a need for evidence-based individual modality interventions targeting quality of life in cancer survivors. Our results demonstrate preliminary promising results in addressing FCR in female cancer survivors. Future research could seek to replicate results with a larger sample. Further research is needed to test this intervention with patients of mixed cancer sites.
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Affiliation(s)
- Christina Tomei
- School of Psychology, University of Ottawa, 136 Jean-Jacques-Lussier Private, Vanier Hall, Ottawa, ON, K1N 6N5, Canada.
| | - Sophie Lebel
- School of Psychology, University of Ottawa, 136 Jean-Jacques-Lussier Private, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
| | - Christine Maheu
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | | | - Cheryl Harris
- Psychology Department, The Ottawa Hospital, Ottawa, ON, Canada
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Abstract
A person who faces the diagnosis of cancer is subjected to changes within his body, but also with regard to his view of himself and his social relationships. Cancer related psychological distress occurs frequently and has a different prevalence according to-among other factors-cancer type and stage of disease. The main psychiatric disturbances observed in patients with cancer are adjustment disorders and affective disorders (anxiety and depression), which in the majority of patients are due to stressors related to the occurrence and threat of the disease and pre-existing psychological vulnerabilities; however, they might also be a direct consequence of biological causes either resulting from bodily modifications induced by the cancer or from treatment side effects. This chapter provides theoretical and practical information on the main psychotherapeutic approaches for cancer patients, complemented by some reflections on their clinical and scientific evidence.
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Affiliation(s)
- Mirjam de Vries
- Service de Psychiatrie de Liaision, Département de Psychiatrie, Centre hospitalier universitaire vaudois, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
| | - Friedrich Stiefel
- Service de Psychiatrie de Liaision, Département de Psychiatrie, Centre hospitalier universitaire vaudois, Rue du Bugnon 21, 1011, Lausanne, Switzerland
- Faculté de Biologie et Médecine, Université de Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland
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Chan A, Gan YX, Oh SK, Ng T, Shwe M, Chan R, Ng R, Goh B, Tan YP, Fan G. A culturally adapted survivorship programme for Asian early stage breast cancer patients in Singapore: A randomized, controlled trial. Psychooncology 2017; 26:1654-1659. [DOI: 10.1002/pon.4357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/16/2016] [Accepted: 12/22/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Alexandre Chan
- Department of Pharmacy; National University of Singapore; Singapore
- Department of Pharmacy; National Cancer Centre Singapore; Singapore
- Duke-NUS Medical School Singapore; Singapore
| | - Yan Xiang Gan
- Department of Pharmacy; National Cancer Centre Singapore; Singapore
| | - Suan Kai Oh
- Department of Pharmacy; National University of Singapore; Singapore
| | - Terence Ng
- Department of Pharmacy; National University of Singapore; Singapore
- Department of Pharmacy; National Cancer Centre Singapore; Singapore
| | - Maung Shwe
- Department of Pharmacy; National University of Singapore; Singapore
- Department of Pharmacy; National Cancer Centre Singapore; Singapore
| | - Raymond Chan
- Queensland University of Technology; Brisbane Queensland Australia
- Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Raymond Ng
- Duke-NUS Medical School Singapore; Singapore
- Division of Medical Oncology; National Cancer Centre Singapore; Singapore
| | - Brandon Goh
- Department of Psychosocial Oncology; National Cancer Centre Singapore; Singapore
| | - Yee Pin Tan
- Department of Psychosocial Oncology; National Cancer Centre Singapore; Singapore
| | - Gilbert Fan
- Department of Psychosocial Oncology; National Cancer Centre Singapore; Singapore
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Simonelli LE, Siegel SD, Duffy NM. Fear of cancer recurrence: a theoretical review and its relevance for clinical presentation and management. Psychooncology 2016; 26:1444-1454. [DOI: 10.1002/pon.4168] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 03/09/2016] [Accepted: 04/27/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Laura E. Simonelli
- Christiana Care Health System; Helen F. Graham Cancer Center & Research Institute; Newark DE USA
| | - Scott D. Siegel
- Christiana Care Health System; Helen F. Graham Cancer Center & Research Institute; Newark DE USA
| | - Nicole M. Duffy
- Christiana Care Health System; Helen F. Graham Cancer Center & Research Institute; Newark DE USA
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Maheu C, Lebel S, Courbasson C, Lefebvre M, Singh M, Bernstein LJ, Muraca L, Benea A, Jolicoeur L, Harris C, Ramanakumar AV, Ferguson S, Sidani S. Protocol of a randomized controlled trial of the fear of recurrence therapy (FORT) intervention for women with breast or gynecological cancer. BMC Cancer 2016; 16:291. [PMID: 27112319 PMCID: PMC4845394 DOI: 10.1186/s12885-016-2326-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/20/2016] [Indexed: 01/31/2023] Open
Abstract
Background Clinically significant levels of fear of cancer recurrence (FCR) affect up to 49 % of cancer survivors and are more prevalent among women. FCR is associated with psychological distress, lower quality of life, and increased use of medical resources. Despite its prevalence, FCR is poorly addressed in clinical care. To address this problem, we first developed, and pilot tested a 6-week, 2 h, Cognitive-existential group intervention therapy that targeted FCR in survivors of breast or gynecological cancer. Following the positive outcome of the pilot, we are now testing this approach in a randomized clinical trial (RCT). Goal and hypotheses: This multicenter, prospective RCT aims to test the efficacy of the intervention. The study hypotheses are that, compared to a control group, cancer survivors participating in the intervention (1) will have less FCR, (2) will show more favorable outcomes on the following measures: cancer-specific distress, quality of life, illness uncertainty, intolerance of uncertainty, perceived risk of cancer recurrence, and coping skills. We further postulate that the between-group differences will persist three and 6 months post-intervention. Methods Sixteen groups of seven to nine women are being allocated to the intervention or the control group. The control group receives a 6-week, 2 h, structurally equivalent support group. We are recruiting 144 cancer survivors from four hospital sites in three Canadian cities. The sample size was based on the moderate pre/post-test changes found in our pilot study and adjusted to the drop-out rates. Measurements: The primary outcome, FCR, is measured by the Fear of Cancer Recurrence Inventory. Secondary outcomes measured include cancer-specific distress, perceived risk of cancer recurrence, illness uncertainty, intolerance of uncertainty, coping, and quality of life. We use reliable and recognized valid scales. Participants are to complete the questionnaire package at four times: before the first group session (baseline), immediately after the sixth session, and 3 and 6 months post-intervention. Analysis: In the descriptive analysis, comparison of group equivalent baseline variables, identification of confounding/intermediate variables and univariate analysis are planned. Each participant’s trajectory is calculated using Generalized Estimating Equation models to determine the time and group effects, after considering the correlation structures of the groups. An intent-to-treat analysis approach may be adopted. Discussion Our Fear of Recurrence Therapy (FORT) intervention has direct implications for clinical service development to improve the quality of life for patients with breast (BC) and gynecological cancer (GC). Based on our pilot data, we are confident that the FORT intervention can guide the development of effective psychosocial cancer survivorship interventions to reduce FCR and improve psychological functioning among women with BC or GC. Trial registration Dr. Christine Maheu registered the trial with ISRCTN registry (Registration number: ISRCTN83539618, date assigned 03/09/2014).
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Affiliation(s)
- Christine Maheu
- Ingram School of Nursing, McGill University, Montreal, Quebec, J7V 0E2, Canada. .,Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2C4, Canada.
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada
| | - Christine Courbasson
- Centre for Addition and Mental Health, CB, DB Therapy & H Therapy Centre, Toronto, Ontario, M4T 1Z2, Canada
| | - Monique Lefebvre
- Department of Psychology and Psychosocial Oncology Program, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, K1H 8L6, Canada
| | - Mina Singh
- School of Nursing, York University, Toronto, Ontario, M3J 1P3, Canada
| | - Lori J Bernstein
- Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2C4, Canada
| | - Linda Muraca
- Auxiliary Breast Health Program, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada
| | - Aronela Benea
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Ontario, M5S 1B2, Canada
| | - Lynne Jolicoeur
- Integrated Cancer Program, The Ottawa Hospital, Ottawa, Ontario, K1H 8L6, Canada
| | - Cheryl Harris
- Centre for Addition and Mental Health, CB, DB Therapy & H Therapy Centre, Toronto, Ontario, M4T 1Z2, Canada
| | | | - Sarah Ferguson
- Obstetrics and Gynecology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2M9, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, M5B 2K3, Canada
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Bahmani B, Motamed Najjar M, Sayyah M, Shafi-Abadi A, Haddad Kashani H. The Effectiveness of Cognitive-Existential Group Therapy on Increasing Hope and Decreasing Depression in Women-Treated With Haemodialysis. Glob J Health Sci 2015; 8:219-25. [PMID: 26755466 PMCID: PMC4954871 DOI: 10.5539/gjhs.v8n6p219] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/10/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Hopefulness is one of the most significant predictors of adaptation in hemodialysis patients, and plays a vital role in the recovery process. In contrast to hopefulness, depression is a frequent psychological reaction of the hemodialysis treatment with many negative consequences. The current research was designed to examine the effect of cognitive-existential treatment on the level of hopefulness and depression in hemodialysis patients. MATERIALS & METHODS This quasi-experimental research included 22 female patients suffering from chronic kidney failure disease undergoing hemodialysis treatment for at least 3 months. The patients were randomly assigned into two groups of experimental and control conditions. The experimental group received a combination of treatment including some elements of "existentialism" philosophy and a "cognitive" approach designed for the Iranian population. The treatment protocol lasted for 12 sessions of 90 minutes twice per week prior to the entry of the patient to the dialysis session. Miller's hope scale and BDI-II-21 were employed to collect the data. Statistical analysis was performed on the data using analysis of covariance by SPSS: 16 software. RESULTS The result of the analysis indicated that there was a significant improvement in hopefulness level and decrease in depression of the patients in the experiment condition (P<0.01). CONCLUSION The result of analysis showed that cognitive-existential treatment resulted in the increase of hopefulness and decrease level of depression in the hemodialysis patients suffering from chronic kidney failure.
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Delalibera M, Presa J, Coelho A, Barbosa A, Franco MHP. Family dynamics during the grieving process: a systematic literature review. CIENCIA & SAUDE COLETIVA 2015; 20:1119-34. [DOI: 10.1590/1413-81232015204.09562014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 05/08/2014] [Indexed: 11/22/2022] Open
Abstract
The loss of a loved one can affect family dynamics by changing the family system and creating the need for family members to reorganize. Good family functioning, which is characterized by open communication, expression of feelings and thoughts and cohesion among family members, facilitates adaptive adjustment to the loss. This study conducted a systematic review of the literature on family dynamics during the grieving process. A search was conducted in the EBSCO, Web of Knowledge and Bireme databases for scientific articles published from January 1980 to June 2013. Of the 389 articles found, only 15 met all the inclusion criteria. The selected studies provided evidence that dysfunctional families exhibit more psychopathological symptoms, more psychosocial morbidity, poorer social functioning, greater difficulty accessing community resources, lower functional capacity at work, and a more complicated grieving process. Family conflicts were also emphasized as contributing to the development of a complicated grieving process, while cohesion, expression of affection and good communication in families are believed to mitigate grief symptoms.
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Tao WW, Jiang P, Liu Y, Aungsuroch Y, Tao XM. Psycho-oncologic interventions to reduce distress in cancer patients: a meta-analysis of controlled clinical studies published in People's Republic of China. Psychooncology 2014; 24:269-78. [DOI: 10.1002/pon.3634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 07/01/2014] [Accepted: 07/06/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Wei-Wei Tao
- School of Nursing; Dalian Medical University; Dalian China
| | - Ping Jiang
- School of Nursing; Dalian Medical University; Dalian China
| | - Ying Liu
- School of Nursing; Dalian Medical University; Dalian China
- Faculty of Nursing; Chulalongkorn University; Bangkok Thailand
| | | | - Xiao-Mei Tao
- Beijing Shijitan Hospital Affiliated to Capital Medical University; Beijing China
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A cognitive-existential intervention to improve existential and global quality of life in cancer patients: A pilot study. Palliat Support Care 2014; 13:981-90. [PMID: 25050872 DOI: 10.1017/s147895151400073x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We developed a specific cognitive-existential intervention to improve existential distress in nonmetastatic cancer patients. The present study reports the feasibility of implementing and evaluating this intervention, which involved 12 weekly sessions in both individual and group formats, and explores the efficacy of the intervention on existential and global quality of life (QoL) measures. METHOD Some 33 nonmetastatic cancer patients were randomized between the group intervention, the individual intervention, and the usual condition of care. Evaluation of the intervention on the existential and global QoL of patients was performed using the existential well-being subscale and the global scale of the McGill Quality of Life (MQoL) Questionnaire. RESULTS All participants agreed that their participation in the program helped them deal with their illness and their personal life. Some 88.9% of participants agreed that this program should be proposed for all cancer patients, and 94.5% agreed that this intervention helped them to reflect on the meaning of their life. At post-intervention, both existential and psychological QoL improved in the group intervention versus usual care (p = 0.086 and 0.077, respectively). At the three-month follow-up, global and psychological QoL improved in the individual intervention versus usual care (p = 0.056 and 0.047, respectively). SIGNIFICANCE OF RESULTS This pilot study confirms the relevance of the intervention and the feasibility of the recruitment and randomization processes. The data strongly suggest a potential efficacy of the intervention for existential and global quality of life, which will have to be confirmed in a larger study.
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Lebel S, Maheu C, Lefebvre M, Secord S, Courbasson C, Singh M, Jolicoeur L, Benea A, Harris C, Fung MFK, Rosberger Z, Catton P. Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study. J Cancer Surviv 2014; 8:485-96. [PMID: 24756313 DOI: 10.1007/s11764-014-0357-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 03/20/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Evidence suggests that fear of cancer recurrence (FCR) is one of the most frequently cited unmet needs among cancer survivors and is associated with psychological distress, stress-response symptoms, and lower quality of life, as well as increased use of health care resources. Despite these factors, few manualized interventions exist to address FCR among cancer survivors. PURPOSE To develop, manualize, and pilot test the feasibility and preliminary efficacy of a 6-week cognitive-existential (CE) group intervention designed to address FCR in women with breast or ovarian cancer. METHODS This study was a single-arm multi-site study with pre-, post-, and 3-month follow-up measurement occasions. RESULTS A total of 56 breast or ovarian cancer survivors enrolled in the study; 44 completed the CE group intervention. Following the intervention, women experienced a reduction in the primary study outcome measure of FCR and secondary study outcome measures of cancer-specific distress and uncertainty. They also reported improvements in secondary study outcome measures of quality of life and coping. The effect sizes of the observed changes were for the most part in the medium to large effect range; furthermore, almost all changes were sustained at 3-month follow-up. CONCLUSION This brief intervention appears feasible and has shown promising results in addressing FCR and related secondary outcomes of cancer-specific distress, uncertainty, quality of life, and coping; however, it should be further tested using a randomized controlled study design to more definitively assess its efficacy. IMPLICATIONS FOR CANCER SURVIVORS FCR is a near-universal worry for cancer survivors that, when left unaddressed, tends to remain stable over time. This study has important implications for all cancer survivors as it is the first published intervention that provides preliminary evidence of its efficacy in decreasing fear of cancer recurrence.
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Affiliation(s)
- Sophie Lebel
- School of Psychology, University of Ottawa, 136 Jean Jacques Lussier, room 4016, Ottawa, Ontario, Canada, K1N6N5,
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Barrera I, Spiegel D. Review of psychotherapeutic interventions on depression in cancer patients and their impact on disease progression. Int Rev Psychiatry 2014; 26:31-43. [PMID: 24716499 DOI: 10.3109/09540261.2013.864259] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Depression, ranging from mild to severe, is the most frequently found psychological symptom among individuals with cancer. Depression in cancer patients has been known to mitigate emotional distress, quality of life, adherence to medical treatment, and overall health outcomes. Specifically, depression has been associated with impaired immune response and with poorer survival in patients with cancer. Various studies have found that psychotherapeutic interventions are effective in reducing symptoms of depression, which in turn could affect disease progression and mortality. This paper provides updated information on psychotherapeutic interventions geared towards cancer patients suffering from depressive disorders, and its impact on disease progression. PubMed, Cochrane Library database, PsycINFO and PsycARTICLES databases were searched from January 1980 through August 2013 using key words: psychotherapy, treatment, oncology, cancer, psycho-oncology, psychosocial issues, psychosocial stress, depression, mood disorder, and psychoneuroimmunology.
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Affiliation(s)
- Ingrid Barrera
- Department of Psychiatry and Behavioral Science, Miller School of Medicine, University of Miami , Miami, Florida , USA
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Mustafa M, Carson‐Stevens A, Gillespie D, Edwards AGK. Psychological interventions for women with metastatic breast cancer. Cochrane Database Syst Rev 2013; 2013:CD004253. [PMID: 23737397 PMCID: PMC11032751 DOI: 10.1002/14651858.cd004253.pub4] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Psychological symptoms are associated with metastatic breast cancer. This is the basis for exploring the impact of psychological interventions on psychosocial and survival outcomes. One early study appeared to show significant survival and psychological benefits from psychological support while subsequent studies have revealed conflicting results. This review is an update of a Cochrane review first published in 2004 and previously updated in 2007. OBJECTIVES To assess the effects of psychological interventions on psychosocial and survival outcomes for women with metastatic breast cancer. SEARCH METHODS We searched the Cochrane Breast Cancer Group Specialised Register, MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCO), online trials and research registers in June/July 2011. Further potentially relevant studies were identified from handsearching references of previous trials, systematic reviews and meta-analyses. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster RCTs of psychological interventions, which recruited women with metastatic breast cancer. Outcomes selected for analyses were overall survival, psychological outcomes, pain, quality of life, condition-specific outcome measures, relationship and social support measures, and sleep quality. Studies were excluded if no discrete data were available on women with metastatic breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data and assessed the quality of the studies using the Cochrane Collaboration risk of bias tool. Where possible, authors were contacted for missing information. Data on the nature and setting of the intervention, relevant outcome data, and items relating to methodological quality were extracted. Meta-analyses was performed using a random-effects or fixed-effect Mantel-Haenszel model, depending on expected levels of heterogeneity. MAIN RESULTS Ten RCTs with 1378 women were identified. Of the seven RCTs on group psychological interventions, three were on cognitive behavioural therapy and four were on supportive-expressive group therapy. The remaining three studies were individual based and the types of psychological interventions were not common to either cognitive behavioural or supportive-expressive therapy. A clear pattern of psychological outcomes could not be discerned as a wide variety of outcome measures and durations of follow-up were used in the included studies. The overall effect of the psychological interventions across six studies, on one-year survival, favoured the psychological intervention group with an odds ratio (OR) of 1.46 (95% confidence interval (CI) 1.07 to 1.99). Pooled data from four studies did not show any survival benefit at five-years follow-up (OR 1.03, 95% CI 0.42 to 2.52). There was evidence of a short-term benefit for some psychological outcomes and improvement in pain scores. AUTHORS' CONCLUSIONS Psychological interventions appear to be effective in improving survival at 12 months but not at longer-term follow-up, and they are effective in reducing psychological symptoms only in some of the outcomes assessed in women with metastatic breast cancer. However, findings of the review should be interpreted with caution as there is a relative lack of data in this field, and the included trials had reporting or methodological weaknesses and were heterogeneous in terms of interventions and outcome measures.
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Affiliation(s)
- Mohammed Mustafa
- Cardiff UniversityCochrane Institute of Primary Care and Public Health, School of Medicine2nd Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Andrew Carson‐Stevens
- Cardiff UniversityCochrane Institute of Primary Care and Public Health, School of Medicine2nd Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - David Gillespie
- Cardiff UniversitySouth East Wales Trials Unit, Institute of Translation, Innovation, Methods and Engagement4th Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Adrian GK Edwards
- Cardiff UniversityCochrane Institute of Primary Care and Public Health, School of Medicine2nd Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
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Faller H, Schuler M, Richard M, Heckl U, Weis J, Küffner R. Effects of Psycho-Oncologic Interventions on Emotional Distress and Quality of Life in Adult Patients With Cancer: Systematic Review and Meta-Analysis. J Clin Oncol 2013; 31:782-93. [PMID: 23319686 DOI: 10.1200/jco.2011.40.8922] [Citation(s) in RCA: 480] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose This study aimed to evaluate the effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer. Methods Literature databases were searched to identify randomized controlled trials that compared a psycho-oncologic intervention delivered face-to face with a control condition. The main outcome measures were emotional distress, anxiety, depression, and quality of life. Outcomes were evaluated for three time periods: post-treatment, ≤ 6 months, and more than 6 months. We applied standard meta-analytic techniques to analyze both published and unpublished data from the retrieved studies. Sensitivity analyses and meta-regression were used to explore reasons for heterogeneity. Results We retrieved 198 studies (covering 22,238 patients) that report 218 treatment-control comparisons. Significant small-to-medium effects were observed for individual and group psychotherapy and psychoeducation. These effects were sustained, in part, in the medium term (≤ 6 months) and long term (> 6 months). Short-term effects were evident for relaxation training. Studies that preselected participants according to increased distress produced large effects at post-treatment. A moderator effect was found for the moderator variable “duration of the intervention,” with longer interventions producing more sustained effects. Indicators of study quality were often not reported. Small-sample bias indicative of possible publication bias was found for some effects, particularly with individual psychotherapy and relaxation training. Conclusion Various types of psycho-oncologic interventions are associated with significant, small-to-medium effects on emotional distress and quality of life. These results should be interpreted with caution, however, because of the low quality of reporting in many of the trials.
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Affiliation(s)
- Hermann Faller
- Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Michael Schuler
- Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Matthias Richard
- Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Ulrike Heckl
- Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Joachim Weis
- Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Roland Küffner
- Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany
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Vedhara K, Beattie A, Metcalfe C, Roche S, Weinman J, Cullum N, Price P, Dayan C, Cooper A, Campbell R, Chalder T. Development and preliminary evaluation of a psychosocial intervention for modifying psychosocial risk factors associated with foot re-ulceration in diabetes. Behav Res Ther 2012; 50:323-32. [DOI: 10.1016/j.brat.2012.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 02/20/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
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Dyadic effects of fear of recurrence on the quality of life of cancer survivors and their caregivers. Qual Life Res 2011; 21:517-25. [DOI: 10.1007/s11136-011-9953-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2011] [Indexed: 10/18/2022]
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Kramer BJ, Kavanaugh M, Trentham-Dietz A, Walsh M, Yonker JA. Complicated grief symptoms in caregivers of persons with lung cancer: the role of family conflict, intrapsychic strains, and hospice utilization. OMEGA-JOURNAL OF DEATH AND DYING 2011; 62:201-20. [PMID: 21495532 PMCID: PMC3265356 DOI: 10.2190/om.62.3.a] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Guided by a stress process conceptual model, this study examines social and psychological determinants of complicated grief symptoms focusing on family conflict, intrapsychic strains, and the potential moderating effect of care quality and hospice utilization. Relying on data from 152 spouse and adult child lung cancer caregiver survey respondents, drawn from an ancillary study of the Assessment of Cancer CarE and SatiSfaction (ACCESS) in Wisconsin, hierarchical multiple regression analysis was used to examine determinants of complicated grief. After controlling for contextual factors and time since death, complicated grief symptoms were higher among caregivers with less education, among families with lower prior conflict but higher conflict at the end-of-life, who had family members who had difficulty accepting the illness, and who were caring for patients with greater fear of death. Additionally, hospice utilization moderated the effect of fear of death on complicated grief. Findings suggest that family conflict, intrapsychic strains, and hospice utilization may help to explain the variability found in complicated grief symptoms among bereaved caregivers. Implications for enhancing complicated grief assessment tools and preventative interventions across the continuum of cancer care are highlighted.
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Affiliation(s)
- Betty J Kramer
- University of Wisconsin-Madison, School of Social Work, Madison, WI 53706, USA.
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Leykin Y, Thekdi SM, Shumay DM, Muñoz RF, Riba M, Dunn LB. Internet interventions for improving psychological well-being in psycho-oncology: review and recommendations. Psychooncology 2011; 21:1016-25. [PMID: 21608075 DOI: 10.1002/pon.1993] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 04/11/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Too few cancer patients and survivors receive evidence-based interventions for mental health symptoms. This review examines the potential for Internet interventions to help fill treatment gaps in psychosocial oncology and presents evidence regarding the likely utility of Internet interventions for cancer patients. METHODS The authors examined available literature regarding Internet interventions tailored to cancer patients' mental health needs and reviewed elements of Internet interventions for mental health relevant to advancing psycho-oncology Internet intervention research. RESULTS Few rigorous studies focusing on mental health of cancer patients have been conducted online. A growing body of evidence supports the efficacy, accessibility, and acceptability of mental health Internet interventions for a variety of general and medical patient populations. The authors present recommendations and guidelines to assist researchers in developing, testing, and disseminating Internet interventions for cancer patients and survivors, to manage and improve their mental health. Issues unique to Internet interventions-including intervention structure, customization, provider interaction, and privacy and confidentiality issues-are discussed. These guidelines are offered as a step toward establishing a set of "best practices" for Internet interventions in psycho-oncology and to generate further discussion regarding the goals of such interventions and their place in cancer care. CONCLUSIONS Internet interventions have the potential to fill an important gap in quality cancer care by augmenting limited available mental health services. These interventions should be developed in a manner consistent with best practices and must be empirically tested and validated. Copyright © 2011 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yan Leykin
- Department of Psychiatry, University of California, San Francisco, CA, USA
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Boesen EH, Karlsen R, Christensen J, Paaschburg B, Nielsen D, Bloch IS, Christiansen B, Jacobsen K, Johansen C. Psychosocial group intervention for patients with primary breast cancer: a randomised trial. Eur J Cancer 2011; 47:1363-72. [PMID: 21458989 DOI: 10.1016/j.ejca.2011.01.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 01/12/2011] [Accepted: 01/19/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE To test the effectiveness of a psycho-educational group intervention to improve psychological distress measured by POMS TMD, Quality of Life measured by European Organisation for Research and Treatment of Cancer (EORTC), the core and breast cancer module, Mental Adjustment measured by MAC and marital relationship measured by BLRI in women with primary breast cancer conducted 10 weeks after surgery. A secondary outcome was 4-year survival. PATIENTS AND METHODS We randomly assigned 210 patients with primary breast cancer to a control or an intervention group. Patients in the intervention group were offered two weekly 6-h sessions of psycho-education and eight weekly 2-h sessions of group psychotherapy. All participants were followed up for Quality of Life, coping ability and social relations 1, 6 and 12 months after the intervention and on survival 4 years after surgical treatment. RESULTS No statistically significant effects of the intervention were found on any of the psychosocial questionnaire outcomes. There were not enough cases of death to analyse overall survival. The only statistically significant result was for patients who used anti depressive medication, for whom almost all measures improved over time, in both the control and intervention groups. CONCLUSION Psycho-education and group psychotherapy did not decrease psychological distress or increase Quality of Life, Mental Adjustment or improve marital relationship among patients with primary breast cancer.
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Affiliation(s)
- Ellen H Boesen
- Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
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Dolbeault S, Brédart A, Cayrou S. Groupes psycho-éducationnels à destination de patients atteints de cancer: quels fondements, quels objectifs, quel format en pratique ? PSYCHO-ONCOLOGIE 2010. [DOI: 10.1007/s11839-010-0266-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dolbeault S, Cayrou S, Brédart A, Viala AL, Desclaux B, Saltel P, Gauvain-Piquard A, Hardy P, Dickes P. The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study. Psychooncology 2009; 18:647-56. [PMID: 19039808 DOI: 10.1002/pon.1440] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Many women with breast cancer need psychological help to cope more effectively after treatment. Cognitive and behavioural techniques are not yet well established in France. A multi-site randomized study was conducted to evaluate the effects of a psycho-educational group intervention in this population. METHODS Two hundred and three patients, recruited after primary treatment, were randomly assigned either to a treatment group (psycho-educational intervention) or to a waiting-list control group. The 8-week programme of 2 h sessions comprised of thematic discussions, information and training in stress management techniques. Evaluation at baseline, after 8 sessions, and 1 month after programme completion, included evaluations using the STAI, POMS, MAC, EORTC QLQ-C30 and EORTC QLQ-BR23 breast module scales. RESULTS We observed a significant reduction in anxiety (STAI, POMS) among group participants, a reduction in anger, depression and fatigue (POMS), a significant improvement in vigor and interpersonal relationships (POMS), in emotional and role functioning, in health status and fatigue level (EORTC QLQ-C30). In contrast, coping strategies (MAC) were not significantly different between groups. No group-related negative effects were observed and the global satisfaction levels were very high. CONCLUSION This study demonstrates the feasibility and effectiveness of a psycho-educational intervention, which can accelerate the reduction of those negative affects which are present at the end of treatment. It represents an excellent complement or an alternative to individual psycho-oncologic therapeutic support, widely proposed in France, and should now be tested in groups with other types of cancer and at other disease phases.
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Affiliation(s)
- S Dolbeault
- Psycho-Oncology Unit, Curie Institute Paris, France.
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Kissane D. Beyond the psychotherapy and survival debate: the challenge of social disparity, depression and treatment adherence in psychosocial cancer care. Psychooncology 2008; 18:1-5. [PMID: 19097139 DOI: 10.1002/pon.1493] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- David Kissane
- Department of Psychiatry and Behavioral Sciences, MSKCC, New York, NY, USA.
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Classen CC, Kraemer HC, Blasey C, Giese-Davis J, Koopman C, Palesh OG, Atkinson A, Dimiceli S, Stonisch-Riggs G, Westendorp J, Morrow GR, Spiegel D. Supportive-expressive group therapy for primary breast cancer patients: a randomized prospective multicenter trial. Psychooncology 2008; 17:438-47. [PMID: 17935144 DOI: 10.1002/pon.1280] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim is to evaluate the effectiveness of a manualized 12-week supportive-expressive group therapy program among primary breast cancer patients treated in community settings, to determine whether highly distressed patients were most likely to benefit and whether therapist's training or experience was related to outcome. METHOD Three hundred and fifty-three women within one year of diagnosis with primary breast cancer were randomly assigned to receive supportive-expressive group therapy or to an education control condition. Participants were recruited from two academic centers and nine oncology practices, which were members of NCI's Community Clinical Oncology Program (CCOP) and were followed over 2 years. RESULTS A 2x2x19 analysis of variance was conducted with main effects of treatment condition, cohort, and baseline distress and their interactions. There was no main effect for treatment condition after removing one subject with an extreme score. Highly distressed women did not derive a greater benefit from treatment. Therapist training and psychotherapy experience were not associated with a treatment effect. CONCLUSIONS This study provides no evidence of reduction in distress as the result of a brief supportive-expressive intervention for women with primary breast cancer. Future studies might productively focus on women with higher initial levels of distress.
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Edwards AG, Hulbert-Williams N, Neal RD. Psychological interventions for women with metastatic breast cancer. Cochrane Database Syst Rev 2008:CD004253. [PMID: 18646104 DOI: 10.1002/14651858.cd004253.pub3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Systematic reviews of psychological interventions for patients with cancer are conflicting, some showing benefits for patients and others not. One early study appeared to show significant survival and psychological benefits from a psychological intervention given to women with metastatic breast cancer. Subsequent studies have however demonstrated conflicting results. OBJECTIVES To assess the effects of psychological interventions (educational, individual cognitive behavioural or psychotherapeutic, or group support) on psychological and survival outcomes for women with metastatic breast cancer. SEARCH STRATEGY For this update, the Cochrane Breast Cancer Group Specialised Register was searched (September 2007). Also searched were MEDLINE (1966-September 2006), CINAHL (1982-September 2006), PsycInfo (1974-September 2006), and SIGLE (1980-September 2006). SELECTION CRITERIA Randomised controlled trials (RCTs) of psychological interventions for women with metastatic breast cancer. Studies which were not t 'intention to treat' were included owing to the nature of the patient group under study and the likely high loss of follow-up data. DATA COLLECTION AND ANALYSIS Data were extracted independently by two reviewers. Data about the nature and setting of the intervention, relevant outcome data and items relating to methodological quality were extracted. MAIN RESULTS Five primary studies (511 women) were identified all group psychological interventions. Two of these were cognitive behavioural interventions and three evaluated support-expressive group therapy. The five studies of group psychological therapies showed very limited evidence of benefit arising from these interventions. Although there was evidence of short-term benefit for some psychological outcomes, in general these were not sustained at follow-up. A clearer pattern of psychological outcomes could not be discerned as a wide variety of outcome measures and durations of follow-up were used in the included studies. The possible longer survival times in women allocated to receive psychological intervention in the early study have not been replicated in the subsequent four studies (including one by members of the first study group), and overall the effects of these interventions on survival are not statistically significant (for example, odds ratio for 5 year survival 0.83 (95% confidence interval [CI] 0.53 - 1.28). AUTHORS' CONCLUSIONS There is insufficient evidence to advocate that group psychological therapies (either cognitive behavioural or supportive-expressive) should be made available to all women diagnosed with metastatic breast cancer. Any benefits of the interventions are only evident for some of the psychological outcomes and in the short term. The possibility of the interventions causing harm is not ruled out by the available data.
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Affiliation(s)
- Adrian Gk Edwards
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, 2nd Floor Neuadd Meirionnydd, Heath Park, Cardiff, Wales, UK, CF14 4YS.
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Psychometric evaluation of the German version of the Life Attitude
Profile–Revised (LAP-R) in prostate cancer patients. Palliat Support Care 2008; 6:119-24. [DOI: 10.1017/s1478951508000199] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:There has been an increasing interest in the measurement of patients efforts
to find meaning during the experience of a life-threatening illness. The aim
of this study was to validate the German version of the Life Attitude
Profile–Revised (LAP-R), a multidimensional measure of meaning
and purpose.Methods:A total of 511 prostate cancer patients with an average age of 64 years
filled in the questionnaire during outpatient follow up care (response rate
70%).Results:Five of the original six dimensions were replicated by exploratory and
confirmatory factor analysis: Coherence, Existential Vacuum,
Choice/Responsibleness, Death Acceptance, and Goal Seeking. The Purpose
dimension was not replicated. Most LAP-R subscales showed good internal
consistencies with Cronbach's α between .80 and .82,
whereas the reliability for Existential Vacuum
(α = .69) and Goal Seeking
(α = .74) was less sufficient,
but still acceptable. Results show significant concurrent associations
between all LAP-R dimensions and measures of emotional distress, coping, and
health-related quality of life; however, moderate correlations were found
only for Existential Vacuum and depression, and inversely for depressive
coping and the mental health subscale.Significance of research:The German LAP-R is a reliable and valid instrument that can be recommended
for further use in research and clinical cancer care.
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Distress in palliative care patients: developing patient-centred approaches to clinical management. Eur J Cancer 2008; 44:1133-8. [PMID: 18359621 DOI: 10.1016/j.ejca.2008.02.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Accepted: 02/25/2008] [Indexed: 11/20/2022]
Abstract
It is widely recognised by clinicians that depression is a difficult symptom to identify amongst patients with advanced illness. Many of the symptoms of depression are difficult to elicit in patients who are approaching the end of life. Additionally, many believe that a 'degree' of depression is almost normal as patients approach life's end. More recently the concept of demoralization as a separate entity to depression has been described which can be briefly described as a disorder of meaning and hope. In this paper, we review these diagnoses together with the latest screening tools which can help clinicians to recognise better such pathologies in their patients and discuss interventions that can be utilised to help patients with depression or demoralization to have a better quality of life.
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Sheikh AI. Posttraumatic growth in trauma survivors: Implications for practice. COUNSELLING PSYCHOLOGY QUARTERLY 2008. [DOI: 10.1080/09515070801896186] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Effectiveness of group psychotherapy compared to social support groups in patients with primary, non-metastatic breast cancer. J Psychosoc Oncol 2008; 25:37-60. [PMID: 18032264 DOI: 10.1300/j077v25n04_03] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the present study is to compare the effectiveness of experiential-existential group psychotherapy with a social support group for women with a primary breast cancer on psychosocial adjustment. A total of 67 well-adjusted women, who had been operated not earlier than 4 months before start of the study, were randomized into one of the two conditions: participating in the group psychotherapy or in the support group. They were questioned at the start of the study, at the end of the intervention, and 1 year after completion of the intervention. Results at follow-up were mixed: Positive changes were reported for Body Image and Recreation, regardless of type of intervention. Other psychosocial adjustment indicators did not change. In general, we may conclude that well-adjusted women diagnosed with breast cancer do not specifically benefit from these types of interventions.
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The existential plight of cancer: meaning making as a concrete approach to the intangible search for meaning. Support Care Cancer 2008; 16:779-85. [DOI: 10.1007/s00520-007-0396-7] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 12/18/2007] [Indexed: 11/26/2022]
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Chan THY, Ho RTH, Chan CLW. Developing an outcome measurement for meaning-making intervention with Chinese cancer patients. Psychooncology 2007; 16:843-50. [PMID: 17149786 DOI: 10.1002/pon.1134] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Psychosocial programs designed for cancer patients often facilitate the search for meaning as one of the therapeutic components. This study aimed to develop a self-report instrument, namely Chinese Cancer Coherence Scale (CCCS), which measures the patients' meaning-making process with reference to the concept of coherence. A panel of eight veteran social workers and psychologists generated statements pertaining to the cancer experience. Results from a two-phase study involving 390 breast cancer patients revealed a two-factor structure of the CCCS, namely incoherent-embittered and coherent-enlightened. The use of the CCCS by practitioners and researchers is recommended in order to understand how Chinese cancer patients make sense of their cancer experience.
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Affiliation(s)
- Timothy H Y Chan
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, China.
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Boutin DL. Effectiveness of Cognitive Behavioral and Supportive-Expressive Group Therapy for Women Diagnosed with Breast Cancer: A Review of the Literature. JOURNAL FOR SPECIALISTS IN GROUP WORK 2007. [DOI: 10.1080/01933920701431594] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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38
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Rouby P. Douleur et cancer: apports et expériences des groupes thérapeutiques chez les femmes atteintes d’un cancer du sein. PSYCHO-ONCOLOGIE 2007. [DOI: 10.1007/s11839-007-0024-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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39
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Mehnert A, Müller D, Koch U. Die Erfassung von sinnbasierten Bewältigungsstrategien und Lebenseinstellungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2007. [DOI: 10.1026/1616-3443.36.3.176] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Fragestellung: Zielsetzung ist die Übersetzung und Validierung des Life Attitude Profile-Revised (LAP-R), eines mehrdimensionalen 48-Item Instruments zur Erfassung von Sinnfindung und Lebenszielen ( Reker, 1992 ). Methode: Der Fragebogen wurde an einer repräsentativ erhobenen Stichprobe von N = 1083 Brustkrebspatientinnen, die über das Hamburgische Krebsregister erfasst wurden, eingesetzt. Neben dem LAP-R erhielten die Patientinnen Selbstbeschreibungsinstrumente zur Erfassung der Krankheitsverarbeitung, der psychischen Belastung, der sozialen Unterstützung und der Lebensqualität. Ergebnisse: Von den postulierten sechs Faktoren konnten mittels exploratorischer Faktorenanalyse fünf Faktoren mit insgesamt 37 Items repliziert werden. Die Dimensionen sind Existenzielle Leere (Cronbachs α = .83), Kohärenz (α = .83), Akzeptanz des Todes (α = .85), Selbstwirksamkeit/Verantwortungsbereitschaft (α = .78) und Suche nach Lebenszielen (α = .80). Das Modell wurde konfirmatorisch geprüft und weist akzeptable Fit-Indizes auf. Die Skalen des LAP-R, die eine positive Lebenseinstellung widerspiegeln (Lebensziele/Bestimmung, Kohärenz, Selbstwirksamkeit/Verantwortungsbereitschaft und Akzeptanz des Todes), korrelieren negativ mit depressiver Krankheitsverarbeitung und mit psychischer Belastung. Die Skalen des LAP-R, die eine negative Lebenseinstellung (Existentielle Leere und Suche nach Lebenszielen) erfassen, korrelieren in entsprechend umgekehrter Richtung. Die Faktoren- und Itemanalysen legen die Bildung einer Kurzform bestehend aus den fünf Items mit den höchsten Ladungen pro Dimension nahe. Schlussfolgerung: Insgesamt liegt ein praktikables, reliables und valides Instrument vor, das für den weiteren Einsatz in der medizinpsychologischen und psychoonkologischen Forschung empfohlen werden kann.
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Affiliation(s)
| | | | - Uwe Koch
- Universitätsklinikum Hamburg-Eppendorf
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40
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Cherny NI. Sedation for the care of patients with advanced cancer. ACTA ACUST UNITED AC 2006; 3:492-500. [PMID: 16955088 DOI: 10.1038/ncponc0583] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2006] [Accepted: 05/02/2006] [Indexed: 11/09/2022]
Abstract
Sedation in the context of palliative medicine is the monitored use of medications to induce varying degrees of unconsciousness to bring about a state of decreased or absent awareness (i.e. unconsciousness) in order to relieve the burden of otherwise intractable suffering. Sedation is used in palliative care in several settings: transient controlled sedation, sedation in the management of refractory symptoms at the end of life, emergency sedation, respite sedation, and sedation for refractory psychological or existential suffering. Sedation is controversial in that it diminishes the capacity of the patient to interact, function, and, in some cases, live. There is no distinct ethical problem in the use of sedation to relieve otherwise intolerable suffering in patients who are dying. Since all medical treatments involve risks and benefits, each potential option must be evaluated for its promise with regards to achieving the goals of care. When risks of treatment are involved, to be justified these risks must be proportionate to the gravity of the clinical indication. Some aspects of management, such as the need for hydration in patients undergoing sedation and the use of sedation in the management of psychological and spiritual suffering, remain controversial.
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Affiliation(s)
- Nathan I Cherny
- Department of Medical Oncology, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel.
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Mehnert A. Sinnfindung und Spiritualität bei Patienten mit chronischen körperlichen Erkrankungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006; 49:780-7. [PMID: 16865631 DOI: 10.1007/s00103-006-0008-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Issues of the meaning of life and spirituality are particularly important subjects given the threat of a serious illness and the confrontation with the finiteness of one's own life. Thus, addressing questions of meaning and spiritual domains of supportive care has been identified as essential by patients as well as by health care professionals. In recent years more research has focussed on theoretical conceptualization, empirical examination as well as on the development of meaning-centred interventions in somatically ill patients. Theoretical models for the understanding, development and adaptation of concepts and interventions addressing meaning and spirituality in the chronically ill are offered by the philosophical tradition of existentialism, logotherapy as well as by cognitive and developmental psychology, in particular studies on autobiographical memory and life story. However, the current state of empirical research focussing on the association between meaning, spirituality and physical as well as mental health and underlying mechanisms is not sufficient to draw reliable conclusions. With regard to psychosocial care, meaning-centred interventions have been developed in recent years primarily within the context of palliative care. These interventions are intended to support patients to find meaning in life in the face of a serious illness and to experience their life as fulfilled.
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Affiliation(s)
- A Mehnert
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52-S 35, 20246 Hamburg, BRD.
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Lee V, Robin Cohen S, Edgar L, Laizner AM, Gagnon AJ. Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Soc Sci Med 2006; 62:3133-45. [PMID: 16413644 DOI: 10.1016/j.socscimed.2005.11.041] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Indexed: 11/19/2022]
Abstract
Existential issues often accompany a diagnosis of cancer and remain one aspect of psychosocial oncology care for which there is a need for focused, empirically tested interventions. This study examined the efficacy of a novel psychological intervention specifically designed to address existential issues through the use of meaning-making coping strategies on psychological adjustment to cancer. Eighty-two breast or colorectal cancer patients were randomly chosen to receive routine care (control group) or up to four sessions that explored the meaning of the emotional responses and cognitive appraisals of each individual's cancer experience within the context of past life events and future goals (experimental group). This paper reports the results from 74 patients who completed and returned pre- and post-test measures for self-esteem, optimism, and self-efficacy. After controlling for baseline scores, the experimental group participants demonstrated significantly higher levels of self-esteem, optimism, and self-efficacy compared to the control group. The results are discussed in light of the theoretical and clinical implications of meaning-making coping in the context of stress and illness.
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Affiliation(s)
- Virginia Lee
- McGill University Health Centre, Montreal General Hospital, Montreal, Canada.
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Friborg O, Sørlie T, Rosenvinge JH. Breast cancer: a manual for a proposed group treatment integrating evidence based resilience factors. Psychol Rep 2005; 97:77-97. [PMID: 16279308 DOI: 10.2466/pr0.97.1.77-97] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The paper presents the structure and content of a manual for a proposed treatment of breast cancer patients in groups. The proposed treatment is structured, time limited, and integrates elements from 1995 work of Spiegel and the Yalom 1995 theory of group therapy as well as empirically derived resilience factors. Addressing the psychological specificity of breast cancer, the overall treatment goals are to help patients to acquire new coping skills for relieving stress, to increase their personal and social competence and their use of available social support, to increase family coherence, to enhance optimism and quality of life, and to help patients develop new values and priorities that comply with their current and future life situation.
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Affiliation(s)
- Oddgeir Friborg
- Department of Psychology, University of Tromsø, 9037 Norway.
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45
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Miyashita M. A randomized intervention study for breast cancer survivors in Japan: effects of short-term support group focused on possible breast cancer recurrence. Cancer Nurs 2005; 28:70-8. [PMID: 15681985 DOI: 10.1097/00002820-200501000-00011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to assess the effect on the mental health of breast cancer survivors in a support group providing an emotional and educational intervention focused on the recurrence of breast cancer. Seventy-eight breast cancer survivors were assigned randomly to an intervention group (n = 45) and a control group (n = 33), respectively. Intervention group members met weekly for 4 weeks for emotional and educational intervention focusing on recurrence of the cancer. Subjects were assessed at baseline and at 1 week and 1 month postintervention. The results indicated that there was no significant effect of the intervention in terms of state anxiety. There was a significant effect of the intervention on life satisfaction in the group scoring high at baseline, as indicated by the mean score changes. The effect was that among the groups scoring high on life satisfaction, the mean score in the intervention group remained unchanged, but in the control group it declined. That is, short-term intervention focusing on recurrence does not improve the mental health of breast cancer patients, but it may help maintain better mental health. Nurses should have proper education to be able to provide correct information about breast cancer and coping skills. Further research with long-term multipurpose support groups that take into account patients' characteristics are needed to provide effective support to women with breast cancer in Japan.
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Affiliation(s)
- Mika Miyashita
- Division of Nursing, Institute of Health Science, Faculty of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan 734-8551.
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Cayrou S, Desclaux B, Guillerd P, Tanneau E, Heim F, Saltel P, Gauvain-Piquard A, Dolbeault S. Groupes psycho-éducationnels pour femmes atteintes de cancers du sein en France : thèmes et techniques. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s1155-1704(05)81207-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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FRIBORG ODDGEIR. BREAST CANCER: A MANUAL FOR A PROPOSED GROUP TREATMENT INTEGRATING EVIDENCE BASED RESILIENCE FACTORS. Psychol Rep 2005. [DOI: 10.2466/pr0.97.5.77-97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Kissane DW, Love A, Hatton A, Bloch S, Smith G, Clarke DM, Miach P, Ikin J, Ranieri N, Snyder RD. Effect of cognitive-existential group therapy on survival in early-stage breast cancer. J Clin Oncol 2004; 22:4255-60. [PMID: 15452189 DOI: 10.1200/jco.2004.12.129] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cognitive-existential group therapy (CEGT) was developed to improve mood and mental attitude toward cancer in women with early-stage breast cancer receiving adjuvant chemotherapy. Given the debate about group therapy's association with increased survival in women with metastatic breast cancer, we were curious to check its effect at a much earlier stage in the cancer journey. PATIENTS AND METHODS We randomly assigned 303 women with early-stage breast cancer who were receiving adjuvant chemotherapy to either 20 sessions of weekly group therapy plus three relaxation classes (n = 154) or to a control condition of three relaxation classes alone (n = 149). The primary outcome was survival. RESULTS CEGT did not extend survival; the median survival time was 81.9 months (95% CI, 64.8 to 99.0 months) in the group-therapy women and 85.5 months (95% CI, 67.5 to 103.6 months) in the control arm. The hazard ratio for death was 1.35 (95% CI, 0.76 to 2.39; P = .31). In contrast, histology and axillary lymph node status were significant predictors of survival. Low-grade histology yielded a hazard ratio of 0.342 (95% CI, 0.17 to 0.69), and axillary lymph node-negative status yielded a hazard ratio of 0.397 (95% CI, 0.20 to 0.78). CONCLUSION CEGT does not prolong survival in women with early-stage breast cancer.
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Affiliation(s)
- David W Kissane
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1242 Second Ave, New York, NY 10021, USA.
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Kissane DW, Grabsch B, Love A, Clarke DM, Bloch S, Smith GC. Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis. Aust N Z J Psychiatry 2004; 38:320-6. [PMID: 15144508 DOI: 10.1080/j.1440-1614.2004.01358.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess psychosocial morbidity in women with breast cancer and to compare the differential rates between women with early stage and advanced disease. METHOD In this report, 303 women with early stage breast cancer, psychiatrically assessed at baseline (as part of a study of cognitive-existential group therapy during adjuvant chemotherapy), are compared with 200 women with advanced breast cancer (similarly assessed in a trial of supportive-expressive group therapy). A structured psychiatric interview plus self-report measures were used to assess psychiatric morbidity, quality of life and cognitive attitude to cancer. RESULTS The early stage patients, whose mean age was 46 years, were on average 3 months post-surgery and had an overall prevalence of DSM-IV psychiatric diagnosis of 45%. The metastatic patients, whose mean age was 51 years, were on average 63 months post-primary diagnosis and had an overall prevalence of DSM-IV diagnosis of 42%; the difference between the two rates was not statistically significant. Of women with early stage breast cancer, 36.7% had mood disorders, 9.6% suffering from major depression and 27.1% from minor depression. In the metastatic sample 31% had mood disorders, 6.5% having major depression and 24.5% with minor depression. Anxiety disorders were present in 8.6% of the early stage group and 6% of women with advanced disease. Fatigue, a past history of depression, and cognitive attitudes of helplessness, hopelessness or resignation were significantly associated with depression in both groups. The women from the metastatic sample were significantly less distressed by hair loss but more dissatisfied with body image, and had higher rates of lymphoedema and hot flushes than the early stage women. CONCLUSIONS The rates of psychosocial distress are high, and similar, across patients with both early and advanced stage breast cancer, although the illness related causes of distress are different. These data present a challenge to clinical services to provide a comprehensive range of support services to ameliorate this distress.
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Affiliation(s)
- David W Kissane
- Department ofpsychiatry and Behavioural Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Abstract
BACKGROUND There have been conflicting results from systematic reviews of psychological interventions for patients with cancer, some showing benefits for patients and others not. One early study appeared to show significant survival benefits as well as psychological benefits from a psychological intervention given to women with metastatic breast cancer. Some further studies have been undertaken, again with conflicting results. OBJECTIVES To assess the effects of psychological interventions (educational, individual cognitive behavioural or psychotherapeutic, or group support) on psychological and survival outcomes for women with metastatic breast cancer. SEARCH STRATEGY We searched the Cochrane Breast Cancer Group Trials Register (September 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), MEDLINE (1966-October 2003), CancerLit (1983-2000), CINAHL (1982-October 2003), PsycInfo (1974-November 2003), and SIGLE (1980-November 2003). SELECTION CRITERIA Randomised controlled trials (RCTs) of psychological interventions for women with metastatic breast cancer. Studies were included even if they were not 'intention to treat', owing to the nature of the patient group under study and the likely high loss of follow-up data. DATA COLLECTION AND ANALYSIS Data were extracted independently by two reviewers. Data about the nature and setting of the intervention, and the relevant outcome data were extracted, along with items relating to methodological quality. MAIN RESULTS Five primary studies were identified, all group psychological interventions. Two of these were cognitive behavioural interventions and three evaluated support-expressive group therapy. The five studies of group psychological therapies for women with metastatic breast cancer showed very limited evidence of benefit arising from these interventions. Although there was evidence of short-term benefit for some psychological outcomes, in general these were not sustained at follow-up. A clearer pattern of psychological outcomes could not be discerned as a wide variety of outcome measures and durations of follow-up were used in the included studies. The possible longer survival times in women allocated to receive psychological intervention in the early study have not been replicated in the subsequent four studies (including one by members of the first study group), and overall the effects of these interventions on survival are not statistically significant (for example, odds ratio for 5 year survival 0.83 (95% confidence interval [CI] 0.53 - 1.28). REVIEWERS' CONCLUSIONS There is insufficient evidence to advocate that group psychological therapies (either cognitive behavioural or supportive-expressive) should be made available to all women diagnosed with metastatic breast cancer. Any benefits of the interventions are only evident for some of the psychological outcomes and in the short term. The possibility of the interventions causing harm is not ruled out by the available data.
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Affiliation(s)
- A G K Edwards
- Department of Primary Care, Swansea Clinical School, University of Wales Swansea, Singleton Park, Swansea, Wales, UK, SA2 8PP
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