Patients with head and neck cancer prefer individualized cognitive behavioural therapy

Cognitive behaviour therapy (CBT) is a widely practiced and approved form of psychotherapy for many psychosocial difficulties. As the efficacy of CBT is recognized, its demand has increased and today exceeds the availability of qualified practitioners. Therefore, the effectiveness of delivering CBT using less labour-intensive modes than individualised therapy has been explored. These include group therapy, bibliotherapy and computer assisted therapy. Given the UK Government's impetus towards patient choice and involvement in the planning of healthcare, it was thought essential to ascertain the preferred delivery mode of patients with head and neck cancer for a CBT based intervention. Therefore, a small retrospective cohort (n= 28) of patients following treatment for head and neck cancer were sent postal questionnaires to ascertain their preferences on mode of CBT delivery. Simultaneously, the views of accredited cognitive behaviour therapists (n= 14) were determined on the optimal mode of CBT delivery to these patients. Findings indicated that patients preferred the more individualized mode of CBT delivery, namely one-to-one therapy, followed closely by bibliotherapy, with group format being the least preferred option. Professionals concurred with patients, in that one-to-one interaction was considered an optimal mode of CBT delivery, but professionals considered it equal to group therapy.     

Evaluation of a group cognitive behavioural intervention for women suffering from menopausal symptoms following breast cancer treatment

Objective: To evaluate a group cognitive behavioural intervention to alleviate menopausal symptoms in women who have had treatment for breast cancer. Methods: A single group design was used with pre‐ and post‐treatment assessment and a 3‐months follow‐up. Seventeen women who had completed active breast cancer treatment were treated. Following a 2‐week daily diary assessment they were offered 6 (90 min) weekly sessions of Group cognitive behaviour therapy (CBT). The CBT included information and discussion, relaxation and paced breathing and CBT to reduce stress and manage hot flushes (HF), night sweats (NS) and sleep. The primary outcome measure was Hot Flush Frequency and Hot Flush Problem Rating; secondary outcomes included the Women's Health Questionnaire (WHQ) and health‐related quality of life (SF 36). Beliefs about HF were monitored in order to examine the effects of cognitive therapy. Results: HF and NS reduced significantly following treatment (38% reduction in frequency and 49% in problem rating) and improvements were maintained at 3 months follow‐up (49% reduction in frequency and 59% in problem rating). Depressed mood, anxiety and sleep (WHQ) significantly improved, as did aspects of quality of life (SF 36) (emotional role limitation, energy/vitality and mental health). There was a significant reduction in negative beliefs about HF, NS and sleep following CBT. Conclusions: These results suggest that CBT delivered in groups might offer a viable option for women with troublesome menopausal symptoms following breast cancer treatment, but further controlled trials are needed. Copyright © 2008 John Wiley & Sons, Ltd.     

Group cognitive behavioural therapy with cancer patients: the views of women participants on a short-term intervention

At present many emotionally distressed cancer patients receive no psychological intervention. The aim of this paper is to examine and report qualitatively on the experiences of a small group of seven newly diagnosed women who underwent a group cognitive behavioural therapy (GCBT) programme. The GCBT programme was part of a larger piece of research comparing patients' experiences of GCBT with that of group social support or no group programme of support. Following the 8-week GCBT programme, qualitative analysis of interview data revealed that patients had learned the skills required to challenge and solve problems and to use the cognitive model and effectively employ behavioural exercises to generate improved coping. The results also suggest that a GCBT programme with newly diagnosed cancer patients may need to allow cancer patients considerable opportunities to ventilate feelings and engage in social support with other patients; this being regarded as a highly valuable component to build into a GCBT programme.     

Factors associated with emotional and behavioural problems among school age children of breast cancer patients

To identify factors linked with emotional and behavioural problems in school age (6- to 17-year-old) children of women with breast cancer. Reports of children's emotional and behavioural problems were obtained from patient mothers, their healthy partners, the children's teacher and adolescents using the Child Behaviour Checklist and Mental Health subscale of the Child Health Questionnaire. Parents reported on their own level of depression and, for patients only, their quality of life. Family functioning was assessed using the Family Assessment Device and Cohesion subscale of the Family Environment Scale. Using a cross-sectional within groups design, assessments were obtained (N=107 families) where the patients were 3-36 months postdiagnosis. Risk of problems in children were linked with low levels of family cohesion, low affective responsiveness and parental over-involvement as reported by both child and mother. Adolescents reported family communication issues, which were associated with externalising behaviour problems. Maternal depression was related to child internalising problems, particularly in girls. Whether the mother was currently on or off chemotherapy was not associated with child problems nor was time since cancer diagnosis. These findings held across child age. Where mothers have early stage breast cancer, a substantial minority of their school-aged children have emotional and behavioural problems. Such cases are characterised by the existence of maternal depression and poor family communication, rather than by the mother's treatment status or time since diagnosis. Targeted treatments, which focus on maternal depression and family communication may benefit the children and, through improved relationships, enhance the patients' quality of life.     

Group cognitive behavioural therapy interventions with cancer patients: a review of the literature

At present there is considerable evidence that suggests cancer patients, once diagnosed, experience significant and long-term psychosocial problems. Several studies have evaluated group interventions, but only a few have used group cognitive behavioural therapy (GCBT) with cancer patients. The following paper represents a review of the literature of GCBT, illustrating the key findings from these studies.     

‘I know they are distressed. What do I do now?’

Significant advances have been made in our understanding of psychological adjustment to cancer over the last 40 years. Most clinicians now recognise the importance of psychosocial factors and the need for skills in emotional support. In the first phase of psycho‐oncology, pioneering work in the 1970s and 1980s mapped the extent of psychological morbidity in cancer. This has been followed by a second phase where clinical trials have demonstrated that psychological treatments are effective. But although clinicians may feel more confident in identifying distress and listening to the patient, they rarely feel confident that they possess the skills to help. This paper will review the progress through the first two phases and argue that we are now in the third phase where we can begin to examine methods for delivering cost‐effective psychological care. One of these methods is to equip staff with basic skills to understand and manage psychological distress. This paper will also describe a programme over the last 10 years to evaluate the effectiveness and clinical impact of such training for palliative care professionals. Copyright © 2013 John Wiley & Sons, Ltd.     

居家认知行为治疗对卵巢癌患者化疗期间心理症状群及希望水平的影响

目的探讨居家认知行为治疗(IH-CBT)对卵巢癌患者化疗期间心理症状群和希望水平的影响。方法采用简单随机化分组的方法将195例行化疗的卵巢癌患者随机分为对照组97例(接受常规护理)和干预组98例(在常规护理的基础上接受IH-CBT)。采用简式简明心境量表(POMS-SF)测评两组患者的心理症状群,采用Herth希望量表测评两组患者的希望水平。结果化疗后,两组患者仍存在紧张-焦虑症状群、精力不足症状群、怨恨症状群,但信息缺乏症状群均消失;对照组患者紧张-焦虑症状群、精力不足症状群、怨恨症状群的各症状均变化不大,干预组患者紧张-焦虑症状群、精力不足症状群、怨恨症状群的各症状均明显缓解。化疗后,干预组患者的希望水平评分明显高于本组化疗前和同时间点对照组患者,差异均有统计学意义(P<0.01)。结论IH-CBT可改善卵巢癌患者的心理症状,提高希望水平,具有临床推广价值。     

The effect of cognitive behavioural therapy integrated with activity pacing on cancer-related fatigue,depression and quality of life among patients with breast cancer undergoing chemotherapy in Ethiopia: A randomised clinical trial

Fatigue is a common symptom experienced by 80% of individuals who receive chemotherapy and is one of the major factors that affect quality of life (QoL) of patients with breast cancer. Our study aimed to assess the effect of cognitive behavioural therapy integrated with activity pacing (CBT-AP) on cancer-related fatigue among patients with breast cancer undergoing chemotherapy. A parallel-group, randomised controlled trial was conducted. Severely fatigued patients were randomly assigned to the CBT-AP or usual care (UC) groups using a computer-generated random sequence. The new intervention was designed for seven sessions: three 2-hour face-to-face and four 30-minute telephone sessions. The primary outcome (fatigue severity) and the secondary outcomes (depression and QoL) were assessed at the end of the intervention and after 3 months. The data were analysed by repeated measures analyses of covariance (RM-ANCOVA). CBT-AP had a significant time effect (P < .001, ηp² = 0.233) in reducing fatigue from baseline (adjusted mean = 7.48) to the end of the intervention (adjusted mean = 6.37) and the 3-month follow-up (adjusted mean = 6.54). Compared to the UC group, the CBT-AP group had lower fatigue and depression scores, and higher global health status scores. The group × time interaction revealed a significant reduction in fatigue and depression in the CBT-AP group compared to the UC group. Therefore, CBT-AP appears to be effective in reducing fatigue and depression and improving QoL in patients with breast cancer undergoing chemotherapy. It is highly recommended to integrate a CBT-AP intervention in routine cancer care.     

Prevalence and predictors of emotional and behavioural functioning of children where a parent has cancer

BACKGROUND:

This study aimed to evaluate prevalence and risk factors for emotional and behavioral problems in dependent children of cancer patients using a multinational research design.

METHODS:

The sample comprised 350 ill parents, 250 healthy partners, and 352 children. Parents assessed the child's psychological functioning using the Child Behavior Checklist, parental depression using the Beck Depression Inventory, family functioning using the General Functioning subscale of the Family Assessment Device, quality of life using short‐form questionnaire, and adolescents (N = 168) self‐reported psychological functioning using the Youth Self Report.

RESULTS:

Children and adolescents, in particular latency‐aged boys and adolescent girls, were of higher risk of psychosocial problems than norms. There was a higher risk of problems when the father was ill than when the mother was ill, but it remains unclear whether this difference was due to the different diagnoses of fathers and mothers, gender or other factors. The best predictor of internalizing problems in children and adolescents was parental depression, and the best predictor of externalizing problems in children and adolescents was family dysfunction.

CONCLUSIONS:

The results indicate the need for a family‐oriented approach to psychological support of cancer patients. Cancer 2009. © 2009 American Cancer Society.     

乳腺癌放化疗患者认知功能障碍的影响因素分析

目的探讨乳腺癌放化疗患者发生认知功能障碍的影响因素。方法选取100例乳腺癌放化疗患者作为研究对象,对患者的基线资料进行问卷调查,应用蒙特利尔认知评估量表(MoCA)、一般性自我效能量表、心理弹性量表对患者的认知情况进行评估,并分析乳腺癌放化疗患者发生认知功能障碍的影响因素。结果100例乳腺癌放化疗患者中,认知功能障碍者24例,认知功能障碍的发生率为24%(24/100)。单因素分析结果显示,不同年龄、文化水平、婚姻状况、工作情况、放化疗不良反应程度、运动锻炼情况、自我效能水平、心理弹性水平乳腺癌放化疗患者的认知功能障碍发生情况比较,差异均有统计学意义(P﹤0.05);不同合并症情况、TNM分期、放化疗情况乳腺癌放化疗患者的认知功能障碍发生情况比较,差异均无统计学意义(P﹥0.05)。多因素分析结果显示,年龄≥60岁、放化疗不良反应程度为2～3级是乳腺癌放化疗患者发生认知功能障碍的危险因素(P﹤0.05),而运动锻炼≥3次/周、自我效能高等水平、心理弹性高等水平是乳腺癌放化疗患者发生认知功能障碍的保护因素(P﹤0.05)。结论乳腺癌放化疗患者认知功能障碍的发生与其年龄、放化疗不良反应程度、运动锻炼情况、自我效能和心理弹性水平有关,积极提高患者的自我效能和心理弹性水平有助于减轻患者的认知功能障碍,从而提高患者的生活质量。     

Psychological wellness and health‐related stigma: a pilot study of an acceptance‐focused cognitive behavioural intervention for people with lung cancer

People with lung cancer experience health‐related stigma that is related to poorer psychosocial and quality of life outcomes. The present Phase 1 study applied mixed methods to test the acceptability of an acceptance‐focused cognitive behavioural intervention targeting stigma for this patient group. Fourteen lung cancer patients completed a 6‐week Psychological Wellness intervention with pre‐ and post‐test outcome measures of psychological and cancer‐specific distress, depression, health‐related stigma and quality of life. In‐depth interviews applying interpretative phenomenological analysis assessed participants' experiences of the intervention. Moderate to large improvements were observed in psychological (η_p² = 0.182) and cancer‐specific distress (η_p² = 0.056); depression (η_p² = 0.621); health‐related stigma (η_p² = 0.139). In contrast, quality of life declined (η_p² = 0.023). The therapeutic relationship; self‐management of distress; and relationship support were highly valued aspects of the intervention. Barriers to intervention included avoidance and practical issues. The lung cancer patients who completed the Psychological Wellness intervention reported improvements in psychological outcomes and decreases in stigma in the face of declining quality of life with patients reporting personal benefit from their own perspectives. A randomised controlled trial is warranted to establish the effectiveness of this approach.     

Development of CBT for chemotherapy-related cognitive change: results of a waitlist control trial

Objective: To evaluate the efficacy of a brief cognitive‐behavioral therapy (CBT) that is being developed for management of cognitive dysfunction following chemotherapy among breast cancer survivors. Memory and Attention Adaptation Training (MAAT) is a brief CBT designed to improve the quality of life and function among cancer survivors with post‐chemotherapy cognitive complaints. Methods: An initial, two‐group (MAAT versus waitlist, no treatment control), randomized clinical trial (RCT) was conducted. Forty stage I and II female breast cancer survivors (mean age = 50; SD = 6.4) were randomized to conditions and assessed at baseline, post‐treatment (8 weeks) and 2‐month follow‐up assessment points on measures of: (1) self‐reported daily cognitive failures; (2) quality of life; and (3) neuropsychological performance. Participants were also assessed for satisfaction with MAAT. Results: With education and IQ as covariates, MAAT participants made significant improvements relative to controls on the spiritual well‐being subscale of the quality of life measure and on verbal memory, but statistical significance was not achieved on self‐report of daily cognitive complaints. However, moderate‐to‐large effect sizes were observed on these outcomes. Participants gave MAAT high satisfaction ratings. Conclusions: Although this initial RCT is a small study, MAAT participants appear to improve on one measure of quality of life and verbal memory performance relative to no treatment controls and rate MAAT with high satisfaction. These data are encouraging and support the continued development and evaluation of MAAT efficacy.Copyright © 2010 John Wiley & Sons, Ltd.     

Cognitive Adaptation Theory and Quality of Life in Late-Stage Cancer Patients

In this study, the question of whether using slightly illusionary, positive attributions of self, control, and meaning (e.g., cognitive adaptation theory), in the face of disconfirmatory evidence, facilitates quality of life in late-stage cancer patients was examined. Eighty late-stage cancer patients (Mean age = 59.7, SD = 12.5; 48.8% male, 51.2% female; varying cancer diagnoses) who recently failed or refused first line anti-neoplastic treatment completed questionnaires assessing meaning, control, self-esteem, and optimism, as well as physical and psychological quality of life. Findings suggest that greater self-esteem, control, and meaning predicted physical and psychological quality of life, with physical quality of life being influenced by control beliefs and psychological quality of life influenced by self-esteem. Optimism independently predicted physical quality of life and neither mediated nor moderated the relationship between cognitive adaptation and quality of life. Findings suggest that slightly positive, illusionary beliefs of self, control, and meaning predicted quality of life even in the presence of clear, disconfirmatory environmental evidence.