A group cognitive behaviour therapy programme with metastatic breast cancer patients

One‐hundred and twenty‐four patients with metastatic breast cancer were randomised to either a group Cognitive Behaviour Therapy (CBT) intervention, or to a no‐therapy control group condition. Both groups received standard oncological care; however, therapy recipients also attended eight weekly sessions of group CBT, followed by a family night, and three further monthly sessions. Patients completed the ‘Profile of Mood States’ (POMS) and the Coopersmith Self‐esteem Inventory (CSI) before and after therapy, and at 3 and 6 month follow‐up periods. Outcome data in the period following therapy showed reduced depression and total mood disturbance, as well as improved self‐esteem amongst therapy participants, relative to a no‐therapy control group. These improvements were no longer evident at the 3 or 6 month follow‐up assessments. We also report on the difficulties associated with conducting a group intervention with this patient cohort. Copyright © 1999 John Wiley & Sons, Ltd.     

The effectiveness of a psycho‐educational group after early‐stage breast cancer treatment: results of a randomized French study

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. Copyright © 2008 John Wiley & Sons, Ltd.     

Effect of Cognitive Behavioral Therapy on Improving Anxiety,Depression, and Quality of Life in Pre-Diagnosed Lung Cancer Patients

Objective: To evaluate the effectiveness of cognitive behavior therapy on anxiety, depression, and quality of life of pre-diagnosed lung cancer patients. Methods: A total of 32 pre-diagnosed subjects were divided into 16 Cognitive behaviour theraphy (CBT)-intervention patients and 16 control subjects. The study subjects were pre-diagnosed lung cancer patients hospitalized at Regional Public Hospital Dr. Moewardi Surakarta. For the treatment group, CBT psychotherapy interventions were given for up to 6 sessions every 2 days. The patient was tested for Hamilton Anxiety Rating Scale (HARS)-based anxiety symptom criteria and Hamilton Depression Rating Scale (HRSD)-based depression and followed The World Health Organization Quality of Life- Brief version (WHOQOL-BREF)-based quality of life criteria. The effect of CBT intervention was measured using an independent t-test and the Mann–Whitney test. Results: There was a significant difference in the intervention group post-test: HARS criteria decreased by −8.38 ± 2.90, HRSD decreased by an average of −6.75 ± 3.30, and WHOQOL-BREF increased by an average of 16.80 ± 10.13 compared with the control group. Conclusion: CBT affects the improvement of anxiety, depression, and quality of life for pre-diagnosed lung cancer patients.     

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.     

Psychosocial interventions as part of breast cancer rehabilitation programs? Results from a systematic review

Objective: This systematic review aimed to determine the effectiveness of psychoeducation, cognitive behavioural therapy (CBT) and social support interventions used in the rehabilitation of breast cancer (BC) patients. Methods: We conducted a systematic literature search to identify randomised controlled trials of female BC patients who underwent different psychosocial interventions during or after primary cancer treatment. The methodological quality of all studies was independently assessed by two reviewers. Studies with low quality, less than 20 participants in each group, patients with metastatic cancer, data not presented separately for BC and studies that included other cancer types were excluded. Results: Among 9617 identified studies, only 18 RCTs published between 1999 and 2008, including 3272 patients were finally included in this systematic evaluation. Outcome measures were categorised into quality of life (QoL), fatigue, mood, health behaviour and social function. Six trials examined psychoeducation had inconsistent results, both during and after the primary treatment. Seven trials examined the effect of CBT, four of which given after primary treatment (range 6–12 weeks) demonstrated improvements in QoL; the other three CBT studies given during primary treatment (range 9–20 weeks) had inconsistencies. Five studies addressed social support and showed no conclusive impacts of this intervention. Conclusions: Limited documentation exists on the efficacy of psychosocial rehabilitation interventions among BC patients. However, we found that patients might have QoL benefits from CBT given after primary BC treatment. More documentation is needed regarding the effects of CBT during primary treatment and the effects of psychoeducation and social support. Copyright © 2010 John Wiley & Sons, Ltd.     

A Pilot Randomized Controlled Trial of Brief Cognitive‐Behavioral Therapy for Anxiety in Patients with Terminal Cancer

Introduction.

Patients with terminal cancer often experience marked anxiety that is associated with poor quality of life. Although cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety disorders, the approach needs to be adapted to address realistic concerns related to having cancer, such as worries about disease progression, disability, and death. In this pilot randomized controlled trial (clinicaltrials.gov identifier {"type":"clinical-trial","attrs":{"text":"NCT00706290","term_id":"NCT00706290"}}NCT00706290), we examined the feasibility and potential efficacy of brief CBT to reduce anxiety in patients with terminal cancer.

Methods.

We adapted CBT by developing treatment modules targeting skills for relaxation, coping with cancer worries, and activity pacing. Adults with incurable malignancies and elevated anxiety based on the Hamilton Anxiety Rating Scale (HAM-A) were randomly assigned to individual CBT or a waitlist control group. Primary outcomes included the number of completed CBT visits and the change in HAM-A scores from baseline to 8-week follow-up per a treatment-blind evaluator. The feasibility criterion was 75% adherence to the intervention.

Results.

We randomized 40 patients with terminal cancers to CBT (n = 20) or waitlist control (n = 20) groups; 70% completed posttreatment assessments. Most patients who received CBT (80%) participated in at least five of the required six therapy sessions. Analysis of covariance models, adjusted for baseline scores, showed that those assigned to CBT had greater improvements in HAM-A scores compared to the control group, with an adjusted mean difference of –5.41 (95% confidence interval: –10.78 to –0.04) and a large effect size for the intervention (Cohen''s d = 0.80).

Conclusion.

Providing brief CBT tailored to the concerns of patients with terminal cancer was not only feasible but also led to significant improvements in anxiety.     

Time‐dependent risk of depression,anxiety, and stress‐related disorders in patients with invasive and in situ breast cancer

Despite concerns about the mental health of breast cancer patients, little is known regarding the temporal risk pattern and risk factors of common mental disorders among these patients. We estimated standardized incidence ratios (SIRs) of depression, anxiety and stress‐related disorders in a Swedish nationwide cohort of 40,849 women with invasive and 4,402 women with in situ breast cancer (2001–2010, median follow‐up = 4.5 years). The impact of patient, tumor and treatment characteristics was analyzed using flexible parametric survival models in a regional cohort of 7,940 invasive breast cancer patients (2001–2013, median follow‐up = 7.5 years). Women with invasive breast cancer showed increased rates of depression, anxiety and stress‐related disorders [overall SIR (95% CI) = 1.57 (1.46–1.69), 1.55 (1.43–1.68) and 1.77 (1.60‐1.95), respectively]. SIRs were highest shortly after diagnosis, but remained increased up to 5 years. Younger age at diagnosis, comorbidity, higher‐grade disease, lymph node involvement and chemotherapy were independently associated with the risk of depression and anxiety in invasive cancer patients, with chemotherapy and higher‐grade disease conferring short‐term risk only, while comorbidities were mainly associated with late‐onset events. No clinical risk factors were identified for stress‐related disorders except for a greater risk associated with younger age. Patients with in situ cancer only showed an increased incidence of stress‐related disorders during the first 6 months after diagnosis [SIR (95% CI) = 2.76 (1.31‐5.79)]. The time‐dependent risk profile of invasive cancer patients may guide health care professionals for timely and targeted psycho‐oncologic interventions.     

Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects.

PURPOSE: Chronic insomnia is highly prevalent in cancer patients. Cognitive-behavioral therapy (CBT) is considered the treatment of choice for chronic primary insomnia. However, no randomized controlled study has been conducted on its efficacy for insomnia secondary to cancer. Using a randomized controlled design, this study conducted among breast cancer survivors evaluated the effect of CBT on sleep, assessed both subjectively and objectively, and on hypnotic medication use, psychological distress, and quality of life. PATIENTS AND METHODS: Fifty-seven women with insomnia caused or aggravated by breast cancer were randomly assigned to CBT (n = 27) or a waiting-list control condition (n = 30). The treatment consisted of eight weekly sessions administered in a group and combined the use of stimulus control, sleep restriction, cognitive therapy, sleep hygiene, and fatigue management. Follow-up evaluations were carried out 3, 6, and 12 months after the treatment. RESULTS: Participants who received the insomnia treatment had significantly better subjective sleep indices (daily sleep diary, Insomnia Severity Index), a lower frequency of medicated nights, lower levels of depression and anxiety, and greater global quality of life at post-treatment compared with participants of the control group after their waiting period. Results were more equivocal on polysomnographic indices. Therapeutic effects were well maintained up to 12 months after the intervention and generally were clinically significant. CONCLUSION: This study supports the efficacy of CBT for insomnia secondary to breast cancer.     

Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: a 3-month longitudinal examination of cognitive processing

Introduction: The experience of cancer can be understood as a psychosocial transition, producing both positive and negative outcomes. Cognitive processing may facilitate psychological adjustment. Methods: Fifty‐five post‐treatment, colorectal cancer survivors (M=65.9 years old; SD=12.7), an average of 13 months post‐diagnosis, were recruited from a state cancer registry and completed baseline and 3‐month questionnaires assessing dispositional (social desirability), cognitive processing (cognitive intrusions, cognitive rehearsal), and psychological adjustment variables (posttraumatic growth (PTG), posttraumatic stress disorder (PTSD) symptomatology, depression, anxiety, positive affectivity). Results: PTSD symptomatology was positively associated with depression, anxiety, and negatively associated with positive affectivity. In contrast, PTG scores were unrelated to PTSD symptomatology, depression, anxiety, and positive affectivity. In addition, PTG was independent of social desirability. Notably, after controlling for age at diagnosis and education, multiple regression analyses indicated that cognitive processing (intrusions, rehearsal) was differentially predictive of psychological adjustment. Baseline cognitive intrusions predicted 3‐month PTSD symptomatology and there was a trend for baseline cognitive rehearsal predicting 3‐month PTG. Conclusions: Additional research is needed to clarify the association between PTG and other indices of psychological adjustment, further delineate the nature of cognitive processing, and understand the trajectory of PTG over time for survivors with colorectal cancer. Copyright © 2008 John Wiley & Sons, Ltd.     

Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia

Objective: Insomnia is a common complaint among cancer survivors. Fortunately, cognitive‐behavioral therapy for insomnia (CBT‐I) has been shown to be an effective treatment in this population. However, it is rarely implemented given its limited availability. To address this barrier, we examined the ability of an easily accessible online CBT‐I program to improve insomnia symptoms in cancer survivors. Methods: Twenty‐eight cancer survivors with insomnia were randomly assigned to either an Internet insomnia intervention (n = 14) or to a waitlist control group (n = 14). The online program, Sleep Healthy Using The Internet, delivers the primary components of CBT‐I (sleep restriction, stimulus control, cognitive restructuring, sleep hygiene, and relapse prevention). Pre‐ and post‐assessment data were collected via online questionnaires and daily sleep diaries. Results: Participants in the Internet group showed significant improvements at post‐assessment compared with those in the control group in overall insomnia severity (F_1,26 = 22.8; p<0.001), sleep efficiency (F_1,24 = 11.45; P = 0.002), sleep onset latency (F_1,24 = 5.18; P = 0.03), soundness of sleep (F_1,24 = 9.34; P = 0.005), restored feeling upon awakening (F_1,24 = 11.95; P = 0.002), and general fatigue (F_1,26 = 13.88; P = 0.001). Although other group × time interactions were not significant, overall adjusted effect sizes for all sleep variables as well as for fatigue, depression, anxiety, and quality of life ranged from small to large. Conclusions: CBT‐I delivered through an interactive, individually tailored Internet intervention may be a viable treatment option for cancer survivors experiencing insomnia. Copyright © 2011 John Wiley & Sons, Ltd.     

Psychological distress among family carers of oesophageal cancer survivors: the role of illness cognitions and coping

Objective: The research aimed to determine the extent to which illness cognitions and coping explain psychological distress (fear of cancer recurrence, anxiety and depression symptoms) among family carers of survivors of oesophageal cancer. Methods: Carers of patients registered with the Oesophageal Patients' Association in the UK were mailed a questionnaire booklet containing questions about medical and demographic variables, the Illness Perception Questionnaire‐Revised, the Cancer Coping Questionnaire, the Concerns about Recurrence Scale and the Hospital Anxiety and Depression Scale. Results: Complete responses were received from 382 family carers (75% male; mean (SD) age=62 (10.91) years). Regression models indicated that the variables measured could explain between 35 and 49% of the variance in psychological distress among carers. Illness cognitions (particularly perceptions of the cause of, consequences of and personal control over oesophageal cancer and the carer's understanding of the condition) explained the majority of this variance. Positive focus coping strategies were also found to be important in explaining psychological distress. Conclusion: The results of this study are consistent with previous research demonstrating that illness cognitions are significant correlates of adaptive outcomes, thereby suggesting that cognition‐based interventions could potentially be effective in minimizing emotional distress among family carers of oesophageal cancer survivors. Copyright © 2010 John Wiley & Sons, Ltd.     

Positive adjustment to breast cancer: development of a disease‐specific measure and comparison of women diagnosed from 2 weeks to 5 years

Objective: Many women describe ‘positive adjustment’ as a consequence of having breast cancer. It is unclear whether positive experiences reflect the absence of anxiety and depression or are part of a separate process of adjustment. Existing measures are not specific to breast cancer and may lack validity. Our aims were as follows: (1) to develop a valid questionnaire to measure positive adjustment after breast cancer; (2) to clarify whether it measures aspects distinct from anxiety and depression and (3) to suggest when positive adjustment typically emerges. Methods: A new measure, the Positive Adjustment Questionnaire (PAQ), was developed and completed by 156 women with breast cancer, allocated to three groups: 2–4 weeks; 6 months–2 years and 2–5 years post‐diagnosis. Other questionnaires were used to assess anxiety and depression and test the validity of the PAQ. Results: Principal components analysis of the PAQ identified four domains of positive adjustment; Fulfilment, Re‐evaluation, New ways of living and Valuing Life. Women questioned 2–5 years after diagnosis reported more fulfilment, re‐evaluation of life and new ways of living than those asked shortly after diagnosis. Differences in these aspects of positive adjustment remained after controlling for anxiety and depression. Conclusions: This study (1) provides a measure specific to positive adjustment following breast cancer; (2) suggests that positive adjustment is different from anxiety and depression and (3) indicates that positive adjustment is seen in women assessed 2–5 years after diagnosis. Psychological therapies that promote positive adjustment could enhance existing interventions that focus on reducing anxiety and depression. Copyright © 2010 John Wiley & Sons, Ltd.     

What is the evidence for the use of mindfulness‐based interventions in cancer care? A review

Objective: The aim of this paper is to present and critically appraise the evidence for the use of mindfulness‐based interventions in cancer care. Methods: Systematic review methods were used. A thorough search of relevant major and specialised electronic databases was made and unpublished and ongoing work was also identified. Both qualitative and quantitative studies were eligible for inclusion. Information about aims, design, participant sample, measures, findings and intervention details were extracted from each study. Results: Thirteen research papers and four conference abstracts published since 2007 were identified which met the criteria, reporting five different types of mindfulness intervention. The 13 papers composed of three randomised control trials, two non‐randomised control trials, five pre and post‐test designs and two qualitative studies. Studies report significant improvements in anxiety, depression, stress, sexual difficulties, physiological arousal and immune function or subjective benefits across all interventions. Methodological limitations were identified. Diversity in study designs and interventions makes comparisons between studies difficult. Some mindfulness interventions may have a place in acute treatment and palliative care. Conclusion: Mindfulness approaches are a promising intervention in cancer care, potentially across the cancer trajectory. Further qualitative research and research into different styles of mindfulness delivery are recommended. Copyright © 2010 John Wiley & Sons, Ltd.     

No improvement in distress and quality of life following psychosocial cancer rehabilitation. A randomised trial

Objective: Rehabilitation programmes are intended to help cancer patients achieve optimal functioning and live independently. We evaluated whether a psychosocial rehabilitation course was effective in relieving cancer patients' distress and improving their well‐being. Methods: Patients with breast, prostate or colorectal cancer diagnosed within 2 years who had finished primary treatment were randomised to usual care or a 6‐day residential course of lectures, discussions and peer groups on issues related to treatment and living with cancer. Changes in self‐reported distress (POMS‐Sf) and quality of life (EORTC QLQ‐C30) from baseline to 1 and 6 months' follow‐up were measured. Analyses were adjusted for baseline scores of outcome, cancer site, time since diagnosis, gender, age and education. Results: Of 507 patients, 452 were included in the analyses, 404 completed the 1‐month and 394 the 6‐month assessment. Patients in the control group showed greater decreases in total mood disturbance and subscales of the POMS‐Sf and showed more improvement in emotional, cognitive and social functioning at both 1 and 6 months and in role functioning at 6 months than the intervention group. A similar pattern was observed in analyses of breast cancer patients only. Conclusion: A 6‐day residential rehabilitation course did not relieve cancer patients' distress or improve their well‐being. Copyright © 2011 John Wiley & Sons, Ltd.     

The relationship between meaning discrepancy and emotional distress among patients with cancer: the role of posttraumatic growth in a collectivistic culture

The aim of this study was to examine the relationship between meaning discrepancy and emotional distress (i.e. anxiety and depression) among patients with cancer in a collectivistic culture, and to explore the stress‐buffering effect of posttraumatic growth on this relationship. We collected data from 198 patients with cancer who completed questionnaires measuring meaning discrepancy, posttraumatic growth, anxiety and depression. Correlation analyses indicated that meaning discrepancy positively correlated with anxiety (r = 0.477, P < 0.01) and depression (r = 0.452, P < 0.01). Three structural equation models were built to compare competing hypotheses. Results showed that the moderation model fits the data better than the mediation and independence models (χ²/df = 1.31, RMSEA = 0.040, CFI = 0.98, GFI = 0.92). The present study demonstrated a positive association between meaning discrepancy and anxiety/depression, and a protective effect of posttraumatic growth on mental health by buffering traumatic stress. The study has clinical implications for the medical practice of oncology; doctors, nurses, relatives and counsellors should attend to the psychological care of patients with cancer by exploring their meaning discrepancy, and promoting the use of posttraumatic growth as a psychological resource to buffer the anxiety and depression of patients with cancer.     

The impact of perceived stage of cancer on carers' anxiety and depression during the patients' final year of life

Objective: This paper explores the effects of perceived stage of cancer (PSOC) on carers' anxiety and depression during the patients' final year. Methods: A consecutive sample of patients and carers (N=98) were surveyed at regular intervals regarding PSOC, and anxiety and depression using the Hospital Anxiety and Depression Scale. Means were compared by gender using the Mann–Whitney U‐test. The chi‐square was used to analyse categorical data. Agreement between carers' and patients' PSOC was estimated using kappa statistics. Correlations between carers' PSOC and their anxiety and depression were calculated using the Spearman's rank correlation. Results: Over time, an increasing proportion of carers reported that the cancer was advanced, culminating at 43% near death. Agreement regarding PSOC was fair (kappa=0.29–0.34) until near death (kappa=0.21). Carers' anxiety increased over the year; depression increased in the final 6 months. Females were more anxious (p=0.049, 6 months; p=0.009, 3 months) than males, and more depressed until 1 month to death. The proportion of carers reporting moderate–severe anxiety almost doubled over the year to 27%, with more females in this category at 6 months (p=0.05). Carers with moderate–severe depression increased from 6 to 15% over the year. Increased PSOC was weakly correlated with increased anxiety and depression. Conclusions: Carers' anxiety exceeded depression in severity during advanced cancer. Females generally experienced greater anxiety and depression. Carers were more realistic than patients regarding the ultimate outcome, which was reflected in their declining mental health, particularly near the end. Copyright © 2008 John Wiley & Sons, Ltd.     

Comparing the efficacy of integrative body-mind-spirit intervention with cognitive behavioral therapy in patient-caregiver parallel groups for lung cancer patients using a randomized controlled trial

Abstract

Purposes/objectives: This paper reports the comparative efficacies of integrative body-mind-spirit intervention (I-BMS) and cognitive behavioral therapy (CBT) in patient-caregiver parallel groups for Chinese patients with lung cancer.

Design: Randomized controlled trial (RCT).

Methods: One hundred and fifty-seven patient-caregiver dyads with no marked functional impairment were randomized into one of the two interventions with eight weekly patient-caregiver parallel groups. Assessments were conducted at baseline, within one, eight- and sixteen-weeks post-intervention. Effects of treatment group across time were analyzed by multilevel modeling.

Findings: CBT led to greater reduction in emotional vulnerability than I-BMS. I-BMS resulted in greater increase in overall QoL and spiritual self-care, and more reduction in depression than CBT. Patients in both interventions experienced improvement in physical, emotional and spiritual, except social, domains of QoL.

Conclusion: I-BMS was more efficacious for diverse domains of QoL, and CBT was more effective for emotional well-being, despite the relatively small between-group effect sizes.

Implications for psychosocial providers/policy: (1) With the expanding repertoire of psychosocial interventions for families facing lung cancer, it has become imperative to investigate the comparative efficacies of empirically supported and culturally adapted interventions. (2) Our findings show that I-BMS was more effective for diverse domains of QoL, while CBT was more efficacious with emotional well-being, although both interventions led to significant improvements in physical, emotional and spiritual domains of patient QoL. (3) Patient-caregiver parallel groups have been shown to be effective for enhancing QoL of Chinese lung cancer patients. (4) Care professionals are encouraged to dispense interventions based on the idiosyncratic needs and preferences of the patients to maximize the treatment effects.     

Prolonged impact of chemotherapy on fatigue in breast cancer survivors: a longitudinal comparison with radiotherapy-treated breast cancer survivors and noncancer controls

BACKGROUND:

In this study, the authors examined the influence of prior treatment on the course of fatigue in breast cancer survivors. Patients who received chemotherapy were expected to have greater fatigue than patients who received radiotherapy and noncancer controls 6 months after the completion of treatment, but they were expected to recover to levels similar to those of the other 2 groups 3 years later.

METHODS:

Patients with stage 0 through II breast cancer completed the Fatigue Symptom Inventory (FSI) and the Profile of Mood States Fatigue Scale (POMS‐FAT) 6 months (T1) and 42 months (T2) after completing chemotherapy with or without radiotherapy (the CT group; n = 103) or radiotherapy only (the RT group; n = 102). An age‐matched group of women with no history of cancer (the NC group; n = 193) was assessed over a similar interval.

RESULTS:

A significant (P = .041) group × time effect for FSI severity scores revealed that fatigue worsened over time in the CT group but remained stable and lower in the RT and NC groups. There also were significant group effects for FSI days (P < .001) and POMS‐FAT (P = .010) scores, indicating that fatigue was significantly greater across time in the CT group than in the NC group (POMS‐FAT) or the RT and NC groups (FSI days).

CONCLUSIONS:

Contrary to expectations, fatigue did not diminish over time in patients with breast cancer who received chemotherapy. This finding has important implications for patient education and for fatigue monitoring during follow‐up. The authors concluded that future research should seek to examine possible mechanisms to explain the apparent prolonged impact of chemotherapy on fatigue in breast cancer survivors. Cancer 2012. © 2011 American Cancer Society.     

"Between Men": a psychosocial rehabilitation programme for men with prostate cancer

The aim of this study was to evaluate the effect of psychosocial rehabilitation on newly diagnosed prostate cancer patients. The “Between Men” programme consisted of seven weekly sessions of physical training (Phys) alone, information (Info) alone or physical training plus information (PhysInfo). After diagnoses, patients (n =211) were consecutively included, stratified and randomised to one of four groups: Phys, Info, PhysInfo or standard care control (C). A nurse specialised in urology, an urologist and a physiotherapist performed the interventions. Patients were followed up during one year with mailed standardised questionnaires. It could not be assumed that the “Between Men” programme had any effect on patients' anxiety and depression (HADS). Health-related quality of life (HRQOL) was associated with stage of disease but not with psychosocial intervention. Thus, Physical Function (PF), Role Function (RF) and Fatigue (FA) were inferior among patients with, than without, metastases of prostate cancer both at baseline and at the 12-month follow-up. This randomized study did not demonstrate any significant effect of psychosocial rehabilitation among prostate cancer patients. Considering the low rate (1/2), of included/eligible patients a less complicated design (intervention versus control) would have been preferred in order to increase power.