Delivering a very brief psychoeducational program to cancer patients and family members in a large group format

Psychosocial interventions for informal caregivers of people living with cancer

BACKGROUND

Increasingly, cancer is recognised as a chronic condition with a growing population of informal caregivers providing care for cancer patients. Informal caregiving can negatively affect the health and well-being of caregivers. We need a synthesised account of best evidence to aid decision-making about effective ways to support caregivers for individuals 'living with cancer'.

OBJECTIVES

To assess the effectiveness of psychosocial interventions designed to improve the quality of life (QoL), physical health and well-being of informal caregivers of people living with cancer compared with usual care.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsycINFO, ProQuest, Open SIGLE, Web of Science from inception up to January 2018, trial registries and citation lists of included studies.

SELECTION CRITERIA

We included randomised and quasi-randomised controlled trials comparing psychosocial interventions delivered to adult informal caregivers of adults affected by cancer on a group or individual basis with usual care. Psychosocial interventions included non-pharmacological interventions that involved an interpersonal relationship between caregivers and healthcare professionals. We included interventions delivered also to caregiver-patient dyads. Interventions delivered to caregivers of individuals receiving palliative or inpatient care were excluded. Our primary outcome was caregiver QoL. Secondary outcomes included patient QoL, caregiver and patient depression, anxiety, psychological distress, physical health status and intervention satisfaction and adverse effects.

DATA COLLECTION AND ANALYSIS

Pairs of review authors independently screened studies for eligibility, extracted data and conducted 'Risk of bias' assessments. We synthesised findings using meta-analysis, where possible, and reported remaining results in a narrative synthesis.

MAIN RESULTS

Nineteen trials (n = 3, 725) were included in the review. All trials were reported in English and were undertaken in high-income countries. Trials targeted caregivers of patients affected by a number of cancers spanning newly diagnosed patients, patients awaiting treatment, patients who were being treated currently and individuals post-treatment. Most trials delivered interventions to caregiver-patient dyads (predominantly spousal dyads) and there was variation in intervention delivery to groups or individual participants. There was much heterogeneity across interventions though the majority were defined as psycho-educational. All trials were rated as being at 'high risk of bias'.Compared to usual care, psychosocial interventions may improve slightly caregiver QoL immediately post intervention (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.04 to 0.53; studies = 2, 265 participants) and may have little to no effect on caregiver QoL at 12 months (SMD 0.14, 95% CI - 0.11 to 0.40; studies = 2, 239 participants) post-intervention (both low-quality evidence).Psychosocial interventions probably have little to no effect on caregiver depression immediately to one-month post-intervention (SMD 0.01, 95% CI -0.14 to 0.15; studies = 9, 702 participants) (moderate-quality evidence). Psychosocial interventions may have little to no effect on caregiver anxiety immediately post-intervention (SMD -0.12, 95 % CI -0.33 to 0.10; studies = 5, 329 participants), depression three-to-six months (SMD 0.03, 95% CI -0.33 to 0.38; studies = 5. 379 participants) post-intervention and patient QoL six to 12 months (SMD -0.05, 95% CI -0.37 to 0.26; studies = 3, 294 participants) post-intervention (all low-quality evidence). There was uncertainty whether psychosocial interventions improve patient QoL immediately (SMD -0.03, 95 %CI -0.50 to 0.44; studies = 2, 292 participants) or caregiver anxiety three-to-six months (SMD-0.25, 95% CI -0.64 to 0.13; studies = 4, 272 participants) post-intervention (both very low-quality evidence). Two studies which could not be pooled in a meta-analysis for caregiver physical health status found little to no effect immediately post-intervention and a small intervention effect 12 months post-intervention. Caregiver or patient satisfaction or cost-effectiveness of interventions were not assessed in any studies. Interventions demonstrated good feasibility and acceptability.Psychosocial interventions probably have little to no effect on patient physical health status immediately post-intervention (SMD 0.17, 95 % CI -0.07 to 0.41; studies = 4, 461 participants) and patient depression three to six months post-intervention (SMD-0.11, 95% CI -0.33 to 0.12; studies = 6, 534 participants) (both moderate-quality evidence).Psychosocial interventions may have little to no effect on caregiver psychological distress immediately to one-month (SMD -0.08, 95% CI -0.42 to 0.26; studies = 3, 134 participants), and seven to 12 months (SMD 0.08, 95% CI -0.42 to 0.58; studies = 2, 62 participants) post-intervention; patient depression immediately (SMD -0.12, 95% CI -0.31 to 0.07; studies = 9, 852 participants); anxiety immediately (SMD -0.13, 95% CI -0.41 to 0.15;studies = 4, 422 participants), and three to six months (SMD -0.22, 95% CI -0.45 to 0.02; studies = 4, 370 participants); psychological distress immediately (SMD -0.02, 95% CI -0.47 to 0.44; studies = 2, 74 participants) and seven to 12 months (SMD -0.27, 95% CI -0.78 to 0.24; studies = 2, 61 participants); and physical health status six to 12 months (SMD 0.06, 95% CI -0.18 to 0.30; studies = 2, 275 participants) post-intervention (all low-quality evidence).Three trials reported adverse effects associated with the interventions, compared with usual care, including higher distress, sexual function-related distress and lower relationship satisfaction levels for caregivers, higher distress levels for patients, and that some content was perceived as insensitive to some participants.Trials not able to be pooled in a meta-analysis did not tend to report effect size and it was difficult to discern intervention effectiveness. Variable intervention effects were reported for patient and caregiver outcomes.

AUTHORS' CONCLUSIONS

Heterogeneity across studies makes it difficult to draw firm conclusions regarding the effectiveness of psychosocial interventions for this population. There is an immediate need for rigorous trials with process evaluations and clearer, detailed intervention descriptions. Cost-effectiveness studies should be conducted alongside future trials.

Group Psychological Therapy: An Integral Part of Care for Cancer Patients

Adjuvant psychological therapy can help cancer patients in 2 main ways. It has, first, a well-documented capacity to alleviate distress and thus improve quality of life. However, if this kind of assistance is to be made available to the majority of cancer patients, a number of problems need to be solved: administrators need to become aware of the evidence for efficacy of psychosocial care for cancer patients; the treatment needs to be advocated in a manner that would benefit patients rather than being left to the patient to request it; and, for reasons of economy, large, classroom-style, psychoeducational classes may need to be offered in place of small support groups. Furthermore, to allow for individual differ ences in preferences and abilities, a variety of modes of help should ideally be made available. The author discusses how the provision of coping strategies can be organized in a progressive way to encourage development of greater coping skills. An example of such a stepwise program is given, all aspects of which have been researched and made available in manuals over some 20 years. The possibility of prolonging life with this kind of therapy is still controversial. While ran domized controlled trials have become the method of choice to investigate this question, reasons are given for strongly preferring more exploratory modes of research at the pres ent early stage of knowledge. The central task is seen as understanding the states of mind that promote healing or longer life, something that cross-sectional, psychometric research has not been able to accomplish. As an alternative, prospective, longitudinal designs are needed, with detailed interview-style analyses of patients' mental attributes. An example is given of one such study. Furthermore, it is suggested that we consider much more intensive therapies of this kind, since the impact of mind on body will logically be related to the extent of psychological change experienced.

Wonders & Worries: evaluation of a child centered psychosocial intervention for families who have a parent/primary caregiver with cancer

OBJECTIVE

Scant evidence exists to guide interventions for children who have a parent with cancer. This study evaluated the outcomes of a community based psychosocial intervention targeted to children dealing with parental or primary caregiver cancer. This curriculum provided an age-appropriate understanding of the illness, facilitated the expression of feelings, identified individual coping skills to help ease feelings related to parent's cancer, and enhanced the family's ability to communicate about the disease.

METHODS

Families whose children participated in the six-week curriculum-based intervention completed a questionnaire that included demographic information, a five-item assessment of changes in parenting abilities, and a nine-item assessment of changes in children's behavioral issues. The prevalence of each reported item was determined through a secondary analyses of cross-sectional data derived from a multi-year sample of these survey results.

RESULTS

A sample of 156 families responded to the survey between 2009 and 2014. A majority of families described improvement in all five areas of parenting abilities assessed including communication skills and confidence in parenting. Amelioration of multiple children's issues was reported including improved communication skills (87%), reduced anxiety (84%), increased feeling of security at home (90%), and improved school performance (73%).

CONCLUSIONS

The results reported here suggest that this child centered psychosocial intervention promoted positive adaptation by actively supporting families and children while a parent/primary caregiver coped with a cancer diagnosis. Future research is planned utilizing a randomized controlled study design to formally evaluate the effectiveness and preventative impact of this manualized six-week curriculum. Copyright © 2016 John Wiley & Sons, Ltd.

Group Interventions for Patients with Cancer and HIV Disease: Part I: Effects on Psychosocial and Functional Outcomes at Different Phases of Illness

Group interventions for individuals facing cancer or HIV disease have drawn considerable attention among researchers and clinicians over the past 20 years. There is growing evidence that group services may be helpful, but which interventions are most effective for participants at which phases in the trajectory of disease has been less clear. Moreover, professionals working in different intervention settings (e.g., primary prevention vs. clinical care) and different disease sites (cancer vs. HIV disease) often have little awareness of relevant advances in other fields. Efforts to integrate findings in the literature may accelerate research and advance the standard of clinical care. The current article, the first in a series of four special reports, critically evaluates the efficacy of group interventions led by professional or trained facilitators for individuals confronted by cancer or HIV, across the spectrum of illness from elevated risk through advanced disease. We examine psychosocial and functional outcomes for different interventions directed toward different patient subgroups, trace common themes, highlight limitations, and offer recommendations for further research.

Are Needs Assessments Cost Effective in Reducing Distress Among Patients With Cancer? A Randomized Controlled Trial Using the Distress Thermometer and Problem List

Purpose

Patients with cancer have a high prevalence of distress. We evaluated whether distress monitoring and needs assessment using the Distress Thermometer and Problem List (DT&PL) improved patient outcomes.

Patients and Methods

We conducted an unblinded, two-arm, parallel randomized controlled trial at two sites among patients starting radiotherapy or chemotherapy. The intervention group completed the DT&PL, rating distress and discussing sources of distress with a trained radiographer/nurse. No specific triage algorithms were followed. The control group received usual care. The main outcome measure was psychological distress (Profile of Mood States [POMS], short form) up to 12 months; secondary outcomes were quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30) and health care costs.

Results

Of 220 patients randomly assigned, 112 patients were allocated to the DT&PL. Ninety-five percent completed the primary outcome at 12 months. The DT&PL took 25 minutes; one third of patients had high levels of distress, and most reported physical (84%) or emotional (56%) problems. There was no evidence of an effect of the DT&PL on adjusted POMS scores over follow-up (difference between groups, −1.84; 95% CI, −5.69 to 2.01; P = .35) or in secondary outcomes. The DT&PL cost £19 ($28) per patient and did not lower subsequent health care costs. Few patients (< 3%) in either arm of the trial were referred to a clinical psychologist.

Conclusion

Patients with cancer have a high prevalence of distress. Needs assessment can be performed quickly and inexpensively. However, the DT&PL was not cost effective in improving patient mood states. It is important to explore the reasons for this so that oncology units can design better services to support patients.

Self-efficacy, perceived preparedness, and psychological distress in women completing primary treatment for breast cancer

The present analyses were conducted to examine demographic and clinical variables associated with mood and health-related distress in a sample of 440 women completing primary treatment for early-stage breast cancer. The authors' aim was to test the hypothesis that higher levels of self-efficacy and perceived preparedness for the end of treatment--the reentry phase--are associated with better mood and lower health-related distress in this sample. Women who had received chemotherapy and who were younger (<50 years) had significantly higher mood disturbance and health-related distress scores. Younger age, preparedness, and self-efficacy predicted 36% of the variance in mood disturbance scores. Self-efficacy and age predicted 26% of the variance in health-related distress. Although further research is needed, our findings suggest that self-efficacy and perceived preparedness represent important constructs to target in the development of interventions for women at the reentry transition.

Effects of an Education Program on Radiation Oncology Patients and Families

Patients and family members in a radiation oncology department participated in a study of a new education/orientation program. Information was presented in oral and in written form. After the intervention, orientation program participants did not differ significantly from control group members in state anxiety, general distress, treatment adherence, or knowledge of radiation therapy. Orientation group patients reported greater satisfaction with clinic care, and the orientation group was significantly more likely to utilize psychological counseling services within the clinic, as well as outside support. Discussion focused on possible explanations for the strikingly favorable program evaluations given by participants despite little evidence that the program was of significant benefit.

Children's Adjustment to Parental Cancer

There is growing empirical evidence that various child and family factors are associated with children's reactions to parental cancer. Children having parents with cancer may respond to parental cancer in different ways in terms of bonadjustment and maladjustment. Children's maladjustment to this pervasive stressor is manifested by a wide variety of physiologic, psychologic, and behavioral stress responses. To date, research on children's adjustment to parental cancer has focused almost exclusively on documenting children's adjustment problems and on describing simple, direct association between the characteristics of children and/or their families, and children's adjustment. The gap in research and clinical practice lies in the lack of a comprehensive model to illuminate children's coping with parental cancer and to guide intervention programs. Based on a synthesis of the literature, this article proposes a model that specifies the relationships among the stressor of having a parent with cancer, moderators and mediator variables, and adjustment. This model can serve as a basis for future research and intervention programs.

Benefits of the uncertainty management intervention for African American and White older breast cancer survivors: 20-month outcomes

In a 2 x 2 randomized block repeated measure design, this study evaluated the follow-up efficacy of the uncertainty management intervention at 20 months. The sample included 483 recurrence-free women (342 White, 141 African American women; mean age = 64 years) who were 5-9 years posttreatment for breast cancer. Women were randomly assigned to either the intervention or usual care control condition. The intervention was delivered during 4 weekly telephone sessions in which survivors were guided in the use of audiotaped cognitive-behavioral strategies and a self-help manual. Repeated measures MANOVAs evaluating treatment group, ethnic group, and treatment by ethnic interaction effects at 20 months indicated that training in uncertainty management resulted in improvements in cognitive reframing, cancer knowledge, and a variety of coping skills. Importantly, the 20-month outcomes also demonstrated benefits for women in the intervention condition in terms of declines in illness uncertainty and stable effects in personal growth over time.

Uncertainty management intervention for older African American and caucasian long-term breast cancer survivors

The survivor uncertainty management intervention study is a randomized controlled study designed to test the efficacy of an intervention that combines training in audiotaped cognitive behavioral strategies to manage uncertainty about cancer recurrence with a self-help manual designed to help women understand and manage long-term treatment side effects and other symptoms. Specifically, women were taught to recognize their own personal triggers of uncertainty (places, events or surroundings, that bring back memories, feelings, or concerns about breast cancer), and then use coping skills such as relaxation, distraction, and calming self-talk to deal with uncertainty. Also, women were taught to use the manual as a resource for dealing with fatigue, lymphedema, pain and other symptoms. Treatment outcome data (Mishel et al., in press) indicated that the uncertainty management intervention resulted in improvements in cognitive reframing, cancer knowledge, social support, knowledge of symptoms and side effects, and coping skills when compared to a control condition. The purpose of the present paper was to report on the use and helpfulness of the intervention components by the 244 women who were in the intervention. Findings indicated that women regularly used the intervention components to deal with triggers of breast cancer recurrence and long-term treatment side effects and most women found the strategies very helpful.

Benefits of the uncertainty management intervention for African American and White older breast cancer survivors: 20-month outcomes

In a 2 x 2 randomized block repeated measure design, this study evaluated the follow-up efficacy of the uncertainty management intervention at 20 months. The sample included 483 recurrence-free women (342 White, 141 African American women; mean age = 64 years) who were 5-9 years posttreatment for breast cancer. Women were randomly assigned to either the intervention or usual care control condition. The intervention was delivered during 4 weekly telephone sessions in which survivors were guided in the use of audiotaped cognitive-behavioral strategies and a self-help manual. Repeated measures MANOVAs evaluating treatment group, ethnic group, and treatment by ethnic interaction effects at 20 months indicated that training in uncertainty management resulted in improvements in cognitive reframing, cancer knowledge, and a variety of coping skills. Importantly, the 20-month outcomes also demonstrated benefits for women in the intervention condition in terms of declines in illness uncertainty and stable effects in personal growth over time.

Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: a randomized controlled trial

BACKGROUND

High-dose therapy with autologous stem cell transplantation (HDT/ASCT) is a commonly used treatment for hematologic malignancies. The procedure causes significant psychological distress and no interventions have been demonstrated to improve mood in these patients. Music therapy has been shown to improve anxiety in a variety of acute medical settings. In the current study, the authors determined the effects of music therapy compared with standard care on mood during inpatient stays for HDT/ASCT.

METHODS

Patients with hematologic malignancy admitted for HDT/ASCT at two sites (Memorial Sloan-Kettering Cancer Center and Ireland Cancer Center in Cleveland, Ohio) were randomized to receive music therapy given by trained music therapists or standard care. Outcome was assessed at baseline and every 3 days after randomization using the Profile of Mood States.

RESULTS

Of 69 patients registered in the study, follow-up data were available for 62 (90%). During their inpatient stay, patients in the music therapy group scored 28% lower on the combined Anxiety/Depression scale (P = 0.065) and 37% lower (P = 0.01) on the total mood disturbance score compared with controls.

CONCLUSIONS

Music therapy is a noninvasive and inexpensive intervention that appears to reduce mood disturbance in patients undergoing HDT/ASCT.

The Living with Cancer Education Programme. I. Development of an Australian education and support programme for cancer patients and their family and friends

After a diagnosis of cancer, patients and their families and friends experience a significant need for information about the illness, treatment and prognosis, as well as support. Structured education and support group-based programmes play a major role in meeting these needs. Following a needs assessment in 1985, the Anti-Cancer Council of Victoria (ACCV), Australia, initiated development of the Living With Cancer Education Programme (LWCEP), a structured 8-week group programme providing education and support for people with cancer and their families and friends. This paper provides an historical overview of the LWCEP, as well as an outline of the programme aims, structure, content and delivery. Recent developments and future directions are also discussed. These include adaptation of the programme for individuals with advanced or recurrent cancer, modification of the programme structure and revision of the evaluation methodology.

An evaluation of a cancer counselling service

The CancerBACUP London Counselling Service offered short-term face-to-face counselling to self-referred cancer patients and their relatives and friends, provided by experienced supervised counsellors working within a humanistic theoretical framework. This study aimed to identify its clients' characteristics, use of the service, extent of perceived benefits and satisfaction with the service. Sociodemographic data were collected in Data Sheets from all 384 clients who booked an appointment over 18 months; they were predominantly female, < 50 years old and from non-manual social classes. Significantly more people in those classes and in the 30-59 age group attended three or more sessions. Three hundred and nine clients who attended at least once were sent an Evaluation Form; 142 responded. The probability of the Evaluation Forms' return was greater for those who had completed more sessions; the great majority of respondents felt that they had benefited, and were satisfied with the service. This study, notwithstanding its limitations, shows that a short course of counselling may be perceived by clients to be helpful; it also raises other issues of value to those involved in cancer services and/or counselling provision.