1
|
Luigjes-Huizer YL, van der Lee ML, Richel C, Masselink RA, de Wit NJ, Helsper CW. Patient-reported needs for coping with worry or fear about cancer recurrence and the extent to which they are being met: a survey study. J Cancer Surviv 2024; 18:791-799. [PMID: 36585574 PMCID: PMC9803402 DOI: 10.1007/s11764-022-01326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Many cancer patients and survivors experience fear or worry about cancer recurrence (FCR). Evidence suggests support for FCR is their largest unmet need. We aimed to assess which types of support are needed, which providers are preferred and to what extent patients' needs are being met. METHODS Together with the Dutch Federation of Cancer Patient Organisations (NFK), a purpose-designed questionnaire was distributed online via e-mail, newsletters and social media. All questions were multiple choice or Likert scales, except for an open-ended question about the preferred provider of care. RESULTS Out of 5323 respondents, 4511 had experienced FCR and were included. Among them, 94% indicated a need for support. The required types of support that were reported the most were talking about FCR (69%), enjoyable activities for distraction (56%) and psychological help or coaching (40%). On average, younger respondents and women wanted more support than older respondents and men. Eighty-five percent of respondents received at least one type of support they wanted. Practical tips about FCR and additional medical check-ups were most often missed. Social contacts provided an important part of support, especially with talking and distracting activities. For other types of support, respondents usually preferred professionals. CONCLUSIONS Almost all patients who experience FCR have a need for support. Even though most receive some support, several gaps remain. IMPLICATIONS FOR CANCER SURVIVORS Many report an unmet need for psychological help or practical tips about FCR. We recommend for healthcare providers to discuss FCR with patients and inform them about the support available.
Collapse
Affiliation(s)
- Yvonne L Luigjes-Huizer
- Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB, Bilthoven, The Netherlands.
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands.
| | - Marije L van der Lee
- Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB, Bilthoven, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Carol Richel
- Dutch Federation of Cancer Patient Organisations, Utrecht, The Netherlands
| | - Roel A Masselink
- Dutch Federation of Cancer Patient Organisations, Utrecht, The Netherlands
| | - Niek J de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Charles W Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| |
Collapse
|
2
|
Wei F, He R, Yang X, Hu Z, Wang Y. Cognitive-behavioural therapy effectiveness for fear of cancer recurrence: systematic review and meta-analysis. BMJ Support Palliat Care 2024:spcare-2023-004639. [PMID: 38789129 DOI: 10.1136/spcare-2023-004639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE Fear of cancer recurrence is one of the psychological distresses for patients with cancer and cancer survivors, which poses a physical and psychological threat. There is scant evidence on the effectiveness of cognitive-behavioural therapy in reducing fear of cancer recurrence. Therefore, we conducted a systematic review and meta-analysis to assess the effectiveness of cognitive-behavioural therapy for fear of cancer recurrence. METHOD The review was reported according to Preferred Reporting Items for Systematic Review and Meta-analyses statement. Seven databases were systematically searched from inception to 31 March 2023. Randomised controlled trials implementing cognitive-behavioural therapy interventions and studies reporting fear of cancer recurrence were included. The methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool 2. RESULTS A total of 32 randomised controlled trials involving 1515 cancer survivors and 1845 patients with cancer undergoing treatment were included. The meta-analysis indicated a significant effect of cognitive-behavioural therapy on fear of cancer recurrence in patients with cancer and cancer survivors compared with controls (g=-0.65; 95% CI=-0.86, -0.44; p<0.001). The results of the overall risk of bias indicated some concerns in 4 studies and a high risk in 28 studies. CONCLUSION The study indicated the effectiveness of cognitive-behavioural therapy intervention for fear of cancer recurrence in patients with cancer and cancer survivors, which should inform future clinical practice of interventions for the treatment of fear of cancer recurrence. PROSPERO REGISTRATION NUMBER CRD42023404948.
Collapse
Affiliation(s)
- Fangxin Wei
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Ruiyao He
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Xin Yang
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Ziqi Hu
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Yu Wang
- Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| |
Collapse
|
3
|
Wei F, Yang X, He R, Hu Z, Wang Y. Effectiveness of Cognitive Behavioral Therapy on Fear of Cancer Recurrence in Breast Cancer: A Systematic Review and Meta-analysis. Cancer Nurs 2024:00002820-990000000-00241. [PMID: 38625783 DOI: 10.1097/ncc.0000000000001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
BACKGROUND Fear of cancer recurrence is one of the psychological distresses that seriously affects the quality of life of breast cancer patients. However, the evidence for cognitive behavioral therapy on fear of cancer recurrence in breast cancer is limited. OBJECTIVE The aim of this study was to evaluate the effectiveness of cognitive behavioral therapy in reducing breast cancer patients' fear of cancer recurrence. METHODS Seven databases were searched for randomized controlled studies on cognitive behavioral therapy for fear of cancer recurrence in cancer patients from the inception of the database to April 30, 2023, with no language restrictions. Meta-analysis was performed using Stata MP 17. The Cochrane Risk of Bias Tool version 2 was used to assess the quality of the included studies. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation method. RESULTS This review includes a total of 13 randomized controlled trials with 1447 breast cancer patients and survivors. When compared with controls, meta-analysis revealed that cognitive behavioral therapy significantly reduced the fear of cancer recurrence (g = -0.44; 95% confidence interval, -0.75 to -0.13; P < .001), whereas subgroup analysis revealed that only mindfulness-based cognitive therapy was significant. The overall risk of bias was high. The Grading of Recommendations, Assessment, Development and Evaluation assessment showed a low overall quality of evidence. CONCLUSIONS Cognitive behavioral therapy may be effective in reducing fear of cancer recurrence in breast cancer patients, and mindfulness-based cognitive therapy is particularly worthy of implementation. IMPLICATIONS FOR PRACTICE Mindfulness-based cognitive therapy may be used as an additional strategy to help manage breast cancer patients' fears of cancer recurrence.
Collapse
Affiliation(s)
- Fangxin Wei
- Author Affiliations: School of Nursing, Jinan University (Mr Wei, and Mss Yang, He, and Hu); and The Community Service Center of Jinan University, The First Affiliated Hospital of Jinan University (Mrs Wang), Guangzhou, China
| | | | | | | | | |
Collapse
|
4
|
Mullis MD, Fisher CL, Kastrinos AL, Sae-Hau M, Weiss ES, Rajotte M, Bylund CL. Survivorship transitions in blood cancer: Identifying experiences and supportive care needs for caregivers. J Cancer Surviv 2023:10.1007/s11764-023-01422-0. [PMID: 37420150 PMCID: PMC11024982 DOI: 10.1007/s11764-023-01422-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE Survivorship care often refers to continued healthcare after cancer treatment. Jacobsen and colleagues advocated to expand this to include patients on extended treatments and maintenance/prophylactic therapies, recognizing the care continuum as more complex. Transitions of care for individuals diagnosed with a blood cancer can be complicated. We sought to better understand blood cancer caregivers' experiences as their diagnosed family member encountered "survivorship transitions" across the continuum. METHODS We conducted semi-structured interviews with adults caring for a parent or a child with a blood cancer. Caregivers were segmented into survivorship groups based on two transitional contexts: (1) when patients transitioned to a new line of therapy (active treatment or maintenance therapy); (2) when patients ended treatment. We conducted a thematic analysis and triangulated findings to compare transitional experiences. RESULTS Caregivers in both groups reported experiencing a "new normal," which included personal, relational, and environmental adjustments. Caregivers in the treatment transitions group (n = 23) also described uncertainty challenges (e.g., losing their "safety net") and disrupted expectations (e.g., feeling "caught off guard" by challenges). Whereas caregivers in the end-of-treatment transitions group (n = 15) described relief coupled with worry (e.g., feeling hopeful yet worried). CONCLUSIONS Survivorship transitions for caregivers are riddled with challenges that include difficult readjustments, uncertainty/worry, and unmet expectations. While there seems to be a cohesive experience of "survivorship transitions," each transition group revealed nuanced distinctions. IMPLICATIONS FOR CANCER SURVIVORS Tailored supportive resources are needed for caregivers throughout survivorship transitions.
Collapse
Affiliation(s)
- M Devyn Mullis
- College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Carla L Fisher
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | | | | | - Carma L Bylund
- College of Medicine, University of Florida, Gainesville, FL, USA
| |
Collapse
|
5
|
Andersen BL, Lacchetti C, Ashing K, Berek JS, Berman BS, Bolte S, Dizon DS, Given B, Nekhlyudov L, Pirl W, Stanton AL, Rowland JH. Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update. J Clin Oncol 2023:JCO2300293. [PMID: 37075262 DOI: 10.1200/jco.23.00293] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
PURPOSE To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors. METHODS A multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted. RESULTS The evidence base consisted of 17 systematic reviews ± meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials. Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety. Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent. The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations. RECOMMENDATIONS It is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity. All oncology patients should be offered education regarding depression and anxiety. For patients with moderate symptoms of depression, clinicians should offer cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions. For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions. For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy. Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.Additional information is available at www.asco.org/survivorship-guidelines.
Collapse
Affiliation(s)
| | | | | | | | | | - Sage Bolte
- Inova Health Foundation, Falls Church, VA
| | - Don S Dizon
- Legorreta Cancer Center at Brown University and Lifespan Cancer Institute, Providence, RI
| | | | - Larissa Nekhlyudov
- Brigham and Women's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | |
Collapse
|
6
|
Merckaert I, Waroquier P, Caillier M, Verkaeren O, Righes S, Liénard A, Libert Y, Kristanto P, Razavi D. Improving emotion regulation in breast cancer patients in the early survivorship period: Efficacy of a brief ecologically boosted group intervention. Psychooncology 2023; 32:597-609. [PMID: 36703250 DOI: 10.1002/pon.6105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE This study reports the short- and mid-term benefits of an eight-session emotion and self-regulation group intervention ecologically boosted through daily app-based prompts. The intervention was designed for breast cancer patients in the early survivorship period meeting criteria for clinical levels of psychological symptoms. METHODS Patients were randomly assigned to the immediate intervention arm (n = 61; intervention received immediately) or to the delayed intervention arm (n = 59; intervention received 5 months later). Psychological symptoms, including anxiety, depressive symptoms, emotional distress, fear of cancer recurrence (FCR), worry, and intrusive thoughts were assessed through questionnaires. Emotion regulation was assessed in a dynamic emotion regulation task and in everyday life. Assessments were completed at baseline (T1), 5 months (T2) and 10 months (T3) later. RESULTS Treated patients reported lower levels of worry and intrusive thoughts. They improved their ability to down-regulate the intensity of their negative emotions when exposed to cancer-related triggers in the dynamic emotion regulation task. They reported fewer and less intense negative emotions and more positive emotions in their everyday life. Benefits were maintained 5 months later, except for positive emotions in everyday life. CONCLUSIONS The results showed that focusing on emotion regulation is a relevant approach in the treatment of psychological symptoms for breast cancer patients in the early survivorship period meeting criteria for clinical levels of psychological symptoms. The intervention led to changes in patients' dynamic and everyday life emotion regulation. Consolidation sessions may be needed to sustain benefits in positive emotions and to increase the effect sizes.
Collapse
Affiliation(s)
- Isabelle Merckaert
- Université libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Unité de Recherche en Psychosomatique et Psycho-oncologie (URPP), Brussels, Belgium.,Institut Jules Bordet, Clinique de Psycho-oncologie, Brussels, Belgium
| | - Pauline Waroquier
- Université libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Unité de Recherche en Psychosomatique et Psycho-oncologie (URPP), Brussels, Belgium.,Institut Jules Bordet, Clinique de Psycho-oncologie, Brussels, Belgium
| | | | | | - Sadio Righes
- Université libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Unité de Recherche en Psychosomatique et Psycho-oncologie (URPP), Brussels, Belgium
| | - Aurore Liénard
- Institut Jules Bordet, Clinique de Psycho-oncologie, Brussels, Belgium
| | - Yves Libert
- Université libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Unité de Recherche en Psychosomatique et Psycho-oncologie (URPP), Brussels, Belgium.,Institut Jules Bordet, Clinique de Psycho-oncologie, Brussels, Belgium
| | - Paulus Kristanto
- Institut Jules Bordet, Data Center, Unité de Gestion de l'Information (UGI), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Darius Razavi
- Université libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Unité de Recherche en Psychosomatique et Psycho-oncologie (URPP), Brussels, Belgium.,Institut Jules Bordet, Clinique de Psycho-oncologie, Brussels, Belgium
| |
Collapse
|
7
|
Jassim GA, Doherty S, Whitford DL, Khashan AS. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2023; 1:CD008729. [PMID: 36628983 PMCID: PMC9832339 DOI: 10.1002/14651858.cd008729.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015. OBJECTIVES To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer. SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes. MAIN RESULTS We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months. Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.
Collapse
Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | - Sally Doherty
- Psychiatry, Royal College of Surgeons in Ireland- Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | | | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
| |
Collapse
|
8
|
Franch M, Alarcón A, Capafons A. Applications of Hypnosis as an Adjuvant in Oncological Settings: A Systematic Review. Int J Clin Exp Hypn 2023; 71:1-24. [PMID: 36622292 DOI: 10.1080/00207144.2022.2160255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Previous research has shown promising results in using hypnosis to treat various symptoms and side effects of medical treatments. The objective was to identify studies that use hypnosis as an adjuvant to evidence-based treatments to evaluate its benefits in patients with cancer. The search identified 873 articles published between 2000 and February 2021, of which 22 were selected using the principles of the PRISMA. Apart from 1 study, all studies showed that interventions improved the measured variables compared to a control group. Most studies showed that hypnosis has positive effects on reducing anxiety, pain, nausea, fatigue, drug use, and length of hospital stays. Hypnosis also improves depressive symptoms, insomnia, hot flashes, well-being, and quality of life, and helps increase adherence to treatment. When used by qualified professionals as an adjuvant to well-established treatments, hypnosis improves symptoms caused by oncological interventions and the disease itself. In addition, hypnosis has no side effects.
Collapse
Affiliation(s)
- Marc Franch
- Personalitat, Avaluació i Tractaments Psicològics, University of Valencia, Spain
| | - Ana Alarcón
- Psicologia Evolutiva, Educativa Social i Metodologia, University Jaime I, Castello de la Plana, Spain
| | - Antonio Capafons
- Personalitat, Avaluació i Tractaments Psicològics, University of Valencia, Spain
| |
Collapse
|
9
|
Wang N, Creedy DK, Zhang M, Lu H, Elder E, Allen J, Guo L, Xiao Q, Gamble J. Designing a Needs-Oriented Psychological Intervention for Chinese Women Undergoing an Abortion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:782. [PMID: 36613103 PMCID: PMC9819149 DOI: 10.3390/ijerph20010782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Accessing good quality abortion care is a fundamental human right and contributes to achieving Sustainable Development Goals. However, well-designed abortion care that meets women's needs is limited. This study aims to systematically develop an intervention to promote the psychological well-being of Chinese women undergoing an abortion. A five-step iterative approach informed by intervention mapping was undertaken to determine the intervention design. Step 1 used in-depth interviews with 14 Chinese women undergoing an abortion to assess real-life stressors and support needs. We identified eight stressors and found women's support needs varied with the time trajectory of the abortion. Step 2 used a focus group discussion with care providers to select modifiable stressors that impact negative psychological outcomes. In Step 3 and Step 4, we determined and integrated the exact strategies to eliminate or mitigate possible modifiable stressors by incorporating information from in-depth interviews and the Transactional Model of Stress and Coping. The integrated strategies were instructional support, informational support, and timely communication. In Step 5, we composed the detailed intervention design according to the best available evidence and, to confirm content validity, consulted 10 women who had undergone abortion in the previous 2-6 weeks. The intervention was titled STress-And-coping suppoRT (START), which included four interacting components: (1) a face-to-face consultation at the first appointment; (2) a printed booklet with information on abortion, self-care, and managing emotions and intimate relationships; (3) a WeChat-based online public profile page offering the same information as the booklet; (4) a telephone hotline. This study paves the way for a new approach to addressing the psychological needs of women experiencing abortion in China. The rigorous process provides an example of developing tailored health promotion interventions.
Collapse
Affiliation(s)
- Na Wang
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
- School of Nursing and Midwifery, Gold Coast Campus, Griffith University, Parklands Drive, Southport, Gold Coast, QLD 4215, Australia
| | - Debra K. Creedy
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD 4131, Australia
| | - Mingna Zhang
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
| | - Hong Lu
- School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Elizabeth Elder
- School of Nursing and Midwifery, Gold Coast Campus, Griffith University, Parklands Drive, Southport, Gold Coast, QLD 4215, Australia
| | - Jyai Allen
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD 4131, Australia
| | - Li Guo
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
| | - Qian Xiao
- School of Nursing, Capital Medical University, 10 Xitoutiao Road, Fengtai District, Beijing 100069, China
| | - Jenny Gamble
- School of Nursing and Midwifery, Logan Campus, Griffith University, University Drive, Meadowbrook, Brisbane, QLD 4131, Australia
| |
Collapse
|
10
|
Caron-Trahan R, Jusseaux AE, Aubin M, Urbanowicz R, Richebé P, Ogez D. Definition and refinement of HYlaDO, a self-hypnosis training program for chronic pain management: A qualitative exploratory study. Explore (NY) 2022; 19:417-425. [PMID: 36008274 DOI: 10.1016/j.explore.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/06/2022] [Accepted: 08/17/2022] [Indexed: 11/04/2022]
Abstract
One in four Canadians is affected by chronic pain, frequently treated with opioids, which present a risk of addiction and overdose. The development of non-pharmacological interventions is therefore crucial. In a pilot project, a self-hypnosis training program showed encouraging results in improving breast cancer patients' quality of life. Based on this program, we developed a new self-hypnosis program for chronic pain patients: HYlaDO (Hypnosis of pain in French, HYpnose de la DOuleur). To structure the process of adapting an existing program to a new context, we used the ORBIT model (Obesity-Related Behavioral Intervention Trials), which consists of four development phases. This study aimed to collect patients' opinions and recommendations, and to refine HYlaDO (ORBIT Phase Ib). Fifteen participants took part in individual semi-structured interviews about this program. Two analysts coded the verbatims, and a thematic categorization was performed. Six themes emerged: practice training, expected vs. perceived effects, chronic pain management, individual practice, satisfaction, and participants' recommendations. Improvements to be considered in this type of program were finally discussed.
Collapse
Affiliation(s)
- Rémi Caron-Trahan
- Department of Psychology, Université de Montréal, Montréal, Canada; Research Center, Hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Anne-Eva Jusseaux
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Maryse Aubin
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada
| | - Robert Urbanowicz
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada; Department of Anesthesiology and pain Medicine, Université de Montréal, Montréal, Canada
| | - Philippe Richebé
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada; Department of Anesthesiology and pain Medicine, Université de Montréal, Montréal, Canada
| | - David Ogez
- Research Center, Hôpital Maisonneuve-Rosemont, 5415, boulevard de l'Assomption, Montréal, Québec H1T 2M4, Canada; Department of Anesthesiology and pain Medicine, Université de Montréal, Montréal, Canada.
| |
Collapse
|
11
|
Psychological interventions targeting patients with metastatic cancer and prolonged survival expectancies: advances and challenges. Curr Opin Oncol 2022; 34:256-264. [PMID: 35703243 DOI: 10.1097/cco.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review the formats and techniques of psychological interventions designed for patients with metastatic cancer and prolonged survival expectancies. RECENT FINDINGS Fifteen interventional studies were selected for this article. One group of psychological interventions focused primarily on patients' adaptation by increasing their knowledge, developing patients' stress management skills, promoting their open communication with healthcare providers, and helping them deal with existential concerns. Another group of interventions focused on patients with moderate and high levels of distress. These interventions provided specific techniques to manage anxiety, depression, fear of cancer progression, and existential distress. Interestingly, interventions targeting distressed patients are not necessarily longer or more intensive than interventions targeting adaptation. The interventions were examined in few randomized controlled trials, and incorporated a broad range of techniques, making comparison of their efficacy difficult. No intervention specifically targeted patients newly diagnosed with metastatic cancer. SUMMARY On the basis of this review, we proposed suggestions according to patients' levels of distress, which differ in intensity, format, techniques, and tools offered. These suggestions may be relevant for the future development and assessment of interventions targeting patients with newly diagnosed metastatic cancer and prolonged survival expectancies.
Collapse
|
12
|
The Impact of VR-CALM Intervention Based on VR on Psychological Distress and Symptom Management in Breast Cancer Survivors. JOURNAL OF ONCOLOGY 2022; 2022:1012813. [PMID: 35712124 PMCID: PMC9197609 DOI: 10.1155/2022/1012813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/06/2022] [Accepted: 05/20/2022] [Indexed: 01/02/2023]
Abstract
Objective To evaluate the effectiveness and feasibility of Managing Cancer and Living Meaningfully based on VR (VR-CALM), which is used to manage expected symptoms of cancer itself, relieve psychological distress, and improve quality of life (QOL) in the Chinese breast cancer survivors (BCs). Methods Ninety-eight patients with breast cancer were recruited in this study. These patients were randomly assigned to the VR-CALM group or the care as usual (CAU) group. All patients were evaluated by the Functional Assessment of Cancer Therapy-Breast cancer patient (FACT-B), Distress Thermometer (DT), Concerns About Recurrence Scale (CARS), Piper Fatigue Scale (PFS), Pittsburgh Sleep Quality Index (PSQI), The Self-Rating Anxiety Scale (SAS), and The Self-Rating Depression Scale (SDS) before and after VR-CALM or CAU application to BCs. We compared the differences in all these scores between the VR-CALM group and the control group. Results Patients in the VR-CALM group showed a significant decrease in levels of distress, anxiety, depression, sleep disorders, and fatigue (t = −6.829, t = −5.819, t = −2.094, t = −3.031, t = −10.082, P ≤ 0.001, 0.001, 0.05, 0.01, 0.001, respectively) and had higher level of quality of life (t = 8.216, P ≤ 0.001) compared with the CAU group after intervention. And postintervention patients in VR-CALM group compared with preintervention showed lower level of distress and remarkable improvement of QOL (t = 11.521, t = −10.379, P ≤ 0.001, 0.001). The preintervention questionnaire revealed no significant between-group differences regarding distress, anxiety, depression, sleep disorders, fatigue, and quality of life. Conclusion VR-CALM is a psychotherapy tailored to the needs of patients with breast cancer. This research innovatively used VR-based CALM intervention to improve psychological and chronic symptoms in BCs. The results of the present study indicate that VR-CALM has salutary effects on the improvement of QOL and relieves psychological distress, anxiety, depression, sleep disorders, and fatigue in BCs.
Collapse
|
13
|
Lyu MM, Siah RCJ, Lam ASL, Cheng KKF. The effect of psychological interventions on fear of cancer recurrence in breast cancer survivors: A systematic review and meta-analysis. J Adv Nurs 2022; 78:3069-3082. [PMID: 35696315 DOI: 10.1111/jan.15321] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 04/07/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effectiveness of psychological interventions in reducing fear of cancer recurrence in breast cancer survivors. DESIGN A systematic review and meta-analysis. DATA SOURCES PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, PsycINFO, Web of Science and ClinicalTrials.gov were searched for relevant studies published from 1 January 1976 to 28 November 2020. METHODS Eligible randomized controlled trials on psychological interventions for reducing fear of cancer recurrence in breast cancer survivors were included in meta-analysis. Review Manager 5.4 was used to conduct the meta-analysis, and the fear of cancer recurrence score was calculated by using standardized mean differences and 95% confidence intervals. Risk of bias was assessed with the Cochrane risk-of-bias tool. Quality of evidence, sensitivity analyses, and subgroup analyses were also conducted. RESULTS This systematic review included 16 randomized controlled trials. We found psychological interventions significantly reduced fear of cancer recurrence. Subgroup analyses indicated that mindfulness and acceptance therapy-based interventions reduced fear of cancer recurrence, whereas cognitive-behavioural therapy combined with psychoeducation did not. Interventions with three to eight sessions were effective, while interventions with nine or more sessions were not. Face-to-face interventions were effective, whereas online interventions were not. The quality of evidence for fear of cancer recurrence was evaluated as moderate due to moderate heterogeneity in the included studies. CONCLUSIONS Psychological interventions were effective in reducing fear of cancer recurrence in breast cancer survivors. Mindfulness and acceptance therapy-based interventions and short-term interventions are recommended. Future well-designed randomized controlled trials aiming to examine the effectiveness of psychological interventions in reducing fear of cancer recurrence are needed. IMPACT The findings of this systematic review may guide the development of psychological interventions and encourage the use of psychological interventions for reducing fear of cancer recurrence in breast cancer survivors.
Collapse
Affiliation(s)
- Meng-Meng Lyu
- National University of Singapore, Singapore, Singapore
| | | | | | - Karis Kin Fong Cheng
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
14
|
Luigjes-Huizer YL, Tauber NM, Humphris G, Kasparian NA, Lam WWT, Lebel S, Simard S, Smith AB, Zachariae R, Afiyanti Y, Bell KJL, Custers JAE, de Wit NJ, Fisher PL, Galica J, Garland SN, Helsper CW, Jeppesen MM, Liu J, Mititelu R, Monninkhof EM, Russell L, Savard J, Speckens AEM, van Helmondt SJ, Vatandoust S, Zdenkowski N, van der Lee ML. What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta-analysis. Psychooncology 2022; 31:879-892. [PMID: 35388525 PMCID: PMC9321869 DOI: 10.1002/pon.5921] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/14/2022] [Accepted: 03/09/2022] [Indexed: 12/20/2022]
Abstract
Objective Care for fear of cancer recurrence (FCR) is considered the most common unmet need among cancer survivors. Yet the prevalence of FCR and predisposing factors remain inconclusive. To support targeted care, we provide a comprehensive overview of the prevalence and severity of FCR among cancer survivors and patients, as measured using the short form of the validated Fear of Cancer Recurrence Inventory (FCRI‐SF). We also report on associations between FCR and clinical and demographic characteristics. Methods This is a systematic review and individual participant data (IPD) meta‐analysis on the prevalence of FCR. In the review, we included all studies that used the FCRI‐SF with adult (≥18 years) cancer survivors and patients. Date of search: 7 February 2020. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. Results IPD were requested from 87 unique studies and provided for 46 studies comprising 11,226 participants from 13 countries. 9311 respondents were included for the main analyses. On the FCRI‐SF (range 0–36), 58.8% of respondents scored ≥13, 45.1% scored ≥16 and 19.2% scored ≥22. FCR decreased with age and women reported more FCR than men. FCR was found across cancer types and continents and for all time periods since cancer diagnosis. Conclusions FCR affects a considerable number of cancer survivors and patients. It is therefore important that healthcare providers discuss this issue with their patients and provide treatment when needed. Further research is needed to investigate how best to prevent and treat FCR and to identify other factors associated with FCR. The protocol was prospectively registered (PROSPERO CRD42020142185).
Collapse
Affiliation(s)
- Yvonne L Luigjes-Huizer
- Helen Dowling Institute, Bilthoven, The Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Nina M Tauber
- Unit for Psychooncology and Health Psychology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Wendy W T Lam
- Division of Behavioural Sciences, School of Public Health, and LKS Faculty of Medicine Jockey Club Institute of Cancer Care, University of Hong Kong, Hong Kong, China
| | - Sophie Lebel
- Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sébastien Simard
- Université du Québec à Chicoutimi (UQAC), Centre Intersectoriel en santé durable, Québec, Québec, Canada
| | - Allan Ben Smith
- Ingham Institute for Applied Medical Research and South West Sydney Clinical Campuses, UNSW, Sydney, New South Wales, Australia
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Yati Afiyanti
- Department of Maternity and Women Health, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Katy J L Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - José A E Custers
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Niek J de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Peter L Fisher
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Jacqueline Galica
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland, Canada
| | - Charles W Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mette M Jeppesen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Jianlin Liu
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Roxana Mititelu
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Evelyn M Monninkhof
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lahiru Russell
- Centre for Quality and Patient Safety Research & Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Josée Savard
- School of Psychology, Université Laval, CHU de Québec-Université Laval Research Center, Université Laval Cancer Research Centre, Quebec, Québec, Canada
| | - Anne E M Speckens
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sanne J van Helmondt
- Helen Dowling Institute, Bilthoven, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
| | - Sina Vatandoust
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Nicholas Zdenkowski
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Marije L van der Lee
- Helen Dowling Institute, Bilthoven, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
15
|
Grégoire C, Faymonville ME, Vanhaudenhuyse A, Jerusalem G, Willems S, Bragard I. Randomized, Controlled Trial of an Intervention Combining Self-Care and Self-Hypnosis on Fatigue, Sleep, and Emotional Distress in Posttreatment Cancer Patients: 1-Year Follow-Up. Int J Clin Exp Hypn 2022; 70:136-155. [PMID: 35344461 DOI: 10.1080/00207144.2022.2049973] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cancer can provoke fatigue, sleep disturbances, and emotional distress. Hypnosis interventions have shown positive short-term effects on these symptoms. However, less is known about their long-term effects. This study assessed the short- and long-term effects of a group intervention combining self-care and self-hypnosis on these symptoms in posttreatment cancer patients. Ninety-five female cancer survivors were randomized to either a hypnosis group intervention or wait-list control. Results showed significant decreases in fatigue, sleep difficulties and emotional distress after intervention for the hypnosis group intervention in comparison to the wait-list control. Most of these positive effects were maintained at 1-year follow-up. Most participants received the hypnosis group intervention approximately 10.65 months after diagnosis, and it is possible that delivering the intervention earlier after diagnosis could have achieved a more robust impact. Further studies are needed to replicate these results in comparison to an active control condition and investigate the best time postdiagnosis for initiating the intervention.
Collapse
Affiliation(s)
- Charlotte Grégoire
- Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Belgium
| | - Marie-Elisabeth Faymonville
- Interdisciplinary Algology Centre, CHU Liège, and Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Belgium
| | - Audrey Vanhaudenhuyse
- Interdisciplinary Algology Centre, CHU Liège, and Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Belgium
| | - Guy Jerusalem
- Medical Oncology Department, CHU Liège and University of Liège, Belgium
| | - Sylvie Willems
- Faculty of Psychology, Speech Therapy and Educational Sciences, University of Liège, Belgium
| | | |
Collapse
|
16
|
Park SY, Lim JW. Cognitive behavioral therapy for reducing fear of cancer recurrence (FCR) among breast cancer survivors: a systematic review of the literature. BMC Cancer 2022; 22:217. [PMID: 35227244 PMCID: PMC8883021 DOI: 10.1186/s12885-021-08909-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022] Open
Abstract
Background Fear of cancer recurrence (FCR) has been addressed as a cause of emotional distress among breast cancer survivors (BCSs). This study aimed to systematically review the evidence on randomized controlled trials (RCTs) of cognitive behavioral therapy (CBT) designed to reduce FCR among BCSs. Methods A systematic review of published original research articles meeting the inclusion criteria was conducted. Five electronic databases, including the Cochrane Library, CINAHL, PubMed, PsycINFO, and Web of Science, were independently searched to identify relevant articles. The Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist was used to evaluate the quality of the eligible studies. Results Through a database search and a manual review process, seventeen quantitative studies with an RCT study design were included in the current systematic review. The interventions varied greatly in length and intensity, but the study designs and methodologies were similar. RCTs with face-to-face interventions of at least 1 month seemed to be more effective in reducing FCR outcomes and complying with than the CONSORT 2010 criteria than those with a brief online or telephone format of interventions; nevertheless, most RCT interventions appeared to be effective. Conclusions These findings highlight the importance of conducting well-designed CBT interventions to reduce FCR in BCSs with diverse populations at multiple sites, thereby improving the quality of research in this area. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08909-y.
Collapse
Affiliation(s)
- So-Young Park
- Ewha Institute for Age Integration Research, Ewha Womans University, 52 Ewhayeodae-gil, Sedaemun-gu, Seoul, 03760, Republic of Korea
| | - Jung-Won Lim
- College of Social Welfare, Kangnam University, 40 Kangnam-Ro, Giheung-Gu, Yongin-Si, Gyeonggi-Do, 16979, Republic of Korea.
| |
Collapse
|
17
|
Cincidda C, Pizzoli SFM, Pravettoni G. Remote Psychological Interventions for Fear of Cancer Recurrence: Scoping Review. JMIR Cancer 2022; 8:e29745. [PMID: 35014956 PMCID: PMC8790693 DOI: 10.2196/29745] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with cancer and survivors may experience the fear of cancer recurrence (FCR), a preoccupation with the progression or recurrence of cancer. During the spread of COVID-19 in 2019, patients and survivors experienced increased levels of FCR. Hence, there is a greater need to identify effective evidence-based treatments to help people cope with FCR. Remotely delivered interventions might provide a valuable means to address FCR in patients with cancer. OBJECTIVE The aim of this study is to first discuss the available psychological interventions for FCR based on traditional cognitive behavioral therapies (CBTs) or contemporary CBTs, in particular, mindfulness and acceptance and commitment therapy, and then propose a possible approach based on the retrieved literature. METHODS We searched key electronic databases to identify studies that evaluated the effect of psychological interventions such as CBT on FCR among patients with cancer and survivors. RESULTS Current evidence suggests that face-to-face psychological interventions for FCR are feasible, acceptable, and efficacious for managing FCR. However, there are no specific data on the interventions that are most effective when delivered remotely. CONCLUSIONS CBT interventions can be efficacious in managing FCR, especially at posttreatment, regardless of whether it is delivered face to face, on the web, or using a blended approach. To date, no study has simultaneously compared the effectiveness of face-to-face, web-based, and blended interventions. On the basis of the retrieved evidence, we propose the hypothetical program of an intervention for FCR based on both traditional CBT and contemporary CBT, named Change Of Recurrence, which aims to improve the management of FCR in patients with cancer and survivors.
Collapse
Affiliation(s)
- Clizia Cincidda
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| |
Collapse
|
18
|
Pradhan P, Sharpe L, Menzies RE. Towards a Stepped Care Model for Managing Fear of Cancer Recurrence or Progression in Cancer Survivors. Cancer Manag Res 2021; 13:8953-8965. [PMID: 34880676 PMCID: PMC8645945 DOI: 10.2147/cmar.s294114] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/07/2021] [Indexed: 01/08/2023] Open
Abstract
Background Fear of cancer recurrence or progression (FCR) is common amongst cancer survivors and an important minority develop clinically significant levels of FCR. However, it is unclear how current clinical services might best support the growing numbers of cancer survivors. Purpose The aim of this study is to develop recommendations for future research in the management of FCR and propose a model of care to help manage FCR in the growing population of cancer survivors. Methods This is a narrative review and synthesis of empirical research relevant to managing FCR. We reviewed meta-analyses, systematic reviews and individual studies that had investigated interventions for FCR. Results A recent, well-conducted meta-analysis confirmed a range of moderately effective treatments for FCR. However, many survivors continued to experience clinical levels of FCR after treatment, indicating a clear need to improve the gold standard treatments. Accessibility of interventions is arguably a greater concern. The majority of FCR treatments require face-to-face therapy, with highly skilled psycho-oncologists to produce moderate changes in FCR. With increasing numbers of cancer survivors, we need to consider how to meet the unmet need of cancer survivors in relation to FCR. Although there have been attempts to develop minimal interventions, these are not yet sufficiently well supported to warrant implementation. Attempts to help clinicians to provide information which might prevent the development of clinically significant FCR have shown some early promise, but research is needed to confirm efficacy. Conclusion The next decade of research needs to focus on developing preventative approaches for FCR, and minimal interventions for those with mild-to-moderate symptoms. When evidence-based approaches to prevent FCR or manage moderate levels of FCR are available, stepped care approaches that could meet the needs of survivors could be implemented. However, we also need to improve existing interventions for severe FCR.
Collapse
Affiliation(s)
- Poorva Pradhan
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Rachel E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Smith AB, Costa D, Galica J, Lebel S, Tauber N, van Helmondt SJ, Zachariae R. Spotlight on the Fear of Cancer Recurrence Inventory (FCRI). Psychol Res Behav Manag 2020; 13:1257-1268. [PMID: 33376421 PMCID: PMC7762428 DOI: 10.2147/prbm.s231577] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
Fear of cancer recurrence (FCR) is a pervasive concern for people living with cancer. The rapidly expanding FCR literature has been weakened somewhat by use of miscellaneous FCR measures of varying quality. The Fear of Cancer Recurrence Inventory (FCRI) has been widely used in observational and intervention studies and the FCRI severity subscale, also known as the FCRI-Short Form (FCRI-SF), is often used to identify potential cases of clinically significant FCR. Given the FCRI's increasing use in research and clinical practice, we aimed to provide an overview, critique, and suggested improvements of the FCRI. Studies citing the original FCRI validation paper were identified and synthesised using narrative and meta-analytic methods. The 42-item FCRI has demonstrated a reasonably robust 7-factor structure across evaluations in multiple languages, although certain subscales (eg, Coping) demonstrate sub-optimal reliability. Confirmation of the cross-cultural equivalence of several FCRI translations is needed. Meta-analysis of FCRI-SF scores revealed a combined weighted mean score of 15.7/36, a little above the lowest proposed cut-off score (≥13) for clinical FCR. Depending on the FCRI-SF cut-off used, between 30.0% and 53.9% of the cancer population (ie, patients and survivors) appear to experience sub-clinical or clinical FCR. Higher FCRI scores were associated with younger age and female gender, pain/physical symptoms and psychological morbidity, consistent with the FCR literature generally. Issues regarding the application and interpretation of the FCRI remain. Whether the FCRI is well suited to assessing fear of progression as well as recurrence is unclear, the meaningfulness of the FCRI total score is debatable, and the use of the FCRI-SF to screen for clinical FCR is problematic, as items do not reflect established characteristics of clinical FCR. Refinement of the FCRI is needed for it to remain a key FCR assessment tool in future research and clinical practice.
Collapse
Affiliation(s)
- Allan Ben Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
| | - Daniel Costa
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Jacqueline Galica
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Kingston, Ontario, Canada
| | - Sophie Lebel
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Nina Tauber
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
- Unit for Psychooncology and Health Psychology (EPoS), Department of Oncology, Aarhus University Hospital and Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
| | - Sanne Jasperine van Helmondt
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Scientific Research Department, Helen Dowling Institute, Bilthoven, the Netherlands
| | - Robert Zachariae
- FORwards, International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Ottawa, Canada
- Unit for Psychooncology and Health Psychology (EPoS), Department of Oncology, Aarhus University Hospital and Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
| |
Collapse
|
21
|
Abstract
BACKGROUND Patient engagement (PE) is a key factor for early-stage breast cancer survivors during survivorship, yet little is known about what factors may contribute to PE. OBJECTIVES The aims of this study were to describe the relationship between sociodemographic factors, survivorship variables, and PE and explore how variations in these variables might contribute to PE in breast cancer survivors. METHODS A cross-sectional, web-based self-report national survey was conducted to assess sociodemographic factors and survivorship variables: health-related quality of life (HRQOL) as measured by 7-item Functional Assessment of Cancer Therapy-General, fear of cancer recurrence, cancer health literacy, and 2 measures of PE (Patient Activation and Knowing Participation in Change) in breast cancer survivors. One open-ended question assessed additional survivorship concerns. Data were analyzed via bivariate associations and backward linear regression modeling in SPSS. RESULTS The sample (N = 303), equally dispersed across the United States, was predominantly middle-aged (mean, 50.70 [SD, 14.01]), white, non-Hispanic women. Knowing Participation in Change and Patient Activation regression models indicate HRQOL was significantly associated with PE (P ≤ .001), whereas findings related to fear of cancer recurrence lacked significance. In the Knowing Participation in Change regression model, HRQOL, social support, and level of education were all significantly associated with PE (P ≤ .001). CONCLUSIONS Breast cancer survivors with higher HRQOL, greater social support, and higher levels of education were more likely to have higher levels of PE. IMPLICATIONS FOR PRACTICE Findings may provide insight as to which survivors may be ready to engage in SC and those who may need more specific tailoring of resources and support.
Collapse
|
22
|
The questionable efficacy of manualized psychological treatments for distressed breast cancer patients: An individual patient data meta-analysis. Clin Psychol Rev 2020; 80:101883. [PMID: 32619813 DOI: 10.1016/j.cpr.2020.101883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 11/21/2022]
Abstract
Previous meta-analyses conclude that psychological treatments are efficacious for emotional distress in breast cancer (BCa). However, the practical relevance of these meta-analyses is questionable; none focused specifically on clinically distressed patients or whether treatment effects were clinically significant. In a two-stage individual patient data (IPD) meta-analysis of 17 randomized controlled trials of manualized psychological treatments in BCa, we evaluated treatment efficacy in distressed BCa patients (n = 1591) using clinical significance and effect size analyses. Outcomes were anxiety, depression, and general distress, evaluated at post-treatment and follow-up. Moderators examined were treatment type, treatment format, therapists' profession, control condition, age, outcome measure, and trial quality. Treated patients were more likely than controls to recover from anxiety and general distress at post-treatment (14-15% more treated patients recovered), but not at mean 8-months follow-up. Overall recovery rates were low: across outcomes, at post-treatment, only 30-32% of treated patients and 15-25% of controls recovered; at follow-up, only 21-30% of treated patients and 18-35% of controls recovered. Small between-group effect sizes in favour of treatment were found across outcomes at post-treatment (g = 0.32-0.34) but not at follow-up. Across the different analysis methods, few moderator effects were found. More efficacious psychological treatments are needed for distressed BCa patients.
Collapse
|
23
|
Lyhne JD, Smith A‘B, Frostholm L, Fink P, Jensen LH. Study protocol: a randomized controlled trial comparing the efficacy of therapist guided internet-delivered cognitive therapy (TG-iConquerFear) with augmented treatment as usual in reducing fear of cancer recurrence in Danish colorectal cancer survivors. BMC Cancer 2020; 20:223. [PMID: 32178640 PMCID: PMC7076981 DOI: 10.1186/s12885-020-06731-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cognitive therapy has been shown to reduce fear of cancer recurrence (FCR), mainly in breast cancer survivors. The accessibility of cognitive behavioural interventions could be further improved by Internet delivery, but self-guided interventions have shown limited efficacy. The aim of this study is to test the efficacy of a therapist guided internet-delivered intervention (TG-iConquerFear) vs. augmented treatment as usual (aTAU) in Danish colorectal cancer survivors. METHODS/DESIGN A population-based randomized controlled trial (RCT) comparing TG-iConquerFear with aTAU (1:1) in n = 246 colorectal cancer survivors who suffer from clinically significant FCR (Fear of Cancer Recurrence Inventory Short Form (FCRI-SF) ≥ 22 and semi-structured interview). Evaluation will be conducted at 2 weeks, 3 and 6 months post-treatment and between-group differences will be evaluated. Long-term effects will be evaluated after one year. Primary outcome will be post-treatment FCR (FCRI-SF). Secondary outcomes are global overall health and global quality of life (Visual Analogue Scales 0-100), bodily distress syndrome (BDS checklist), health anxiety (Whiteley-6), anxiety (SCL4-anx), depression (SCL6-dep) and sickness absence and health expenditure (register data). Explanatory outcomes include: Uncertainty in illness (Mishels uncertainty of illness scale, short form, MUIS), metacognitions (MCQ-30 negative beliefs about worry subscale), and perceived risk of cancer recurrence (Visual analogue Scale 1-100). DISCUSSION This RCT will provide valuable information on the clinical and cost-effectiveness of TG-iConquerFear vs. aTAU for CRC survivors with clinical FCR, as well as explanatory variables that may act as outcome moderators or mediators. TRIAL REGISTRATION ClinicalTrials.gov; NCT04287218, registered 25.02.2020. https://clinicaltrials.gov/ct2/results?cond=&term=NCT04287218&cntry=&state=&city=&dist=.
Collapse
Affiliation(s)
- Johanne Dam Lyhne
- Department of Clinical Oncology, University Hospital of Southern Denmark, Vejle, Beriderbakken 4, 7100 Vejle, Denmark
| | - Allan ‘ Ben’ Smith
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170 Australia
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, bygn. 4, 1, 8000 Aarhus C, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, bygn. 4, 1, 8000 Aarhus C, Denmark
| | - Lars Henrik Jensen
- Department of Clinical Oncology, University Hospital of Southern Denmark, Vejle, Beriderbakken 4, 7100 Vejle, Denmark
| |
Collapse
|
24
|
Aguiar Fernández FX, Pino-Juste M, Navarro Pérez JJ. Beneficios de un programa grupal de tratamiento no farmacológico en el afrontamiento del cáncer en mujeres españolas. Una síntesis cualitativa. SAUDE E SOCIEDADE 2020. [DOI: 10.1590/s0104-12902020181001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumen En el presente trabajo se analizan los beneficios de un programa grupal de tratamiento no farmacológico realizado por la Asociación Española contra el Cáncer en Galicia (España). Se analizaron 14 ediciones del programa en las que participaron 361 mujeres con cáncer de edades comprendidas entre los 33 y los 82 años. Se adoptó un diseño descriptivo de carácter etnográfico triangulando las técnicas de análisis y las fuentes de recogida de datos por medio de un cuestionario de satisfacción, 32 entrevistas en profundidad y un grupo de discusión con profesionales. Los resultados apoyan la idea de que el programa grupal analizado ha conseguido un elevado grado de satisfacción entre las mujeres participantes en todas las ediciones, ha favorecido la aceptación y el afrontamiento positivo de la enfermedad, aumentado los conocimientos y las habilidades para resolver los problemas relacionados con el proceso, así como promovido las relaciones sociales, la participación en la comunidad y el apoyo social. Desde el punto de vista práctico y profesional, nuestro estudio evidencia la importancia de diseñar e implementar programas grupales desde el ámbito psicosocial y con carácter interdisciplinar que permitan mejorar las estrategias de afrontamiento y el apoyo en poblaciones de mujeres diagnosticadas de cáncer.
Collapse
|
25
|
Johns SA, Stutz PV, Talib TL, Cohee AA, Beck-Coon KA, Brown LF, Wilhelm LR, Monahan PO, LaPradd ML, Champion VL, Miller KD, Giesler RB. Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3-arm pilot randomized controlled trial. Cancer 2019; 126:211-218. [PMID: 31539169 DOI: 10.1002/cncr.32518] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/07/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fear of cancer recurrence (FCR) has a profound negative impact on quality of life (QOL) for many cancer survivors. Breast cancer survivors (BCS) are particularly vulnerable, with up to 70% reporting clinically significant FCR. To the authors' knowledge, evidence-based interventions for managing FCR are limited. Acceptance and commitment therapy (ACT) promotes psychological flexibility in managing life's stressors. The current study examined the feasibility and preliminary efficacy of group-based ACT for FCR in BCS. METHODS Post-treatment BCS (91 patients with stage I-III disease) with clinical FCR randomly were assigned to ACT (6 weekly 2-hour group sessions), survivorship education (SE; 6 weekly 2-hour group sessions), or enhanced usual care (EUC; one 30-minute group coaching session with survivorship readings). FCR severity (primary outcome) and avoidant coping, anxiety, post-traumatic stress, depression, QOL, and other FCR-related variables (secondary outcomes) were assessed at baseline (T1), after the intervention (T2), 1 month after the intervention (T3), and 6 months after the intervention (T4) using intent-to-treat analysis. RESULTS Satisfactory recruitment (43.8%) and retention (94.5%) rates demonstrated feasibility. Although each arm demonstrated within-group reductions in FCR severity over time, only ACT produced significant reductions at each time point compared with baseline, with between-group differences at T4 substantially favoring ACT over SE (Cohen d for effect sizes, 0.80; P < .001) and EUC (Cohen d, 0.61; P < .01). For 10 of 12 secondary outcomes, only ACT produced significant within-group reductions across all time points. By T4, significant moderate to large between-group comparisons favored ACT over SE and EUC with regard to avoidant coping, anxiety, depression, QOL, and FCR-related psychological distress. CONCLUSIONS Group-based ACT is a feasible and promising treatment for FCR and associated outcomes in BCS that warrants testing in larger, fully powered trials.
Collapse
Affiliation(s)
- Shelley A Johns
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Patrick V Stutz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Tasneem L Talib
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Andrea A Cohee
- Indiana University School of Nursing, Indianapolis, Indiana
| | - Kathleen A Beck-Coon
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University School of Nursing, Indianapolis, Indiana
| | - Linda F Brown
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura R Wilhelm
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Charleston, West Virginia
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michelle L LaPradd
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Kathy D Miller
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Research and Clinical Trials, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - R Brian Giesler
- Department of Psychology, Butler University, Indianapolis, Indiana
| |
Collapse
|
26
|
Tauber NM, O'Toole MS, Dinkel A, Galica J, Humphris G, Lebel S, Maheu C, Ozakinci G, Prins J, Sharpe L, Smith AB, Thewes B, Simard S, Zachariae R. Effect of Psychological Intervention on Fear of Cancer Recurrence: A Systematic Review and Meta-Analysis. J Clin Oncol 2019; 37:2899-2915. [PMID: 31532725 PMCID: PMC6823887 DOI: 10.1200/jco.19.00572] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Fear of cancer recurrence (FCR) is a significantly distressing problem that affects a substantial number of patients with and survivors of cancer; however, the overall efficacy of available psychological interventions on FCR remains unknown. We therefore evaluated this in the present systematic review and meta-analysis. METHODS We searched key electronic databases to identify trials that evaluated the effect of psychological interventions on FCR among patients with and survivors of cancer. Controlled trials were subjected to meta-analysis, and the moderating influence of study characteristics on the effect were examined. Overall quality of evidence was evaluated using the GRADE system. Open trials were narratively reviewed to explore ongoing developments in the field (PROSPERO registration no.: CRD42017076514). RESULTS A total of 23 controlled trials (21 randomized controlled trials) and nine open trials were included. Small effects (Hedges’s g) were found both at postintervention (g = 0.33; 95% CI, 0.20 to 0.46; P < .001) and at follow-up (g = 0.28; 95% CI, 0.17 to 0.40; P < .001). Effects at postintervention of contemporary cognitive behavioral therapies (CBTs; g = 0.42) were larger than those of traditional CBTs (g = 0.24; β = .22; 95% CI, .04 to .41; P = .018). At follow-up, larger effects were associated with shorter time to follow-up (β = −.01; 95% CI, −.01 to −.00; P = .027) and group-based formats (β = .18; 95% CI, .01 to .36; P = .041). A GRADE evaluation indicated evidence of moderate strength for effects of psychological intervention for FCR. CONCLUSION Psychological interventions for FCR revealed a small but robust effect at postintervention, which was largely maintained at follow-up. Larger postintervention effects were found for contemporary CBTs that were focused on processes of cognition—for example, worry, rumination, and attentional bias—rather than the content, and aimed to change the way in which the individual relates to his or her inner experiences. Future trials could investigate how to further optimize and tailor interventions to individual patients’ FCR presentation.
Collapse
Affiliation(s)
- Nina M Tauber
- Aarhus University, Aarhus, Denmark.,International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada
| | | | - Andreas Dinkel
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Technical University of Munich, Munich, Germany
| | - Jacqueline Galica
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | - Gerry Humphris
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of St Andrews, St Andrews, United Kingdom
| | - Sophie Lebel
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Maheu
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,McGill University, Montréal, Québec, Canada
| | - Gozde Ozakinci
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of St Andrews, St Andrews, United Kingdom
| | - Judith Prins
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Louise Sharpe
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of Sydney, Sydney, NSW, Australia
| | - Allan Ben Smith
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Ingham Institute for Applied Medical Research and University of New South Wales, Sydney, NSW, Australia
| | - Belinda Thewes
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,University of Sydney, Sydney, NSW, Australia
| | - Sébastien Simard
- International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Université du Québec à Chicoutimi, Saguenay, Québec, Canada
| | - Robert Zachariae
- Aarhus University, Aarhus, Denmark.,International Psycho-Oncology Society Fear of Cancer Recurrence Special Interest Group, Toronto, Ontario, Canada.,Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
27
|
Psychological support for patients with cancer: evidence review and suggestions for future directions. Curr Opin Support Palliat Care 2019; 12:276-292. [PMID: 30074924 DOI: 10.1097/spc.0000000000000360] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Psychological distress and mental health comorbidity are common in cancer. Various therapeutic frameworks have been used for interventions to improve psychological wellbeing and quality of life in cancer patients with mixed results. This article reviews contributions to that literature published since January 2017. RECENT FINDINGS The majority of new psychological intervention research in cancer has used cognitive behavioural therapy (CBT) or mindfulness-based interventions. CBT has been considered a gold-standard intervention and recent evidence justifies continuation of this. Recent reviews call into question the validity of evidence for mindfulness-based interventions. A smaller number of trials using acceptance and commitment therapy, meta-cognitive therapy, dignity therapy and coaching have emerged, and whereas findings are promising, additional fully powered trials are required. Weaker evidence exists for counselling, support-based and narrative therapy interventions. SUMMARY Efficacious, timely and acceptable psychological interventions are a necessary component of comprehensive cancer care. There is some way to go before the evidence conclusively points towards which interventions work for which cancer groups and for which specific outcomes. Methodological limitations must be addressed in future trials; at the forefront remains the need for fully powered, head-to-head comparison trials.
Collapse
|
28
|
Petricone-Westwood D, Jones G, Mutsaers B, Leclair CS, Tomei C, Trudel G, Dinkel A, Lebel S. A Systematic Review of Interventions for Health Anxiety Presentations Across Diverse Chronic Illnesses. Int J Behav Med 2018; 26:3-16. [DOI: 10.1007/s12529-018-9748-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
29
|
Grégoire C, Faymonville ME, Vanhaudenhuyse A, Charland-Verville V, Jerusalem G, Bragard I. Randomized controlled trial of an 8-week intervention combining self-care and hypnosis for post-treatment cancer patients: study protocol. BMC Cancer 2018; 18:1113. [PMID: 30442120 PMCID: PMC6238378 DOI: 10.1186/s12885-018-5046-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/06/2018] [Indexed: 01/06/2023] Open
Abstract
Background Cancer has a lot of consequences on patients’ quality of life (such as cancer-related fatigue (CRF), sleep difficulties and emotional distress) and on patients’ partners and their relationship, such as distress and communication difficulties. These consequences are undertreated, and interventions based on hypnosis often focus on breast cancer patients only. This paper describes the study protocol of a longitudinal randomized controlled trial aiming to assess the efficacy of an 8-week intervention combining hypnosis and self-care to improve cancer patients’ CRF, sleep and emotional distress and to indirectly improve their partners’ distress. Methods A power analysis required a total sample of 88 patients. To test the efficacy of the intervention, results of the experimental group receiving the intervention will be compared to those of the control group. Data will be collected by questionnaires, relaxation tasks, an attentional bias task, and everyday life assessments measured at four different times: 1.) before inclusion in the study (baseline); 2.) after the intervention; and 3.) at 4- and 12-month follow-up. Partners’ symptoms will also be evaluated with questionnaires at the same measurement times. Discussion There is a growing interest in alternative approaches (such as hypnosis) in addition to standard therapies in oncology settings. The results of this study should be useful for improving knowledge about long-term efficacy of hypnosis-based group interventions for CRF, sleep and distress among all types of cancer patients and their partners, and to better understand the mechanisms of emotional regulation in cancer patients through the attentional bias task. Trial registration ClinicalTrials.gov (NCT03144154). Retrospectively registered on the 1st of May, 2017. Electronic supplementary material The online version of this article (10.1186/s12885-018-5046-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Charlotte Grégoire
- Public Health Department and Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Liège, Belgium.
| | - Marie-Elisabeth Faymonville
- Algology-Palliative Care Department, CHU Liège, and Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Audrey Vanhaudenhuyse
- Algology-Palliative Care Department, CHU Liège, and Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Vanessa Charland-Verville
- GIGA-Consciousness, Coma Science Group & Neurology Department, University and CHU of Liège, Liège, Belgium
| | - Guy Jerusalem
- Medical Oncology Department, CHU Liège and University of Liège, Liège, Belgium
| | - Isabelle Bragard
- Public Health Department and Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| |
Collapse
|
30
|
Hall DL, Luberto CM, Philpotts LL, Song R, Park ER, Yeh GY. Mind-body interventions for fear of cancer recurrence: A systematic review and meta-analysis. Psychooncology 2018; 27:2546-2558. [PMID: 29744965 PMCID: PMC6488231 DOI: 10.1002/pon.4757] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/21/2018] [Accepted: 04/19/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a common existential concern and source of distress among adults with a cancer history. Multiple randomized controlled trials (RCTs) have examined mind-body approaches to mitigating FCR. We summarized characteristics of these trials and calculated their pooled effects on decreasing FCR. METHODS Six electronic databases were systematically searched from inception to May 2017, using a strategy that included multiple terms for RCTs, cancer, mind-body medicine, and FCR. Data extraction and reporting followed Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes on self-report measures of FCR were computed by using random-effects models. RESULTS Nineteen RCTs (pooled N = 2806) were included. Most studies (53%) were published since 2015 and targeted a single cancer type (84%; mostly breast). Intervention sessions (median = 6, mode = 4) tended to last 120 minutes and occur across 1.5 months. Delivery was predominantly in-person (63%) to either groups (42%) or individuals (42%). Most interventions incorporated multiple mind-body components (53%), commonly cognitive-behavioral skills (58%), or meditative practices (53%). Small-to-medium pooled effect sizes were observed postintervention (Hedges' g = -0.36, 95% CI = -0.49, -0.23, P < .001) and at follow-up assessments (median = 8 months, P < .001). Potential modifiers (control group design, group/individual delivery, use of cognitive-behavioral or mindfulness skills, number of mind-body components, cancer treatment status, and number of sessions) did not reach statistical significance. CONCLUSIONS Mind-body interventions are efficacious for reducing FCR, with small-to-medium effect sizes that persist after intervention delivery ends. Recommendations include testing effects among survivors of various cancers and exploring the optimal integration of mind-body practices for managing fundamental uncertainties and fears during cancer survivorship.
Collapse
Affiliation(s)
- Daniel L. Hall
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Rhayun Song
- College of Nursing, Chungnam National University, South Korea
| | - Elyse R. Park
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
| | - Gloria Y. Yeh
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW Due to medical advances and an aging population, the number of cancer survivors continues to rise. Survivors often experience late and long-term sequelae of cancer and its treatment (e.g., fatigue, pain, fear of recurrence, and stress). As a result, some patients have utilized or expressed interest in integrative medicine (IM) modalities for prevention of recurrence, optimizing health, enhancing quality of life, and managing symptoms. The purpose of this review is to focus on research published during the past year that informs our understanding of the utility of IM for cancer survivors. RECENT FINDINGS Physical activity, diet, dietary supplements, mind-body modalities, acupuncture, and massage therapy all may play a role in the management of the physical (e.g., fatigue and pain) and emotional (e.g., anxiety and fear) issues faced by cancer survivors. SUMMARY IM therapies are appealing to and utilized by many cancer survivors and may reduce symptom burden. Clinicians who provide cancer survivorship care may improve patient care by understanding the evidence for and against their use.
Collapse
|
32
|
Kaidar-Person O, Meattini I, Deal AM, Francolini G, Carta G, Terzo L, Camporeale J, Muss H, Marks LB, Livi L, Mayer DK, Zagar TM. The use of psychological supportive care services and psychotropic drugs in patients with early-stage breast cancer: a comparison between two institutions on two continents. Med Oncol 2017; 34:144. [PMID: 28726045 DOI: 10.1007/s12032-017-1003-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/14/2017] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the mental health consumption among patients with early-stage breast cancer in two radiation oncology departments in two countries (USA and Italy). Data were extracted from the medical records of consecutive patients treated between 2014 and 2015 in two centers. Extracted data included patient's demographics, treatment, referral to psychological supportive care programs, and prescribed psychotropic drugs. Data from the two centers were compared using Student's t, Wilcoxon, Fisher's exact, and Jonckheere-Terpstra tests. Adjusted relative risks (RR) were estimated using Poisson regression. A total of 231 (Italy = 110, USA = 121) patients were included, with a mean age of 60 years. The crude rate of psychological supportive care visits was similar in the US versus the Italian cohort (28.9 vs. 21.8%, p = 0.23). The crude rate of prescribed psychotropic drug was higher in the US cohort versus Italian cohort (43.8 vs. 18.2%, p < 0.0001). These differences remained significant after adjusting for breast cancer subtype, stage, and treatment (RR 1.8, 95 CI 1.17-2.76). Between 20 and 30% of patients receive psychological supportive care during treatment for breast cancer. The use of psychotropic medication was higher in the US cohort than the cohort from Italy. The reasons for these differences might be related to social and cultural differences and the method of prescribing medication.
Collapse
Affiliation(s)
- Orit Kaidar-Person
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, USA. .,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero, Universitaria Careggi - University of Florence, Florence, Italy
| | - Allison M Deal
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Giulio Francolini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero, Universitaria Careggi - University of Florence, Florence, Italy
| | - Giulio Carta
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero, Universitaria Careggi - University of Florence, Florence, Italy
| | - Lauren Terzo
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, USA
| | - Jayne Camporeale
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Hyman Muss
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.,Department of Medicine, Division of Medical Oncology, UNC Hospital, Chapel Hill, NC, USA
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Lorenzo Livi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero, Universitaria Careggi - University of Florence, Florence, Italy
| | - Deborah K Mayer
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Timothy M Zagar
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| |
Collapse
|
33
|
Charland-Verville V, Faymonville ME, Vanhaudenhuyse A, Raaf M, Grégoire C, Bragard I. Apprentissage de l’autohypnose/autobienveillance en oncologie. Pour qui ? Comment ? Dans quel intérêt ? Une revue de la littérature internationale. PSYCHO-ONCOLOGIE 2017. [DOI: 10.1007/s11839-017-0614-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|