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Li Z, Laginha KJ, Boyle F, Daly M, Dinner F, Hirsch P, Hobbs K, Kirsten L, Mazariego C, McAuley R, O'Brien M, O'Reilly A, Taylor N, Tobin L, Lewis S, Smith AL. Professionally led support groups for people living with advanced or metastatic cancer: a systematic scoping review of effectiveness and factors critical to implementation success within real-world healthcare and community settings. J Cancer Surviv 2024:10.1007/s11764-023-01515-w. [PMID: 38191752 DOI: 10.1007/s11764-023-01515-w] [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: 09/08/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE To examine the effectiveness of professionally led support groups for people with advanced or metastatic cancer, and identify factors critical to implementation success within real-world settings. METHODS Databases (MEDLINE; PsychINFO; CINAHL) and grey literature were searched for empirical publications and evaluations. Articles were screened for eligibility and data systematically extracted, charted and summarised using a modified scoping review methodology. Implementation factors were mapped using Proctor's implementation framework and the Consolidated Framework for Implementation Research 2.0. RESULTS A total of 1691 publications were identified; 19 were eligible for inclusion (8 randomised controlled trials, 7 qualitative studies, 2 cohort studies, 2 mixed methods studies). Most (n=18) studies focused on tumour-specific support groups. Evidence supported professionally led support groups in reducing mood disturbances (n=5), distress (i.e. traumatic stress, depression) (n=4) and pain (n=2). Other benefits included social connectedness (n=6), addressing existential distress (n=5), information and knowledge (n=6), empowerment and sense of control (n=2), relationships with families (n=2) and communication with health professionals (n=2). Thirteen studies identified factors predicting successful adoption, implementation or sustainment, including acceptability (n=12; 63%), feasibility (n=6; 32%) and appropriateness (n=1; 5%). Key determinants of successful implementation included group leaders' skills/experience, mode of operation, travelling distance, group composition and membership and resourcing. CONCLUSIONS Professionally led tumour-specific support groups demonstrate effectiveness in reducing mood disturbances, distress and pain among patients. Successful implementation hinges on factors such as leadership expertise, operational methods and resource allocation. IMPLICATIONS FOR CANCER SURVIVORS Professionally led support groups may fill an important gap in supportive care for people with advanced or metastatic cancer.
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Affiliation(s)
- Zhicheng Li
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Rm 111b, Edward Ford Building (A27), Camperdown, NSW, 2006, Australia
| | - Kitty-Jean Laginha
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michele Daly
- Cancer Institute NSW, Consumer Advisory Panel, Sydney, NSW, Australia
| | | | - Pia Hirsch
- Advanced Breast Cancer Group, Brisbane, Qld, Australia
| | - Kim Hobbs
- Westmead Centre for Gynaecological Cancers, Westmead, NSW, Australia
| | | | - Carolyn Mazariego
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Mary O'Brien
- Advanced Breast Cancer Group, Brisbane, Qld, Australia
| | | | - Natalie Taylor
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Tobin
- Breast Cancer Network Australia, Camberwell, VIC, Australia
| | - Sophie Lewis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrea L Smith
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Rm 111b, Edward Ford Building (A27), Camperdown, NSW, 2006, Australia.
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2
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Li Y, Reed SD, Winger JG, Hyland KA, Fisher HM, Kelleher SA, Miller SN, Davidian M, Laber EB, Keefe FJ, Somers TJ. Cost-Effectiveness Analysis Evaluating Delivery Strategies for Pain Coping Skills Training in Women With Breast Cancer. THE JOURNAL OF PAIN 2023; 24:1712-1720. [PMID: 37187219 PMCID: PMC10524546 DOI: 10.1016/j.jpain.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/28/2023] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Abstract
Pain coping skills training (PCST) is efficacious in patients with cancer, but clinical access is limited. To inform implementation, as a secondary outcome, we estimated the cost-effectiveness of 8 dosing strategies of PCST evaluated in a sequential multiple assignment randomized trial among women with breast cancer and pain (N = 327). Women were randomized to initial doses and re-randomized to subsequent doses based on their initial response (ie, ≥30% pain reduction). A decision-analytic model was designed to incorporate costs and benefits associated with 8 different PCST dosing strategies. In the primary analysis, costs were limited to resources required to deliver PCST. Quality-adjusted life-years (QALYs) were modeled based on utility weights measured with the EuroQol-5 dimension 5-level at 4 assessments over 10 months. A probabilistic sensitivity analysis was performed to account for parameter uncertainty. Implementation of PCST initiated with the 5-session protocol was more costly ($693-853) than strategies initiated with the 1-session protocol ($288-496). QALYs for strategies beginning with the 5-session protocol were greater than for strategies beginning with the 1-session protocol. With the goal of implementing PCST as part of comprehensive cancer treatment and with willingness-to-pay thresholds ranging beyond $20,000 per QALY, the strategy most likely to provide the greatest number of QALYs at an acceptable cost was a 1-session PCST protocol followed by either 5 maintenance telephone calls for responders or 5 sessions of PCST for nonresponders. A PCST program with 1 initial session and subsequent dosing based on response provides good value and improved outcomes. PERSPECTIVE: This article presents the results of a cost analysis of the delivery of PCST, a nonpharmacological intervention, to women with breast cancer and pain. Results could potentially provide important cost-related information to health care providers and systems on the use of an efficacious and accessible nonmedication strategy for pain management. TRIALS REGISTRATION: ClinicalTrials.gov: NCT02791646, registered 6/2/2016.
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Affiliation(s)
- Yanhong Li
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Shelby D. Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Joseph G. Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Kelly A. Hyland
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Hannah M. Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Sarah A. Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Shannon N. Miller
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Marie Davidian
- Department of Statistics, North Carolina State University, Raleigh, NC
| | - Eric B. Laber
- Department of Statistical Sciences, Duke University, Durham, NC
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Tamara J. Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
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Cox-Martin E, Phimphasone-Brady P, Hoffecker L, Glasgow RE. Psychosocial Interventions for Pain Management in Breast Cancer Survivors: A RE-AIM Evaluation. J Clin Psychol Med Settings 2023; 30:182-196. [PMID: 35562602 DOI: 10.1007/s10880-022-09874-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 12/24/2022]
Abstract
Psychosocial interventions for breast-cancer-related pain are effective, yet over 45% of survivors continue to struggle with this often-chronic side effect. This study evaluated multilevel indicators that can influence successful translation of interventions into clinical practice. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was applied to evaluate reporting of individual and setting/staff-level intervention indicators. A systematic search and multi-step screening process identified 31 randomized controlled trials for psychosocial interventions for breast cancer-related pain. Average reporting of indicators for individual-level dimensions (Reach and Effectiveness) were 65.2% and 62.3%, respectively. Comparatively, indicators for setting/staff-level dimensions were reported at a lower average frequency (Implementation, 46.8%; Adoption, 15.2%; Maintenance, 7.7%). Low reporting of setting/staff-level dimensions suggests gaps in the sustained implementation of psychosocial interventions. Implementation science methods and frameworks could improve trial design and accelerate the translation of psychosocial interventions for breast cancer-related pain into clinical practice.
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Affiliation(s)
- Emily Cox-Martin
- VA Puget Sound Health Care System, 9600 Veterans Dr SW, Tacoma, WA, 98493, USA.
| | | | - Lilian Hoffecker
- Strauss Health Sciences Library, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Russell E Glasgow
- Department of Family Medicine, and ACCORDS Center, University of Colorado School of Medicine, Aurora, CO, USA
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4
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Hwang KS, Lee KH, Yang CM, Lee HJ, Lee SY. Effects of Psychosocial Interventions for Patients with Breast Cancer: A Meta-analysis. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:118-125. [PMID: 36700318 PMCID: PMC9889899 DOI: 10.9758/cpn.2023.21.1.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 01/27/2023]
Abstract
Objective This study involved a meta-analysis of South Korean studies regarding psychosocial interventions for patients with breast cancer to provide basic data to support the development of an integrated healthcare service model. Methods Randomized controlled studies with a pretest-posttest design were selected, and those presenting means, standard deviations, and standardized mean differences were included. For quality evaluation and heterogeneity testing, the Jadad scale and the Q-value and I2 were used. To estimate the effect size of each study, Hedge's g was used. Publication bias was analyzed with the Funnel plot and Egger's regression test. Results Of the 28 studies selected for the, meta-analysis was performed on eight. The total number of datasets included in the meta-analysis was 33. The evaluation based on the Jadad scale revealed no significant inter-rater variation (p = 0.35). The mean number of sessions was 7.93 and the mean intervention time was 13.2 hours. The interventions were mostly administered in a group structure (94%) and, regarding the type, they were categorized as integrated (36.4%), cognitive (30.3%), and meditation (24.2%). The mean effect size was 1.21 against no treatment group. Conclusion The analyzed studies showed heterogeneity, with a corresponding asymmetry found on the Funnel plot. Despite the heterogeneity and publication bias, the mean effect size was significantly large. Cognitive interventions, meditation, and psychological education programs are expected to assist in reducing negative emotions and enhancing quality of life in patients with breast cancer.
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Affiliation(s)
- Kyu-Sic Hwang
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Korea,Korea Brain-Behavior Mental Health Institute, Jeonju, Korea
| | - Kuy-Haeng Lee
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Korea,Korea Brain-Behavior Mental Health Institute, Jeonju, Korea,Department of Psychiatry, Wonkwang University School of Medicine, Iksan, Korea
| | - Chan-Mo Yang
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Korea,Korea Brain-Behavior Mental Health Institute, Jeonju, Korea,Department of Psychiatry, Wonkwang University School of Medicine, Iksan, Korea
| | - Hye-Jin Lee
- Department of Public Health, Wonkwang University Graduate School, Iksan, Korea
| | - Sang-Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Korea,Korea Brain-Behavior Mental Health Institute, Jeonju, Korea,Department of Psychiatry, Wonkwang University School of Medicine, Iksan, Korea,Address for correspondence: Sang-Yeol Lee Department of Psychiatry, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Korea, E-mail: , ORCID: https://orcid.org/0000-0003-1828-9992
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5
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Nicklas L, Albiston M, Dunbar M, Gillies A, Hislop J, Moffat H, Thomson J. A systematic review of economic analyses of psychological interventions and therapies in health-related settings. BMC Health Serv Res 2022; 22:1131. [PMID: 36071425 PMCID: PMC9450839 DOI: 10.1186/s12913-022-08158-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background This review aims to synthesise evidence on the economic impact of psychological interventions and therapies when applied to a broad range of physical health conditions. Methods The following bibliographic databases were searched for relevant articles: MEDLINE (Ovid), EMBASE (Ovid) and PsycINFO (Ebsco). As this review was intended to update an earlier review, the date range for the search was restricted to between January 2012 and September 2018. Reference lists from the review articles were also searched for relevant articles. Study quality was evaluated using the Scottish Intercollegiate Network Guidelines (SIGN) appraisal checklists for both economic studies and Randomised Controlled Trials (RCTs). When the economic analyses did not provide sufficient detail for quality evaluation, the original RCT papers were sought and these were also evaluated. Half of the papers were quality rated by a second author. Initial agreement was high and all disagreements were resolved by discussion. Results This yielded 1408 unique articles, reduced to 134 following screening of the title and abstract. The full texts of the remaining articles were reviewed by at least one team member and all exclusions were discussed and agreed by the team. This left 46 original research articles, alongside five systematic reviews. Fifty-seven per cent of the articles were deemed to be of high quality, with the remainder of acceptable quality. Fifteen different medical conditions were covered, with chronic pain (10 articles) and cancer (9 articles) being the two most investigated health conditions. Three quarters of the papers reviewed showed evidence for the cost-effectiveness of psychological interventions in physical health, with the clearest evidence being in the field of chronic pain and cancer. Conclusions This paper provides a comprehensive integration of the research on the cost-effectiveness of psychological therapies in physical health. Whilst the evidence for cost-effectiveness in chronic pain and cancer is encouraging, some health conditions require further study. Clearly, as the primary research is international, and was therefore conducted across varying health care systems, caution must be exercised when applying the results to counties outside of those covered. Despite this, the results are of potential relevance to service providers and funders. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08158-0.
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Affiliation(s)
- Leeanne Nicklas
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK.
| | - Mairi Albiston
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| | - Martin Dunbar
- Stobhill Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Alan Gillies
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| | | | - Helen Moffat
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Judy Thomson
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
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6
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Arnaud A, Grenier J, Boustany R, Kirscher S, Mege A, de Rauglaudre G, Vazquez L, Debourdeau P. Role of supportive care in improving the quality of life and reducing unscheduled hospital care in patients with metastatic breast cancer. Support Care Cancer 2021; 29:3735-3742. [PMID: 33205324 DOI: 10.1007/s00520-020-05877-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Metastatic breast cancer (MBC) patients experience long survival and report poorer quality of life than localized breast cancer patients. Comprehensive supportive care (CSC) has been shown to improve the quality of life (QoL) of MBC. The respective part of each support care has not been fully examined, and little is known about whether meeting patients' needs is accompanied by decreased unscheduled hospital care (UHC). METHODS This prospective monocentric study included women who started a new treatment line for MBC between January 2018 and December 2018. The endpoints were factors associated with UHC and QoL (SF36) at month 12. RESULTS 100 patients were offered CSC, 78 were included (21 refusals, 1 no MBC). CSC was provided to 60 patients: pain (43%), psychological (37%), kinesitherapy (30%), social assistance (22%), esthetic (18%), nutrition (18%), massage (13%), and none (10%). CSC rate was not statistically different among patients with (58%) and without UHD (49%). Factors associated with a decrease of UHC were age > 65 years (p = 0.01), no previous treatment for MBC (p = 0.0001) with a trend for the lack of CSC (p = 0.054). Among the 8 domains of the SF36 scale, only health change perception was improved (p = 0.01) and its predictive factors were treatment carried out as planned (p = 0.0004), pain care (p = 0.003), and lack of MBC progression (p = 0.0035). CONCLUSION CSC can improve QoL in MBC. Painful patients might benefit more from CSC. UHC did not decrease for patients receiving CSC as expected possibly because of their important needs for clinical care.
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Affiliation(s)
- Antoine Arnaud
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | - Julien Grenier
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | - Rania Boustany
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | - Sylvie Kirscher
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | - Alice Mege
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | | | - Léa Vazquez
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France.
| | - Philippe Debourdeau
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
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7
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Youens D, Halkett G, Wright C, O'Connor M, Schofield P, Jefford M, Aranda S, Kane R, Moorin R. Assessing the cost-effectiveness of RT Prepare: A radiation therapist-delivered intervention for reducing psychological distress prior to radiotherapy. Psychooncology 2019; 28:1110-1118. [PMID: 30884030 DOI: 10.1002/pon.5065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/20/2019] [Accepted: 03/09/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the cost-effectiveness of RT Prepare in reducing breast cancer patients' psychological distress before treatment, compared with usual care. METHODS RT Prepare, an intervention involving patient education and support consultations with a radiation therapist (RT), was implemented at three Australian sites (Australian New Zealand Clinical Trials Registration: ACTRN12611001000998). The primary outcome was change in psychological distress using the Hospital Anxiety and Depression Scale (HADS); secondary outcomes were changes in quality of life (QoL) and additional health service use. Costs (2015 $AU) included consultation time and training delivery. Between-group comparisons of HADS and QoL used generalised linear mixed models, and comparisons of health service use used negative binomial regression. Incremental cost-effectiveness ratios (ICERs) indicated mean costs per 1-point decrease in HADS score. Sensitivity analyses explored variation in facility size and uncertainty in intervention effectiveness. RESULTS Among 218 controls and 189 intervention participants, the intervention significantly lowered HADS scores at treatment commencement (adjusted mean difference 1.06 points). There was no significant effect on QoL or additional service use. Mean intervention costs were AU$171 per participant (US$130, €119) mostly related to RT training (approximately AU$142 (US$108, €99). An ICER of $158 (US$120, €110) was estimated. Cost-effectiveness improved in a sensitivity analysis representing a large facility with higher patient numbers. CONCLUSION This study provides new data on the cost-effectiveness of an RT-delivered intervention to reduce psychological distress prior to treatment, which will be useful to inform delivery of similar services. As most costs were upfront, cost-effectiveness would likely improve if implemented as standard care.
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Affiliation(s)
- David Youens
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia
| | - Georgia Halkett
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia
| | - Cameron Wright
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia.,School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania
| | - Moira O'Connor
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Western Australia
| | - Penelope Schofield
- Department of Psychology, Swinburne University of Technology, Hawthorn, Victoria.,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria.,Sir Peter MacCallum Department of Oncology and Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria
| | - Michael Jefford
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria.,Sir Peter MacCallum Department of Oncology and Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria
| | - Sanchia Aranda
- Cancer Council Australia, Sydney, New South Wales.,School of Health Sciences, The University of Melbourne, Melbourne, Victoria
| | - Robert Kane
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Western Australia
| | - Rachael Moorin
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia.,Centre for Health Services Research, School of Population and Global Health, University of Western Australia, Crawley, Western Australia
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Serfaty M, Armstrong M, Vickerstaff V, Davis S, Gola A, McNamee P, Omar RZ, King M, Tookman A, Jones L, Low JT. Acceptance and commitment therapy for adults with advanced cancer (CanACT): A feasibility randomised controlled trial. Psychooncology 2018; 28:488-496. [DOI: 10.1002/pon.4960] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Marc Serfaty
- Marie Curie Palliative Care Research Department, Division of Psychiatry; University College London; London UK
| | - Megan Armstrong
- Marie Curie Palliative Care Research Department, Division of Psychiatry; University College London; London UK
- Camden and Islington NHS Foundation Trust, St. Pancras Hospital; London UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry; University College London; London UK
- Department of Primary Care and Population Health; University College London; London UK
| | - Sarah Davis
- Marie Curie Palliative Care Research Department, Division of Psychiatry; University College London; London UK
| | - Anna Gola
- Marie Curie Palliative Care Research Department, Division of Psychiatry; University College London; London UK
| | - Philip McNamee
- Marie Curie Palliative Care Research Department, Division of Psychiatry; University College London; London UK
- Camden and Islington NHS Foundation Trust, St. Pancras Hospital; London UK
| | - Rumana Z. Omar
- Department of Statistical Science; University College London; London UK
| | - Michael King
- Marie Curie Palliative Care Research Department, Division of Psychiatry; University College London; London UK
| | | | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry; University College London; London UK
| | - Joseph T.S. Low
- Marie Curie Palliative Care Research Department, Division of Psychiatry; University College London; London UK
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9
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Shaw J, Pearce A, Lopez AL, Price MA. Clinical anxiety disorders in the context of cancer: A scoping review of impact on resource use and healthcare costs. Eur J Cancer Care (Engl) 2018; 27:e12893. [DOI: 10.1111/ecc.12893] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/13/2018] [Accepted: 06/19/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Joanne Shaw
- Psycho-oncology Co-operative Research Group (PoCoG); School of Psychology; The University of Sydney; Sydney New South Wales Australia
| | - Alison Pearce
- Centre for Health Economics Research and Evaluation; University of Technology; Sydney New South Wales Australia
| | - Anna-Lena Lopez
- Psycho-oncology Co-operative Research Group (PoCoG); School of Psychology; The University of Sydney; Sydney New South Wales Australia
| | - Melanie A. Price
- Psycho-oncology Co-operative Research Group (PoCoG); School of Psychology; The University of Sydney; Sydney New South Wales Australia
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10
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van der Spek N, Vos J, van Uden-Kraan CF, Breitbart W, Cuijpers P, Knipscheer-Kuipers K, Willemsen V, Tollenaar RAEM, van Asperen CJ, Leeuw IMVD. Cost-utility analysis of meaning-centered group psychotherapy for cancer survivors. Psychooncology 2018; 27:1772-1779. [PMID: 29624807 PMCID: PMC6043397 DOI: 10.1002/pon.4726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Meaning-centered group psychotherapy for cancer survivors (MCGP-CS) improves meaning, psychological well-being, and mental adjustment to cancer and reduces psychological distress. This randomized controlled trial was conducted to investigate the cost-utility of MCGP-CS compared with supportive group psychotherapy (SGP) and care-as-usual (CAU). METHODS In total, 170 patients were randomized to MCGP-CS, SGP, or CAU. Intervention costs, direct medical and nonmedical costs, productivity losses, and health-related quality of life were measured until 6 months follow-up, using the TIC-P, PRODISQ, data from the hospital information system, and the EQ-5D. The cost-utility was calculated by comparing mean cumulative costs and quality-adjusted life years (QALYs). RESULTS Mean total costs ranged from €4492 (MCGP-CS) to €5304 (CAU). Mean QALYs ranged .507 (CAU) to .540 (MCGP-CS). MCGP-CS had a probability of 74% to be both less costly and more effective than CAU, and 49% compared with SGP. Sensitivity analyses showed these findings are robust. If society is willing to pay €0 for one gained QALY, MCGP-CS has a 78% probability of being cost-effective compared with CAU. This increases to 85% and 92% at willingness-to-pay thresholds of €10 000 and €30 000, which are commonly accepted thresholds. CONCLUSIONS MCGP-CS is highly likely a cost-effective intervention, meaning that there is a positive balance between the costs and gains of MCGP-CS, in comparison with SGP and CAU.
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Affiliation(s)
- Nadia van der Spek
- Department of Clinical Psychology, VU University, VdBoechorststraat 1, room 2B-64, Amsterdam 1081 BT, The Netherlands
| | - Joël Vos
- Department of Psychology, University of Roehampton, London, UK
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia F van Uden-Kraan
- Department of Clinical Psychology, VU University, VdBoechorststraat 1, room 2B-64, Amsterdam 1081 BT, The Netherlands
- Department of Otolaryngology – Head & Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University, VdBoechorststraat 1, room 2B-64, Amsterdam 1081 BT, The Netherlands
| | - Kitty Knipscheer-Kuipers
- Ingeborg Douwes Centrum, Center for psychological care for cancer patients, Amsterdam, The Netherlands
| | - Vincent Willemsen
- Ingeborg Douwes Centrum, Center for psychological care for cancer patients, Amsterdam, The Netherlands
| | - Rob AEM Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical Psychology, VU University, VdBoechorststraat 1, room 2B-64, Amsterdam 1081 BT, The Netherlands
- Department of Otolaryngology – Head & Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Chen Y, Ahmad M. Effectiveness of adjunct psychotherapy for cancer treatment: a review. Future Oncol 2018; 14:1487-1496. [DOI: 10.2217/fon-2017-0671] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- YokeYong Chen
- Health Psychology Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abd Aziz, 50300 Kuala Lumpur, Singapore
| | - Mahadir Ahmad
- Health Psychology Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abd Aziz, 50300 Kuala Lumpur, Singapore
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Bradley N, Lloyd‐Williams M, Dowrick C. Effectiveness of palliative care interventions offering social support to people with life-limiting illness-A systematic review. Eur J Cancer Care (Engl) 2018; 27:e12837. [PMID: 29573500 PMCID: PMC6001732 DOI: 10.1111/ecc.12837] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2018] [Indexed: 11/03/2022]
Abstract
Individuals managing the challenges of life-limiting illness require adequate social support to maintain quality of life. Qualitative research reports that patients value highly the social support obtained in palliative care interventions such as day care and group therapies. This systematic review aims to summarise existing quantitative evidence on palliative care interventions that facilitate social support. Research literature was systematically searched using electronic databases and key journals. Searches returned a total of 6,247 unique titles of which sixteen were eligible for inclusion. Interventions include group therapies, group practical interventions and palliative day care. Outcome measures and study designs were heterogeneous. Only one study used a validated outcome measure of social support. Benefits were influenced by participant characteristics such as baseline distress. Partial economic evaluation was attempted by two studies. Methodological challenges include attrition and use of outcome measures that were insensitive to change. Statistically significant results were reported in psychological and physical domains. Evidence is limited due to methodological issues and a scarcity of quantitative research, particularly regarding long-term benefits and cost-effectiveness. Interventions may be more beneficial to some groups than others.
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Affiliation(s)
- N. Bradley
- Academic Palliative and Supportive Care Studies GroupInstitute of Psychology Health and SocietyUniversity of LiverpoolLiverpoolUK
| | - M. Lloyd‐Williams
- Academic Palliative and Supportive Care Studies GroupInstitute of Psychology Health and SocietyUniversity of LiverpoolLiverpoolUK
| | - C. Dowrick
- Academic Palliative and Supportive Care Studies GroupInstitute of Psychology Health and SocietyUniversity of LiverpoolLiverpoolUK
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13
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Watson M, Dunn J. The multidisciplinary art and science of cancer care: integrating psycho-oncology. Future Oncol 2016; 12:2775-2778. [DOI: 10.2217/fon-2016-0374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Maggie Watson
- Pastoral & Psychological Care, Compton House, The Royal Marsden NHS Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Jeffrey Dunn
- Cancer Council Queensland, Australia
- School of Public Health, Griffith University, Brisbane, Australia
- School of Social Science, University of Queensland, Australia
- Institute of Resilient Regions, USQ, Australia
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Martinez KA, Friese C, Kershaw T, Given CW, Fendrick AM, Northouse L. Effect of a Nurse-Led Psychoeducational Intervention on Healthcare Service Utilization Among Adults With Advanced Cancer. Oncol Nurs Forum 2016; 42:E310-8. [PMID: 26148327 DOI: 10.1188/15.onf.e310-e318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE/OBJECTIVES To examine differences in healthcare service utilization among patients with advanced cancer participating in a nurse-led psychoeducational intervention. DESIGN Secondary analysis of trial data. SETTING Four Michigan cancer centers. SAMPLE 484 patients with advanced cancer. METHODS Patients were randomized to three groups. MAIN RESEARCH VARIABLES Study arm (brief, extensive, or control), ED visitation (one or more times versus none), inpatient hospitalizations (one or more times versus none), and covariates. FINDINGS No significant differences in ED visits or inpatient hospitalizations were observed among study arms. ED visits were more frequent for patients with lung or colorectal cancer, more comorbidities, and lower baseline QOL. Baseline QOL was associated with inpatient hospitalizations in the adjusted analysis. CONCLUSIONS The psychoeducational intervention, either in brief or extensive format, is unlikely to increase healthcare service utilization. IMPLICATIONS FOR NURSING Efficacious nurse-led psychoeducational interventions to improve QOL do not place undue burdens on the healthcare system and may improve care.
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D'Abramo F, Goerling U, Guastadisegni C. Targeted drugs and Psycho-oncological intervention for breast cancer patients. J Negat Results Biomed 2016; 15:6. [PMID: 27036549 PMCID: PMC4818528 DOI: 10.1186/s12952-016-0049-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/09/2016] [Indexed: 01/06/2023] Open
Abstract
Personalized medicine is a new field based on molecular biology and genomics in which targeted tumor therapies are administered to patients. Psycho-oncology is a complementary approach that considers social and psychological aspects of patients as part of the treatments for cancer patients. The aim of this mini-review is to weigh clinical benefits for breast cancer patients of both treatments and possibily enhance benefits by modulating the use of both interventions. We have compared and evaluated on the one hand the use of anti Vascular Endothelial Growth Factor and, on the other hand, psycho-oncological interventions in metastatic and non-metastatic breast cancer patients. Both treatments did not increase survival of metastatic breast cancer patients, while in a selected study psycho-oncological interventions extended lifespan of non-metastatic breast cancer patients and ameliorate psychological and social factors of metastatic breast cancer patients. Because the two approaches address completely different aspects of cancer patients, if the comparison is limited to the extension of survival, the value of these two treatments cannot be assessed and compared. It is likely that by comparing patients reported outcomes, possibly by using standardized Quality of Life questionnaires, both patients and health care providers can weigh the benefits of the two treatments. It is therefore important to evaluate the use of cancer patients’ quality of life measures as a mean to improve their experiences about life and treatment, and possibly to extend their survival.
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Affiliation(s)
- Flavio D'Abramo
- Department of Psychology, Freie Universität Berlin, Hittorfstr. 16, 14195, Berlin, Deutschland.
| | - Ute Goerling
- Charité Comprehensive Cancer Center, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Cecilia Guastadisegni
- Department of Environment and Primary Prevention, Italian National Institute of Health, ISS, V.le Regina Elena 299, 00161, Rome, Italy
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Acceptance and commitment therapy for adults with advanced cancer (CanACT): study protocol for a feasibility randomised controlled trial. Trials 2016; 17:77. [PMID: 26865162 PMCID: PMC4750179 DOI: 10.1186/s13063-016-1169-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/12/2016] [Indexed: 12/26/2022] Open
Abstract
Background One-third of people with cancer experience psychological distress and may suppress distressing thoughts, emotions, and concerns, leading to further problems. Conventional psychological treatments reduce distress by problem solving, but in advanced cancer, when ill health is progressive and death may be approaching, physical and psychological difficulties are complex and have no simple solutions. Acceptance and Commitment Therapy encourages acknowledgement and acceptance of mental experiences, increasing people’s ability to work with problems that cannot be solved. Previous pilot work in advanced cancer confirms that distress can be associated with an avoidance of experiencing uncomfortable thoughts and emotions. Methods/Design This feasibility randomised controlled trial of Acceptance Commitment Therapy aims to establish parameters for a larger trial. Fifty-four participants with advanced cancer will be randomly allocated to up to eight sessions (each 1 hour) of Acceptance Commitment Therapy or a talking control. Participants will be recruited from those attending outpatient services and hospice day care at three specialist palliative care units in North and East London, United Kingdom. The primary outcome is a measure of functioning in four areas of life (physical, social/family, emotional, and general activity) using the Functional Assessment of Cancer Therapies - General questionnaire at 3 months after randomisation. Secondary outcomes are (i) acceptance using the Acceptance and Action Questionnaire; (ii) psychological distress using the Kessler Psychological Distress Scale; (iii) physical functioning using a timed walk and sit-to-stand test; and (iv) quality of life measures including the Euroqol-5 Dimensions and ICECAP Supportive Care measures. Qualitative data will be collected at 3 months to explore the participants’ experiences of the trial and therapy. Data will be collected on the costs of care. Discussion Data generated on the recruitment, retention, and experience of the interventions and the usefulness of the outcome measures will inform the adaptations required and whether changes in function are consistent with existing data when planning for a sufficiently powered randomised controlled trial. Trial registration ISRCTN13841211 (registered 22 July 2015). Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1169-8) contains supplementary material, which is available to authorized users.
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17
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Dieng M, Cust AE, Kasparian NA, Mann GJ, Morton RL. Economic evaluations of psychosocial interventions in cancer: a systematic review. Psychooncology 2016; 25:1380-1392. [DOI: 10.1002/pon.4075] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/22/2015] [Accepted: 12/17/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Mbathio Dieng
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
| | - Anne E. Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health; The University of Sydney; Sydney NSW Australia
| | - Nadine A. Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine; University of New South Wales; Sydney NSW Australia
| | - Graham J. Mann
- Centre for Cancer Research, Westmead Millennium Institute for Medical Research and Melanoma Institute Australia; The University of Sydney; Sydney NSW Australia
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre; The University of Sydney; Sydney NSW Australia
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18
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Hollingworth W, Metcalfe C, Mancero S, Harris S, Campbell R, Biddle L, McKell-Redwood D, Brennan J. Are Needs Assessments Cost Effective in Reducing Distress Among Patients With Cancer? A Randomized Controlled Trial Using the Distress Thermometer and Problem List. J Clin Oncol 2013; 31:3631-8. [DOI: 10.1200/jco.2012.48.3040] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with cancer have a high prevalence of distress. We evaluated whether distress monitoring and needs assessment using the Distress Thermometer and Problem List (DT&PL) improved patient outcomes. Patients and Methods We conducted an unblinded, two-arm, parallel randomized controlled trial at two sites among patients starting radiotherapy or chemotherapy. The intervention group completed the DT&PL, rating distress and discussing sources of distress with a trained radiographer/nurse. No specific triage algorithms were followed. The control group received usual care. The main outcome measure was psychological distress (Profile of Mood States [POMS], short form) up to 12 months; secondary outcomes were quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30) and health care costs. Results Of 220 patients randomly assigned, 112 patients were allocated to the DT&PL. Ninety-five percent completed the primary outcome at 12 months. The DT&PL took 25 minutes; one third of patients had high levels of distress, and most reported physical (84%) or emotional (56%) problems. There was no evidence of an effect of the DT&PL on adjusted POMS scores over follow-up (difference between groups, −1.84; 95% CI, −5.69 to 2.01; P = .35) or in secondary outcomes. The DT&PL cost £19 ($28) per patient and did not lower subsequent health care costs. Few patients (< 3%) in either arm of the trial were referred to a clinical psychologist. Conclusion Patients with cancer have a high prevalence of distress. Needs assessment can be performed quickly and inexpensively. However, the DT&PL was not cost effective in improving patient mood states. It is important to explore the reasons for this so that oncology units can design better services to support patients.
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Affiliation(s)
- William Hollingworth
- William Hollingworth, Chris Metcalfe, Susan Harris, Rona Campbell, Lucy Biddle, Denise McKell-Redwood, and James Brennan, University of Bristol; James Brennan, University Hospitals Bristol National Health Service Foundation Trust, Bristol; and Susana Mancero, Royal United Hospital Bath National Health Service Trust, Bath, United Kingdom
| | - Chris Metcalfe
- William Hollingworth, Chris Metcalfe, Susan Harris, Rona Campbell, Lucy Biddle, Denise McKell-Redwood, and James Brennan, University of Bristol; James Brennan, University Hospitals Bristol National Health Service Foundation Trust, Bristol; and Susana Mancero, Royal United Hospital Bath National Health Service Trust, Bath, United Kingdom
| | - Susana Mancero
- William Hollingworth, Chris Metcalfe, Susan Harris, Rona Campbell, Lucy Biddle, Denise McKell-Redwood, and James Brennan, University of Bristol; James Brennan, University Hospitals Bristol National Health Service Foundation Trust, Bristol; and Susana Mancero, Royal United Hospital Bath National Health Service Trust, Bath, United Kingdom
| | - Susan Harris
- William Hollingworth, Chris Metcalfe, Susan Harris, Rona Campbell, Lucy Biddle, Denise McKell-Redwood, and James Brennan, University of Bristol; James Brennan, University Hospitals Bristol National Health Service Foundation Trust, Bristol; and Susana Mancero, Royal United Hospital Bath National Health Service Trust, Bath, United Kingdom
| | - Rona Campbell
- William Hollingworth, Chris Metcalfe, Susan Harris, Rona Campbell, Lucy Biddle, Denise McKell-Redwood, and James Brennan, University of Bristol; James Brennan, University Hospitals Bristol National Health Service Foundation Trust, Bristol; and Susana Mancero, Royal United Hospital Bath National Health Service Trust, Bath, United Kingdom
| | - Lucy Biddle
- William Hollingworth, Chris Metcalfe, Susan Harris, Rona Campbell, Lucy Biddle, Denise McKell-Redwood, and James Brennan, University of Bristol; James Brennan, University Hospitals Bristol National Health Service Foundation Trust, Bristol; and Susana Mancero, Royal United Hospital Bath National Health Service Trust, Bath, United Kingdom
| | - Denise McKell-Redwood
- William Hollingworth, Chris Metcalfe, Susan Harris, Rona Campbell, Lucy Biddle, Denise McKell-Redwood, and James Brennan, University of Bristol; James Brennan, University Hospitals Bristol National Health Service Foundation Trust, Bristol; and Susana Mancero, Royal United Hospital Bath National Health Service Trust, Bath, United Kingdom
| | - James Brennan
- William Hollingworth, Chris Metcalfe, Susan Harris, Rona Campbell, Lucy Biddle, Denise McKell-Redwood, and James Brennan, University of Bristol; James Brennan, University Hospitals Bristol National Health Service Foundation Trust, Bristol; and Susana Mancero, Royal United Hospital Bath National Health Service Trust, Bath, United Kingdom
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Arving C, Brandberg Y, Feldman I, Johansson B, Glimelius B. Cost-utility analysis of individual psychosocial support interventions for breast cancer patients in a randomized controlled study. Psychooncology 2013; 23:251-8. [PMID: 24115469 DOI: 10.1002/pon.3411] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 07/04/2013] [Accepted: 08/27/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim was to explore the cost-utility in providing complementary individual psychosocial support to breast cancer patients compared with standard care (SC). METHODS Patients just starting adjuvant therapy (n = 168) at Uppsala University Hospital, Sweden, were consecutively included and randomized into three groups: psychosocial support from a specially trained nurse (INS), from a psychologist (IPS), or SC. Psychological effects and healthcare utilization were monitored during a 2-year period. The hospital billing system provided cost estimates. Quality-adjusted life years (QALYs) were calculated using health-related quality of life data from the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ C-30) translated into the Euro Quality of Life- 5-Dimensional classification. On the basis of the medical cost offset, a cost-utility analysis was performed. RESULTS Health care utilization was mainly related to the breast cancer diagnosis and treatment. The intervention costs amounted to about €500 or 3% of the total costs. Total health care costs, including interventions cost, were lower in the INS (€18,670) and IPS (€20,419) groups than in the SC group (€25,800). The number of QALYs were also higher in the INS (1.52 QALY) and IPS (1.59 QALY) groups, compared with the SC group (1.43 QALY). CONCLUSIONS The cost-utility analysis revealed that, during adjuvant treatment for breast cancer, the individual psychosocial support interventions provided here was cost effective because the health care costs were lower and QALYs were higher compared to SC alone.
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Affiliation(s)
- Cecilia Arving
- Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden
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20
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The benefits of psychosocial interventions for cancer patients undergoing radiotherapy. Health Qual Life Outcomes 2013; 11:121. [PMID: 23866850 PMCID: PMC3721996 DOI: 10.1186/1477-7525-11-121] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 07/08/2013] [Indexed: 01/04/2023] Open
Abstract
Background Many patients with cancer experience depression and anxiety, and an associated decrease in quality of life (QOL) during radiation therapy (RT). The main objective of the study was to determine the benefits of psychosocial interventions for cancer patients who received RT. Methods Patients with cancer (n = 178) who agreed to participate in the study were randomized to the intervention arm (n = 89) or the control arm (n = 89). Patients in the intervention group received psychosocial care during RT, whereas the control group received RT only. The benefits of the intervention were evaluated using the Zung Self-rating Depression Scale (SDS) to measure depression, the Self-rating Anxiety Scale (SAS) to assess anxiety, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) to survey health-related QOL. The association between intervention and survival was also assessed. Results Patients randomly assigned to the intervention arm showed significant improvements on symptoms of depression (p < 0.05) and anxiety (p < 0.05), health-related QOL (p < 0.05) (i.e. better global health status, and physical and emotional functioning, and less insomnia) when compared with controls. In the subset analysis, female patients, those that received high dose irradiation, and those that underwent adjuvant chemotherapy could benefit more from psychosocial intervention. There was no difference between the two groups in disease-free survival (DFS) (2-year DFS 79.8% in the intervention arm and 76.4% in the control arm; p = 0.527) and overall survival (OS) (2-year OS 83.1% in the intervention arm and 84.3% in the control arm; p = 0.925) Conclusions Psychosocial intervention is a cost-effective approach that can improve a patient’s mood and QOL both during and after RT. However, the intervention was not found to reduce the risk of cancer recurrence and death. Trial registration ChiCTR-TRC-12002438
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Stey AM, Fei K, Franco R, Mendelson A, Bickell NA. Cost of comprehensive patient assistance program in early breast cancer patients. SPRINGERPLUS 2013; 2:173. [PMID: 23667818 PMCID: PMC3650234 DOI: 10.1186/2193-1801-2-173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 03/15/2013] [Indexed: 12/01/2022]
Abstract
Existing comprehensive patient assistance programs can help cancer patients overcome needs and barriers to care: yet the costs of such programs and who utilizes them is not well described. 333 women with primary early stage breast cancer in New York City either chose to attend or abstain from attending one of these programs. We obtained the operating costs of the most utilized patient assistance program. Patients who utilized patient assistance programs were significantly more likely to be English speaking (p=0.04) and have 1.5 years more advanced schooling than non-utilizers (p=0.008). At the cost of 73 dollars per hour encounters, patients reported benefiting the most from information resources (71% of patients) followed by emotional support (52% of patients); 5% of patients reported getting help with insurance, 5% with financial assistance, 4% with help obtaining medication, 2% with transportation. Existing comprehensive patient assistance programs offer informational, psychological and financial support at low cost. Patients who currently use these programs are English speakers with more education.
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Affiliation(s)
- Anne M Stey
- Department of Health Policy, Mount Sinai Medical Center, New York, NY 10029 USA ; 10940 Wilshire Blvd., Suite 710, Los Angeles, CA 90024 USA
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22
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Björneklett HG, Rosenblad A, Lindemalm C, Ojutkangas ML, Letocha H, Strang P, Bergkvist L. A randomized controlled trial of support group intervention after breast cancer treatment: results on sick leave, health care utilization and health economy. Acta Oncol 2013; 52:38-47. [PMID: 23106175 DOI: 10.3109/0284186x.2012.734921] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND More than 50% of breast cancer patients are diagnosed before the age of 65. Returning to work after treatment is, therefore, of interest for both the individual and society. The aim was to study the effect of support group intervention on sick leave and health care utilization in economic terms. MATERIAL AND METHODS Of 382 patients with newly diagnosed breast cancer, 191 + 191 patients were randomized to an intervention group or to a routine control group, respectively. The intervention group received support intervention on a residential basis for one week, followed by four days of follow-up two months later. The support intervention included informative-educational sections, relaxation training, mental visualization and non-verbal communication. Patients answered a questionnaire at baseline, two, six and 12 months about sick leave and health care utilization. RESULTS There was a trend towards longer sick leave and more health care utilization in the intervention group. The difference in total costs was statistically significantly higher in the intervention group after 12 months (p = 0.0036). CONCLUSION Costs to society were not reduced with intervention in its present form.
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Mewes JC, Steuten LM, IJzerman MJ, van Harten WH. Effectiveness of multidimensional cancer survivor rehabilitation and cost-effectiveness of cancer rehabilitation in general: a systematic review. Oncologist 2012; 17:1581-93. [PMID: 22982580 PMCID: PMC3528391 DOI: 10.1634/theoncologist.2012-0151] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 08/20/2012] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Many cancer survivors suffer from a combination of disease- and treatment-related morbidities and complaints after primary treatment. There is a growing evidence base for the effectiveness of monodimensional rehabilitation interventions; in practice, however, patients often participate in multidimensional programs. This study systematically reviews evidence regarding effectiveness of multidimensional rehabilitation programs for cancer survivors and cost-effectiveness of cancer rehabilitation in general. METHODS The published literature was systematically reviewed. Data were extracted using standardized forms and were summarized narratively. RESULTS Sixteen effectiveness and six cost-effectiveness studies were included. Multidimensional rehabilitation programs were found to be effective, but not more effective than monodimensional interventions, and not on all outcome measures. Effect sizes for quality of life were in the range of -0.12 (95% confidence interval [CI], -0.45-0.20) to 0.98 (95% CI, 0.69-1.29). Incremental cost-effectiveness ratios ranged from -€16,976, indicating cost savings, to €11,057 per quality-adjusted life year. CONCLUSIONS The evidence for multidimensional interventions and the economic impact of rehabilitation studies is scarce and dominated by breast cancer studies. Studies published so far report statistically significant benefits for multidimensional interventions over usual care, most notably for the outcomes fatigue and physical functioning. An additional benefit of multidimensional over monodimensional rehabilitation was not found, but this was also sparsely reported on. Available economic evaluations assessed very different rehabilitation interventions. Yet, despite low comparability, all showed favorable cost-effectiveness ratios. Future studies should focus their designs on the comparative effectiveness and cost-effectiveness of multidimensional programs.
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Affiliation(s)
- Janne C. Mewes
- University of Twente, Department of Health Technology and Services Research, Enschede, The Netherlands
| | - Lotte M.G. Steuten
- University of Twente, Department of Health Technology and Services Research, Enschede, The Netherlands
| | - Maarten J. IJzerman
- University of Twente, Department of Health Technology and Services Research, Enschede, The Netherlands
| | - Wim H. van Harten
- University of Twente, Department of Health Technology and Services Research, Enschede, The Netherlands
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Department of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands
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GORDON LG, BEESLEY VL, SCUFFHAM PA. Evidence on the economic value of psychosocial interventions to alleviate anxiety and depression among cancer survivors: A systematic review. Asia Pac J Clin Oncol 2011; 7:96-105. [DOI: 10.1111/j.1743-7563.2011.01395.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Falagas ME, Zarkadoulia EA, Ioannidou EN, Peppas G, Christodoulou C, Rafailidis PI. The effect of psychosocial factors on breast cancer outcome: a systematic review. Breast Cancer Res 2008; 9:R44. [PMID: 17640330 PMCID: PMC2206717 DOI: 10.1186/bcr1744] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Revised: 06/15/2007] [Accepted: 07/17/2007] [Indexed: 11/10/2022] Open
Abstract
Introduction We sought to review the available evidence regarding the effect of psychosocial factors on the survival of breast cancer patients. Methods We systematically searched the PubMed and PsycINFO databases to identify relevant studies. Results We identified 31 studies examining the association of various psychosocial parameters with overall breast cancer survival/disease free survival and 6 studies examining whether psychological intervention influences the disease outcome. Of the 31 studies summarized in this overview, 25 (80.6%) showed a statistically significant association between at least one psychosocial variable and disease outcome. Parameters associated with better breast cancer prognosis are social support, marriage, and minimizing and denial, while depression and constraint of emotions are associated with decreased breast cancer survival; however, the role of these factors has not been verified in all studies. Conclusion Most of the studies show a significant relationship between psychosocial factors and survival, but the actual psychosocial variables related to survival are not consistently measured across studies and the findings for many of the psychosocial variables with survival/recurrence are not consistent across studies. Thus, more research is warranted regarding the role of social support, marriage, minimizing and denial, depression and constraint of emotions on breast cancer survival.
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Affiliation(s)
- Matthew E Falagas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Henry Dunant Hospital, Athens, Greece
| | | | | | - George Peppas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
- Department of Surgery, Henry Dunant Hospital, Athens, Greece
| | - Christos Christodoulou
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
- Department of Medical Oncology, Henry Dunant Hospital, Athens, Greece
| | - Petros I Rafailidis
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
- Department of Medicine, Henry Dunant Hospital, Athens, Greece
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Daley AJ, Crank H, Saxton JM, Mutrie N, Coleman R, Roalfe A. Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol 2007; 25:1713-21. [PMID: 17470863 DOI: 10.1200/jco.2006.09.5083] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To examine the effects of aerobic exercise therapy on quality of life (QoL) and associated outcomes in women treated for breast cancer. Evidence suggests that exercise may be beneficial, but no trial has included an exercise-placebo and a usual-care group to control for the attention effects that might be associated with aerobic exercise interventions in cancer patients. PATIENTS AND METHODS A total of 108 women who had been treated for breast cancer 12 to 36 months previously were randomly assigned to supervised aerobic exercise therapy (n = 34), exercise-placebo (body conditioning; n = 36), or usual care (n = 38). Exercise therapy and exercise-placebo sessions took place three times per week for 8 weeks. Outcomes included QoL, depression, exercise behavior, aerobic fitness; outcomes were assessed at baseline and at the 8- and 24-week follow-up. RESULTS Analyses of covariance revealed a significant mean difference of 9.8 units in Functional Assessment of Cancer Therapy-General (primary outcome) favoring aerobic exercise therapy at 8 weeks, relative to usual care. Significant differences that favored aerobic exercise therapy relative to usual care were recorded for Functional Assessment of Cancer Therapy-Breast, social/family well-being, functional well-being, and breast cancer subscale scores at 8-week follow-up. Psychological health outcomes improved modestly for both intervention groups; these improvements were sustained for several end points. CONCLUSION Exercise therapy had large, clinically meaningful, short-term beneficial effects on QoL in women treated for breast cancer; this finding cannot be attributable to attention, given that the exercise-placebo group did not report similar effects relative to usual care.
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Affiliation(s)
- Amanda J Daley
- Department of Primary Care and General Practice, Medical School, University of Birmingham, Birmingham, United Kingdom.
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