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Fraguell-Hernando C, Limonero JT, Gil F. Psychological intervention in patients with advanced cancer at home through Individual Meaning-Centered Psychotherapy-Palliative Care: a pilot study. Support Care Cancer 2020; 28:4803-4811. [PMID: 31974770 DOI: 10.1007/s00520-020-05322-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare Individual Meaning-Centered Psychotherapy-Palliative Care (IMCP-PC) to counselling-based psychotherapy in patients receiving home palliative care (PC). METHODS Fifty-one patients with advanced-stage cancer receiving home PC were recruited for this. Two-arm (individual meaning-centered psychotherapy-palliative-IMCP-PC-care vs. counselling) randomized feasibility trial. Anxiety, depression, demoralization, and emotional distress were evaluated before and after three psychotherapy sessions. Patient perceptions of the treatment were assessed after completion of therapy. RESULTS Thirty-two patients (16 in each group) completed all three sessions as well as the pre- and post-therapy questionnaires and were therefore included in the final analysis. All patients in the IMCP-PC group showed a significant decrease in levels of demoralization (despair), anxiety, depression, and emotional distress. By contrast, the only variable that significantly improved in the counselling group was demoralization. The post-treatment questionnaire revealed no significant between-group differences regarding patient perception of the structure, focus, or length of treatment. However, the IMCP-PC group rated the treatment more highly with regard to its value in helping them to find meaning in life. CONCLUSIONS IMCP-PC is a specific psychotherapy tailored to the needs of patients with advanced cancer. The results of the present study indicate that this treatment is suitable for patients at end of life that are not able to attend outpatient sessions. Although more research is needed, the findings of this feasibility trial suggest that the IMCP-PC merits consideration for patients receiving home palliative care (PC).
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Affiliation(s)
- Clara Fraguell-Hernando
- EAPS Mutuam Barcelona, Barcelona, Spain.,Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Joaquín T Limonero
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
| | - Francisco Gil
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.,Psycho-Oncology Unit, Hospital Duran i Reynals, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), Spain
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2
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Gramaglia C, Gambaro E, Vecchi C, Licandro D, Raina G, Pisani C, Burgio V, Farruggio S, Rolla R, Deantonio L, Grossini E, Krengli M, Zeppegno P. Outcomes of music therapy interventions in cancer patients-A review of the literature. Crit Rev Oncol Hematol 2019; 138:241-254. [PMID: 31121392 DOI: 10.1016/j.critrevonc.2019.04.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Effectiveness of music-based interventions (MI) on cancer patients' anxiety, depression, pain and quality of life (QoL) is a current research theme. MI are highly variable, making it challenging to compare studies. OBJECTIVE AND METHODS To summarize the evidence on MI in cancer patients, 40 studies were reviewed following the PRISMA statement. Studies were included if assessing at least one outcome among anxiety, depression, QoL and pain in patients aged ≥ 18, with an active oncological/onco-haematological diagnosis, participating to any kind of Music Therapy (MT), during/after surgery, chemotherapy or radiotherapy. RESULTS A positive effect of MI on the outcomes measured was supported. Greater reductions of anxiety and depression were observed in breast cancer patients. MI involving patients admitted to a hospital ward were less effective on QoL. CONCLUSION The increasing evidence about MI effectiveness, tolerability, feasibility and appreciation, supports the need of MI implementation in Oncology, Radiotherapy and Surgery wards, and promotion of knowledge among health operators.
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Affiliation(s)
- Carla Gramaglia
- Psychiatry Institute, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy; Psychiatry Ward, Azienda Ospedaliera Universitaria Maggiore della Carità, Corso Mazzini 18, Novara, Via Solaroli 17, Italy.
| | - Eleonora Gambaro
- Psychiatry Institute, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Camilla Vecchi
- Psychiatry Institute, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Davide Licandro
- School of Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Giulia Raina
- Laboratory of Physiology and Experimental Surgery, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Carla Pisani
- Radiotherapy Unit, Azienda Ospedaliera Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Vincenzo Burgio
- Radiotherapy Unit, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Serena Farruggio
- Laboratory of Physiology and Experimental Surgery, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Roberta Rolla
- Clinical Chemistry Unit, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy; Department of Health Sciences, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Letizia Deantonio
- Radiotherapy Unit, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy; Radiotherapy Unit, Azienda Ospedaliera Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Elena Grossini
- Laboratory of Physiology and Experimental Surgery, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Marco Krengli
- Radiotherapy Unit, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy; Radiotherapy Unit, Azienda Ospedaliera Universitaria Maggiore della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Patrizia Zeppegno
- Psychiatry Institute, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy; Psychiatry Ward, Azienda Ospedaliera Universitaria Maggiore della Carità, Corso Mazzini 18, Novara, Via Solaroli 17, Italy
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3
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Gentry MT, Lapid MI, Clark MM, Rummans TA. Evidence for telehealth group-based treatment: A systematic review. J Telemed Telecare 2018; 25:327-342. [DOI: 10.1177/1357633x18775855] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Interest in the use of telehealth interventions to increase access to healthcare services is growing. Group-based interventions have the potential to increase patient access to highly needed services. The aim of this study was to systematically review the available literature on group-based video teleconference services. Methods The English-language literature was searched using Ovid MEDLINE, PubMed, PsycINFO and CINAHL for terms related to telehealth, group therapy and support groups. Abstracts were reviewed for relevance based on inclusion criteria. Multiple study types were reviewed, including open-label, qualitative and randomised controlled trial study designs. Data were compiled regarding participants, study intervention and outcomes. Specific areas of interest were the feasibility of and satisfaction with telehealth technology, as well as the effect of video teleconference delivery on group dynamics, including therapeutic alliance. Results Forty published studies met the inclusion criteria and were included in the review. Six were randomised controlled trials. Among the studies, there was a broad range of study designs, participants, group interventions and outcome measures. Video teleconference groups were found to be feasible and resulted in similar treatment outcomes to in-person groups. However, few studies were designed to demonstrate noninferiority of video teleconference groups compared with in-person groups. Studies that examined group process factors showed small decreases in therapeutic alliance in the video teleconference participants. Conclusions Video teleconference groups are feasible and produce outcomes similar to in-person treatment, with high participant satisfaction despite technical challenges. Additional research is needed to identify optimal methods of video teleconference group delivery to maximise clinical benefit and treatment outcomes.
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Affiliation(s)
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, USA
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4
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Almutairi KM, Alodhayani AA, Alonazi WB, Vinluan JM. Assessment of Health-Related Quality of Life Among Caregivers of Patients with Cancer Diagnosis: A Cross-Sectional Study in Saudi Arabia. JOURNAL OF RELIGION AND HEALTH 2017; 56:226-237. [PMID: 27236467 DOI: 10.1007/s10943-016-0261-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A descriptive cross-sectional survey was conducted over 5 months in two tertiary hospitals in Riyadh, Saudi Arabia. The 5-month period was from November 2014 to March 2015. The survey instrument used was a Short-Form Health Survey SF-36 (the RAND 36-item) questionnaire that measure QOL of the caregivers. Our study subjects included 289 randomly selected Saudi caregivers. Almost all the mean scores were increased (higher than 50) with the exception of levels of energy/fatigue. Role functioning/physical scored the highest (81.02 ± 35.33) followed by physical functioning (76.34 ± 29.83). Other domains of QOL scored (71.02 ± 35.33) for the role functioning/emotional; pain (71.15 ± 28.48), emotional well-being (60.58 ± 18.44); social functioning (58.39 ± 25.83), and general health (54.32 ± 17.08). In multivariate regression analysis, the model predicts that the contributions of age, gender, and the cancer type of patients were a statistically significant predictor with the QOL domains of caregivers. Cancer caregivers in Saudi Arabia caring for patients more than 1 year after diagnosis reported favorable QOL. Factors associated with QOL domains included age, gender of the caregivers, and the types of cancer patients. These findings are encouraging as a baseline for providing more information to future studies in QOL of caregivers.
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Affiliation(s)
- Khalid M Almutairi
- Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia.
| | - Abdulaziz A Alodhayani
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Wadi B Alonazi
- College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Jason M Vinluan
- Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
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5
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Lo C, Hales S, Rydall A, Panday T, Chiu A, Malfitano C, Jung J, Li M, Nissim R, Zimmermann C, Rodin G. Managing Cancer And Living Meaningfully: study protocol for a randomized controlled trial. Trials 2015; 16:391. [PMID: 26335704 PMCID: PMC4557481 DOI: 10.1186/s13063-015-0811-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 06/18/2015] [Indexed: 11/23/2022] Open
Abstract
Background We have developed a novel and brief semi-structured psychotherapeutic intervention for patients with advanced or metastatic cancer, called Managing Cancer And Living Meaningfully. We describe here the methodology of a randomized controlled trial to test the efficacy of this treatment to alleviate distress and promote well-being in this population. Methods/Design The study is an unblinded randomized controlled trial with 2 conditions (intervention plus usual care versus usual care alone) and assessments at baseline, 3 and 6 months. The site is the Princess Margaret Cancer Centre, part of the University Health Network, in Toronto, Canada. Eligibility criteria include: ≥ 18 years of age; English fluency; no cognitive impairment; and diagnosis of advanced cancer. The 3–6 session intervention is manualized and allows for flexibility to meet individual patients’ needs. It is delivered over a 3–6 month period and provides reflective space for patients (and their primary caregivers) to address 4 main domains: symptom management and communication with health care providers; changes in self and relations with close others; sense of meaning and purpose; and the future and mortality. Usual care at the Princess Margaret Cancer Centre includes distress screening and referral as required to in-hospital psychosocial and palliative care services. The primary outcome is frequency of depressive symptoms and the primary endpoint is at 3 months. Secondary outcomes include diagnosis of major or minor depression, generalized anxiety, death anxiety, spiritual well-being, quality of life, demoralization, attachment security, posttraumatic growth, communication with partners, and satisfaction with clinical interactions. Discussion Managing Cancer And Living Meaningfully has the potential to relieve distress and promote psychological well-being in patients with advanced cancer and their primary caregivers. This trial is being conducted to determine its benefit and inform its dissemination. The intervention has cross-national relevance and training workshops have been held thus far with clinicians from North and South America, Europe, the Middle East, Asia and Africa. Trial Registration ClinicalTrials.gov NCT01506492 4 January 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0811-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chris Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Sarah Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Anne Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Tania Panday
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Aubrey Chiu
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Carmine Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Judy Jung
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Rinat Nissim
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada. .,Department of Medicine, University of Toronto, Suite RFE 3-805, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. .,Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada.
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6
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Dubruille S, Libert Y, Merckaert I, Reynaert C, Vandenbossche S, Roos M, Bron D, Razavi D. The prevalence and implications of elderly inpatients' desire for a formal psychological help at the start of cancer treatment. Psychooncology 2014; 24:294-301. [DOI: 10.1002/pon.3636] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 07/04/2014] [Accepted: 07/06/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Stéphanie Dubruille
- Faculté des Sciences Psychologiques et de l'Éducation; Université Libre de Bruxelles; Brussels Belgium
- Service de Médecine Psychosomatique, Cliniques Universitaires de Mont-Godinne; Université Catholique de Louvain; Louvain-la-Neuve Belgium
| | - Yves Libert
- Faculté des Sciences Psychologiques et de l'Éducation; Université Libre de Bruxelles; Brussels Belgium
- Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Isabelle Merckaert
- Faculté des Sciences Psychologiques et de l'Éducation; Université Libre de Bruxelles; Brussels Belgium
- Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Christine Reynaert
- Service de Médecine Psychosomatique, Cliniques Universitaires de Mont-Godinne; Université Catholique de Louvain; Louvain-la-Neuve Belgium
| | | | - Myriam Roos
- Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Dominique Bron
- Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | - Darius Razavi
- Faculté des Sciences Psychologiques et de l'Éducation; Université Libre de Bruxelles; Brussels Belgium
- Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
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7
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Shahi V, Lapid MI, Kung S, Atherton PJ, Sloan JA, Clark MM, Rummans TA. Do age and quality of life of patients with cancer influence quality of life of the caregiver? J Geriatr Oncol 2014; 5:331-6. [PMID: 24726867 DOI: 10.1016/j.jgo.2014.03.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 12/06/2013] [Accepted: 03/21/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE There are significant burdens associated with providing care for loved ones with cancer. However, caregiver quality of life (QOL) is often overlooked. With the increasing number of older adults with cancer, it is important to determine whether a patient's age and QOL have any association with the caregiver's QOL. The objective of our study was to describe caregiver QOL and explore whether patient age and other psychosocial factors impact caregiver QOL. MATERIALS AND METHODS Baseline information from patients with advanced cancer undergoing radiation and their caregivers, who were enrolled in a randomized, controlled clinical trial to test the effectiveness of a structured, multidisciplinary QOL intervention, was analyzed for this study. Caregivers completed the Caregiver Quality of Life Index-Cancer (CQOLC) Scale. Both patients and caregivers completed the Linear Analogue Self-Assessment (LASA) to measure QOL, and Profile of Mood States (POMS) to measure mood states. RESULTS Overall, 131 patient-caregiver pairs participated in the study. At baseline, caregivers of older adults (≥65years) had higher mental (P=0.01), emotional (P=0.003), spiritual (P<0.01), and social support (P=0.03) LASA QOL scores. Caregivers of older adults also had higher baseline QOL (CQOLC, P=0.003) and mood (POMS, P=0.04) than caregivers of younger adults. Caregivers of patients with higher LASA QOL scores had higher overall (P=0.02), mental (P=0.006), physical (P=0.02), emotional (P=0.002), and spiritual LASA QOL scores (P=0.047). CONCLUSIONS Caregivers of older adults with advanced cancer demonstrated better QOL and fewer mood disturbances compared to caregivers of younger patients. When patients have good QOL, caregivers also had good QOL.
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Affiliation(s)
- Varun Shahi
- Mayo Medical School, Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Simon Kung
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Pamela J Atherton
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jeff A Sloan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew M Clark
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Teresa A Rummans
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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8
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Lo C, Hales S, Jung J, Chiu A, Panday T, Rydall A, Nissim R, Malfitano C, Petricone-Westwood D, Zimmermann C, Rodin G. Managing Cancer And Living Meaningfully (CALM): phase 2 trial of a brief individual psychotherapy for patients with advanced cancer. Palliat Med 2014; 28:234-42. [PMID: 24170718 DOI: 10.1177/0269216313507757] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Advanced cancer brings substantial physical and psychosocial challenges that may contribute to emotional distress and diminish well-being. In this study, we present preliminary data concerning the effectiveness of a new brief individual psychotherapy, Managing Cancer And Living Meaningfully (CALM), designed to help individuals cope with this circumstance. AIM To test the feasibility and preliminary effectiveness of CALM to reduce emotional distress and promote psychological well-being and growth. DESIGN CALM is a brief, manualized, semi-structured individual psychotherapy for patients with advanced cancer. This study employed a phase 2 intervention-only design. The primary outcome was depressive symptoms and the secondary outcomes were death anxiety, attachment security, spiritual well-being and psychological growth. These were assessed at 3 months (t1) and 6 months (t2). Multilevel regression was used to model change over time. SETTING/PARTICIPANTS A total of 50 patients with advanced or metastatic cancer were recruited from the Princess Margaret Cancer Centre, Toronto, Canada. RESULTS A total of 39 patients (78%) were assessed at baseline, 24 (48%) at t1, and 16 (32%) at t2. Analyses revealed reductions over time in depressive symptoms: beta = -0.13, confidence interval (CI.95) = (-0.23, -0.022) and death anxiety: beta = -0.23, CI.95 (-0.40, -0.061); and an increase in spiritual well-being: beta = 0.14, CI.95 (0.026, 0.26). CONCLUSIONS CALM may be a feasible intervention to benefit patients with advanced cancer. The results are encouraging, despite attrition and small effect sizes, and support further study.
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Affiliation(s)
- Chris Lo
- 1Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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9
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Clark MM, Rummans TA, Atherton PJ, Cheville AL, Johnson ME, Frost MH, Miller JJ, Sloan JA, Graszer KM, Haas JG, Hanson JM, Garces YI, Piderman KM, Lapid MI, Netzel PJ, Richardson JW, Brown PD. Randomized controlled trial of maintaining quality of life during radiotherapy for advanced cancer. Cancer 2012; 119:880-7. [PMID: 22930253 DOI: 10.1002/cncr.27776] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/18/2012] [Accepted: 06/22/2012] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psychosocial interventions often address only 1 domain of quality of life (QOL), are offered to patients with early-stage cancer, do not include the caregiver, and are delivered after cancer treatment has been completed. METHODS In the current randomized controlled trial, 131 patients with advanced cancer who received radiotherapy and their caregivers were randomly assigned to either a 6-session, structured, multidisciplinary intervention arm or a standard care arm. The average age of the patients was 58 years, the majority were male (63%), and tumor types varied (gastrointestinal [37%], brain [22%], head and neck [16%], lung [13%], and other [12%]). The six 90-minute sessions addressed the 5 domains of QOL: cognitive, physical, emotional, social, and spiritual. The in-person intervention was followed by 10 brief telephone counseling sessions that took place over the next 6 months. RESULTS Of the 117 patients who completed the study, overall QOL (assessed by Functional Assessment of Cancer Therapy-General [FACT-G]) at week 4 was significantly higher in the intervention group (n = 54) compared with the standard arm control group (n = 63) (75.2 vs 68.7; P = .02). The 10 brief telephone contacts did not appear to impact QOL because at week 27 the groups had identical QOL (means of 77.6 and 77.7, respectively). There was no effect of the intervention noted on caregiver QOL. CONCLUSIONS Participating in a 6-session multidisciplinary intervention was found to be effective in maintaining the QOL of patients with advanced cancer who were actively receiving radiotherapy. The QOL and symptom burden of this population is striking, making it important to identify effective QOL strategies to implement in conjunction with cancer care.
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Affiliation(s)
- Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA.
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10
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Nissim R, Freeman E, Lo C, Zimmermann C, Gagliese L, Rydall A, Hales S, Rodin G. Managing Cancer and Living Meaningfully (CALM): a qualitative study of a brief individual psychotherapy for individuals with advanced cancer. Palliat Med 2012; 26:713-21. [PMID: 22042225 DOI: 10.1177/0269216311425096] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although psychosocial care has been regarded as central to palliative and supportive care, there have been few empirically tested approaches to individual intervention. AIM The subjective experience of advanced cancer patients receiving a new manualized brief individual psychotherapy, referred to as Managing Cancer and Living Meaningfully (CALM), was examined prior to the initiation of a randomized controlled trial testing the effectiveness of this intervention. DESIGN Semi-structured interviews were conducted with patients who had a diagnosis of advanced cancer, and who underwent the intervention. SETTING/PARTICIPANTS Patients were recruited from a large urban regional cancer center in Toronto, Canada. The 10 interviewees included seven women and three men. All had completed between three to six CALM sessions prior to the interview. RESULTS The CALM intervention was associated with profound and unique patient-identified benefits and no patient-identified risks or concerns. Five interrelated benefits of the intervention were identified: (1) a safe place to process the experience of advanced cancer; (2) permission to talk about death and dying; (3) assistance in managing the illness and navigating the healthcare system; (4) resolution of relational strain; and (5) an opportunity to 'be seen as a whole person' within the healthcare system. These benefits were regarded by participants as unique in their cancer journey. CONCLUSIONS Findings from a qualitative study suggest that the CALM intervention provides substantial benefits for patients with advanced cancer prior to the end of life. Findings informed the development of a randomized controlled trial to evaluate the effectiveness of this intervention.
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Affiliation(s)
- Rinat Nissim
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada.
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11
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Le souhait d’aide psychologique des patients âgés atteints d’un cancer. PSYCHO-ONCOLOGIE 2012. [DOI: 10.1007/s11839-012-0356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Hodges LJ, Walker J, Kleiboer AM, Ramirez AJ, Richardson A, Velikova G, Sharpe M. What is a psychological intervention? A metareview and practical proposal. Psychooncology 2011; 20:470-8. [PMID: 20878870 DOI: 10.1002/pon.1780] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE What do we mean by a 'psychological intervention' in the context of cancer care? It is critical to know what treatments are included under this term, if data from diverse treatment trials are to be summarized in order to inform clinical practice. We, therefore, aimed to determine how the term 'psychological intervention' has been defined and used to group and compare interventions in reviews of cancer care. METHODS We conducted a review of existing reviews (a metareview). These included systematic and narrative reviews and meta-analyses of interventions that were described as 'psychological', with the aim of determining: (a) the definitions for 'psychological interventions' that were used and (b) the treatments that were included within this category. RESULTS We identified 66 relevant reviews. Surprisingly, we were unable to find any explicit definition of the term 'psychological intervention' in these reviews. The reviews included 79 different treatments with little consistency between reviews in which treatments were included. CONCLUSIONS There is confusion about what 'psychological intervention' means in the cancer review literature. A clearer definition is essential to summarize research findings. We propose that rather than simply grouping interventions as 'psychological', it would be more useful if reviews focussed on specified domains of the interventions, namely content, proposed mechanism, target outcome, and methods of delivery. This would enable greater specificity in the review question, more meaningful comparisons, and would hopefully provide clearer answers for the readers of the reviews. A checklist for the summarizing of reports of interventions for review is provided.
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Kimman ML, Dirksen CD, Voogd AC, Falger P, Gijsen BCM, Thuring M, Lenssen A, van der Ent F, Verkeyn J, Haekens C, Hupperets P, Nuytinck JKS, van Riet Y, Brenninkmeijer SJ, Scheijmans LJEE, Kessels A, Lambin P, Boersma LJ. Nurse-led telephone follow-up and an educational group programme after breast cancer treatment: results of a 2 × 2 randomised controlled trial. Eur J Cancer 2011; 47:1027-36. [PMID: 21237636 DOI: 10.1016/j.ejca.2010.12.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 11/17/2010] [Accepted: 12/07/2010] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate whether frequent hospital follow-up in the first year after breast cancer treatment might partly be replaced by nurse-led telephone follow-up without deteriorating health-related quality of life (HRQoL), and whether a short educational group programme (EGP) would enhance HRQoL. PATIENTS AND METHODS A multicentre pragmatic randomised controlled trial (RCT) with a 2×2 factorial design was performed among 320 breast cancer patients who were treated with curative intent. Participants were randomised to follow-up care as usual (3-monthly outpatient clinic visits), nurse-led telephone follow-up, or the former strategies combined with an educational group programme. The primary outcome for both interventions was HRQoL, measured by EORTC QLQ-C30. Secondary outcomes were role and emotional functioning and feelings of control and anxiety. RESULTS Data of 299 patients were available for evaluation. There was no significant difference in HRQoL between nurse-led telephone and hospital follow-up at 12 months after treatment (p = 0.42; 95% confidence interval (CI) for difference: -1.93-4.64) and neither between follow-up with or without EGP (p = 0.86; 95% CI for difference: -3.59-3.00). Furthermore, no differences between the intervention groups and their corresponding control groups were found in role and emotional functioning, and feelings of control and anxiety (all p-values > 0.05). CONCLUSION Replacement of most hospital follow-up visits in the first year after breast cancer treatment by nurse-led telephone follow-up does not impede patient outcomes. Hence, nurse-led telephone follow-up seems an appropriate way to reduce clinic visits and represents an accepted alternative strategy. An EGP does not unequivocally affect positive HRQoL outcomes.
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Affiliation(s)
- M L Kimman
- Maastricht University Medical Centre, Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht, The Netherlands.
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Sharif F, Abshorshori N, Tahmasebi S, Hazrati M, Zare N, Masoumi S. The effect of peer-led education on the life quality of mastectomy patients referred to breast cancer-clinics in Shiraz, Iran 2009. Health Qual Life Outcomes 2010; 8:74. [PMID: 20653966 PMCID: PMC2919455 DOI: 10.1186/1477-7525-8-74] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 07/23/2010] [Indexed: 11/22/2022] Open
Abstract
Background Breast cancer among women is a relatively common with a more favorable expected survival rates than other forms of cancers. This study aimed to determine the improved quality of life for post-mastectomy women through peer education. Methods Using pre and post test follow up and control design approach, 99 women with stage I and II of breast cancer diagnosis were followed one year after modified radical mastectomy. To measure the quality of life an instrument designed by the European organization for research and treatment of cancer, known as the Quality of Life Question (QLQ-30) and it's breast cancer supplementary measure (QLQ-BR23) at three points in time (before, immediately and two months after intervention) for both groups were used. The participant selection was a convenient sampling method and women were randomly assigned into two experimental and control groups. The experimental group was randomly assigned to five groups and peer educators conducted weekly educational programs for one month. Tabulated data were analyzed using chi square, t test, and repeated measurement multivariate to compare the quality of life differences over time. Results For the experimental group, the results showed statistically significant improvement in all performance aspects of life quality and symptom reduction (P < 0.001), while the control group had no significant differences in all aspects of life quality. Conclusion The findings of this study suggest that peer led education is a useful intervention for post-mastectomy women to improves their quality of life.
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Affiliation(s)
- Farkhondeh Sharif
- Mental Health Nursing Department, Fatemeh, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Dale HL, Adair PM, Humphris GM. Systematic review of post-treatment psychosocial and behaviour change interventions for men with cancer. Psychooncology 2010; 19:227-37. [PMID: 19588538 DOI: 10.1002/pon.1598] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The psychosocial impacts of a cancer diagnosis include reduced quality of life, poorer inter-personal relationships, hopelessness and mental illness. Worse outcomes, including mortality rates have been found for single men with cancer compared with women and partnered men. The aim of this systematic review was to examine the effectiveness of post-treatment psychosocial and behaviour change interventions for adult men with cancer, in order to inform the development of an intervention. A focus on single men was intended. METHODS Ten databases were searched via Ovid and Web of Science. Papers were systematically extracted by title, abstract and full paper according to the inclusion/exclusion criteria. Full papers were assessed by two authors. INCLUSION CRITERIA participants at any stage of a cancer diagnosis, > or =50% male and aged 18+; psychosocial and/or behavioural post-treatment interventions, using any format; a one-three level of evidence. Couple/carer/family interventions were excluded. RESULTS From 9948 studies initially identified, 11 were finally included in the review. They implemented cognitive behaviour therapy, hypnosis or psychoeducational interventions. All studies had some positive results, however, lack of reporting of intervention content and methodological issues limit the findings. No studies intervened with single men, and none provided comparative outcomes for marital status. CONCLUSIONS Effectiveness of interventions was difficult to assess as, while all had benefits, their generalisability was limited due to methodological and reporting limitations. Improved reporting procedures are required to allow for replication.
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Affiliation(s)
- Hannah L Dale
- Department of Clinical Psychology, NHS Fife, Cupar, UK.
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Frenkel M, Ari SL, Engebretson J, Peterson N, Maimon Y, Cohen L, Kacen L. Activism among exceptional patients with cancer. Support Care Cancer 2010; 19:1125-32. [PMID: 20512358 DOI: 10.1007/s00520-010-0918-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Accepted: 05/11/2010] [Indexed: 12/28/2022]
Abstract
BACKGROUND The "exceptional patients" with cancer are survivors who had advanced cancer considered incurable by medical report and who subsequently became disease-free or experienced unexplained survival time given the nature of their disease or treatment. This experience is a puzzling phenomenon that has not been formally investigated in a cancer population. The purpose of this study was to understand exceptional patients' accounts of their experience. MATERIALS AND METHODS This study used a narrative approach with a cross-case thematic analysis. Recruitment took place at health care centers in the USA and Israel. Oncologists in both centers were asked to identify patients who had an exceptional disease course. Patients were then contacted and interviewed; an audio recording was made of each narrative account and then transcribed. Interviews and thematic analyses were conducted independently at each site. These thematic findings from each site were discussed with both research teams and a common underlying theme was identified, which is the focus of this report. RESULTS Twenty-six participants were interviewed: 14 from the USA and 12 from Israel. All the participants have had advanced disease with a range of diagnoses that included breast, colorectal, pancreatic, ovarian cancer, glioblastoma multiforme, and others. The main recurrent theme from both the US and Israeli sites was personal activism. This was manifested in taking charge and getting involved in the process of diagnosis and treatment, as well as becoming more altruistic in their relationships with others. In many cases, this was reflected in a change in a philosophy about life. CONCLUSIONS In this study, we found that activism was a major theme that was independently observed in both Israel and the U.S.A. This has implications for health care providers to facilitate patient engagement in the care and treatment of their disease. Further research on this phenomenon is needed.
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Affiliation(s)
- Moshe Frenkel
- Integrative Medicine Program, Unit 145, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Geffen JR. Integrative Oncology for the Whole Person: A Multidimensional Approach to Cancer Care. Integr Cancer Ther 2010; 9:105-21. [DOI: 10.1177/1534735409355172] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Today, more than ever before, millions of people are seeking an approach to medicine and health care that is more comprehensive, more holistic and integrative, and more compassionate and sensitive to their needs as a whole person. This is particularly true for those dealing with cancer. Changing patient demographics, heightened consumer demand for complementary and alternative medicine (CAM) products and services, advances in medical science and technology, expanding access to the Internet and health information, and other factors have contributed to a wave of transformation that is unprecedented in its impact on the entire health care system. These trends have fueled the emerging fields of integrative medicine and oncology, which are growing rapidly. As these fields continue to evolve, they will move beyond the present integrative model to a broader vision of whole-person, multidimensional care that will more fully and coherently address and embrace all dimensions of the human experience. This article describes 6 major driving forces behind the wave of transformation presently under way in medicine and health care. It provides a brief, historical overview of integrative medicine and oncology and summarizes the present status of these emerging fields. It discusses the future of integrative medicine and oncology, including a multidimensional approach to care, and highlights 5 key elements that underlie this approach. Finally, it describes The Seven Levels of Healing — a model of multidimensional care—and concludes with a discussion of 3 important challenges and opportunities for medicine and health care that lie on the horizon.
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Merckaert I, Libert Y, Messin S, Milani M, Slachmuylder JL, Razavi D. Cancer patients' desire for psychological support: prevalence and implications for screening patients' psychological needs. Psychooncology 2010; 19:141-9. [DOI: 10.1002/pon.1568] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schou I, Ekeberg O, Karesen R, Sorensen E. Psychosocial intervention as a component of routine breast cancer care-who participates and does it help? Psychooncology 2008; 17:716-20. [PMID: 18033695 DOI: 10.1002/pon.1264] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Women who participated in the hospital psychosocial support groups following breast cancer surgery were compared with non-participants. The Hospital Anxiety and Depression Scale and the EORTC quality of life questionnaire were used to measure emotional distress and quality of life at the time of diagnosis and after 12 months. The General Life Orientation Test-Revised was used to measure dispositional optimism. Of 165 women, 87% reported that they had been invited to participate, and 66% participated. The salient predictor for participating in support group was optimism (OR 0.89 CI: 95% 0.83-0.98, p=0.01). No significant difference was found between the prevalence of anxiety and depression caseness at the time of diagnosis, but after 12 months, the prevalence of anxiety caseness was significantly lower among the participants than that among the non-participants (19% vs 34%, p=0.04). In conclusion, psychosocial intervention as a component of routine breast cancer care appears to have a long-term clinical beneficial effect on anxiety. For depression and quality of life, the study is inconclusive. Self-selection may prevent patients at risk of adverse outcome to participate in support groups.
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Affiliation(s)
- Inger Schou
- Cancer and Surgical Department, Ulleval University Hospital, Oslo, Norway.
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Kimman ML, Voogd AC, Dirksen CD, Falger P, Hupperets P, Keymeulen K, Hebly M, Dehing C, Lambin P, Boersma LJ. Follow-up after curative treatment for breast cancer: Why do we still adhere to frequent outpatient clinic visits? Eur J Cancer 2007; 43:647-53. [PMID: 17251004 DOI: 10.1016/j.ejca.2006.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 11/10/2006] [Accepted: 12/04/2006] [Indexed: 11/16/2022]
Abstract
Follow-up after curative treatment for breast cancer consists of frequent outpatient clinic visits, scheduled at regular intervals. Its aim is primarily to detect local disease recurrence, or a second primary breast cancer, but also to provide information and psychosocial support. The cost-effectiveness of these frequent visits is being questioned however, leading to a search for less intensive follow-up strategies, such as follow-up by the general practitioner, patient-initiated or nurse-led follow-up or contact by telephone. These strategies are generally considered to be safe, but they are not yet widely accepted in clinical practice. Since brief interventions based on self-education and information have been shown to be able to improve quality of life, we hypothesise that these interventions may lead to a better acceptance of reduced follow-up by both patients and professionals.
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Affiliation(s)
- M L Kimman
- MAASTRO Clinic, Maastricht, The Netherlands.
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Kimman ML, Voogd AC, Dirksen CD, Falger P, Hupperets P, Keymeulen K, Hebly M, Dehing C, Lambin P, Boersma LJ. Improving the quality and efficiency of follow-up after curative treatment for breast cancer--rationale and study design of the MaCare trial. BMC Cancer 2007; 7:1. [PMID: 17199887 PMCID: PMC1769389 DOI: 10.1186/1471-2407-7-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 01/02/2007] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND After curative treatment for breast cancer women frequently attend scheduled follow-up examinations. Usually the follow-up is most frequent in the first 2-3 years (2-4 times a year); thereafter the frequency is reduced to once a year in most countries. Its main aim is to detect local disease recurrence, or a second primary breast cancer, but also to provide information and psychosocial support. However, the cost-effectiveness of these frequent visits is under much debate, leading to a search for less intensive and more cost-effective follow-up strategies. In this paper the design of the MaCare trial is described. This trial compares the cost-effectiveness of four follow-up strategies for curatively treated breast cancer patients. We investigate the costs and effects of nurse-led telephone follow-up and a short educational group programme. METHODS/DESIGN The MaCare trial is a multi centre randomised clinical trial in which 320 breast cancer patients are randomised into four follow-up strategies, focussed on the first 18 months after treatment: 1) standard follow-up; 2) nurse-led telephone follow-up; 3) arm 1 with the educational group programme; 4) arm 2 with the educational group programme. Data is collected at baseline and 3, 6, 12 and 18 months after treatment. The primary endpoint of the trial is cancer-specific quality of life as measured by the global health/QoL scale of the EORTC QLQ-C30. Secondary outcomes are perceived feelings of control, anxiety, patients' satisfaction with follow-up and costs. A cost-effectiveness analysis will be performed from a societal perspective. DISCUSSION Reduced follow-up strategies for breast cancer have not yet been widely applied in clinical practice. Improvement of psychosocial support and information to patients could lead to a better acceptance of reduced follow-up. The MaCare trial combines a reduced follow-up strategy with additional psychosocial support. Less frequent follow-up can reduce the burden on medical specialists and costs. The educational group programme can improve QoL of patients, but also less frequent follow-up can improve QoL by reducing the anxiety experienced for each follow-up visit. Results of the trial will provide knowledge on both costs and psychosocial aspects regarding follow-up and are expected in 2009.
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Affiliation(s)
- Merel L Kimman
- Maastro Clinic, Maastricht, The Netherlands
- Department GROW – MAASTRO, Maastricht University, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, The Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands
| | - Paul Falger
- Department of Medical Psychology, University Hospital Maastricht, The Netherlands
| | - Pierre Hupperets
- Department of Medical Oncology, University Hospital Maastricht, The Netherlands
| | | | - Marlene Hebly
- Department of Surgery, University Hospital Maastricht, The Netherlands
| | | | - Philippe Lambin
- Maastro Clinic, Maastricht, The Netherlands
- Department GROW – MAASTRO, Maastricht University, The Netherlands
- Department of Radiation Oncology, University Hospital Maastricht, The Netherlands
| | - Liesbeth J Boersma
- Maastro Clinic, Maastricht, The Netherlands
- Department GROW – MAASTRO, Maastricht University, The Netherlands
- Department of Radiation Oncology, University Hospital Maastricht, The Netherlands
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Davidson JR, Feldman-Stewart D, Brennenstuhl S, Ram S. How to provide insomnia interventions to people with cancer: insights from patients. Psychooncology 2007; 16:1028-38. [PMID: 17352006 DOI: 10.1002/pon.1183] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic insomnia affects approximately one quarter of cancer patients. Non-pharmacologic interventions are the treatment of choice for chronic insomnia, yet they are rarely offered to people with cancer. The study question was how to make these interventions available to cancer patients. Twenty-six cancer patients who had sleep difficulty participated in focus groups or one-to-one interviews. The key questions included: What would be the best way for you to find out about a service for insomnia treatment? What would make it easy/difficult for you to participate? Transcripts were examined independently by three readers who identified participants' answers to the questions, as well as themes that emerged from participants' reflections on their experience with cancer and sleep difficulty. The readers then worked together to reach consensus on a final classification system for describing the content of patients' responses. Participants provided many practical answers to our specific questions. In addition, the following themes emerged: sleep difficulty needs greater recognition by health professionals; patients wish to receive more information about sleep and sleep difficulty; and that although patients perceive sleep as being important, they are reluctant to report sleep problems to doctors. Furthermore, participants recommended that the assessment and treatment of sleep difficulty be integrated into the health care system while considering the cancer-treatment status and energy level of patients.
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Kung S, Rummans TA, Colligan RC, Clark MM, Sloan JA, Novotny PJ, Huntington JL. Association of optimism-pessimism with quality of life in patients with head and neck and thyroid cancers. Mayo Clin Proc 2006; 81:1545-52. [PMID: 17165633 DOI: 10.4065/81.12.1545] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the relationship between optimism-pessimism and quality of life (QOL) in survivors of head and neck and thyroid cancers. PATIENTS AND METHODS Between 1963 and 2000, 190 patients completed both the Minnesota Multiphasic Personality Inventory (MMPI), used to assess explanatory style (optimism-pessimism), and either the 12-Item or 36-Item Short-Form Health Survey (SF-12 or SF-36), used to assess QOL. The MMPIs were completed an average of 13.4 years before the QOL assessment. The QOL measures were completed an average of 12.5 years after cancer diagnosis. Patients were divided into quartiles based on their MMPI Optimism-Pessimism scale score. Analysis was performed for all patients, those with head and neck cancer, and those with thyroid cancer. Adjustments were made for age, sex, and disease stage. RESULTS For all 190 patients, optimism was associated with a higher QOL on both the mental and the physical component scales and 6 of 8 subscales of the SF-12 and SF-36. For patients with head and neck cancer, optimism was associated with higher QOL on 3 subscales but neither component scale. For patients with thyroid cancer, optimism was associated with higher QOL on both component scales and 6 subscales. After adjusting for age, sex, and disease stage, optimism was not associated with QOL in the head and neck cancer group. CONCLUSIONS Optimism was associated with a higher QOL in survivors of thyroid cancer compared with survivors of head and neck cancer. After adjusting for age, sex, and disease stage, optimism was not associated with QOL for survivors of head and neck cancer. Optimism was more associated with the mental rather than physical QOL subscales.
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Affiliation(s)
- Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
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Lepore SJ, Coyne JC. Psychological interventions for distress in cancer patients: a review of reviews. Ann Behav Med 2006; 32:85-92. [PMID: 16972802 DOI: 10.1207/s15324796abm3202_2] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We review a decade of review articles concerning psychosocial interventions for cancer patients. We find a distinct progression in the tone of interpretations of the literature, as better quality studies accumulate and the sophistication of reviews improves. The current literature does not make a compelling case for the value of these interventions for the typical cancer patient. The bulk of the literature reviews in this field take a narrative rather than a systematic approach, and serious compromises in standards are necessary to muster an adequate set of studies for review. The more rigorous the review, the less likely it is to conclude there is evidence that psychological interventions are effective.
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Affiliation(s)
- Stephen J Lepore
- Department of Public Health, Temple University, Philadelphia, PA 19122, USA.
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Rummans TA, Clark MM, Sloan JA, Frost MH, Bostwick JM, Atherton PJ, Johnson ME, Gamble G, Richardson J, Brown P, Martensen J, Miller J, Piderman K, Huschka M, Girardi J, Hanson J. Impacting Quality of Life for Patients With Advanced Cancer With a Structured Multidisciplinary Intervention: A Randomized Controlled Trial. J Clin Oncol 2006; 24:635-42. [PMID: 16446335 DOI: 10.1200/jco.2006.06.209] [Citation(s) in RCA: 248] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The primary goal of this study was to evaluate the feasibility and effectiveness of a structured, multidisciplinary intervention targeted to maintain the overall quality of life (QOL), which is more comprehensive than psychosocial distress, of patients undergoing radiation therapy for advanced-stage cancer. Patients and Methods Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0% to 50% were randomly assigned to either an eight-session structured multidisciplinary intervention arm or a standard care arm. The eight 90-minute sessions addressed the five domains of QOL including cognitive, physical, emotional, spiritual, and social functioning. The primary end point of maintaining overall QOL was assessed by a single-item linear analog scale (Linear Analog Scale of Assessment or modified Spitzer Uniscale). QOL was assessed at baseline, week 4 (end of multidisciplinary intervention), week 8, and week 27. Results Of the 103 participants, overall QOL at week 4 was maintained by the patients in the intervention (n = 49), whereas QOL at week 4 significantly decreased for patients in the control group (n = 54). This change reflected a 3-point increase from baseline in the intervention group and a 9-point decrease from baseline in the control group (P = .009). Intervention participants maintained their QOL, and controls gradually returned to baseline by the end of the 6-month follow-up period. Conclusion Although intervention participants maintained and actually improved their QOL during radiation therapy, control participants experienced a significant decrease in their QOL. Thus, a structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment.
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Affiliation(s)
- Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic Cancer Center, and Medical Social Services, Mayo Clinic, Rochester MN 55905, USA.
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