A Cognitive Behavioral Intervention for Symptom Management in Patients With Advanced Cancer

Indiana University Bloomington, Bloomington, Indiana, United States
Oncology Nursing Forum (Impact Factor: 2.79). 12/2005; 32(6):1190-8. DOI: 10.1188/05.ONF.1190-1198
Source: PubMed


To evaluate the effectiveness of a cognitive behavioral intervention in decreasing symptom severity in patients with advanced cancer undergoing chemotherapy.
Prospective, randomized clinical trial based on cognitive behavioral theory.
Six urban cancer centers in the midwestern United States.
124 patients 21 years of age or older were recruited and randomized to receive conventional care or conventional care and an intervention. Participants were newly diagnosed with stage III, stage IV, or recurrent cancer (solid tumor or non-Hodgkin lymphoma), undergoing chemotherapy, cognitively intact, and able to read and speak English.
Data were gathered via telephone interviews at baseline and 10 and 20 weeks after randomization. Nurses with experience in oncology delivered a five-contact, eight-week intervention aimed at teaching patients problem-solving techniques to affect symptom severity.
Gender, site of cancer, age, symptom severity and depressive symptoms at baseline, group (i.e., experimental versus control), and total symptom severity.
Patients in the experimental group and those with lower symptom severity at baseline had significantly lower symptom severity at 10 and 20 weeks; the experimental difference at 20 weeks occurred primarily in those 60 years of age and younger. Depressive symptoms at baseline predicted symptom severity at 20 weeks; however, age, gender, and site of cancer did not affect symptom severity at either time point.
A cognitive behavioral intervention to teach problem-solving skills can be effective for patient symptom self-management during and following an intervention.
Problem-solving strategies should be included in educational programs for patients with advanced cancer, particularly those 60 years of age and younger.

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    • "A meta-analysis of psychosocial interventions in cancer patients found an average effect size (standardized difference between means) of 0.41 for treatment-and disease-related symptoms (Meyer and Mark, 1995). Such symptom management interventions generally focus on either a single cancer site or a single symptom (Doorenbos et al., 2005; Given et al., 2004; Sherwood et al., 2005), mostly fatigue, pain or insomnia (Miaskowski et al., 2004; Oliver et al., 2001; Pickett et al., 2002; Quesnel et al., 2003). Yet these symptoms rarely occur alone (Dodd et al., 2001; Doorenbos et al., 2005). "
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    ABSTRACT: The multiplicity and complexity of symptoms in patients treated with chemotherapy requires multifaceted symptom management interventions. The aim of this systematic review was to describe the characteristics and evaluate the effectiveness of complex nursing interventions that target multiple symptoms in patients receiving chemotherapy. We searched Medline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials for randomized controlled trials that compared complex nursing interventions to usual care and that provided data on symptom prevalence, severity, distress or limitations. Characteristics of the interventions were described in a narrative way. Regarding the effectiveness of the interventions, ratios of means were calculated in order to present data in a comparable and clinically interpretable way. We included 11 studies, some with considerable risk of bias. Despite being heterogeneous, the interventions have patient education, symptom assessment and coaching in common. Although some interventions fail to show significant effects, others significantly reduce aspects of symptom burden by 10-88%. Although some complex nursing interventions in this systematic review produce clinically meaningful and statistically relevant reductions in symptom burden, based on the available data it is not possible to make definitive conclusions about the vital parts, circumstances or preferred target population of the interventions. Quality of the studies and modeling and piloting of the interventions are important challenges for future research.
    International journal of nursing studies 09/2013; 51(3). DOI:10.1016/j.ijnurstu.2013.08.008 · 2.90 Impact Factor
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    • "The 2001 Institute of Medicine (IOM) report, Crossing the Quality Chasm, indicated that the US health care system fails to effectively manage important symptoms (eg, pain and fatigue) in those with chronic diseases, such as cancer. This is particularly disturbing because of the fact that effective symptom management can produce improvements in quality of life (Given et al., 2004; Sherwood et al., 2005; Sikorskii et al., 2007) and, in some cases, even lengthen survival (Temel et al., 2010) for cancer patients. Several barriers to effective symptom management exist, including underdetection and undertreatment of symptoms, inadequate monitoring of symptom response and adherence to treatment regimens, and the failure to adjust treatment in patients whose symptoms persist in spite of initial interventions (Kroenke et al., 2009). "
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    ABSTRACT: Pain and depression are 2 of the most common and disabling cancer-related symptoms. In the Indiana Cancer Pain and Depression trial, 202 cancer patients with pain and/or depression were randomized to the intervention group and received centralized telecare management augmented by automated symptom monitoring (ASM). Over the 12-month trial, the average patient completed 2 ASM reports and 1 nurse call per month. Satisfaction with both ASM and care management was high regardless of patient characteristics or cancer type. Adherence was also generally good, although several predictors of fewer ASM reports and nurse calls were identified. Only a minority of ASM reports triggered a nurse call, suggesting the efficiency of coupling clinician-delivered telecare management with automated monitoring.
    The Journal of ambulatory care management 04/2011; 34(2):126-39. DOI:10.1097/JAC.0b013e31820ef628
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    • "In clinical practice, healthcare providers are faced with trying to assist older breast cancer survivors in managing these symptoms. Yet, with a few exceptions (Sherwood et al., 2005), research has focused on testing symptom interventions that address a single symptom (Dodd et al., 2001). "
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    ABSTRACT: To test the feasibility and acceptability of an individualized representational intervention to improve symptom management (IRIS) in older breast cancer survivors and test the short-term effects of an IRIS on symptom distress. Two small randomized clinical trials and one pre-experimental study. Oncology clinic and community. 41 women with breast cancer (aged 65 years and older) in pilot study 1, 20 in pilot study 2, and 21 in pilot study 3. In pilot study 1, women were randomized to the IRIS or usual care control. In pilot study 2, women were randomized to the IRIS or delayed IRIS (wait list) control. In pilot study 3, all women received the IRIS by telephone. Measures were collected at baseline, postintervention, and follow-up (up to four months). Feasibility, acceptability, symptom distress, symptom management behaviors, symptom management barriers, and quality of life. Across three pilot studies, 76% of eligible women participated, 95% completed the study, 88% reported the study was helpful, and 91% were satisfied with the study. Some measures of symptom distress decreased significantly after the IRIS, but quality of life was stable. Women in the IRIS group changed their symptom management behaviors more than controls. Preliminary evidence supports the need for and feasibility of an IRIS. Nurses may help older breast cancer survivors manage their numerous chronic symptoms more effectively by assessing women's beliefs about their symptoms and their current symptom management strategies.
    Oncology Nursing Forum 06/2009; 36(3):E133-43. DOI:10.1188/09.ONF.E133-E143 · 2.79 Impact Factor
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