Stanton AL, Ganz PA, Kwan L, et al. Outcomes from the moving beyond cancer psychoeducational, randomized, controlled trial with breast cancer patients

Department of Psychiatry, Georgetown University, Washington, Washington, D.C., United States
Journal of Clinical Oncology (Impact Factor: 18.43). 10/2005; 23(25):6009-18. DOI: 10.1200/JCO.2005.09.101
Source: PubMed


Evidence suggests that the re-entry phase (ie, early period after medical treatment completion) presents distinct challenges for cancer patients. To facilitate the transition to recovery, we conducted the Moving Beyond Cancer (MBC) trial, a multisite, randomized, controlled trial of psychoeducational interventions for breast cancer patients.
Breast cancer patients were registered within 6 weeks after surgery. After medical treatment, they completed baseline measures and were randomly assigned to standard National Cancer Institute print material (CTL); standard print material and peer-modeling videotape (VID); or standard print material, videotape, two sessions with a trained cancer educator, and informational workbook (EDU). Two primary end points were examined: energy/fatigue and cancer-specific distress. Secondary end points were depressive symptoms and post-traumatic growth. Perceived preparedness for re-entry was analyzed as a moderator of effects.
Of 558 women randomly assigned to treatment, 418 completed the 6-month assessment and 399 completed the 12-month assessment. In analyses controlling for study site and baseline depressive symptoms, VID produced significant improvement in energy/fatigue at 6 months relative to CTL, particularly among women who felt less prepared for re-entry at baseline. No significant main effect of the interventions emerged on cancer-specific distress, but EDU prompted greater reduction in this outcome relative to CTL at 6 months for patients who felt more prepared for re-entry. Between-group differences in the primary outcomes were not significant at 12 months, and no significant effects emerged on the secondary end points.
A peer-modeling videotape can accelerate the recovery of energy during the re-entry phase in women treated for breast cancer, particularly among those who feel less prepared for re-entry.

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    • "In general, findings demonstrate accelerated improvement in the intervention group, compared with the control condition, on such outcomes as depressive symptoms and negative mood (Dolbeault et al., 2009; Marcus et al., 2010), fatigue (Dolbeault et al., 2009; Stanton et al., 2005), sexual dysfunction (Marcus et al., 2010), quality of life (Meneses et al., 2007), and cancer-related benefit finding (Marcus et al., 2010). All conducted with breast cancer survivors, most interventions evidenced positive effects 1 to 6 months later (Dolbeault et al., 2009; Meneses et al., 2007; Stanton et al., 2005), and some positive effects persisted through 18 months (Marcus et al., 2010). Few controlled trials of interventions to promote return to work during reentry are available (Hoving, Broekhuizen, & Frings-Dresen, 2009), although multidisciplinary approaches (e.g., physical exercise, education, counseling) show promise (de Boer et al., 2011). "
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    ABSTRACT: The number of individuals living with a history of cancer is estimated at 13.7 million in the United States and is expected to rise with the aging of the population. With expanding attention to the psychosocial and physical consequences of surviving illness, psychological science and evidence-based practice are making important contributions to addressing the pressing needs of cancer survivors. Research is demonstrating that adults diagnosed with cancer evidence generally positive psychosocial adjustment over time; however, a subset is at risk for compromised psychological and physical health stemming from long-term or late effects of cancer and its treatment. In this article, we characterize survivorship after medical treatment completion during the periods of reentry, early survivorship, and long-term survivorship. We describe the major psychosocial and physical sequelae facing adults during those periods, highlight promising posttreatment psychosocial and behavioral interventions, and offer recommendations for future research and evidence-based practice. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    American Psychologist 02/2015; 70(2):159-174. DOI:10.1037/a0037875 · 6.87 Impact Factor
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    • "For example, pilot testing of a self-management intervention with face-to-face and telephone contact (the Taking Charge intervention [20]) showed beneficial effects on dealing with post-treatment concerns. The Moving Beyond Cancer randomised controlled trial [21] demonstrated beneficial effects of psychoeducational print material and peer modeling videos for BCS on regaining energy in the re-entry phase. "
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    ABSTRACT: Background After completion of curative breast cancer treatment, patients go through a transition from patient to survivor. During this re-entry phase, patients are faced with a broad range of re-entry topics, concerning physical and emotional recovery, returning to work and fear of recurrence. Standard and easy-accessible care to facilitate this transition is lacking. In order to facilitate adjustment for all breast cancer patients after primary treatment, the BREATH intervention is aimed at 1) decreasing psychological distress, and 2) increasing empowerment, defined as patients’ intra- and interpersonal strengths. Methods/design The non-guided Internet-based self-management intervention is based on cognitive behavioural therapy techniques and covers four phases of recovery after breast cancer (Looking back; Emotional processing; Strengthening; Looking ahead). Each phase of the fully automated intervention has a fixed structure that targets consecutively psychoeducation, problems in everyday life, social environment, and empowerment. Working ingredients include Information (25 scripts), Assignment (48 tasks), Assessment (10 tests) and Video (39 clips extracted from recorded interviews). A non-blinded, multicentre randomised controlled, parallel-group, superiority trial will be conducted to evaluate the effectiveness of the BREATH intervention. In six hospitals in the Netherlands, a consecutive sample of 170 will be recruited of women who completed primary curative treatment for breast cancer within 4 months. Participants will be randomly allocated to receive either usual care or usual care plus access to the online BREATH intervention (1:1). Changes in self-report questionnaires from baseline to 4 (post-intervention), 6 and 10 months will be measured. Discussion The BREATH intervention provides a psychological self-management approach to the disease management of breast cancer survivors. Innovative is the use of patients’ own strengths as an explicit intervention target, which is hypothesized to serve as a buffer to prevent psychological distress in long-term survivorship. In case of proven (cost) effectiveness, the BREATH intervention can serve as a low-cost and easy-accessible intervention to facilitate emotional, physical and social recovery of all breast cancer survivors. Trial registration This study is registered at the Netherlands Trial Register (NTR2935)
    BMC Cancer 09/2012; 12(1):394. DOI:10.1186/1471-2407-12-394 · 3.36 Impact Factor
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    • "In a trial with a fatigue endpoint, the CG received standard print material, IG group 1 an additional peermodelling videotape, and IG 2 an additional videotape, two sessions with a trained cancer educator, and informational workbook . IG 1 improved in fatigue significantly at 6 months compared to the CG (Stanton et al., 2005). Another study applied a cognitivebehavioural therapy approach resulting in small to medium effects on CRF (Dolbeault et al., 2009). "
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    ABSTRACT: OBJECTIVE: To evaluate a patient education program that aims at reducing perceived fatigue in cancer survivors. METHODS: In ten German centres, 261 patients with cancer-related fatigue were randomly assigned to a patient education program consisting of 6 sessions à 90 min or standard care. The primary outcome measure was cancer-related fatigue. Data were analysed using analysis of variance (ANOVA) with repeated measures. RESULTS: Patients in the intervention group showed statistically significant reduction in cancer-related fatigue (F = 76.510, p < 0.001, η(2) = 0.248). Secondary outcomes also showed significant improvements in all measures, including quality of life (F = 29.607, p < 0.001, η(2) = 0.113), general self-efficacy (F = 27.680, p < 0.001, η(2) = 0.107), exercise self-efficacy (F = 49.230, p < 0.001, η(2) = 0.175), physical activity (F = 8.036, p < 0.001, η(2) = 0.033), anxiety (F = 33.194, p < 0.001, η(2) = 0.125), depression (F = 24.604, p < 0.001, η(2) = 0.096), and fatigue knowledge (F = 55.157, p < 0.001, η(2) = 0.192). CONCLUSION: The program was effective in reducing perceived fatigue as well as further outcomes. PRACTICE IMPLICATIONS: This newly developed education program has the potential to fill a gap in the care of cancer survivors. The program needs further evaluation in other countries employing a control group of patients receiving equal time and attention as the intervention group.
    European journal of oncology nursing: the official journal of European Oncology Nursing Society 08/2012; 17(2). DOI:10.1016/j.ejon.2012.07.002 · 1.43 Impact Factor
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