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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