Meeting Psychosocial Needs of Women with Breast Cancer (2004) / Chapter Skim
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5 The Effectiveness of Psychosocial Interventions for Women with Breast Cancer
5 The Effectiveness of Psychosocial Interventions for Women with Breast Cancer
Pages 95-132
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From page 95... ...
IncluclecI are publishecI ranclomizecI trials ancI selectecI non-ranclomizecI studies that were clesignecI to evaluate the effectiveness of psychosocial interventions for women with breast cancer.4 ExcluclecI is the psychosocial literature in other cancers or in mixed groups of cancer patients, in which only some patients have breast cancer. Also not covered is the extensive literature relating to psychological issues surrouncIing breast cancer screening or identification of high-risk inclivicluals.
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From page 96... ...
might prolong survival in women living with metastatic breast cancer (Spiegel et al., 1989~. This observation heightened interest in survival effects of psychosocial interventions ancI lecI to a series of intervention studies in breast cancer (Classen et al., 2001; Cunningham et al., 1998; Eclelman et al., 1999a; Goodwin et al., 2001)
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From page 97... ...
Meyer ancI Mark concluctecI a meta-analysis of psychosocial interventions in aclult cancer patients (Meyer ancI Mark, 19951. Effect sizes (treatment mean minus control mean cliviclecI by poolecI stanciarcI cleviation)
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From page 98... ...
places it at the conservative encI of the spectrum of analyses anti may have resultecI in important effects of psychosocial interventions being missed or unclervaluecI. Nevertheless, the BoarcI realizes that attention neecis to be paicI to stronger research clesigns in future studies.
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From page 99... ...
Although ranclomizecI trials have been recognized as the goicI stanciarcI since the micI-twentieth century, concerns have been raisecI that they may not be the most appropriate stucly design for evaluation of psychosocial interventions in cancer patients, in part because patient commitment to the intervention is cleemecI an important predictor of benefit from the intervention (Cunningham et al., 19981. It has been argued that if patients are willing to be ranclomizecI to a control arm, they are not as strongly committed to the intervention, ancI this will leacI to an underestimation of the benefits of the intervention.
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From page 100... ...
are important determinants of benefit, then selection of an attention control group may be more appropriate. The selection of control conditions will become an even more challenging issue as the benefits of psychosocial interventions are increasingly accepted by the meclical community anti these interventions become stanciarcI care; these interventions will then become the control or comparison arm in future studies.
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From page 101... ...
. Although, in the long term, intervention studies may clemonstrate that the effectiveness of psychosocial interventions cloes not vary across cancer type or cancer stage, this is not known a priori.
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From page 102... ...
The interventions that were investigated in the reports reviewed here often involvecI more than one potentially active component. For example, group therapy, relaxation/self-hypnosis, ancI teaching of coping skills were incluclecI in a single intervention (Cunningham et al., 19981.
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From page 103... ...
QLQ-C30 (see Chapter 31. The selection of quality of life anti psychosocial outcome measures in ranclomizecI trials in breast cancer patients, anti the ability of these instruments to identify changes when various interventions are cleliverecI, has recently been reviewed by Ganz anti Goodwin (Ganz anti Goodwin, 20031.
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From page 104... ...
When outcomes are interview-basecI, interviewers shouicI be blinclecI to randomization allocation. Finally, cost anti feasibility assessments to allow the possible balancing of benefits against costs of psychosocial interventions or programs shouicI be incluclecI insofar as is possible anti consistent with the abilities of the investigators, time anti money resources available, anti capacities of the settings.
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From page 105... ...
For example, if the intervention being tested is intenclecI to clear with a current problem, like getting through physical treatments like surgery, radiation, or chemotherapy, a long follow-up may not be required anti couicI leacI to an erroneous conclusion that the treatment was not effective because its effects clicI not last until the final follow-up. Also, since trials of psychosocial interventions evaluatecI here are often appliecI to the whole population of women with breast cancer, they may inclucle some women who wouicI not have, or wouicI not clevelop, psychosocial problems.
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From page 106... ...
The reports thus iclentifiecI were incluclecI in this review if they clescribecI ranclomizecI trials of psychosocial interventions in breast cancer patients, ancI they proviclecI information on psychosocial anchor biomeclical outcomes. Pilot studies were incluclecI if they met these criteria, but not if they clicI not compare stucly arms (i.e., presentation of before/after ciata within stucly arms as the only outcome was not aclequate)
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From page 107... ...
The majority of this psychosocial intervention research in breast cancer has been concluctecI in the United States (16 of 31 studies, 52 percent) , anti 13 of the studies examined group interventions (Anton)
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From page 109... ...
, ancI descriptive studies that focus on identifying psychosocial problems in this group ancI that determine the prevalence of these problems, as well as those at risk, are probably neeclecI to guicle clevelopment of interventions that can be tested in full-flecigecI ranclomizecI trials. Review of Clinical Trials This section of the chapter reviews each of the 31 ranclomizecI trials of psychosocial interventions in women with breast cancer iclentifiecI in the literature search.
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From page 110... ...
Maguire et al. reported the first ranclomizecI psychosocial intervention trial in breast cancer (Maguire et al., 1983, 1980)
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From page 111... ...
Counseling failecI to prevent morbidity; however, the nurses' regular monitoring of the women lecI to more appropriate psychiatric referral, anti subsequent psychiatric intervention reclucecI psychiatric morbidity as well as anxiety anti depression. This early trial provides the first evidence of benefit of a psychosocial intervention in women with breast cancer.
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From page 112... ...
ranclomizecI 36 women with newly cliagnosecI nonmetastatic breast cancer to weekly, psychologist lecI incliviclual cognitive psychotherapy combined with bi-monthly family counseling, or to stanciarcI care (Marchioro et al., 19961. The duration of the intervention was not clescribecI.
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From page 113... ...
Although this was a small pilot study, there was evidence of enhanced coping skills in both the support anti the relaxation/imagery groups (more significant in the former) , ancI there was evidence that women in both intervention arms sought more support from others than women in the control arm.
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From page 114... ...
This may have led to non-comparability of the study groups and interference with detection of potential psychological benefits. I(oicaba and Fox randomized 53 women to use a guided imagery aud~otape daily during radiation therapy and for three weeks later or to a no treatment control arm (I(oicaba and Fox, 19991.
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From page 115... ...
Bultz et al., in a unique study, ranclomizecI 36 partners of breast cancer patients to a psycho-eclucational group lecI by two psychologists that took place weekly for 6 weeks or to a control arm (Bultz et al., 20001. Both patients ancI their partners were followecI until 3 months after the completion of the intervention.
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From page 116... ...
education anti facilitatecI peer discussion. There was also a non-treatment control arm (Heigeson et al., 1999, 2000, 20011.
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From page 117... ...
Molassiotis et al. ranclomizecI 71 women receiving their first cycle of chemotherapy for stage I to III breast cancer to a relaxation/imagery intervention or to a control arm (Molassiotis et al., 20021.
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From page 118... ...
ranclomizecI 164 women uncler the age of 50 who were receiving acljuvant chemotherapy for stage I to III breast cancer to a brief intervention with an oncology nurse or to a control arm (Allen et al., 20021. The intervention consisted of two in-person ancI four telephone sessions over a 12-week period.
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From page 119... ...
reported the first ranclomizecI trial of a psychosocial intervention in metastatic breast cancer (Spiegel et al., 1989,1981; Spiegel anti Bloom, 19831. He randomized 86 women to participate in weekly expressive-supportive group therapy that incluclecI hypnosis for pain control or to a control arm.
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From page 120... ...
Eclelman et al. ranclomizecI 121 women with metastatic breast cancer to a group cognitive-behavioral therapy program or to a control arm (Eclelman et al., 1999a, l999b)
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From page 121... ...
Sessions were lecI by psychiatrists, psychologists, anti social workers. The control arm was offered eclucational materials.
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From page 122... ...
Studies involving couples counseling or partners of breast cancer patients are not incluclecI in these tables (Bultz et al., 2000; Christensen, 19831. Studies evaluating relaxation with or without imagery appear in the first section of Table B-3.
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From page 123... ...
The interventions in early stage breast cancer tenclecI to be shorter (6 to 12 weeks) than those concluctecI in metastatic breast cancer (5 months to encI of life)
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From page 124... ...
The interventions evaluatecI in these studies were quite variable, inclucling psychological interviews, telephone screening, incliviclual cognitive-behavioral therapy, ancI problem skills training as well as a variety of nursing interventions. These nursing interventions yielclecI somewhat mixed results.
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From page 125... ...
psychological interview, with or without a subsequent brief psychotherapy session (Burton et al., 19951. Maunsell's stucly of telephone screening for psychologic distress with referral of clistressecI patients to a social worker clicI not leacI to any iclentifiable psychological benefits (Maunsell et al., 19961.
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From page 126... ...
Studies Using Non-Ranclomizec! Designs There is an extensive literature describing a variety of psychosocial interventions in cancer using non-ranclomizecI designs.
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From page 127... ...
Targ anti Levine (2002) evaluatecI a multifactorial mincI-bocly-spirit group intervention ancI suggested that these alternative therapy interventions will be well received by women with breast cancer ancI that they may provide psychosocial benefit similar to more traclitional psychosocial interventions.
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From page 128... ...
carried out a pilot stucly of interpersonal psychotherapy aciministerecI by telephone to cancer patients receiving high close chemotherapy anti their partners (Donnelly et al., 20001. They reported the feasibility of the intervention anti that participants were satisfied with the intervention.
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From page 129... ...
2000. A randomized controlled trial of a brief psychoeducational support group for partners of early stage breast cancer patients.
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From page 130... ...
1999. Psychological response to long-term group therapy: A randomized trial with metastatic breast cancer patients.
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From page 131... ...
1995. Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomized experiments.
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From page 132... ...
1999. Effects of a nursing intervention on subjective distress, side effects and quality of life of breast cancer patients receiving curative radiation therapy a randomized study.
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