Group support for patients with metastatic cancer. A randomized outcome study.
01 May 1981-Archives of General Psychiatry (American Medical Association)-Vol. 38, Iss: 5, pp 527-533
TL;DR: Objective evidence is provided that a supportive group intervention for patients with metastatic cancer results in psychological benefit and mechanisms underlying the effectiveness of this group intervention are explored.
Abstract: • The effects of weekly supportive group meetings for women with metastatic carcinoma of the breast were systematically evaluated in a one-year, randomized, prospective outcome study. The groups focused on the problems of terminal illness, including improving relationships with family, friends, and physicians and living as fully as possible in the face of death. We hypothesized that this intervention would lead to improved mood, coping strategies, and self-esteem among those in the treatment group. Eighty-six patients were tested at four-month intervals. The treatment group had significantly lower mooddisturbance scores on the Profile of Mood States scale, had fewer maladaptive coping responses, and were less phobic than the control group. This study provides objective evidence that a supportive group intervention for patients with metastatic cancer results in psychological benefit. Mechanisms underlying the effectiveness of this group intervention are explored.
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TL;DR: Findings provide limited support for use of nonpharmacological interventions to manage cancer-related fatigue, and the lack of research with heightened fatigue as an eligibility criterion is a notable weakness of the existing evidence base.
Abstract: Cancer-related fatigue has been defined as “a persistent subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning” (Mock et al., 2000). Studies suggest it is among the most common symptoms experienced by cancer patients with advanced disease and those being treated with radiotherapy and chemotherapy (Ahlberg, Ekman, Gaston-Johansson, & Mock, 2003). Furthermore, fatigue does not appear to be limited to the active treatment period. Many individuals with no clinical evidence of disease continue to experience fatigue for months or even years following treatment completion (Servaes, Verhagen, & Bleijenberg, 2002). The clinical significance of fatigue has been examined primarily in terms of its impact on quality of life. Among patients treated with chemotherapy or radiotherapy, more than one third perceived that fatigue interfered with their ability to work, relationships with others, and physical and emotional well-being (Vogelzang et al., 1997).
Mechanisms involved in the development and persistence of cancer-related fatigue are only partially understood. Available evidence suggests that fatigue can occur as a consequence of metabolic changes associated with the underlying disease as well those induced by cancer treatments (Stasi, Abriani, Beccaglia, Terzoli, & Amadori, 2003). In addition, fatigue can occur as a concomitant of other common symptoms experienced by cancer patients (e.g., nausea, and pain; Stasi et al., 2003). A growing body of research also suggests that cognitive and behavioral factors may contribute to exacerbation and persistence of fatigue (Stasi et al., 2003). With regard to behavioral factors, attention has focused on the role of physical activity. Preliminary evidence suggests that cancer patients who reduce their physical activity may experience a worsening and perpetuation of fatigue due to reductions in cardiorespiratory fitness or muscle weakening (Ahlberg et al., 2003). With regard to cognitive factors, several studies have shown that the tendency to catastrophize (i.e., have negative expectations regarding one’s ability to cope with fatigue) is associated with worse fatigue (Broeckel, Jacobsen, Horton, Balducci, & Lyman, 1998; Donovan, Small, Andrykowski, Munster, & Jacobsen, 2007; Jacobsen, Andrykowski, & Thors, 2004; Jacobsen, Azzarello, & Hann, 1999).
Research bearing on the management of fatigue can be divided into studies that have evaluated pharmacological or nonpharmacological approaches. In drawing this distinction, we note the lack of any studies that have formally evaluated a combination of pharmacological and nonpharmacological approaches. The current review focuses on the body of scientific evidence regarding the efficacy of nonpharmacological approaches for the management of cancer-related fatigue. As described below, previous reviews suggest this literature can be divided into activity-based interventions and psychological interventions. Activity-based interventions include professionally supervised programs and unsupervised (i.e., home-based) programs designed to promote exercise activity. Psychological interventions represent a more heterogeneous set of approaches that can include cognitive– behavioral therapy, supportive therapy, supportive-expressive therapy, and psychoeducation.
To date, there has been one systematic review (Lawrence, Kupelnick, Miller, Devine, & Lau, 2004) and no meta-analysis encompassing both psychological and activity-based interventions for people with cancer. The previous review, which included studies published through 2001, sought to identify all English language articles that dealt with the assessment, occurrence, and treatment of fatigue in cancer patients. With regard to treatment studies, the search identified 10 randomized controlled trials (RCTs) assessing the efficacy of interventions for cancer-related fatigue. Although specific search items used were not described, the results of our search (described below) suggest they may have been too narrow to result in identification of all relevant studies. This earlier review identified four principal methodological concerns with the existing treatment literature. First, reporting of the basic design elements was found to be inconsistent across studies. Second, studies typically evaluated numerous endpoints without identifying those that were of primary interest and without identifying effect sizes that would be considered clinically important. Third, because endpoints were typically not defined prospectively, sample sizes in these studies were viewed as having been chosen arbitrarily. Fourth, the patient populations in several trials were quite heterogeneous with regard to cancer types and treatments. This heterogeneity was considered responsible for much of the observed variance in fatigue in these trials. With regard to the efficacy of nonpharmacological interventions, the authors concluded that the results of two trials suggested exercise (Dimeo, Stieglitz, Novelli-Fischer, Fetscher, & Keul, 1999; Mock et al., 1997) might be helpful in reducing or preventing cancer-related fatigue.
The objective of this review is to provide a systematic evaluation of the efficacy of nonpharmacological interventions on fatigue in people with cancer. Toward this end, we sought to identify all RCTs of activity-based and psychological interventions conducted with adults with cancer in which fatigue was assessed as an outcome and to evaluate the efficacy of these interventions against fatigue using qualitative and quantitative methods. As part of the review, we also evaluated the methodological quality of these trials.
282 citations
TL;DR: The data indicate that social support is multidimensional, suggesting an interactive process whereby family support improves outlook, both outlook and opportunities for social exchange are related to one's sense of social functioning.
279 citations
TL;DR: There are data to support the use of some CAM modalities in terminally ill patients, and evidence-based recommendations are generated and areas for future research are identified.
279 citations
TL;DR: Women who participated in thematic counseling were significantly less depressed and less anxious and had more knowledge of their illness, better relationships with care givers, fewer sexual difficulties, and more participation in leisure activities.
Abstract: Many clinicians use group support to reduce the psychosocial difficulties of persons with cancer. This study compared the long-term benefits of a thematic counseling model used both as a structure for group support and for counseling patients individually. The thematic model included eight counseling sessions focused on information about cancer and positive health strategies such as progressive relaxation, diet, and exercise. The psychosocial status of women newly diagnosed with gynecologic cancer was assessed before the counseling, immediately after counseling, and again 6 months later. The women who participated in thematic counseling were significantly less depressed and less anxious and had more knowledge of their illness, better relationships with care givers, fewer sexual difficulties, and more participation in leisure activities. Data confirmed the model to be equally helpful whether it was used as a structure for individual counseling or more cost-effective group counseling. This model is easily adaptable to the needs of persons with other forms of cancer.
273 citations
TL;DR: Although no one treatment is proven to alleviate cancer-related fatigue a number of strategies show therapeutic promise and there is a growing body of literature which documents the extent and severity of fatigue in cancer populations.
272 citations
References
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TL;DR: In this paper, the effects of reward or reinforcement on preceding behavior depend in part on whether the person perceives the reward as contingent on his own behavior or independent of it, and individuals may also differ in generalized expectancies for internal versus external control of reinforcement.
Abstract: The effects of reward or reinforcement on preceding behavior depend in part on whether the person perceives the reward as contingent on his own behavior or independent of it. Acquisition and performance differ in situations perceived as determined by skill versus chance. Persons may also differ in generalized expectancies for internal versus external control of reinforcement. This report summarizes several experiments which define group differences in behavior when Ss perceive reinforcement as contingent on their behavior versus chance or experimenter control. The report also describes the development of tests of individual differences in a generalized belief in internal-external control and provides reliability, discriminant validity and normative data for 1 test, along with a description of the results of several studies of construct validity.
21,451 citations
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01 Jan 1969
TL;DR: In this article, the implications of terminal illness for patients and for those involved in their care were discussed, and patients invited to talk about their experience found great relief in expressing their fear and anger and were able to move towards a state of acceptance and peace.
Abstract: Although most areas of human experience are nowadays discussed freely and openly, the subject of death is still surrounded by conventional attitudes and reticence that offer only fragile comfort because they evade the real issues. The dying may thus be denied the opportunity of sharing their feelings and discussing their needs with family, friends, or hospital staff. Although receiving devoted medical care, a dying patient is often socially isolated and avoided, since professional staff and students can find contact painful and embarrasing.
Aware of the strains imposed on all sides by this situation, Dr Kubler-Ross established a seminar at the University of Chicago to consider the implications of terminal illness for patients and for those involved in their care. Patients invited to talk about their experience often found great relief in expressing their fear and anger and were able to move towards a state of acceptance and peace. The seminar, initially composed of students of medicine, sociology, psychology, and theology, but later joined by hospital staff and relatives of patients, enabled many members to come to terms with their own feelings and to respond constructi to what the patients had to teach them.
5,220 citations
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TL;DR: A study of 800 outpatient visits to Children's Hospital of Los Angeles as discussed by the authors explored the effect of verbal interaction between doctor and patient on patient satisfaction and follow-through on follow-up.
Abstract: Study of 800 outpatient visits to Childrens Hospital of Los Angeles to explore the effect of the verbal interaction between doctor and patient on patient satisfaction and follow-through on...
947 citations