Psychological Interventions in Patients with Cancer

Psychological Interventions in Patients with malignant neoplastic diseaseIntroductionPatients with genus Cancer whitethorn visit comorbid conditions such as perplexity and opinion, and symptoms including weariness, na aima and vomiting. Anxiety and stamp ar both in truth vulgar and it has been estimated that 1625% of newly diagnosed shtupcer patients experience tot every last(predicate)y depression or depressed mood (DSM-IV criteria) (Sellick 1999). Studies in wo workforce with nipple crabby person deport ordern that up to 30% develop mental morbidity ( both anxiety or depressive disorder) inwardly one socio-economic class of diagnosis (Bleiker 2000 Maguire 2000). Cancer-related symptoms ar alike very common. As many as 7080% of all pubic louse patients receiving chem oppositeapy experience nausea and vomiting (Lindley et al. 1989 Morrow 1992) and 78% of patients are estimated to be touched by fatigue (Ashbury et al. 1998), in particular those with adforefron tced crab louse and those receiving beam of light and chemotherapy sermon (Ahlberg et al. 2003 Jacobsen et al. 2007), where symptoms may persist even afterwards(prenominal) intercession has washed-up (Servaes et al. 2002).The use of psychological interventions can be advantageous in the perplexity of cancer-related conditions and symptoms and may declaration in improved timber of life and bring out long-term returns (Devine and Westlakes 1995). Psychological interventions may be classified into four assorts (which in any case take broader psychosocial interventions) as described below (Fawzy et al.1995 Greer 2002 Edwards et al. 2004)Cognitive behavioural interventions pertain the identification and correction of those thoughts, feelings and behaviours that may be involved in the teaching and/or maintenance of cancer-related symptoms or conditions (Jacobsen 1998). idiosyncratic psychotherapy interventions involve one-to-one interaction between patient and therapist, aimed at reducing feelings of sorrow and make up the patients morale, self-esteem and ability to cope (Fawzy et al. 1995)Educational interventions offer up patients with information about cancer, ways of coping with the disease and what resources are on tap(predicate) to help them, with the aim of reducing comm solitary(prenominal) experienced feelings such as inadequacy, confusion, helplessness and loss of crack (Fawzy et al. 1995). stem interventions may be every patient led or led by health bearing professionals and administer to pull up stakes social financial abide for cancer patients (Leszcz and Goodwin 1998). sensation intervention within this category, supportive-expressive group therapy, involves building bonds, expressing emotions, improving the relationship between patient and healthcare professional and improving coping skills (Edwards et al. 2004).It is in any case important to consider the strength of other interventions, such as the use of complementary therapies, which may be utilise alongside psychological interventions to achieve a greater upbeat in cancer-related conditions and symptoms than those obtained development psychological interventions alone.This paper reports the process and findings of a literary productions critical surveil performed to identify and evaluate produce literature on psychological interventions in patients with cancer, and other interventions that may as well as be effective in achieving improved psychological upshots, together with a discussion of how the present self-possessed may guide informed decision-making on best clinical practice. information sources and search strategyElectronic searches were performed on the Medline, CINAHL and PsychINFO databases for English language articles make between 1998 and 2008. Search terms included cancer AND intervention OR cancer AND therapy plus education OR patient education OR educational OR cognitive behavioural OR cognitive OR psychotherapy OR psychological OR supportive-expressive OR supportive OR group psychotherapy. For each campaign, the character of both the rill itself and the report in the published literature were assessed.Literature reviewMain resultsWell- knowing, single or multicentre, randomised controlled examinations involving large study samples were selected for inclusion, together with systematic reviews and meta-analyses. Only UK published literature was originally planned for inclusion however, due to the express trope of high feeling, well- intentional studies place, searches were performed again to identify suitable non-UK articles. compendious of studies selectedCognitive behavioural interventionsOne randomised controlled trial and one systematic review were identified from the UK-published articles found during the electronic searches. The randomised controlled study by Moynihan et al. investigated the use of accessary psychological therapy in 73 men with newly diagnosed, non-suicidal men with testicular cancer (Moynihan et al. 1998). This is a cognitive behavioural treatment programme designed specifically for patients with cancer. The therapist was a mental health nurse with experience of caring for testicular patients and who was trained in adjuvant psychological therapy techniques. expiry measures included validated self-completed questionnaires such as the hospital Anxiety and slump Scale, the mental adjustment to cancer scale and the psychosocial adjustment to illness scale. The treatment group showed a minimal reduction in anxiety after 2 months and when adjustment for histology, stage of disease and type of treatment was made, the discovered effect was not significant. No between group differences in depression stimulates were as accepteded after 2 months. after 1 year, control patients actually achieved better anxiety and depression scores than those in the treatment group. This study thusly concluded that there was no take in from the use of adjuvant psychological therapy in men with testicular cancer.The systematic review performed by Richardson et al. evaluated the use of hypnosis for nausea and vomiting in patients with various types of cancer (Richardson et al. 2006). Study thespians were children in 5 of the 6 randomised controlled studies selected. Meta-analyses demonstrated a large effect size of hypnosis compared with standard treatment, and this effect was at to the lowest degree as large as that achieved with cognitive-behavioural therapy. Limitations of this review were that the sample sizes of the studies included were small, and rough of the studies were poorly described in the published literature. As the majority of the studies were conducted in children, go on seek is necessary in adults to confirm these findings.A enactment of non-UK published studies evaluating the use of cognitive-behavioural develop in patients with cancer were also identified. A randomised controlled study conducted by Korstjens et a l. investigated the set up of strong-arm plus cognitive-behavioural training compared with physical training alone on quality of life in 147 patients with various cancers who had completed treatment (Korstjens et al. 2008). Quality of life was measured using the RAND-36. After 12 weeks, there were no differences between groups in quality of life. It can therefore be concluded that adding cognitive-behavioural training had no added acquire on cancer survivors quality of life compared with physical training alone.Individual psychotherapeutic interventionsFenlon et al. conducted a randomised controlled trial to investigate the effect of peace training in reducing the incidence of hot flushes 150 women with immemorial breast cancer (Fenlon et al. 2008). Study participants in the treatment group real a single slackening training session in mating with the use of practice tapes. moment measures included a patient journal and validated measures of anxiety and quality of life. After 1 month, the incidence and scratchiness of hot flushes were significantly taked (pEducational interventionsA randomised controlled trial by Ream et al. evaluated an educational support intervention (i.e. investigator-designed information pack) for fatigue in 103 chemotherapy-nave cancer patients. Additional psychological support was also provided by nurses. After 3 months, the intervention group reported significantly less fatigue, pooh-pooh levels of anxiety, depression and distress, and better adaptive coping (all pJones et al. carried out a randomised trial to investigate whether different types of educational information could increase interaction between the patient and others, thereby improving emotional support and psychological well-being (Jones et al. 2006). A total of 325 patients with breast or prostate cancer who were about to begin radiotherapy participated in the study. Patients were given either a general information booklet on cancer or else a booklet containing personalised information. Outcome measures included the use of Likert scales to score answers to questions on anxiety and depression (non-validated) and Helgesons social support questionnaire. Results showed no differences between groups in anxiety or depression scores provided patients who received personalised information reported that they were more likely to show their booklet to others and believe it helped in discussions. These findings educe that this type of intervention may have the potential to improve emotional well-being by increase the levels of support patients receive from others.A systematic review conducted by smith et al. evaluated the effectiveness of mindfulness-based stress reduction as supportive therapy (Smith et al. 2005). This is a highly-structured psycho-educational, skill-based therapy that combines mindfulness meditation with hatha yoga. both randomised controlled and four uncontrolled trials were selected which used self-reported outcome measures for mood, stress, anxiety and quality of life. Study findings showed improvements in mood and sleep quality and reductions in stress in patients following the use of this intervention. However, the studies included in this review largely involved small sample sizes and may therefore be underpowered. Furthermore, the quality of the written study manuscripts was variable for example, some contained limited descriptions of the randomisation process and a lack of methods on sampling and participant recruitment. While these results are encouraging and suggest that mindfulness-based stress reduction may be effective as a self-administered intervention for cancer patients, further research conducted through well-designed, randomised controlled trials is needed to confirm these preliminary findings. free radical psychological interventionsA non-UK published study was conducted to investigate the effectiveness of infirmary psychosocial support groups on emotional distress and quality of lif e in 108 women with breast cancer (Schou et al. 2007). Outcome measures involved the use of the validated Hospital Anxiety and depression Scale and the EORTC quality of life questionnaire. After 12 months, the prevalence of anxiety was significantly lower among group participants than in non-participants (19% vs 34% p=0.04). These findings suggest that psychosocial support appears to have a long-term benefit on anxiety although the effects of this intervention on depression and quality of life were inconclusive in this study.Another non-UK published randomised controlled trial has been conducted to investigate the effect of supportive-expressive group therapy compared with educational materials on distress in 125 women with metastatic breast cancer (Classen et al. 2001). Participants were offered either one year of weekly group therapy plus educational materials or educational materials only. Outcome measures included the Profile of Mood assigns (POMS) to assess mood disturbance a nd bear upon of Event Scale (IES) to assess change over time in trauma symptoms. Patients who received weekly therapy showed a significantly greater free fall in traumatic stress symptoms than those in the control group just now no between group differences in mood disturbance were observed. It can be concluded that supportive-expressive group therapy may offer some benefit in reducing distress in women with metastatic breast cancer.complementary/ utility(a) interventionsWilkinson et al. conducted a multicentre randomised controlled trial to investigate the effectiveness of aromatherapy rub off in the prudence of anxiety and depression in 288 patients with cancer diagnosed with clinical anxiety and/or depression (Wilkinson et al. 2007). Patients were randomised to receive either a course of aromatherapy rub down plus usual supportive care or supportive care only. Outcome measures included the validated State Subscale of the State Anxiety Inventory (SAI) and the Center for Epid emiological Studies Depression (CES-D) Scale. At 6 weeks post-randomisation, patients who received aromatherapy massage showed a significant improvement in clinical anxiety and/or depression compared with those receiving standard care only (p=0.001) scarce this effect was not sustained at 10 weeks post-randomisation (p=0.10) Patients receiving the aromatherapy intervention also recorded a greater improvement in self-reported anxiety at both 6 and 10 weeks than those in the control group (p=0.04). These results suggest that although aromatherapy massage may not confer long-term benefits to patients with cancer, short-term benefitsmmay be seen.Strengths and weaknesses of this literature reviewAs previously stated, one of the major limitations of this review was that the original searches only included UK-published articles. As a lack of impregnablely quality published research was identified, further searches were conducted to identify suitable non-UK articles to include in the rev iew. Although a number of studies were selected that recruited participants with various types of cancer, several studies involved patients with only breast cancer and only one study was conducted in men only. It may therefore be argued that the scope of this review was too narrow. One of the systematic reviews which were included (Richardson et al. 2007) involved small studies which were sometimes poorly designed or poorly written up. The findings of this systematic review should therefore be treated with caution until supported with data from randomised controlled trials.The strengths of this review are that well-designed randomised controlled trials were included, with sample sizes large enough for adequate power. The reports of these trials were generally good quality and comprehensively written with a logical flow. The aims and/or objectives were clearly stated, and descriptions of study design, participant recruitment and selection, and the randomisation process were included . Many of the outcome measures used were validated instruments, a description of all measures was included and eliminate statistical analyses were used to analyse the data.Implications for clinical practicePrevious research and systematic reviews have reported conflicting findings on whether psychological interventions for patients with cancer are beneficial or not (Greer 2002 Edwards et al. 2004). The current review also presents conflicting data on the benefits of psychological interventions in cancer patients. Two of the studies selected presented evidence that cognitive behavioural interventions provide no added benefit to cancer patients. Interestingly, a systematic review concluded that hypnosis may be beneficial but many of the studies were conducted in children so whether these findings are also observed in adults requires further investigation. Individual psychotherapeutic interventions such as relaxation training may be beneficial for breast cancer patients in reducing di stress although no improvement in anxiety or quality of life was observed. The effectiveness of these types of interventions in men and in patients with other types of cancer requires further research.Educational interventions and group psychological interventions produced the best outcomes of all the psychological interventions evaluated. In particular, the use of educational booklets and information packs, either used alone or in conjunction with psychological support, may result in improvements in psychological and emotional well-being in patients with cancer. Again, further research is needed to determine whether these types of interventions are beneficial in patients with all types of cancer. Psychosocial support groups and supportive-expressive group therapy have both been shown to be beneficial in women with breast cancer, particularly in reducing anxiety and distress. Further evidence is needed to demonstrate the effectiveness of these interventions in men. Complementary and /or alternative treatments such as aromatherapy may play a government agency as adjuvant therapies and can be beneficial in the short-term focal point of anxiety and depression in cancer patients.ConclusionsThis review has provided evidence that certain psychological interventions such as educational and group interventions may provide some benefit to cancer patients in the management of cancer-related conditions and symptoms including anxiety, depression, fatigue, nausea and vomiting. both short- and long-term improvements in quality of life and emotional well-being may be achievable using these interventions but further research is needed to provide the evidence to guide best practice.Psychological and psychiatric support go are currently unable to meet demand from oncology services and the oncology nurse is ideally placed to play a key role in the provision of psychological care and support for cancer patients, either directly or as part of a multidisciplinary team. For exampl e, educational interventions such as information leaflets can be developed and provided to patients by the oncology nurse, who would also able to lead group therapy sessions. It is essential that the nurse has sufficient familiarity of the most appropriate psychological intervention to use for patients and the skill and expertise to implement this effectively to ensure a successful outcome.BibliographyAhlberg, K., Ekman, T., Gaston-Johannson, F., Mock, V. 2003, Assessment and management of cancer-related fatigue in adults, Lancet, vol. 362, pp. 64050.Ashbury, F.D., Findlay, H., Reynolds, B., McKerracher, K. A., A Canadian survey of cancer patients experiences are their needs being met? Journal of distressingness and Symptom Management, vol. 16, no. 5, pp. 298306.Bleiker, E. M., Pouwer, F., van der Ploeg, H. M., Leer, J. W., Ader, H. 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Crooks, D. 1999, Depression and cancer an appraisal of the literature for prevalence, detection, and practice guideline development, Psycho-oncology, vol, 8, pp. 31533.Servaes, P., Verhagen, C., Bleijenberg, G. 2002, dash in cancer patients during and after treatment prevalence, correlates and interventions, European Journal of Cancer, vol. 38, pp. 2743.Smith, J. F., Richardson, J., Hoffman, C., Pilkington, K. 2005, Mindfulness-based stress reduction as supportive therapy in cancer care systematic review, Journal of Advanced Nursing, vol. 52, no. 3, pp. 31527.Wilkinson, S. M. , Love, S. B., Westcombe, A. M., Gambles, M. A., Burgess, C. C., Cargill, A., Young, T., Maher, E. J., Ramirez, A. J. 2007, Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer a multicenter, randomized controlled trial, Journal of Clinical Oncology, vol. 25, no. 5, pp. 5329.Table 1. Summary of main UK published studies selected