Advances in behavioral intervention in comprehensive cancer treatment

Abstract

This discussion reviews the current status of behavioral intervention with adult and pediatric cancer patients. The goal is to give the front-line clinician a basis for determining which behavioral intervention procedure to incorporate into clinical practice. After defining the term behavioral medicine and describing its new role in comprehensive cancer treatment, the discussion examines the use of behavioral procedures to control aversive side-effects of treatment. Although the control of chemotherapy side-effects is the primary focus (since most of the behavioral research on symptom control has dealt with reduction of nausea and vomiting with chemotherapy), the application of behavioral principles to other side-effects (i.e., anxiety and pain) associated with the aggressive treatment of cancer is assessed. The third topic is behavioral intervention to control child distress during invasive procedures. The discussion ends with a consideration of new directions of research and practice.

The Psychosocial Impact and Value of Participating in a Storytelling Intervention for Patients Diagnosed with Cancer: An Integrative Review

“…(7) No significant impact on depression, physical self efficacy or pain (7) fatalism and fear significantly decreased in the storytelling group. (9) post treatment depression (Z = −1.49, p = 0.14; ) and fatigue (Z = −0.13, p = 0.90) slightly higher for control group vs storytelling group (10) I liked sharing with other women with breast cancer (mean 3.81SD 0.39 out of a possible 4 as agreement with statement) (11) The group helped me feel better about myself (mean 3.79SD0.41 out of a possible 4 as agreement with statement) (11) Shared understanding of coping-shared strategies Definition: One outcome for the storytelling is the provision of a shared understanding of illness. The groups provide a natural fit to the need for human interaction.…”

“…despite many family members dying of the disease. 3I was able to express my feelings (mean 3.72SD 0.45 out of a possible agreement of 4 with the statement) (11) I was able to express my concern in the group (mean 3.72SD0.45 out of a possible agreement of 4 with the statement) (11) Social well being Definition: benefit on social or well-being, with a direct benefit on isolation and from others. Groups also reported increase in family and work relationships.…”

“…Another said: "Yes, it was really good" and others joined in, saying: "this was very thought-provoking." (1) Source trust (belief and trust in the source of this message) was higher in Story group compared to comparison group (T = −10.61, p < 0.001) (8) Source trust was positively related to positive exercise related behaviours (8) I liked sharing with other women with breast cancer (mean 3.84 SD 0.37 out of a possible agreement of 4 with statement) (11) I could share thoughts in the group that I could not share with most people (mean 3.63 SD 0.49 out of a possible agreement of 4 with statement) (11) Factors or Mechanisms that influenced the experience Allows a space for emotions to be expressed and validation of suffering Definition: content of discussion was important being able to share opening about feelings was important.…”

“…However, limited studies have been included within review evidence. For instance, there was very limited evidence of storytelling as a benefit for the side effects of cancer treatment [11] or as a behavioural treatment for paediatric patients [12]. In a broader review in chronic illness only 2 out of 10 studies considered the benefits of storytelling on individuals with cancer [13].…”

“…(10) Those strategies were aimed at producing "virtually shared experiences" (Errante, p. 24) that allowed group members to vicariously enter the storytellers' realities and work toward shared meaning (Watson, 2003). 3It was good to learn from other patients about their feelings (mean 3.97SD 0.16 out of a possible score of 4.0 for agreement with statement) (11) Retelling a story to reframe its content = Decrease blame on themselves Shared social experience Definition: a need to re-explore meaning Frequent retelling may have occurred because stories allow people to forget and reinvent certain aspects of their pasts, making them more acceptable in current circumstances 3The stories often need to be re-explored for meaning in light of what participants now know. Revised versions then are used to validate identities and suffering, for both the participant and the group.…”