Early rehabilitation of cancer patients—An individual randomized stepped‐care stress‐management intervention

Abstract

Objective: To evaluate the effects of an individual stepped-care stressmanagement intervention for cancer patients on cancer-related stress reactions (intrusion/avoidance), and secondarily on psychological distress (anxiety/depression) and emotional reactivity (impatience/hostility). Methods:Consecutively 291 cancer patients were included in a randomized controlled intervention study. Patients randomized to the intervention who did not report clinically significant stress levels (n = 72) after the first counseling session participated in only one counseling session and a follow-up (Step 1). The remaining patients (n = 66) received an additional three to eight sessions, depending on individual needs (Step 2).The intervention used techniques derived from cognitive behavioral therapy (CBT) such as daily registration of events and behaviors as well as scheduled behavioral and physical activity, along with short relaxation exercises. The intervention was completed within 26 weeks of inclusion. The Impact of Event Scale, Hospital Anxiety and Depression Scale, and Everyday Life Stress Scale were used to evaluate effects for 2 years. Results:The linear mixed effects model analysis showed a difference between the randomization groups in favor of the intervention for avoidance and intrusion after the first 6 weeks (P = 0.001 and P = 0.003) and for emotional reactivity after 17 weeks (P = 0.007). There were no differences in psychological distress. Decreases in cancerrelated stress reactions and depression were noted for the Step 2 intervention.Conclusions: An individual stepped-care stress-management intervention for cancer patients, performed by specially educated health professionals using techniques derived from CBT, seems beneficial for cancer patients and may therefore be a realistic complement to routine cancer care. KEYWORDS anxiety, cancer, counseling, depression, life stress, linear mixed effects model, methods derived from cognitive behavioral therapy, oncology, psychological, stress disorders 1 | BACKGROUND There is a call for rehabilitation in cancer care, due to a new situation characterized by a stable rise in the incidence of cancer overall and an increasing number of cancer survivors. 1,2 Based on a holistic approach to rehabilitation and the Model of Functional Health, a theoretical framework of rehabilitation, 3 cancer rehabilitation aims to prevent and reduce the physical, psychological, social, and spiritual consequences of a cancer disease and its treatment. 4Cancer may result in cancer-related stress reactions such as intrusive thoughts (eg, re-experiencing the trauma) and avoidance (eg, denial of the event and emotional numbing). 5-7 Prevalence of intrusive

The effect of psychologically informed practice with behavioural graded activity in cancer survivors: systematic review and meta-analysis

“…Breast cancer was the most explored cancer, with nine studies on this condition [ 34 , 36 , 37 , 43 , 44 , 50 , 51 , 56 , 62 ], two studies referred to ovarian cancer [ 58 , 61 ] and two to prostate cancer [ 33 , 49 ]. The remaining 20 studies included all cancer types [ 30 – 32 , 35 , 38 – 42 , 45 – 48 , 52 – 55 , 57 , 59 , 60 ].…”

“…The length of the provided intervention varied from 1 [ 37 , 49 , 61 ] to 6 months [ 30 – 33 , 38 – 40 , 60 ]. The length of the follow-up assessments ranged from 10 weeks [ 60 ] to 2 years [ 32 ].…”

“…Twenty studies described self-reported physical activity [ 31 , 33 – 37 , 40 , 43 – 45 , 47 – 52 , 54 – 57 ], 18 reported on fatigue [ 30 , 31 , 34 , 37 , 38 , 40 , 47 , 49 – 58 , 61 ], 17 on psychological distress [ 30 , 32 – 38 , 44 , 45 , 47 , 49 , 50 , 54 , 55 , 57 , 59 ], 14 on HRQoL [ 30 , 33 , 34 , 36 , 37 , 42 , 44 , 45 , 47 , 52 , 55 , 56 , 60 , 61 ], 13 on depression [ 32 – 34 , 37 , 41 , 42 , 44 , 46 , 58 – 62 ], eleven on anxiety [ 32 , 33 , 37 , 41 , 42 , 44 , 46 , 59 – 62 ], eleven on functioning [ 30 , 33 , 34 , 36 ,…”

Cancer Survivors’ Experience of Health-Related Quality of Life Six to Eight Years after Diagnosis—A Qualitative Study

“…The study used a qualitative methodology with semi-structured focus groupinterviews to gain an in-depth understanding of participants' experience of their HRQOL 6 -8 years after cancer diagnosis. We formed focus groups with a sample of cancer survivors who had engaged in a randomized controlled trial (RCT) of early rehabilitation during cancer treatment, the participants were included in the RCT at the point of diagnosis [15]. Consecutively 291 cancer patients participated in the RCT, and 211 cancer survivors consented to participate in the follow up-study.…”

Stress Response on Behavioral Response of University Students During the Peak Period of COVID-19

“… 19 Studies on cancer patients have found that stress management intervention reduces cancer-related negative behavioral reactions. 20 Adolescents’ externalized stress-related behaviors are often associated with ineffective cognitive coping strategies (i.e., constructive thinking). 21 These results indicate that stress management is related to behavioral response and stress response.…”