Effect of neutropenia on the impact of a cognitive‐behavioral intervention for symptom management

Abstract

BACKGROUNDTrials of cognitive‐behavioral interventions (CBI) designed to reduce symptom severity or improve dimensions of quality of life seldom consider how the side effects of treatment or the complications imposed by the disease or treatment may moderate the impact of the trial on the designated outcome. To address this issue, the moderating effect of neutropenia on the impact of a CBI for reducing symptom severity was evaluated among patients with cancer undergoing chemotherapy.METHODSThe authors described the impact of a randomized trial of a 10‐contact, 20‐week CBI on symptom severity, as well as the moderating effect of a neutropenic episode on symptom severity at 20 weeks. Severity scores were based on sum scores (0–10) for 15 symptoms.RESULTSThere was an effect for age (younger) and group on severity at 20 weeks and an interaction between neutropenia and group. Among patients with no evidence of neutropenia, those in the experimental arm had a 9‐point lower severity score at 20 weeks. Among patients who experienced neutropenia, differences in symptom severity by arm of the trial were < 3 points. Further, fatigue, fever, and pain were more prevalent among patients with neutropenia.CONCLUSIONSPatients who experienced neutropenia did not benefit from a CBI to lower symptoms. The overall effect of this intervention came almost exclusively from patients without neutropenia. Cancer 2005. © 2005 American Cancer Society.

Cognitive behavioral symptom management intervention in patients with cancer: survival analysis

“…In the study by Andersen et al (2008), small group interventions provided strategies to reduce stress, improve mood, improve health behaviors and maintain adherence to cancer treatment, which provided both psychological support and behavioral education [11]. In the present study, a problem-solving cognitive behavioral intervention was used to reduce symptom severity in participants undergoing chemotherapy for solid tumors [25][26][27]. Whereas other studies used group therapy as a delivery method, in the present study, cognitive behavioral intervention was delivered though individual contact using weekly phone calls.…”

“…Details of the intervention and outcomes were described in previous publications [25][26][27] . This secondary analysis was reviewed and approved by the institutional review board at the University of Pittsburgh.…”

Integrative Nonpharmacologic Behavioral Interventions for the Management of Cancer-Related Fatigue

“…As with exercise interventions, a growing body of empiric data supports the use of psychosocial interventions for the management of CRF. Randomized, controlled clinical trials have examined a variety of psychosocial interventions in cancer survivors during and after treatment (Table 2) [139][140][141][142][143][144][145][146][147][148][149][150][151][152][153].…”

Measuring health-related quality of life and neutropenia-specific concerns among older adults undergoing chemotherapy: validation of the Functional Assessment of Cancer Therapy–Neutropenia (FACT-N)

“…Participants reported interference in their daily activities due to CIN, negative emotions, social isolation, and a reduced sense of self-worth. In a recent randomized trial of an intervention to improve cancer symptom management, Given et al [13] found that neutropenia modulated the effect of the intervention on symptom severity. Patients with CIN did not experience an improvement in their symptoms, while patients without CIN did improve with the symptom management intervention.…”