Feasibility of a Patient-Controlled Cognitive-Behavioral Intervention for Pain, Fatigue, and Sleep Disturbance in Cancer

Abstract

Purpose To evaluate the feasibility of a patient-controlled cognitive-behavioral intervention for pain, fatigue, and sleep disturbance during treatment for advanced cancer, and to assess initial efficacy of the intervention in controlling symptoms. Design One-group pretest-posttest design. Setting Outpatient oncology clinics at a Comprehensive Cancer Center in the Midwestern United States. Sample 30 adults with advanced (recurrent or metastatic) colorectal, lung, prostate, or GYN cancer receiving chemotherapy or radiotherapy. Methods Participants completed baseline measures (demographics, symptom inventory) and received education and training to use an MP3 player loaded with 12 cognitive-behavioral strategies (e.g., relaxation exercises, guided imagery, nature sound recordings). Participants used the strategies as needed for symptom management over the following 2-weeks, keeping a log of symptom ratings with each use. Following the two-week intervention, participants completed a second symptom inventory and an evaluation of the intervention. Main Research Variables Feasibility, patient-controlled cognitive-behavioral intervention, pain, fatigue, sleep disturbance. Findings 73% of the 43 eligible patients agreed to participate (N=30) and of these, 90% (n=27) completed the study. The majority of participants reported that they enjoyed the intervention, had learned useful skills, and perceived improvement in their symptoms. Symptom scores at 2-weeks did not differ significantly from baseline, however significant reductions in pain, fatigue, and sleep disturbance severity were found in ratings made immediately before and after use of a cognitive-behavioral strategy. Conclusions The patient-controlled cognitive-behavioral intervention appears feasible for further study and could reduce day-to-day severity of co-occurring pain, fatigue, and sleep disturbance. Implications for Nursing A randomized controlled trial is necessary to test efficacy of the intervention for co-occurring pain, fatigue, and sleep disturbance. In the mean time, based on previous efficacy studies, cognitive-behavioral strategies can be recommended for certain individual symptoms.

Effects of Slow-Stroke Back Massage on Symptom Cluster in Adult Patients With Acute Leukemia

“…The inclusion criteria were as follows: patients (1) with acute leukemia receiving chemotherapy; (2) 18 to 50 years of age; (3) reporting the intensity scores of pain, fatigue, and sleep disorders of 3 or more on the numeric rating scale (NRS); (4) reporting a sleep score of more than 5 according to the Pittsburgh Sleep Quality Index (PSQI); (5) at least 3 months after the diagnosis of cancer; (6) did not have a prior history of pain, fatigue, or sleep disorders noted in their medical history; (7) who did not have underlying diseases such as diabetes, peripheral nerve disease, and deep vein thrombosis; and (8) who did not have physical damage or skin diseases in the massage area. The exclusion criteria during the intervention were patients who (1) did not attend 2 consecutive sessions of massage therapy or 3 sessions throughout the study, (2) transferred to other centers, (3) experienced a deterioration in their condition, and (4) were unwilling to continue the study.…”

“…The 3 problems often co-occur and are considered to be a symptom cluster in cancer patients. 3 The concept of symptom clusters is an approach to studying multiple co-occurring and interrelated symptoms in cancer patients. 4 Symptom clusters are defined as ''2 or more symptoms that are related to each other and that occur together'' with stronger relationships to each other than to symptoms outside the cluster.…”

Cancer Symptom Cluster Management

“…In two separate trials, Kwekkeboom and colleagues 51–52 first demonstrated feasibility, then conducted a pilot randomized controlled trial, of a cognitive-behavioral symptom cluster intervention among adults experiencing co-occurring pain, fatigue, and sleep disturbance during treatment for advanced (metastatic or recurrent) cancer. In the pilot RCT, 86 patients were randomized to the cognitive-behavioral intervention or a waitlist control group.…”

Educational Practices and Self-Care: Evidence in Scientific Production of Nursing

“…[15][16][17][18][19][20][21] Os dados que emergiram dos estudos analisados mostram que os rápidos avanços na tecnologia e acesso à internet tornaram-se não apenas um modo viável para a realização de intervenções educativas, mas também uma plataforma que pode ser divulgada e implementada amplamente. Além disso, as intervenções pela internet e os programas que podem ser por ela divulgados permitem que o conteúdo do programa possa ser padronizado, direcionado para idades específicas e fases do desenvolvimento e podem ser facilmente atualizados.…”

“…Havia, ainda, o acompanhamento de enfermagem por meio de videoconferências programadas, oportunizando troca de saberes, o esclarecimento sobre dúvi-das que poderiam surgir, além da implementação de estraté-gias para melhorar a capacidade de autocuidado. [16][17][18][19] Também foram identificados dois trabalhos contendo práticas educativas em saúde relacionadas ao autocuidado realizados com moradores de zonas rurais. Estes utilizaram as tecnologias por meio de programas que fornecem educação, monitoramento e comunicação, em conjunto com as visitas domiciliares.…”