Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. A web-based intervention (RESTORE) to support self-management of cancer-related fatigue following primary cancer treatment: a multi-centre proof of concept randomised controlled trial BREATH: Web-Based Self-Management for Psychological Adjustment After Primary Breast Cancer--Results of a Multicenter Randomized Controlled Trial. Is education an effective management strategy for reducing cancer-related fatigue? Effects of an educational intervention for managing fatigue in women with early stage breast cancer. A Web-based self-management exercise and diet intervention for breast cancer survivors: pilot randomized controlled trial.
In a r and omized controlled design , this study tested the efficacy of a theoretically based uncertainty management intervention delivered to older long-term breast cancer survivors . The sample included 509 recurrence-free women ( 360 Caucasian , 149 African-American women ) with a mean age of 64 years ( S.D.=8.9 years ) who were 5 - 9 years post-treated for breast cancer . Women were r and omly assigned to either the intervention or usual care control condition . The intervention was delivered during four weekly telephone sessions , in which study nurses guided cancer survivors in the use of audiotaped cognitive-behavioral strategies to manage uncertainty about recurrence , and a self-help manual design ed to help women underst and and manage long-term treatment side effects and other symptoms . Treatment outcome data on uncertainty management were gathered at pre-intervention and 10-months afterward . Repeated measures MANOVA evaluating treatment group , ethnic group , and treatment by ethnic interaction effects indicated that training in uncertainty management result ed in improvements in cognitive reframing , cancer knowledge , patient-health care provider communication , and a variety of coping skills . Results are discussed in terms of the importance of theory-based interventions for cancer survivors that target triggers of uncertainty about recurrence and in terms of ethnic differences in response to the intervention Purpose Cancer-related fatigue ( CRF ) is a frequent and distressing symptom experienced after cancer treatment . RESTORE is the first web-based re source design ed to enhance self-efficacy to manage CRF following curative-intent treatment . The aim of this study is to test the proof of concept and inform the design of an effectiveness trial . Methods A multi-centre parallel-group two-armed ( 1:1 ) exploratory r and omised controlled trial ( RCT ) with qualitative process evaluation was employed in the study . Participants ( ≥18 years ; ≤5 years post treatment with moderate to severe fatigue ) were recruited and r and omly assigned to RESTORE or a leaflet . Feasibility and acceptability were measured by recruitment , attrition , intervention adherence , completion of outcome measures and process evaluation . Change in self-efficacy to manage CRF was also explored . Outcome measures were completed at baseline ( T0 ) , 6 weeks ( T1 ) and 12 weeks ( T2 ) . Data were analysed using mixed-effects linear regression and directed content analysis . Results One hundred and sixty-three people participated in the trial and 19 in the process evaluation . The intervention was feasible ( 39 % of eligible patients consented ) and acceptable ( attrition rate 36 % ) . There was evidence of higher fatigue self-efficacy at T1 in the intervention group vs comparator ( mean difference 0.51 [ −0.08 to 1.11 ] ) , though the difference in groups decreased by 12 weeks . Time since diagnosis influenced perceived usefulness of the intervention . Modifications were suggested . Conclusion Proof of concept was achieved . The RESTORE intervention should be subject to a definitive trial with some adjustments . Provision of an effective supportive re source would empower cancer survivors to manage CRF after treatment completion . Trial registration IS RCT PURPOSE Early breast cancer survivors ( BCSs ) report high unmet care needs , and easily accessible care is not routinely available for this growing population . The Breast Cancer E-Health ( BREATH ) trial is a Web-based self-management intervention to support the psychological adjustment of women after primary treatment , by reducing distress and improving empowerment . PATIENTS AND METHODS This multicenter , r and omized , controlled , parallel-group trial evaluated whether care as usual ( CAU ) plus BREATH is superior to CAU alone . BREATH is delivered in sixteen fully automated weekly modules covering early survivorship issues . Two to 4 months post-treatment , BCSs were r and omly assigned to receive CAU + BREATH ( n = 70 ) or CAU alone ( n = 80 ) using a stratified block design ( ratio 1:1 ) . Primary outcomes were distress ( Symptom Checklist-90 ) and empowerment ( Cancer Empowerment Question naire ) , assessed before r and om assignment ( baseline , T0 ) and after 4 ( T1 ) , 6 ( T2 ) , and 10 months ( T3 ) of follow-up . Statistical ( analysis of covariance ) and clinical effects ( reliable change index ) were tested in an intention-to-treat analysis ( T0 to T1 ) . Follow-up effects ( T0 to T3 ) were assessed in assessment completers . RESULTS CAU + BREATH participants reported significantly less distress than CAU-alone participants ( -7.79 ; 95 % CI , -14.31 to -1.27 ; P = .02 ) with a small-to-medium effect size ( d = 0.33 ) , but empowerment was not affected ( -1.71 ; 95 % CI , 5.20 to -1.79 ; P = .34 ) . More CAU + BREATH participants ( 39 of 70 [ 56 % ] ; 95 % CI , 44.1 to 66.8 ) than CAU-alone participants ( 32 of 80 [ 40 % ] ; 95 % CI , 30.0 to 51.0 ) showed clinical ly significant improvement ( P = .03 ) . This clinical effect was most prominent in low-distress BCSs . Secondary outcomes confirmed primary outcomes . There were no between-group differences in primary outcomes during follow-up . CONCLUSION Access to BREATH reduced distress among BCSs , but this effect was not sustained during follow-up Purpose The use of education is recommended to teach patients self-care behaviours to reduce cancer-related fatigue , however , there is little evidence of its effectiveness or optimal timing . This educationally based cancer-related fatigue intervention trial , CAN-FIT , aim ed to reduced severity of fatigue in radiotherapy patients . Methods One hundred and ten participants aged ≥18 years undergoing curative radiotherapy were r and omly assigned to receive ( 1 ) pre- and post-radiotherapy fatigue education and support ( RFES ) ; ( 2 ) pre-RFES only ; ( 3 ) post-RFES only ; or ( 4 ) no RFES ( st and ard care ) . Data collection occurred at pre- and post- radiotherapy and at 6-weeks follow-up . Results The intervention was not associated with reduction in fatigue levels at any assessment point . Significant changes were seen with secondary activity-based outcomes : Physical activity participation : Pre-RFES was associated with significantly greater increase in vigorous [ Assessment (Ax)1-Ax2 : 1.05 ( 0.24 , 1.86 ) p < 0.01 : Ax2–Ax3 : 1.24 , ( 0.44 , 2.03 ) p < 0.01 ] and moderate physical activity participation [ Ax1–Ax2 : 1.4 ( 0.53 , 2.26 ) p < 0.01 ] . Post-RFES was associated with significant improvements in walking levels [ Ax1–Ax3 : 5.82 ( 0.07 , 11.56 ) p < 0.05 ] compared with no pre-RFES . Paid and unpaid employment : Pre-RFES was associated with slower return to pre-treatment levels of paid work [ Ax2–Ax3 : −0.72 ( −1.41 , −0.04 ) p < 0.05 ] than no pre-RFES . Post-RFES was associated with decreased levels of unpaid work [ Ax1–Ax3 : 561.79 ( 51.21 , 1,072.37 ) p < 0.05 ] compared with no post-RFES . Conclusion The CAN-FIT programme did not significantly improve the primary outcome , level of fatigue , regardless of when it was delivered , however , significant changes were observed in activity-based outcomes . Further investigations into educationally based programmes should target activity participation rather than changes in underlying fatigue to improve overall patient health PURPOSE This r and omized controlled trial of out patients with breast cancer ( stage I or II ) evaluated the effects of a 3-week educational intervention on patient levels of fatigue . METHODS Norwegian out patients were r and omized into an intervention group ( n = 79 ) and a control group ( n = 81 ) . Women with fatigue ( > 2.5 on a 0 - 10 numeric rating scale , NRS ) completed the  Fatigue Question naire ( FQ ) and the  Lee Fatigue Scale ( LFS ) at baseline ( after treatment ) ( T1 ) , immediately after intervention ( T2 ) and 3 months after intervention ( T3 ) . RESULTS The mean fatigue score ( NRS ) at study entry was 6.1 ( SD 1.7 ) and 36 % ( n = 57 ) had a score ≥7 . There were no statistically significant differences between the fatigue measures of women in the intervention and control group at T2 or T3 in the overall sample after the intervention . Using an NRS cut-off of 5 , there was a borderline difference for women who scored < 5 for chronic fatigue on FQ ( p = 0.062 ) and a significant difference for energy on LFS ( p = 0.042 ) where the women in the intervention group had less fatigue . Using an NRS cut-off score of 6 , there was a borderline difference for women who scored < 6 for fatigue on FQ ( p = 0.062 ) and a significant difference for energy on LFS ( p = 0.021 ) where women in the intervention group had more energy than those in the control group . CONCLUSIONS Further research is needed to identify psycho-educational interventions to reduce levels of fatigue and to tailor an intervention based on the level of fatigue . Fatigue measurements should be chosen more carefully BACKGROUND Regular exercise and dietary practice s have been shown to affect the health-related quality of life ( HRQOL ) and survival of breast cancer patients . OBJECTIVE The current study aim ed to investigate whether the WSEDI was a feasible and primarily effective method for promoting exercise and dietary behaviours for breast cancer patients . DESIGN A 12-week r and omized , controlled trial . SETTING Oncology outpatient treatment clinics at 3 university hospitals and 1 National Cancer Center in South Korea . PARTICIPANTS Fifty-nine breast cancer patients who had received curative surgery and completed primary cancer treatment within 12 months prior to the study and who had been diagnosed with stage 0-III cancers within 2 years prior to the study were recruited . METHODS Participants were r and omly assigned to either the intervention group , which used a Web-based self-management exercise and diet intervention program incorporating transtheoretical model (TTM)-based strategies ( n=29 ) , or to the control group , which used a 50-page educational booklet on exercise and diet ( n=28 ) . The intervention efficacy was measured at the baseline and 12 weeks via a Web-based survey that addressed the promotion of exercise and consumption of 5 servings of fruits and vegetables ( F&V ) per day , dietary quality , HRQOL , anxiety , depression , fatigue , motivational readiness , and self-efficacy . RESULTS The proportion of subjects who performed at least moderate-intensity aerobic exercise for at least 150 min per week ; ate 5 servings of F&V per day ; and had overall improvements in dietary quality , physical functioning and appetite loss ( HRQOL ) , fatigue , and motivational readiness was greater in the intervention group than in the control group . The self-efficacy with respect to exercise and F&V consumption was greater in the intervention group than in the control group . A Web-based program that targets changes in exercise and dietary behaviours might be effective for breast cancer survivors if the TTM theory has been used to inform the program strategy , although further research with a larger sample size is required to enable definitive conclusions
Purpose Many cancer survivors experience problems with persisting symptoms such as pain , fatigue , anxiety and depression post-treatment .
Self-management interventions are recommended for cancer patients as they can help individuals identify and manage these continuing symptoms .
This systematic review examines the type , content and impact of self-management interventions for cancer survivors on health outcomes such as activity participation , self-efficacy , quality of life and symptom management .