Direct improvement of quality of life using a tailored quality of life diagnosis and therapy pathway: randomised trial in 200 women with breast cancer Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Online counseling via e-mail for breast cancer patients on the German internet: preliminary results of a psychoeducational intervention Randomized controlled trial of an educational intervention for managing fatigue in women receiving adjuvant chemotherapy for early-stage breast cancer. Supportive-expressive group therapy for primary breast cancer patients: a randomized prospective multicenter trial. Psychologic intervention improves survival for breast cancer patients Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Effect of support groups with coaching on adaptation to early stage breast cancer. 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Background : Despite thous and s of papers , the value of quality of life ( QoL ) in curing disease remains uncertain . Until now , we lacked tools for the diagnosis and specific treatment of diseased QoL. We approached this problem stepwise by theory building , modelling , an exploratory trial and now a definitive r and omised controlled trial ( RCT ) in breast cancer , whose results we report here . Methods : In all , 200 representative Bavarian primary breast cancer patients were recruited by five hospitals and treated by 146 care professionals . Patients were r and omised to either ( 1 ) a novel care pathway including diagnosis of ‘ diseased ’ QoL ( any QoL measure below 50 points ) using a QoL profile and expert report sent to the patient 's coordinating practitioner , who arranged QoL therapy consisting of up to five st and ardised treatments for specific QoL defects or ( 2 ) st and ard postoperative care adhering to the German national guideline for breast cancer . The primary end point was the proportion of patients in each group with diseased QoL 6 months after surgery . Patients were blinded to their allocated group . Results : At 0 and 3 months after surgery , diseased QoL was diagnosed in 70 % of patients . The QoL pathway reduced rates of diseased QoL to 56 % at 6 months , especially in emotion and coping , compared with 71 % in controls ( P=0.048 ) . Relative risk reduction was 21 % ( 95 % confidence interval ( CI ) : 0–37 ) , absolute risk reduction 15 % ( 95 % CI : 0.3–29 ) , number needed to treat (NNT)=7 ( 95 % CI : 3–37 ) . When QoL therapy finished after successful treatment , diseased QoL often returned again , indicating good responsiveness of the QoL pathway . Conclusion : A three-component outcome system including clinician-derived objective , patient-reported subjective end points and qualitative analysis of clinical relevance was developed in the last 10 years for cancer as a complex intervention . A separate QoL pathway was implemented for the diagnosis and treatment of diseased QoL and its effectiveness tested in a community-based , pragmatic , definitive RCT . While the pathway was active , it was effective with an NNT of 7 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 Objectives : The internet offers new possibilities in psychosocial patient care . However , empirical data are lacking for oncological patients . A field-experimental study was conducted to obtain initial data to enable evaluation of the effectiveness of online counseling via e-mail for breast cancer patients . A secondary objective was to explore how patients reached by the service can be characterized on psychosocial status and illness . Methods : On a dedicated German- language website , 235 breast cancer patients registered for psychosocial counseling via e-mail . 133 registrants were r and omly assigned to a treatment group to receive immediate counseling or to a waiting list control group . The two-month counseling session took the form of a psychoeducation , individually tailored to each patient . Psychosocial outcome measures including psychological distress ( BSI ) and quality of life ( EORTC QLQ-C30 ) were assessed at registration and at a two-month follow-up . Descriptive data were recorded at registration . At the conclusion of the program , participants were asked to complete a patient satisfaction question naire ( ZUF-8 ) . Results : BSI responses showed that 85 % of all patients were initially diagnosable with comorbid psychopathology . Despite high severity of distress and attendant large reductions in quality of life , 72 % of all patients were not obtaining conventional assistance . Among counseling participants ( n=31 ) , no significant improvements in distress or quality of life were found in comparison to the control group ( n=34 ) , but patient satisfaction was nonetheless high . Conclusion : The study demonstrates that online counseling via e-mail reaches patients with unmet therapeutic needs , but also indicated its limitations , suggesting that the online setting may be most useful for prompting and supporting a transition to conventional counseling services PURPOSE To evaluate the efficacy of a psychoeducational intervention in improving cancer-related fatigue .  PATIENTS AND METHODS This r and omized controlled trial involved 109 women commencing adjuvant chemotherapy for stage I or II breast cancer in five chemotherapy treatment centers . Intervention group patients received an individualized fatigue education and support program delivered in the clinic and by phone over three 10- to 20-minute sessions 1 week apart . Instruments included a numeric rating scale assessing confidence with managing fatigue ; 11-point numeric rating scales measuring fatigue at worst , average , and best ; the Functional Assessment of Cancer Therapy-Fatigue and Piper Fatigue Scales ; the Cancer Self-Efficacy Scale ; the European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 ; and the Hospital Anxiety and Depression Scale . For each outcome , separate analyses of covariance of change scores between baseline ( T1 ) and the three follow-up time points ( T2 , T3 , and T4 ) were conducted , controlling for the variable 's corresponding baseline value . RESULTS Compared with the intervention group , mean difference scores between the baseline ( T1 ) and immediate after the test ( T2 ) assessment s increased significantly more for the control group for worst and average fatigue , Functional Assessment of Cancer Therapy-Fatigue , and Piper fatigue severity and interference measures . These differences were not observed between baseline and T3 and T4 assessment s. No significant differences were identified for any pre- or post-test change scores for confidence with managing fatigue , cancer self-efficacy , anxiety , depression , or quality of life . CONCLUSION Preparatory education and support has the potential to assist women to cope with cancer-related fatigue in the short term . However , further research is needed to identify ways to improve the potency and sustainability of psychoeducational interventions for managing cancer-related fatigue OBJECTIVE The aim is to evaluate the effectiveness of a manualized 12-week supportive-expressive group therapy program among primary breast cancer patients treated in community setting s , to determine whether highly distressed patients were most likely to benefit and whether therapist 's training or experience was related to outcome . METHOD Three hundred and fifty-three women within one year of diagnosis with primary breast cancer were r and omly assigned to receive supportive-expressive group therapy or to an education control condition . Participants were recruited from two academic centers and nine oncology practice s , which were members of NCI 's Community Clinical Oncology Program ( CCOP ) and were followed over 2 years . RESULTS A 2x2x19 analysis of variance was conducted with main effects of treatment condition , cohort , and baseline distress and their interactions . There was no main effect for treatment condition after removing one subject with an extreme score .  Highly distressed women did not derive a greater benefit from treatment . Therapist training and psychotherapy experience were not associated with a treatment effect . CONCLUSIONS This study provides no evidence of reduction in distress as the result of a brief supportive-expressive intervention for women with primary breast cancer . Future studies might productively focus on women with higher initial levels of distress The question of whether stress poses a risk for cancer progression has been difficult to answer . A r and omized clinical trial tested the hypothesis that cancer patients coping with their recent diagnosis but receiving a psychologic intervention  would have improved survival compared with patients who were only assessed OBJECTIVES Considerable morbidity persists among survivors of breast cancer ( BC ) including high levels of psychological stress , anxiety , depression , fear of recurrence , and physical symptoms including pain , fatigue , and sleep disturbances , and impaired quality of life . Effective interventions are needed during this difficult transitional period . METHODS We conducted a r and omized controlled trial of 84 female BC survivors ( Stages 0-III ) recruited from the H. Lee Moffitt Cancer and Research Institute . All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and /or chemotherapy .  Subjects were r and omly assigned to a 6-week Mindfulness-Based Stress Reduction ( MBSR ) program design ed to self-regulate arousal to stressful circumstances or symptoms ( n=41 ) or to usual care ( n=43 ) . Outcome measures compared at 6 weeks by r and om assignment included vali date d measures of psychological status ( depression , anxiety , perceived stress , fear of recurrence , optimism , social support ) and psychological and physical subscales of quality of life ( SF-36 ) . RESULTS Compared with usual care , subjects assigned to MBSR(BC ) had significantly lower ( two-sided p<0.05 ) adjusted mean levels of depression ( 6.3 vs 9.6 ) , anxiety ( 28.3 vs 33.0 ) , and fear of recurrence ( 9.3 vs 11.6 ) at 6 weeks , along with higher energy ( 53.5 vs 49.2 ) , physical functioning ( 50.1 vs 47.0 ) , and physical role functioning ( 49.1 vs 42.8 ) . In stratified analyses , subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning . CONCLUSIONS Among BC survivors within 18 months of treatment completion , a 6-week MBSR(BC ) program result ed in significant improvements in psychological status and quality of life compared with usual care The effects of 8-week cancer support groups ( CSGs ) with and without coaching on adaptation were tested in a sample of 181 women with newly diagnosed early stage breast cancer .  CSG participation with coaching result ed in higher quality of relationship with significant other at CSG conclusion ; this effect was not sustained 8 weeks later . CSG participation had no effect on symptom distress , emotional distress , or functional status . On average , symptom distress was low , emotional distress was moderate , and functional status was relatively high . Independent of CSGs , symptom distress decreased and functional status increased over time from entry into the study to 16 weeks later . Further research is needed to determine the optimal starting time and length for CSGs OBJECTIVE The current report provides the result of a Phase II clinical trial regarding the effectiveness and feasibility of problem-solving therapy for psychological distress experienced by Japanese early-stage breast cancer patients . METHODS Participants were 36 post-surgery Japanese breast cancer patients in a university hospital located in Osaka Prefecture , Japan . After screening for psychological distress using the Distress and Impact Thermometer and the Hospital Anxiety and Depression Scale , highly distressed patients were exposed to 5 weekly sessions of the problem-solving therapy program . RESULTS Nineteen patients completed the intervention and follow-up . There was a significant difference between the pre-intervention and the 3-month follow-up in the total Hospital Anxiety and Depression Scale score ( P = 0.02 ) , and the mean change score from the pre-intervention to the follow-up was 6.05 ( SD = 1.94 ) . The intervention had a large effect size ( d = 0.82 ) . There were also significant changes in worry , self-efficacy and quality of life measures . CONCLUSIONS The findings of our study suggest that the problem-solving therapy program has potential to be effective for alleviating psychological distress experienced by Japanese early-stage breast cancer patients . The true effectiveness of the program should be confirmed by a future r and omized control trial PURPOSE To test the effectiveness of a psycho-educational group intervention to improve psychological distress measured by POMS TMD , Quality of Life measured by European Organisation for Research and Treatment of Cancer ( EORTC ) , the core and breast cancer module , Mental Adjustment measured by MAC and marital relationship measured by BLRI in women with primary breast cancer conducted 10 weeks after surgery . A secondary outcome was 4-year survival . PATIENTS AND METHODS We r and omly assigned 210 patients with primary breast cancer to a control or an intervention group . Patients in the intervention group were offered two weekly 6-h sessions of psycho-education and eight weekly 2-h sessions of group psychotherapy . All participants were followed up for Quality of Life , coping ability and social relations 1 , 6 and 12 months after the intervention and on survival 4 years after surgical treatment . RESULTS No statistically significant effects of the intervention were found on any of the psychosocial question naire outcomes . There were not enough cases of death to analyse overall survival . The only statistically significant result was for patients who used anti depressive medication , for whom almost all measures improved over time , in both the control and intervention groups . CONCLUSION Psycho-education and group psychotherapy did not decrease psychological distress or increase Quality of Life , Mental Adjustment or improve marital relationship among patients with primary breast cancer A Roy adaptation model-based support and education intervention for women with early-stage breast cancer was tested in a three-group , three-phase r and omized clinical trial of a sample of 125 women . The experimental group received 13 months of combined individual telephone and in-person group support and education , Control Group 1 received 13 months of telephone-only individual support and education , and Control Group 2 received one-time mailed educational information . The experimental group and Control Group 1 reported less mood disturbance at the end of all three phases , less loneliness at the end of Phases II and III , and a higher- quality relationship with a significant other at the end of Phase II than did Control Group 2 . No group differences were found for cancer-related worry or well-being . The findings suggest that individual telephone support may provide an effective alternative to in-person support groups . Further study of telephone interventions is recommended using ethnically and economically heterogeneous sample Objectives : To test experimentally whether a psychological intervention reduces depression-related symptoms and markers of inflammation among cancer patients and to test one mechanism for the intervention effects . Depression and inflammation are common among cancer patients . Data suggest that inflammation can contribute to depressive symptoms , although the converse remains untested . Methods : As part of a r and omized clinical trial , newly diagnosed breast cancer patients ( n = 45 ) with clinical ly significant depressive symptoms were evaluated and r and omized to psychological intervention with assessment or assessment only study arms . The intervention spanned 12 months , with assessment s at baseline , 4 , 8 , and 12 months . Mixed-effects modeling tested the hypothesis that the intervention reduced self-reported depressive symptoms ( Center for Epidemiological Studies Depression scale , Profile of Mood States Depression and Fatigue subscales , and Medical Outcomes Study -Short Form 36 Bodily Pain subscale ) and immune cell numbers that are elevated in the presence of inflammation ( white blood cell count , neutrophil count , and helper/suppressor ratio ) . Mediation analyses tested whether change in depressive symptoms , pain , or fatigue predicted change in white blood cell count , neutrophil count , or the helper/suppressor ratio . Results : The intervention reduced significantly depressive symptoms , pain , fatigue , and inflammation markers . Moreover , the intervention effect on inflammation was mediated by its effect on depressive symptoms . Conclusions : This is the first experiment to test whether psychological treatment effective in reducing depressive symptoms would also reduce indicators of inflammation . Data show that the intervention reduced directly depressive symptoms and reduced indirectly inflammation . Psychological treatment may treat effectively depressive symptoms , pain , and fatigue among cancer patients . CES-D = Center for Epidemiological Studies -Depression scale , Iowa short form ; SF-36 = Medical Outcomes Study -Short Form 36 ; KPS = Karnofsky Performance Status OBJECTIVE The importance of psychosocial counselling after a diagnosis of cancer has been acknowledged and many intervention studies have been carried out , with the aim to find out which types of intervention are most effective in enhancing quality of life in cancer patients . A factor which could be part of effective counselling could be the time of offering psychosocial counselling . The aim of this study was to research the effect of time of enrolment in a psychosocial group intervention on psychosocial adjustment . METHODS In the present study , 67 women with early stage breast cancer were r and omised in a psychosocial group intervention program starting within 4 months after surgery or in the same intervention program starting at least 3 months later . RESULTS The main conclusion of this study is that women who started with their intervention early were less distressed at 6 months follow-up than women who were in the delayed condition . Medical and demographic variables were predictive for some psychosocial adjustment indicators , but were not associated with time of enrolment . Regardless of time of enrolment , women improved in distress , body image and recreational activities , but showed a decrease in social interaction . CONCLUSION Though results are limited , based on these results we suggest that psychosocial counselling should be offered as soon after diagnosis or surgery for breast cancer . PRACTICE IMPLICATION S Women diagnosed with primary breast cancer should be able to start with psychological counselling soon after being diagnosed , to prevent them from becoming distressed at long term OBJECTIVE This study examined the effect of a cognitive-behavioral stress management ( CBSM ) intervention on emotional well-being and immune function among women in the months following surgery for early-stage breast cancer . METHOD Twenty-nine women were r and omly assigned to receive either a 10-week CBSM intervention ( n=18 ) or a comparison experience ( n=11 ) . The primary psychological outcome measure was benefit finding . The primary immune function outcome measure was in vitro lymphocyte proliferative response to anti CD3 . RESULTS Women in the CBSM intervention reported greater perceptions of benefit from having breast cancer compared to the women in the comparison group . At 3-month follow-up , women in the CBSM group also had improved lymphocyte proliferation . Finally , increases in benefit finding after the 10-week intervention predicted increases in lymphocyte proliferation at the 3-month follow-up . CONCLUSION A CBSM intervention for women with early-stage breast cancer facilitated positive emotional responses to their breast cancer experience in parallel with later improvement in cellular immune function In a phase I National Cancer Institute (NCI)-funded clinical trial , 34 breast cancer survivors , six weeks to one year post-treatment , were recruited to participate in a 6-class , 8-week long imagery stress reduction program entitled " Envision the Rhythms of Life . " Patients practice d imagery during and between sessions . Outcomes for quality of life and cortisol rhythm were assessed pre- to post-intervention , in two subsets of survivors ( intravenous [ IV ] chemotherapy , or no IV chemotherapy ) . Thirty survivors completed the 8-week program . Quality of life outcomes demonstrated statistically and clinical ly significant outcomes for the functional assessment of cancer therapy-general ( FACT-G ) global index ( p<.001 ) , representing improvements in survivor quality of life related to physical , social/family , emotional , and function well-being . Survivors also improved significantly on the breast cancer ( p<.001 ) and spiritual subscales ( p = .008 . ) Brief symptom inventory ( BSI ) assessment reported significant improvement for the global index ( p<.001 ) which included the categories of depression , somatization and anxiety . At eight weeks , cortisol rhythm , a biochemical indicator of stress and likelihood of cancer recurrence , produced a trend toward improvement for the fifth time point of the day ( p = .18 ) . Likert-based stress scales showed highly significant reductions in stress ( p<.0001 ) with subjects practicing imagery the most producing the best scores . Outcomes suggest the imagery program may significantly improve survivor quality of life and reduce stress UNLABELLED This r and omized controlled trial assessed the effect of a SMART ( Stress Management and Resiliency Training ) program among 25 women diagnosed with breast cancer .  Resilience , perceived stress , anxiety , and quality of life improved at 12 weeks in the active but not the control arm . A brief training in the SMART program can enhance resilience and quality of life and decrease stress and anxiety . INTRODUCTION Patients with breast cancer experience stress and anxiety related to their diagnosis , with result ing lower quality of life . The purpose of this study was to assess the effect of a SMART ( Stress Management and Resiliency Training ) program for increasing resiliency and for decreasing stress and anxiety among mentors who themselves were previously diagnosed with breast cancer . MATERIAL S AND METHODS The program consisted of two 90-minute group training sessions , a brief individual session , and 3 follow-up telephone calls . Twenty-four mentors at Mayo Clinic in Rochester , Minnesota , were r and omized in a single-blind , wait-list controlled clinical trial to either the SMART intervention or a control group for 12 weeks . Primary outcome measures assessed at baseline and at week 12 included the Connor Davidson Resilience Scale , Perceived Stress Scale , Smith Anxiety Scale , and Linear Analog Self Assessment Scale . RESULTS Twenty patients completed the study . A statistically significant improvement in resilience , perceived stress , anxiety , and overall quality of life at 12 weeks , compared with baseline was observed in the study arm . No significant difference in any of these measures was noted in the control group . CONCLUSION This study demonstrates that a brief , predominantly group-based resilience training intervention is feasible in patients with previous breast cancer ; also , it may be efficacious OBJECTIVE Treatment of breast cancer is usually associated with significant psychological stress . In this study , we examined the effects of relaxation and visualization therapy ( RVT ) on psychological distress , cortisol levels , and immunological parameters of breast cancer patients undergoing radiotherapy .  METHODS Participants were r and omly assigned to either the experimental ( n=20 ) who underwent group RVT for 24 consecutive days or control group ( n=14 ) who were on radiotherapy only .  Psychological scores ( stress , anxiety , and depression ) were measured by structured clinical interviews . Salivary cortisol was assessed along the day . Lymphocytes were isolated and cultured to measure T-cell proliferation and sensitivity to glucocorticoids ( GCs ) . RESULTS RVT was effective to reduce stress , anxiety , and depression scores ( all P<.05 ) . However , cortisol levels as well as proliferation remained unchanged following RVT . Although T cells of experimental group were more sensitive to GCs than cells of controls at baseline , no changes were noted following RVT . Cortisol levels were positively correlated to anxiety and depression scores and inversely correlated to T-cell proliferation and sensitivity to GCs . CONCLUSION We conclude that the psychological intervention was capable to attenuate the emotional distress presented during radiotherapy treatment . A longer RVT or worse psychological morbidity at baseline may be necessary to translate psychological into biological changes The authors report a 3-year follow-up of the effects of 8-week support group interventions on the quality of life of women with early stage breast cancer . Shortly after diagnosis , women were r and omly assigned to 1 of 4 conditions : control , education , peer discussion , and education plus peer discussion . The education group intervention focused on providing information to enhance control over the illness experience , whereas the peer discussion group intervention focused on providing emotional support through the expression of feelings . Consistent with the results that emerged 6 months after the interventions ( V. S. Helgeson , S. Cohen , R. Schulz , & J. Yasko , 1999 ) , the authors found that the benefits of the education intervention were maintained over a 3-year period ( N=252 ) , although effects dissipated with time . The authors continued to find no benefits of the peer discussion intervention , either alone or in combination with education PURPOSE This r and omized clinical trial tests the hypothesis that a psychological intervention can reduce emotional distress , improve health behaviors and dose-intensity , and enhance immune responses . PATIENTS AND METHODS We studied 227 women who were surgically treated for regional breast cancer . Before adjuvant therapy , women completed interviews and question naires assessing emotional distress , social adjustment , and health behaviors . A 60-mL blood sample was drawn for immune assays . Patients were r and omly assigned to either the intervention group or assessment only group . The intervention was conducted in small patient groups , with one session per week for 4 months . The sessions included strategies to reduce stress , improve mood , alter health behaviors , and maintain adherence to cancer treatment and care . Re assessment occurred after completion of the intervention . RESULTS As predicted , patients receiving the intervention showed significant lowering of anxiety , improvements in perceived social support , improved dietary habits , and reduction in smoking ( all P < .05 ) . Analyses of adjuvant chemotherapy dose-intensity revealed significantly more variability ( ie , more dispersion in the dose-intensity values ) for the assessment arm ( P < .05 ) . Immune responses for the intervention patients paralleled their psychological and behavioral improvements . T-cell proliferation in response to phytohemagglutinin and concanavalin A remained stable or increased for the Intervention patients , whereas both responses declined for Assessment patients ; this effect was replicated across three concentrations for each assay ( all P < .01 ) . CONCLUSION These data show a convergence of significant psychological , health behavior , and biologic effects after a psychological intervention for cancer patients Abstract The survivor uncertainty management intervention study is a r and omized controlled study design ed to test the efficacy of an intervention that combines training in audiotaped cognitive behavioral strategies to manage uncertainty about cancer recurrence with a self-help manual design ed to help women underst and and manage long-term treatment side effects and other symptoms . Specifically , women were taught to recognize their own personal triggers of uncertainty ( places , events or surroundings , that bring back memories , feelings , or concerns about breast cancer ) , and then use coping skills such as relaxation , distraction , and calming self-talk to deal with uncertainty . Also , women were taught to use the manual as a re source for dealing with fatigue , lymphedema , pain and other symptoms . Treatment outcome data ( Mishel et al. , in press ) indicated that the uncertainty management intervention result ed in improvements in cognitive reframing , cancer knowledge , social support , knowledge of symptoms and side effects , and coping skills when compared to a control condition . The purpose of the present paper was to report on the use and helpfulness of the intervention components by the 244 women who were in the intervention . Findings indicated that women regularly used the intervention components to deal with triggers of breast cancer recurrence and long-term treatment side effects and most women found the strategies very helpful BACKGROUND We conducted a r and omised , controlled trial of cognitive-existential group therapy ( CEGT ) for women with early stage breast cancer receiving adjuvant chemotherapy with the aim of improving mood and mental attitude to cancer . METHODS Women were r and omised to 20 sessions of weekly group therapy plus 3 relaxation classes or to a control arm receiving 3 relaxation classes . Assessment s , independently done at baseline , 6 and 12 months , included a structured psychiatric interview and vali date d question naires covering mood , attitudes to cancer , family relationships , and satisfaction with therapy . RESULTS Three hundred and three of 491 ( 62 % ) eligible patients participated over 3 years .  Distress was high pre-intervention : 10 % were diagnosed as suffering from major depression , 27 % from minor depression and 9 % from anxiety disorders . On an intention-to-treat analysis , there was a trend for those receiving group therapy ( n=154 ) to have reduced anxiety ( p=0.05 , 2-sided ) compared to controls ( n=149 ) . Women in group therapy also showed a trend towards improved family functioning compared to controls ( p=0.07 , 2-sided ) . The women in the groups reported greater satisfaction with their therapy ( p<0.001 , 2-sided ) , appreciating the support and citing better coping , self-growth and increased knowledge about cancer and its treatment . They valued the CEGT therapy . Overall effect size for the group intervention was small ( d=0.25 ) , with cancer recurrence having a deleterious effect in three of the 19 therapy groups . Psychologists as a discipline achieved a moderate mean effect size ( d=0.52 ) . CONCLUSION CEGT is a useful adjuvant psychological therapy for women with early stage breast cancer . Interaction effects between group members and therapists are relevant to outcome . Group-as-a-whole effects are powerful , but the training and experience of the therapist is especially critical to an efficacious outcome PURPOSE The r and omized study aim ed to determine the efficacy of psychological intervention consisting of relaxation and guided imagery to reduce anxiety and depression in gynecologic and breast cancer patients undergoing brachytherapy during hospitalization . METHODS AND MATERIAL S Sixty-six patients programmed to receive brachytherapy in two hospitals in Barcelona ( Spain ) were included in this study . The patients were r and omly allocated to either the study group ( n=32 ) or the control group ( n=34 ) . Patients in both groups received training regarding brachytherapy , but only study group patients received training in relaxation and guided imagery . After collection of sociodemographic data , all patients were given a set of question naires on anxiety and depression : the Hospital Anxiety and Depression Scale ( HADS ) , and on quality of life : Cuestionario de Calidad de Vida QL-CA-AFex ( CCV ) , prior to , during and after brachytherapy . RESULTS The study group demonstrated a statistically significant reduction in anxiety ( p=0.008 ) , depression ( p=0.03 ) and body discomfort ( p=0.04 ) compared with the control group . CONCLUSIONS The use of relaxation techniques and guided imagery is effective in reducing the levels of anxiety , depression and body discomfort in patients who must remain isolated while undergoing brachytherapy . This simple and inexpensive intervention enhances the psychological wellness in patients undergoing brachytherapy . State : This study has passed Ethical Committee review OBJECTIVE Major depression is the most common psychiatric disorder among breast cancer patients and is associated with substantial impairment . Although some research has explored the utility of psychotherapy with breast cancer patients , only 2 small trials have investigated the potential benefits of behavior therapy among patients with well-diagnosed depression . METHOD In a primarily Caucasian , well-educated sample of women ( age = 55.4 years , SD = 11.9 ) diagnosed with breast cancer and major depression ( n = 80 ) , this study was a r and omized clinical trial testing the efficacy of 8 sessions of behavioral activation treatment for depression ( BATD ) compared to problem-solving therapy . Primary outcome measures assessed depression , environmental reward , anxiety , quality of life , social support , and medical outcomes . RESULTS Across both treatments , results revealed strong treatment integrity , excellent patient satisfaction with treatment protocol s , and low patient attrition ( 19 % ) . Intent-to-treat analyses suggested both treatments were efficacious , with both evidencing significant pre-post treatment gains across all outcome measures . Across both treatments , gains were associated with strong effect sizes , and based on response and remission criteria , a reliable change index , and numbers-needed-to-treat analyses , approximately ¾ of patients exhibited clinical ly significant improvement . No significant group differences were found at posttreatment . Treatment gains were maintained at 12-month follow-up , with some support for stronger maintenance of gains in the BATD group . CONCLUSIONS BATD and problem-solving interventions represent practical interventions that may improve psychological outcomes and quality of life among depressed breast cancer patients . Study limitations and future research directions are discussed OBJECTIVE This study evaluated the psychological effects of a pre-surgical stress management training ( SMT ) in cancer patients . METHODS Stress management training comprised four sessions in total : on 5 days and 1 day pre-surgery and on 2 days and 1 month post-surgery . Patients also received audio CDs with relaxation and coping skills exercises .  Patients were r and omly assigned to the  SMT ( N = 34 ) or a regular care condition ( N = 36 ) .  Depression , anxiety , quality of life , perception of control , fatigue , pain , sleep problems , and surgery-related somatic symptoms were measured at Day 6 and Day 1 pre-surgery , and Day 2 , 5 , 30 and 90 post-surgery . RESULTS Depression and fatigue decreased in the intervention group and increased in the control group , leading to significant group differences at Day 2 ( fatigue ) and Day 5 post-surgery ( fatigue and depression ) . It also appeared that surgery-related symptoms had increased more in the control group 3 months post-surgery than in the SMT group . No intervention effects were observed for anxiety , pain , and sleep problems . CONCLUSION The use of a short psychological intervention is effective in reducing depression and fatigue in the post-surgical period , although the effects are of short duration Background . Previous integrative literature review s and meta-analyses have yielded conflicting results regarding the effectiveness of  psychosocial interventions for cancer patients . Methods . An integrative review of the literature focused on 19 r and omized , controlled trials ( 2006–2011 ) was completed to examine the effectiveness of psychosocial interventions for cancer patients . Eligibility criteria : Inclusion criteria were the study was an English language r and omized controlled clinical trial . Results . Seven studies involved nurses . Eleven studies result ed in positive outcomes . Overall , study quality was limited . In eight studies the intervention was not adequately described , 7 studies did not contain a hypothesis , 4 did not include clear eligibility criteria , 10 studies did not r and omize appropriately , 9 did not list recruitment date s , 11 did not include a power analysis , 14 did not include blinded patients or data collectors , 11 did not use an intent-to-treat analysis , 10 did not clarify reasons for drop outs , and 11 did not discuss treatment fidelity . Conclusions . Future studies should build on previous findings , use comparable outcome measures , and adhere to st and ards of quality research . Qualitative studies are needed to determine what cancer patients of varied ages , cancer stages , and racial/ethnic background s believe would be an effective intervention to manage their psychosocial needs OBJECTIVES --To assess outside a clinical trial the psychological outcome of different treatment policies in women with early breast cancer who underwent either mastectomy or breast conservation surgery depending on the surgeon 's opinion or the patient 's choice . To determine whether the extent of psychiatric morbidity reported in women who underwent breast conservation surgery  was associated with their participation in a r and omised clinical trial . DESIGN -- Prospect i ve , multicentre study capitalising on individual and motivational differences among patients and the different management policies among surgeons for treating patients with early breast cancer . SETTING --12 District general hospitals , three London teaching hospitals , and four private hospitals . PATIENTS --269 Women under 75 with a probable diagnosis of stage I or II breast cancer who were referred to 22 different surgeons . INTERVENTIONS --Surgery and radiotherapy or adjuvant chemotherapy , or both , depending on the individual surgeon 's stated preferences for managing early breast cancer . MAIN OUTCOME MEASURES --Anxiety and depression as assessed by st and ard methods two weeks , three months , and 12 months after surgery . RESULTS --Of the 269 women , 31 were treated by surgeons who favoured mastectomy , 120 by surgeons who favoured breast conservation , and 118 by surgeons who offered a choice of treatment . Sixty two of the women treated by surgeons who offered a choice were eligible to choose their surgery , and 43 of these chose  breast conserving surgery . The incidences of anxiety , depression , and sexual dysfunction were high in all treatment groups . There were no significant differences in the incidences of anxiety and depression between women who underwent mastectomy and those who underwent lumpectomy . A significant effect of surgeon type on the incidence of depression was observed , with patients treated by surgeons who offered a choice showing less depression than those treated by other surgeons ( p = 0.06 ) . There was no significant difference in psychiatric morbidity between women treated by surgeons who offered a choice who were eligible to choose their treatment and those in the same group who were not able to choose . Most of the women ( 159/244 ) gave fear of cancer as their primary fear rather than fear of losing a breast . The overall incidences of psychiatric morbidity in women who underwent mastectomy and those who underwent lumpectomy were similar to those found in the Cancer Research Campaign breast conservation study . At 12 months 28 % of women who underwent mastectomy in the present study were anxious compared with 26 % in the earlier study , and 27 % of women in the present study who underwent lumpectomy were anxious compared with 31 % in the earlier study . In both the present and earlier study 21 % of women who underwent mastectomy were depressed , and 19 % of women who underwent lumpectomy in the present study were depressed compared with 27 % in the earlier study . ) CONCLUSIONS --There is still no evidence that women with early breast cancer who undergo breast conservation surgery have less psychiatric morbidity after treatment than those who undergo mastectomy . Women who surrender autonomy for decision making by agreeing to participate in r and omised clinical trials do not experience any different psychological , sexual , or social problems from those women who are treated for breast cancer outside a clinical trial OBJECTIVE To evaluate the efficacy of a brief cognitive-behavioral therapy ( CBT ) that is being developed for management of cognitive dysfunction following chemotherapy among breast cancer survivors .  Memory and Attention Adaptation Training ( MAAT ) is a brief CBT design ed to improve the quality of life and function among cancer survivors with post-chemotherapy cognitive complaints . METHODS An initial , two-group  ( MAAT versus waitlist , no treatment control ) , r and omized clinical trial ( RCT ) was conducted . Forty stage I and II female breast cancer survivors ( mean age = 50 ; SD = 6.4 ) were r and omized to conditions and assessed at baseline , post-treatment ( 8 weeks ) and 2-month follow-up assessment points on measures of : ( 1 ) self-reported daily cognitive failures ; ( 2 ) quality of life ; and ( 3 ) neuropsychological performance . Participants were also assessed for satisfaction with MAAT . RESULTS With education and IQ as covariates , MAAT participants made significant improvements relative to controls on the spiritual well-being subscale of the quality of life measure and on verbal memory , but statistical significance was not achieved on self-report of daily cognitive complaints . However , moderate-to-large effect sizes were observed on these outcomes . Participants gave MAAT high satisfaction ratings . CONCLUSIONS Although this initial RCT is a small study , MAAT participants appear to improve on one measure of quality of life and verbal memory performance relative to no treatment controls and rate MAAT with high satisfaction . These data are encouraging and support the continued development and evaluation of MAAT efficacy BACKGROUND Many women with breast cancer need psychological help to cope more effectively after treatment . Cognitive and behavioural techniques are not yet well established in France . A multi-site r and omized study was conducted to evaluate the effects of a psycho-educational group intervention in this population . METHODS Two hundred and three patients , recruited after primary treatment , were r and omly assigned either to a treatment group ( psycho-educational intervention ) or to a waiting-list control group . The 8-week programme of 2 h sessions comprised of thematic discussion s , information and training in stress management techniques . Evaluation at baseline , after 8 sessions , and 1 month after programme completion , included evaluations using the STAI , POMS , MAC , EORTC QLQ-C30 and EORTC QLQ-BR23 breast module scales . RESULTS We observed a significant reduction in anxiety ( STAI , POMS ) among group participants , a reduction in anger , depression and fatigue ( POMS ) , a significant improvement in vigor and interpersonal relationships ( POMS ) , in emotional and role functioning , in health status and fatigue level ( EORTC QLQ-C30 ) . In contrast , coping strategies ( MAC ) were not significantly different between groups . No group-related negative effects were observed and the global satisfaction levels were very high . CONCLUSION This study demonstrates the feasibility and effectiveness of a psycho-educational intervention , which can accelerate the reduction of those negative affects which are present at the end of treatment . It represents an excellent complement or an alternative to individual psycho-oncologic therapeutic support , widely proposed in France , and should now be tested in groups with other types of cancer and at other disease phases PURPOSE / OBJECTIVES To describe women 's unexpected and distressing symptom experiences after breast cancer treatment . RESEARCH APPROACH Qualitative and descriptive . SETTING Depending upon their preference , participants were interviewed in their homes or in a private office space in a nearby library . PARTICIPANTS Purposive sample of 13 women 1 - 18 years after breast cancer treatment . METHOD OLOGIC APPROACH Secondary analysis of phenomenologic data ( constant comparative method ) . MAIN RESEARCH VARIABLES Breast cancer symptom distress , ongoing symptoms , and unexpected experiences . FINDINGS Women described experiences of unexpected and distressing symptoms in the years following breast cancer treatment . Symptoms included pain , loss of energy , impaired limb movement , cognitive disturbance , changed sexual experience , and lymphedema . Four central themes were derived : living with lingering symptoms , confronting unexpected situations , losing precancer being , and feeling like a has-been . Distress intensified when women expected symptoms to disappear but symptoms persisted instead . Increased distress also was associated with sudden and unexpected situations or when symptoms elicited feelings of loss about precancer being and feelings of being a has been . Findings suggest that symptom distress has temporal , situational , and attributive dimensions . CONCLUSIONS Breast cancer survivors ' perceptions of ongoing and unexpected symptoms have important influences on quality of life . Underst and ing temporal , situational , and attributive dimensions of symptom distress empowers nurses and healthcare professionals to help breast cancer survivors prepare for subsequent ongoing or unexpected experiences in the years after breast cancer treatment . INTERPRETATION Follow-up care for breast cancer survivors should foster dialogue about ways that symptoms might emerge and that unexpected situations might occur . Prospect i ve studies are needed to examine symptom distress in terms of temporal , situational , and attributive dimensions and explore the relationship between symptom distress and psychological distress after breast cancer treatment BACKGROUND We report a clinical trial comparing the effectiveness of education-based and peer discussion -based group interventions on adjustment to breast cancer . METHODS Women with stage I , II , or III breast cancer ( n = 312 ) were r and omly assigned to 1 of 4 group conditions : control , education , peer discussion , or education plus peer discussion ( combination ) . Seven groups ( each comprising 8 - 12 women ) were conducted in each of the 4 conditions ( 28 groups total ) . Adjustment was measured before the intervention , immediately after the intervention , and 6 months after the intervention . RESULTS Consistently positive effects on adjustment were seen in the education groups both immediately following and 6 months after the intervention . There were no benefits of participation in peer discussion groups , and some indications of adverse effects on adjustment at both follow-up examinations . The effects could be explained by changes in self-esteem , body image , and intrusive thoughts about the illness . CONCLUSIONS Education-based group interventions facilitated the initial adjustment of women diagnosed with early stage breast cancer . There was no evidence of benefits from peer discussion group interventions Purpose Although patients receive information prior to commencing radiotherapy , they often experience anxiety and distress . We conducted a pilot r and omised controlled trial to determine whether a radiation therapist led psycho-educational intervention for breast cancer patients prior to radiotherapy is likely to be effective in reducing radiotherapy-related concerns , patient anxiety and depression . Methods The intervention comprised two face-to-face consultations with a radiation therapist ( one prior to radiation planning and the other prior to treatment ) . Patients completed surveys at baseline , prior to treatment planning and on the first day of treatment . Outcome measures included the Hospital Anxiety and Depression Scale , Radiation Therapy Related Patient Concerns and Radiation Therapy Knowledge Scales . Results One hundred and twenty two patients completed baseline measures . Fifty-eight patients received usual care , and 64 received the intervention .  After the first consultation , patient anxiety was significantly lower in the intervention group ( p = 0.048 ) , as were concerns about radiotherapy ( p = 0.001 ) . There were no differences between groups for depression . Patient knowledge for the intervention group was higher after the first consultation ( p < 0.001 ) . Conclusion This intervention is likely to be effective in reducing patient anxiety and concerns and increasing knowledge . Future research is required to test this intervention with a larger population In a 2 x 2 r and omized block repeated measure design , this study evaluated the follow-up efficacy of the uncertainty management intervention at 20 months . The sample included 483 recurrence-free women ( 342 White , 141 African American women ; mean age = 64 years ) who were 5 - 9 years posttreatment for breast cancer . Women were r and omly assigned to either the intervention or usual care control condition . The intervention was delivered during 4 weekly telephone sessions in which survivors were guided in the use of audiotaped cognitive-behavioral strategies and a self-help manual . Repeated measures MANOVAs evaluating treatment group , ethnic group , and treatment by ethnic interaction effects at 20 months indicated that training in uncertainty management result ed in improvements in cognitive reframing , cancer knowledge , and a variety of coping skills . Importantly , the 20-month outcomes also demonstrated benefits for women in the intervention condition in terms of declines in illness uncertainty and stable effects in personal growth over time The purpose of this r and omized control trial was to verify the effectiveness of a brief group intervention that combines stress management psycho-education and physical activity ( ie , independent variable ) intervention in reducing fatigue and improving energy level , quality of life ( mental and physical ) , fitness ( VO2submax ) , and emotional distress ( ie , dependent variables ) in breast cancer survivors . This study applied Lazarus and Folkman stress-coping theoretical framework , as well as Salmon 's unifying theory of physical activity . Eighty-seven French-speaking women who had completed their treatments for nonmetastatic breast cancer at a university hospital in Quebec City , Canada , were r and omly assigned to either the group intervention ( experimental ) or the usual-care ( control ) condition . Data were collected at baseline , postintervention , and at 3-month follow-up . The 4-week group intervention was cofacilitated by 2 nurses . Results showed that participants in the intervention group showed greater improvement in fatigue , energy level , and emotional distress at 3-month follow-up , and physical quality of life at postintervention , compared with the participants in the control group . These results suggest that a brief psycho-educational group intervention focusing on active coping strategies and physical activity is beneficial to cancer survivors after breast cancer treatments OBJECTIVE The purpose was to examine whether social-cognitive variables would moderate the efficacy of a couple-focused group intervention ( CG ) for women diagnosed with early stage breast cancer . DESIGN Participants ( N = 238 ) were r and omly assigned to 6 sessions of a couple-focused group versus usual care . Intent to treat growth curve modeling analyses indicated that emotional expression and emotional processing moderated CG effects on depression . MAIN OUTCOME MEASURES The primary outcome measures for this study were psychological distress and psychological well-being . RESULTS Treatment attrition analyses separating out participants assigned to but not attending CG indicated that emotional expression , emotional processing , and protective buffering moderated the effects of CG among those who attended CG with the most consistent effects noted for emotional processing on indicators of distress and well-being . CONCLUSION The CG intervention may be more effective for patients who begin the group experience using emotional approach coping strategies to deal with cancer PURPOSE The purpose of this study was to determine whether participation in a group psychosocial intervention by patients with breast cancer would result in an improvement in psychological measures and in reduced billings in general medical expenses . DESCRIPTION OF STUDY Eligible women who had completed treatment for stage 0 , I , or II primary breast cancer were prospect ively and r and omly assigned to either the  intervention ( n=46 ) or control ( n=43 ) group . Both groups received the usual psychosocial care ; however , the intervention group also participated in six weekly cognitive/behavioral psychosocial meetings . All were assessed on psychiatric symptoms , mood , depression , and coping strategies at four time periods : pre-intervention , post-intervention , 1-year follow-up , and 2-year follow-up . Alberta Healthcare billing records were obtained covering the 2-year follow-up period to determine the amount billed per person over the course of the study . RESULTS Women in the intervention group had less depression , less overall mood disturbance , better overall quality of life , and fewer psychiatric symptoms than those in the control group , beginning immediately post-intervention and remaining so at 2 years post-intervention . Billing in the intervention group was an average of $ 147 less than in the control group , a 23.5 % reduction . CLINICAL IMPLICATION S This is the first study to show that a psychosocial intervention can reduce direct healthcare billings in a sample of patients with cancer . Importantly , these findings help to justify the routine availability of such programs in cancer treatment facilities worldwide Background : Older breast cancer survivors ( BCSs ) are at risk for late and long-term treatment effects on quality of life ( QOL ) , including lower physical functioning and fear of recurrence . Two promising approaches to address this include dance/movement therapy and mindfulness . Objective : The purpose of this 2-group r and omized controlled pilot feasibility study was to test short-term effects of a 12-week Mindful Movement Program ( MMP ) intervention combining mindfulness with self-directed movement on QOL and mindfulness in female BCSs 50 years or older and at 12 months or more following treatment . Methods : Consented participants were r and omized to an experimental group ( EG ) ( 12 weekly MMP sessions ) or a control group  ( no sessions ) . All completed question naires 3 times . The EG participants kept home practice diaries . Analysis was conducted after intervention for immediate effects on outcome variables and 6 weeks later for maintenance of effects . Results : Participants ( n = 49 ) ranged in age from 50 to 90 years ( average , 65.6 years ) and were at 9.8 years since diagnosis ( range , 1–32 years ) , and the majority were white , unpartnered , and retired . After intervention , EG participants showed improved QOL via decreased fear of recurrence and increased mindfulness attitude . At 6 weeks , initial effects were retained . Conclusions : The MMP appears to benefit older BCSs by reducing fear of recurrence and improving mindfulness attitude . Although these findings are promising , a larger study is needed to determine more specifically what short- and long-term effects are possible . Implication s for Practice : The combination of self-directed movement and mindfulness , as tested here , may be a valuable tool for promoting health and well-being in older long-term survivors of breast cancer The aim of this study was to evaluate a manualized cognitive behavioral group intervention for early-stage breast cancer patients . Sixty-nine women were recruited at an Irish specialist oncology hospital and assigned to a 6-week cognitive behavior therapy ( CBT ) program or an educational control group . Participants were assessed at baseline , 6 weeks , and 6-month follow-up . Groups × Time ( 2 × 3 ) ANOVAs showed that the program did not lead to greater improvement on st and ardized measures of coping , quality of life , or mood compared with the control group . Regression analyses showed that maladaptive coping and distress at baseline were predictive of psychological adjustment at follow-up . Level of distress was also predictive of quality of life at follow-up . Repeated measures ANOVAs of data from cases in the intervention group showed that patients who completed the program showed significant improvement in problem severity , impact of problems , coping ability , and goal attainment from pre- to posttreatment , and these gains were maintained at follow-up for problem severity and impact of problems , but not for coping ability or goal attainment . Participation in the program did not lead to less health service usage during the period from baseline to follow-up , compared with the educational control group . A controlled trial provided limited evidence for the effectiveness of brief cognitive behavior intervention  in enhancing psychological adjustment of early-stage breast cancer patients with non clinical ly significant levels of psychological distress . Future research should evaluate the effectiveness of the program for patients with elevated levels of psychological distress and limited coping re sources PURPOSE Psychological interventions are efficacious in reducing emotional distress for cancer patients . However , it is not clear whether psychological improvements are , in turn , related to improved health . A clinical trial tests whether a psychological intervention for cancer patients can do so , and also tests two routes to achieve better health : ( a ) reducing patients ' Emotional Distress , and /or ( b ) enhancing their functional immunity . METHODS Post-surgery , 227 breast cancer patients were r and omized to intervention or assessment only Study Arms . Conducted in small groups , intervention sessions were offered weekly for 4 months and followed by monthly sessions for 8 months . Measures included psychological ( distress ) , biological ( immune ) , and health outcomes ( performance status and evaluations of patient 's symptomatology , including toxicity from cancer treatment , lab values ) collected at baseline , 4 months , and 12 months . RESULTS A path model revealed that intervention participation directly improved health ( p<.05 ) at 12 months . These effects remained when statistically controlling for baseline levels of distress , immunity , and health as well as sociodemographic , disease , and cancer treatment variables . Regarding the mechanisms for achieving better health , support was found for an indirect effect of distress reduction . That is , by specifically lowering intervention patients ' distress at 4 months , their health was improved at 12 months ( p<.05 ) . Although the intervention simultaneously improved patients ' T-cell blastogenesis in response to phytohemagglutinin ( PHA ) , the latter increases were unrelated to improved health . CONCLUSION A convergence of biobehavioral effects and health improvements were observed . Behavioral change , rather than immunity change , was influential in achieving lower levels of symptomatology and higher functional status . Distress reduction is highlighted as an important mechanism by which health can be improved Background When diagnosed with breast cancer , most women ’s lives change as well as their perspectives on and appreciation of life . The aim of the present study was to evaluate whether psychosocial support intervention could influence health-related quality of life ( HRQOL ) and fatigue during the first year after diagnosis . Material and methods Of 382 patients with newly diagnosed breast cancer , 191 patients were r and omized to an intervention group and 191 patients were r and omized to a routine control group .  The intervention group received support intervention that lasted 1 week on a residential basis , followed by 4 days of follow-up 2 months later . The support intervention included informative educational parts , relaxation training , mental visualization , and nonverbal communication .  HRQOL was measured using the European Organization for Research and Treatment of Cancer ( EORTC ) QLQ-C30 and QLQ-BR23 question naires and fatigue with the Norwegian version of the fatigue scale at baseline and at 2 , 6 , and 12 months after intervention . Result There was a time-dependent improvement in both functional and symptom scales between baseline and 12 months as measured by the EORTC QLQ-C30 and BR23 question naires and there was a decrease in fatigue between baseline and after 2 months with further improvement up to 12 months in both groups , but there were no differences between the intervention and control groups at any point in time . Conclusion HRQOL improves and symptoms of fatigue decrease over time , but we could not see any additional effect from the rehabilitation program in this setting The study assessed whether a nursing intervention based on self-regulation theory , the Attentional Focus and Symptom Management Intervention ( AFSMI ) , could help women who underwent day surgery for breast cancer to achieve better pain management and decreased emotional distress . The sample consisted of 117 patients with breast cancer who were out patients and undergoing surgery as part of the initial treatment for their cancer . All subjects were interviewed at three different occasions . The subjects were r and omized into the experimental group ( n = 61 ) or the usual care group ( control , n = 56 ) . The subjects in the experimental group received the intervention in two sessions , 3 - 4 days and 10 - 11 days after surgery . The outcomes were the subjects ' pain and emotional distress . Results showed significant differences between the experimental and control group at post-test on home management , total mood disturbance , confusion and tension scores implying that the intervention was effective in achieving these outcomes . Clinical significance has illustrated that a nursing intervention applied during immediate recovery of breast cancer surgery is quite clinical ly relevant to reduce emotional distress . Self-regulation theory could effectively be used as a guide in developing nursing intervention programs in practice for patients with cancer undergoing day surgery as a primary treatment BACKGROUND The pilot study used clinical trial methodology to differentiate the effects of imagery and support on coping , life attitudes , immune function , quality of life , and emotional well-being after breast cancer . METHODS Women ( N = 47 ) who completed treatment for primary breast cancer , excluding stage IV , were r and omly assigned to st and ard care ( n = 15 ) or six weekly support ( n = 16 ) or imagery ( n = 16 ) sessions .  Self-report measures included Ways of Coping-Cancer , Life Attitude Profile , Quality of Life ( FACT-B ) , Profile of Mood States , and Functional Support . Immune measures included natural killer cell activity , plasma neopterin , interferon-gamma , interleukins 1 alpha , 1 beta , and 2 , and beta-endorphin levels . Differences between groups over time were tested using general linear models , adjusted for pretest score and covariates ( age , stage , and months posttreatment ) . RESULTS For all women , interferon-gamma increased , neopterin decreased , quality of life improved , and natural killer activity remained unchanged . Compared with st and ard care , both interventions improved coping skills ( seeking support ) and perceived social support , and tended to enhance meaning in life . Support boosted overall coping and death acceptance . When comparing imagery with support , imagery participants tended to have less stress , increased vigor , and improved functional and social quality of life . CONCLUSION Although imagery reduced stress and improved quality of life , both imagery and support improved coping , attitudes , and perception of support . The clinical implication s of these changes warrant further testing OBJECTIVE This study aims to test two telephone-delivered interventions for their efficacy in improving quality of life ( QOL ) ( psychological , physical , social , and spiritual ) among Latinas with breast cancer and their family members or friends ( labeled supportive partners in this study ) . METHODS Latinas with breast cancer and their supportive partners ( SPs ) were r and omly assigned to one of two telephone delivered 8-week interventions : ( i ) telephone interpersonal counseling ( TIP-C ) or ( ii ) telephone health education ( THE ) . QOL assessment s were made at baseline , immediately after the 8-week interventions ended , and at an 8-week follow-up . Seventy Latinas and their 70 SPs completed all assessment s ( 36 in health education and 34 in counseling ) and were included in the final analysis . RESULTS Both Latinas with breast cancer and their SPs had significant improvements in virtually all dimensions of QOL over the 16 weeks of the investigation . However , there was no evidence documenting the superiority of either intervention for improving QOL . Preliminary cost analysis found that the counseling intervention cost about $ 164.68 for one dyad compared with $ 107.03 for health education . The majority of participants reported benefit from the intervention and liked that the intervention was in Spanish , included SPs , and was delivered by telephone . CONCLUSION The results of this study show that relatively brief , culturally appropriate , and highly accessible telephone-delivered interventions that provide emotional and information support can bring about substantial improvements in QOL for both Latinas with breast cancer and their SPs BACKGROUND AND PURPOSE Previous literature s on young adult survivors of childhood cancer show inconsistent findings with regards to their psychological distress and health-related quality of life ( HRQOL ) . Much of the available data focus on negative patient outcomes following cancer treatments prescribed from 1970 to 1990 . In the present study , HRQOL and psychological distress of young adult survivors in Hong Kong was examined . It focused on subjects who had received cancer treatments prescribed in the last two decades . METHODS A structured telephone survey was conducted with 614 eligible survivors and 208 sibling controls in Hong Kong . RESULTS The survivors reported significantly lower mean scores in physical role and functioning , whereas their mental , social , and psychological well-being was similar to that of their sibling controls . Being female , older age , longer survival time , and specific cancer diagnoses were the factors associated with poorer physical and mental adaptation . HRQOL was negatively correlated with psychological distress . CONCLUSIONS Findings of the study suggest that most survivors adjusted fairly well in mental , psychological , and social aspects . Survivors with a higher risk of poor HRQOL could benefit from appropriate screening and counseling at an early stage to mitigate their survivorship difficulties . Prospect i ve follow-up studies on childhood cancer survivors are recommended to detect changes over longer survival periods PURPOSE Cognitive-existential group therapy ( CEGT ) was developed to improve mood and mental attitude toward cancer in women with early-stage breast cancer receiving adjuvant chemotherapy . Given the debate about group therapy 's association with increased survival in women with metastatic breast cancer , we were curious to check its effect at a much earlier stage in the cancer journey . PATIENTS AND METHODS We r and omly assigned 303 women with early-stage breast cancer who were receiving adjuvant chemotherapy to either 20 sessions of weekly group therapy plus three relaxation classes  ( n = 154 ) or to a  control condition of three relaxation classes alone ( n = 149 ) . The primary outcome was survival . RESULTS CEGT did not extend survival ; the median survival time was 81.9 months ( 95 % CI , 64.8 to 99.0 months ) in the group-therapy women and 85.5 months ( 95 % CI , 67.5 to 103.6 months ) in the control arm . The hazard ratio for death was 1.35 ( 95 % CI , 0.76 to 2.39 ; P = .31 ) . In contrast , histology and axillary lymph node status were significant predictors of survival . Low- grade histology yielded a hazard ratio of 0.342 ( 95 % CI , 0.17 to 0.69 ) , and axillary lymph node-negative status yielded a hazard ratio of 0.397 ( 95 % CI , 0.20 to 0.78 ) . CONCLUSION CEGT does not prolong survival in women with early-stage breast cancer Background : Psychosocial interventions can improve psychological quality of life ( symptoms of depression and anxiety ) of both women with breast cancer and their partners , but are not offered routinely to women and their partners . Objective : To test the hypotheses that telephone-delivered psychosocial interventions decrease depression and anxiety in women with breast cancer and their partners . Methods : The design of the study was a three-wave repeated measures with a between-subjects factor ( treatment group ) . Ninety-six women and their 96 partners were assigned r and omly to participate in one of three different 6-week programs : ( a ) telephone interpersonal counseling ( TIP-C ) ; ( b ) self-managed exercise ; or ( c ) attention control ( AC ) . Results : The mixed-model analysis of variance for symptoms of depression among women with breast cancer revealed  women 's depressive symptom scores decreased over time in all groups . For anxiety , women 's symptoms of anxiety decreased in the TIP-C and exercise groups over time , but not in the AC group . A parallel set of analyses was conducted on  partners ' depression and anxiety data . Symptoms of depression and anxiety among the partners decreased substantially over the course of the investigation . Similar to the women , partners '  symptoms of anxiety decreased significantly in the TIP-C and exercise groups , but not in the AC group . Discussion : Findings from this study support that these telephone-delivered psychosocial interventions were effective for decreasing symptoms of depression and anxiety to improve psychological quality of life when compared to an AC group Background : At the time of diagnosis , patients with cancer are highly exposed to the risk of psychological morbidity . The effects of psychosocial intervention for newly diagnosed cancer patients have not been extensively studied . Objective : The objective of this study was to test the effects of a dyadic peer support intervention on self-efficacy , anxiety , depression , and mental adjustment among newly diagnosed breast cancer patients in Korea . Methods : This study used a r and omized controlled trial design . One hundred twenty-nine patients were recruited within 1 month of diagnosis with breast cancer in the National Cancer Center in Korea . The study participants were r and omly assigned to either experimental ( n = 64 ) or control ( n = 65 ) group . The experimental group underwent dyadic peer support intervention during the 6 weeks after surgery . The control group received the usual care . Results : There was a significant difference in changes in self-efficacy for self-management of breast cancer between the experimental and control groups ; however , no significant changes were observed in anxiety , depression , and mental adjustment between the 2 groups . Conclusions : A 6-week dyadic peer support intervention was feasible and effective for increasing self-efficacy for self-management among newly diagnosed breast cancer patients in Korea . However , this intervention did not improve other psychological outcomes . Implication s for Practice : Oncology nurses are optimally positioned to promote adjustment in patients with cancer . Trained peer support partners , supervised by skilled nurses , may be useful in improving self-efficacy of patients newly diagnosed with breast cancer BACKGROUND A diagnosis of breast cancer and treatment are psychologically stressful events , particularly over the first year after diagnosis . Women undergo many dem and ing and anxiety-arousing treatments such as surgery , radiation and chemotherapy . Psychosocial interventions that promote psychosocial adaptation to these challenges may modulate physiological processes ( neuroendocrine and immune ) that are relevant for health outcomes in breast cancer patients . METHODS Women with Stages 1 - 3 breast cancer recruited 4 - 8 weeks after surgery were r and omized to either a 10-week group-based cognitive behavioral stress management ( CBSM ) intervention or a 1-day psychoeducational control group and completed question naires and late afternoon blood sample s at study entry and 6 and 12 months after assignment to experimental condition . RESULTS Of 128 women initially providing psychosocial question naire and blood sample s at study entry , 97 provided complete data for anxiety measures and cortisol analysis at all time points , and immune assays were run on a subset of 85 of these women . Those assigned to a 10-week group-based CBSM intervention evidence d better psychosocial adaptation ( lower reported cancer-specific anxiety and interviewer-rated general anxiety symptoms ) and physiological adaptation ( lower cortisol , greater Th1 cytokine [ interleukin-2 and interferon-gamma ] production and IL-2:IL-4 ratio ) after their adjuvant treatment compared to those in the control group . Effects on psychosocial adaptation indicators and cortisol appeared to hold across the entire 12-month observation period . Th1 cytokine regulation changes held only over the initial 6-month period . CONCLUSIONS This intervention may have facilitated a " recovery or maintenance " of Th1 cytokine regulation during or after the adjuvant therapy period . Behavioral interventions that address dysregulated neuroendocrine function could play a clinical ly significant role in optimizing host immunologic resistance during a vulnerable period OBJECTIVE The purpose of this article is to evaluate an 8-week pilot intervention based on Social Cognitive Theory to improve quality of life for women with breast cancer . METHODS A total of 32 breast cancer patients were r and omized to either the intervention or st and ard care .  Outcome variables included quality of life , mood , self-efficacy , outcome expectations , and self-regulation . RESULTS Effect sizes were calculated to examine the impact of the intervention , with moderate to large effect sizes found for several subscales of the outcome expectations variable : learning about cancer and treatment ( d = 0.85 ) , having a positive attitude ( d = 0.54 ) , talking about cancer ( d = 1.02 ) , engaging in relaxation ( d = 0.62 ) , and setting goals ( d = 1.58 ) . SIGNIFICANCE OF RESULTS A nonparametric sign test was conducted , indicating that women in the intervention condition either improved more or showed less decline than the women in st and ard care , p = .034 , two-tailed . Implication s and suggestions for the content and delivery of future psychosocial interventions with cancer patients are review ed The feasibility of a r and omized clinical trial to implement and compare the effectiveness of three components of an intervention for women with breast cancer and their partners was tested . The intervention components , st and ardized education by videotape ( SE ) , telephone counseling ( TC ) , and education with telephone counseling ( SE + TC ) , were design ed with a complementary approach to disease management of breast cancer at each of four phases of the breast cancer experience : diagnostic , postsurgery , adjuvant therapy , and ongoing recovery . A st and ardized Telephone Counseling Training Manual was developed . A nonprobability sample of 12 patient-partner pairs was accrued . Four pairs were r and omly assigned to each of the three intervention components . A set of question naires was completed by each patient and partner at baseline and following each intervention for assessment of emotional , physical , and social adjustment , and perceived support . Attrition was minimal and return rate for the completed question naires at all five data - collection points was high . Validation of the SE and the TC , one of the objectives , was by data from the preliminary descriptive study ( Hoskins , 1990–1994 ) , pretests and posttests for st and ardized education , audiotapes for each phase-specific telephone counseling session , and evaluation forms for each intervention session . The positive findings included significant changes from pre- to postmeasurement in patients ' and partners ' scores for the st and ardized education in each of the four phases . Even with the limited statistical power , the effects were marked , lending support for a full-scale r and omized clinical trial , to underst and better the relative treatment efficacy and differential benefit of one or some interventions over others PURPOSE / OBJECTIVES To test the value of telephone-administered cognitive-behavioral therapy in a study of patients with breast cancer . DESIGN Women were assigned r and omly to a therapy group or an assessment -only control group . SETTING A tertiary cancer treatment center serving rural areas of North Dakota and Minnesota . SAMPLE Women were recruited within three to four months of stage I ( n = 27 ) or stage II ( n = 26 ) breast cancer diagnosis . Age ranged from 30 - 82 ( mean = 51.5 years ) . Most participants ( n = 35 ) underwent a modified radical mastectomy ; 17 underwent a lumpectomy .  METHODS Therapy involved 10 30-minute ( or less ) telephone sessions . Data that were collected from mailed question naires included psychological distress ( Profile of Mood States ) , perceived stress , coping ( Coping Response Indices-Revised ) , quality of life ( Medical Outcome Scale ) , and satisfaction with therapy . Measures were completed at baseline and at 4- and 10-month follow-up intervals . MAIN RESEARCH VARIABLES Telephone therapy , stress , coping , and quality of life . FINDINGS With time , women in the therapy and control groups reported reduced stress and improved quality of life . However , significant reductions in some kinds of distress ( anxiety , anger , depression , and confusion ) were not observed . Most therapy participants liked the telephone treatment sessions but showed only modest improvement ( less anxiety and confusion ) compared with women in the control group . CONCLUSIONS Most patients reported being comfortable with the telephone therapy and said that they felt better as a result of it . However , the outcome data showed that telephone therapy -- as carried out in this study --produced only modest benefits . Research ers need to consider who is best for delivering such therapy . IMPLICATION S FOR NURSING PRACTICE Providing telephone therapy to patients with breast cancer has potential benefits , and nurses may be the appropriate professionals to administer the therapy PURPOSE / OBJECTIVES To examine the feasibility of using an emotional expression intervention with patients with cancer and test the hypothesis that emotional expression improves psychosocial adjustment . DESIGN Sequentially r and omized pretest/post-test design with repeated measures . SETTING Two radiation therapy ( RT ) facilities . SAMPLE Women completing RT for stage I or II breast cancer , who spoke and read English , were independent in self-care , and provided written consent . Subjects ( N = 44 ) were middle-aged ( mean = 53.6 years ) , Caucasian , married , and well educated . METHODS Following a baseline interview , subjects were sequentially r and omized to an attentional control group , a single dose , or a three-dose emotional expression writing group . Interventions were administered at the time of completion of RT . Follow-up telephone interviews were completed at 1 , 4 - 6 , 16 , and 28 weeks post-RT . MAIN RESEARCH VARIABLES Positive and negative affect , intrusiveness of thoughts , use of avoidant coping , side effect severity , trait negative affectivity , content of written essay , and themes derived from content analysis . FINDINGS A high level of acceptance and completion of emotional expression existed , but no effect of the intervention on psychosocial adjustment was evident . Process measures in the three-dose group changed as expected . No relationship existed between content changes and outcome measures . CONCLUSIONS Emotional expression is feasible for patients with cancer , but the efficacy of the intervention in improving mood and decreasing cognitive intrusion and avoidance was not supported . Emotional expression processes were consistent with those seen in other sample s and may influence outcomes that were not addressed in this study . IMPLICATION S FOR NURSING PRACTICE More extensive testing is needed , including additional outcome variables . Essays reveal concerns around communication , recurrence , and health behavior changes that should be considered in practice The effectiveness of support group interventions for cancer patients has been established among White patients but has been virtually unstudied among minority patients . The current study represents the 1st r and omized support group intervention targeted to African American women with breast cancer . Participants ( N = 73 ) with nonmetastatic breast cancer were r and omly assigned to an 8-week group intervention or an assessment -only control condition At 12 months , the intervention result ed in improved mood as well as improved general and cancer-specific psychological functioning among women with greater baseline distress or lower income . Subsequent research is needed to address effective methods of enrolling and following women with fewer psychosocial and financial re sources , as they were the most likely to benefit from this particular intervention OBJECTIVE The primary objective was to conduct a detailed analysis of individual variation in psychological morbidity in the year following surgery for breast cancer . The salience of the patients ' " illness perceptions " to morbidity was examined as a secondary objective . METHODS Psychological morbidity was assessed with the  General Health Question naire ( GHQ-28 )  in a prospect i ve study of 371 women having surgery for primary breast cancer . Patients also completed the  Illness Perception Question naire ( IPQ ) , Mental Adjustment to Cancer Scale ( MAC ) and the Eysenck Personality Scales ( EPS ) .  Assessment s were made postoperatively and at 3 , 6 and 12 months after surgery . RESULTS Whilst descriptive statistics indicated a general reduction in mean distress over the 12-month follow-up , close analysis showed that a quarter of all patients maintained clinical ly significant levels of distress throughout the period . Patients with chronically elevated distress were characterised by higher levels of neuroticism , greater symptom awareness , more pain and poorer self-rated general health . In the regression analysis , psychological morbidity across the 1-year follow-up was predicted principally by the immediate postoperative state of distress , IPQ symptom awareness and the perceived time line of the illness , general health and , to a more minor extent , by neuroticism . CONCLUSION There is marked individual variation in psychological morbidity in the year following breast cancer surgery , which is reliably predicted by the patient 's immediate postoperative state of distress , her perception of the impact of the symptoms and the time line of the disease . Subgroups of patients with chronically high distress are characterised by factors including personality and negative perceptions and beliefs about their illness Prospect i ve data are limited on the course of anxiety and depression and their determinants in women with early breast cancer . These parameters were assessed before adjuvant radiotherapy ( RT ) and over 5 years follow-up . Of 2208 women recruited to the START QOL study , 35 % reported clinical ly relevant levels of anxiety and /or depression pre-RT ; there was no significant change in these proportions over time . However , 75 % women with high baseline anxiety recorded further high scores over time whilst one in six had high scores at every follow-up point . Depression showed a similar pattern with lower frequencies at all time points ; very few with initial normal scores developed clinical ly relevant anxiety or depression over time . Lower educational level predicted worse anxiety and depression over time ; younger age predicted worse anxiety and chemotherapy predicted worse depression . Scores in the borderline or case range for anxiety or depression at baseline were both significantly associated with worse mood states over 5 years . These findings indicate the course of anxiety and depression in women with specific risk factors . This subgroup of patients requires greater clinical attention PROBLEM Although research ers suggest treatments that provide patients with an active coping strategy may increase patients ' sense of self-efficacy , previous studies have not measured patients ' self-efficacy . METHODS Eighteen women receiving chemotherapy for breast cancer were r and omized to  efficacy-enhancing experimental  ( n = 10 ) and usual-care control  ( n = 8) groups . The experimental group received five interventions delivered monthly . Variables-- quality of life , symptom distress , and self-care self-efficacy -- were measured at baseline and at 4 and 8 months later . FINDINGS At 4 and 8 months the interaction effects for the Functional Assessment of Cancer Treatment-Breast , used to measure quality of life , ranged from small for functional concerns to large for social concerns . Interaction effects for symptom distress , measured by the Symptom Distress Scale , were large . Interaction effects for self-care self-efficacy ranged from small for Enjoying Life and Stress Reduction , medium for Stress Reduction , and large for Making Decisions . CONCLUSIONS Interventions to promote self-efficacy may increase quality of life and decrease distress for women diagnosed with breast cancer The aim of this study was determine the effectiveness of a mindfulness-based stress-reduction ( MBSR ) program on quality of life ( QOL ) and psychosocial outcomes in women with early-stage breast cancer , using a three-arm r and omized controlled clinical trial ( RCT ) . This RCT consisting of 172 women , aged 20–65 with stage I or II breast cancer consisted of the 8-week MBSR , which was compared to a nutrition education program ( NEP ) and usual supportive care ( UC ) . Follow-up was performed at three post-intervention points : 4 months , 1 , and 2 years . St and ardized , vali date d self-administered question naires were adopted to assess psychosocial variables . Statistical analysis included descriptive and regression analyses incorporating both intention-to-treat and post hoc multivariable approaches of the 163 women with complete data at baseline , those who were r and omized to MBSR experienced a significant improvement in the primary measures of QOL and coping outcomes compared to the NEP , UC , or both , including the spirituality subscale of the FACT-B as well as dealing with illness scale increases in active behavioral coping and active cognitive coping . Secondary outcome improvements result ing in significant between-group contrasts favoring the MBSR group at 4 months included meaningfulness , depression , paranoid ideation , hostility , anxiety , unhappiness , and emotional control . Results tended to decline at 12 months and even more at 24 months , though at all times , they were as robust in women with lower expectation of effect as in those with higher expectation . The MBSR intervention appears to benefit psychosocial adjustment in cancer patients , over and above the effects of usual care or a credible control condition . The universality of effects across levels of expectation indicates a potential to utilize this stress reduction approach as complementary therapy in oncologic practice To the authors ' knowledge , there had been no evidence for the efficacy of psychosocial intervention among Japanese cancer patients . The objective of this study was to determine the effect of a psychosocial group intervention in reducing psychologic distress and enhancing coping in this population in a r and omized controlled trial OBJECTIVE Rehabilitation programmes are intended to help cancer patients achieve optimal functioning and live independently . We evaluated whether a psychosocial rehabilitation course was effective in relieving  cancer patients '  distress and improving their well-being . METHODS Patients with breast , prostate or colorectal cancer diagnosed within 2 years who had finished primary treatment were  r and omised to usual care or a 6-day residential course of lectures , discussion s and peer groups on issues related to treatment and living with cancer . Changes in self-reported distress ( POMS-Sf ) and quality of life ( EORTC QLQ-C30 ) from baseline to 1 and 6 months ' follow-up were measured . Analyses were adjusted for baseline scores of outcome , cancer site , time since diagnosis , gender , age and education . RESULTS Of 507 patients , 452 were included in the analyses , 404 completed the 1-month and 394 the 6-month assessment . Patients in the control group showed greater decreases in total mood disturbance and subscales of the POMS-Sf and showed more improvement in emotional , cognitive and social functioning at both 1 and 6 months and in role functioning at 6 months than the intervention group . A similar pattern was observed in analyses of breast cancer patients only . CONCLUSION A 6-day residential rehabilitation course did not relieve cancer patients '  distress or improve their well-being Background : Neuroendocrine dysregulation influenced by psychosocial stress is related to breast cancer recurrence . Very few studies examine the impacts of psychotherapy on diurnal cortisol patterns among breast cancer survivors . Methods : Forty-eight breast cancer patients who completed active cancer treatment were r and omly assigned to receive either 8 weekly body-mind-spirit ( BMS ) group therapy sessions or 1 educational ( EDU ) session . Self-report measures included the Beck Depression Inventory-II ( BDI-II ) , and the Meaning in Life question naire ( MLQ ) including two subscales : MLQ-Presence and MLQ- Search . Salivary cortisol levels were collected by the subjects in their homes at the time of awakening , 30 and 45 min after awakening , and at 12.00 , 17.00 , and 21.00 h. Measurement time points include baseline , the 2nd month ( completion of BMS therapy ) , the 5th month , and the 8th month . Results : There were no significant differences in BDI-II scores ( p>0.05 ) and MLQ-Presence scores ( p > 0.05 ) between BMS and EDU groups at baseline or across the three follow-ups . Nevertheless , greater MLQ- Search scores were found in the BMS group compared to the EDU group during the 5th month of follow-up ( p < 0.01 ) . The higher level of cortisol at 21.00 h ( p < 0.01 ) and a flatter diurnal cortisol pattern were more likely to occur in EDU than in BMS participants ( p < 0.05 ) at the 8th month of follow-up . Conclusion : BMS group therapy likely contributed to enhancing an active search for meaning in life toward more opportunities for personal growth and to maintaining stable cortisol responses to everyday life stress for breast cancer survivors There has been much interest in the psychosocial issues faced by breast cancer patients because of the high prevalence of the disease and the severe psychological impact of the cancer itself , as well as its treatment . The objective of our study was to investigate the determinants of psychiatric morbidity among postoperative ambulatory breast cancer patients . The variables examined included the patients ' biomedical characteristics , demographic characteristics , current concerns , coping responses and social support factors . Patients Completed the  Hospital Anxiety and Depression Scale ( HADS ) and the Mental Adjustment to Cancer scale ( MAC scale ) , and information pertaining to demographic variables , current concerns and social support factors was obtained by a specially design ed question naire . Available data were obtained from 148 r and omly selected postoperative ambulatory breast cancer patients . The prevalence of psychiatric morbidity ( including clinical anxiety and depression ) evaluated by using the HADS cut-off point was 23 % . The results of univariate analyses indicated that pain , dyspnea , having children with health problems , various other concerns ( about children , other family members , the patients ' own health and future treatment ) and poor coping responses ( low fighting spirit , high anxious preoccupation , high fatalism and high helplessness/hopelessness ) were significant determinants of the patients ' psychiatric morbidity . Additionally , in the logistic regression analysis , having children with health problems and having a low fighting spirit and a high helplessness/hopelessness were final significant determinants . Postoperative ambulatory breast cancer patients with these problems should be given careful attention , and psychosocial intervention may be beneficial for them OBJECTIVE To determine whether a telephone counseling program can improve psychosocial outcomes among breast cancer patients post-treatment . METHODS A r and omized trial was conducted involving 21 hospitals and medical centers , with assessment s ( self-administered question naires ) at baseline , 12 and 18 months post-enrollment . Eligibility criteria included early stage diagnosis , enrollment during last treatment visit , and the ability to receive the intervention in English . Endpoints included distress ( Impact of Event Scale ) , depression ( Center for Epidemiologic Studies Depression Scale ) , and two study -specific measures : sexual dysfunction and personal growth .  The control group ( n=152 ) received a re source directory for breast cancer ; the intervention group ( n=152 ) also received a one-year , 16 session telephone counseling program augmented with additional print material s. RESULTS Significant intervention effects were found for sexual dysfunction at 12 ( p=0.03 ) and 18 months ( p=0.04 ) and personal growth ( 12 months : p=0.005 ; 18 months : p=0.03 ) . No differences by group were found in mean scores for distress and depression , with both groups showing significant improvement at 12 and 18 months ( all p values for within-group change from baseline were < or=0.003 ) . However , when dichotomized at cutpoints suggestive of the need for a clinical referral , the control group showed virtually no change at 18 months , whereas the intervention group showed about a 50 % reduction in both distress ( p=0.07 ) and depression ( p=0.06 ) . CONCLUSIONS Telephone counseling may provide a viable method for extending psychosocial services to cancer survivors nationwide Patients with breast cancer who undergo autologous bone marrow/peripheral blood stem cell transplantation ( ABMT ) cope not only with a life-threatening medical treatment , but also with multiple , interrelated symptoms including pain , fatigue , psychological distress , and nausea . The purpose of this study was to determine , in a r and omized controlled clinical trial , whether a comprehensive coping strategy program ( CCSP ) was effective in significantly reducing pain , fatigue , psychological distress , and nausea in patients with breast cancer who underwent ABMT .  The CCSP was composed of preparatory information , cognitive restructuring , and relaxation with guided imagery . R and omization placed 52 patients in the CCSP treatment group and 58 patients in the control group . The CCSP was found to be effective in significantly reducing nausea as well as nausea combined with fatigue 7 days after the ABMT when the side effects of treatment were most severe . These results are important given the high incidence of nausea and fatigue in the ABMT population . The CCSP-treated group experienced mild anxiety as compared with the control group who reported moderate anxiety . The greatest effectiveness of CCSP may correspond to the time of the greatest morbidity for patients with breast cancer who have undergone ABM A prospect i ve , multidisciplinary , 5-year study of 69 consecutive female patients with early ( T0,1N0,1M0 ) breast cancer was conducted . Patients ' psychological responses to the diagnosis of cancer were assessed 3 months postoperatively . These responses were related to outcome 5 years after operation . Recurrence-free survival was significantly common among patients who had initially reacted to cancer by denial or who had a fighting spirit than among patients who had responded with stoic acceptance or feelings of helplessness and hopelessness BACKGROUND Throughout the illness trajectory , women with breast cancer experience issues that are related to physical , emotional , and social adjustment . Despite a general consensus that state-of-the-art treatment for breast cancer should include educational and counseling interventions to reduce illness or treatment-related symptoms , there are few prospect i ve , theoretically based , phase-specific r and omized , controlled trials that have evaluated the effectiveness of such interventions in promoting adjustment . PURPOSE The aim of this study is to examine the physical , emotional , and social adjustment of women with early-stage breast cancer who received psychoeducation by videotapes , telephone counseling , or psychoeducation plus telephone counseling as interventions that address the specific needs of women during the diagnostic , postsurgery , adjuvant therapy , and ongoing recovery phases of breast cancer . DESIGN Primary data from a r and omized controlled clinical trial . SETTING Three major medical centers and one community hospital in New York City . METHODS A total of 249 patients were r and omly assigned to either the control group receiving usual care or to one of the three intervention groups . The interventions were administered at the diagnostic , postsurgery , adjuvant therapy , and ongoing recovery phases . Analyses were based on a mixed model analysis of variance . MAIN RESEARCH VARIABLES AND MEASUREMENT : Physical adjustment was measured by the side effects incidence and severity subscales of the Breast Cancer Treatment Response Inventory ( BCTRI ) and the overall health status score of the Self-Rated Health Subscale of the Multilevel Assessment Instrument . Emotional adjustment was measured using the psychological well-being subscale of the Profile of Adaptation to Life Clinical Scale and the side effect distress subscale of BCTRI . Social adjustment was measured by the domestic , vocational , and social environments subscales of the Psychosocial Adjustment to Illness Scale . FINDINGS Patients in all groups showed improvement over time in overall health , psychological well-being , and social adjustment . There were no significant group differences in physical adjustment , as measured by side effect incidence , severity , or overall health . There was poorer emotional adjustment over time in the usual care ( control ) group as compared to the intervention groups on the measure of side effect distress . For the telephone counseling group , there was a marked decline in psychological well-being from the adjuvant therapy phase through the ongoing recovery phase . There were no significant group differences in the dimensions of social adjustment . CONCLUSION The longitudinal design of this study has captured the dynamic process of adjustment to breast cancer , which in some aspects and at various phases has been different for the control and intervention groups . Although patients who received the study interventions improved in adjustment , the overall conclusion regarding physical , emotional , and social adjustment is that usual care , which was the st and ard of care for women in both the  usual care (  control ) and intervention groups , supported their adjustment to breast cancer , with or without additional interventions . IMPLICATION S FOR NURSING The results are important to evidence -based practice and the determination of the efficacy and cost-effectiveness of interventions in improving patient outcomes . There is a need to further examine adjustment issues that continue during the ongoing recovery phase . KEY POINTS Psychoeducation by videotapes and telephone counseling decreased side effect distress and side effect severity and increased psychological well-being during the adjuvant therapy phase . All patients in the control and intervention groups improved in adjustment . Adjustment issues are still present in the ongoing recovery phase OBJECTIVE Although women 's breast cancer affects both women and their male partners , as well as their relationships , few interventions have been developed to work with couples confronting breast cancer . The current investigation presents the pilot results from a new couple-based intervention program for breast cancer that teaches couples how to minimize negative effects and maximize positive functioning during this difficult time . METHOD In this pilot study , 14 couples in which the wife had early stage breast cancer were r and omly assigned to one of the two treatment conditions : Couple-based relationship enhancement ( RE ) or treatment-as-usual ( TAU ) . RESULTS The results from this study suggest that compared with couples receiving treatment-as-usual , both women and men in the RE condition experienced improved functioning on individual psychological variables as well as relationship functioning at posttest and 1-year follow-up . In addition , women in RE show fewer medical symptoms at both time periods . CONCLUSIONS In this pilot study , the couple-based intervention , RE , has shown promise in improving individual , medical , and relationship functioning for couples in which the woman is facing breast cancer , and therefore merits further investigation on a larger scale
BACKGROUND Breast cancer is the most common cancer affecting women worldwide .
It is a distressing diagnosis and , as a result , considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer .
Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life .
As a consequence , multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer .
OBJECTIVES To assess the effects of psychological interventions on psychological morbidities , quality of life and survival among women with non-metastatic breast cancer .