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In a r and omized controlled design , this study tested the efficacy of a theoretically based uncertainty management intervention delivered to older long-term breast cancer survivors . The sample included 509 recurrence-free women ( 360 Caucasian , 149 African-American women ) with a mean age of 64 years ( S.D.=8.9 years ) who were 5 - 9 years post-treated for breast cancer . Women were r and omly assigned to either the intervention or usual care control condition . The intervention was delivered during four weekly telephone sessions , in which study nurses guided cancer survivors in the use of audiotaped cognitive-behavioral strategies to manage uncertainty about recurrence , and a self-help manual design ed to help women underst and and manage long-term treatment side effects and other symptoms . Treatment outcome data on uncertainty management were gathered at pre-intervention and 10-months afterward . Repeated measures MANOVA evaluating treatment group , ethnic group , and treatment by ethnic interaction effects indicated that training in uncertainty management result ed in improvements in cognitive reframing , cancer knowledge , patient-health care provider communication , and a variety of coping skills . Results are discussed in terms of the importance of theory-based interventions for cancer survivors that target triggers of uncertainty about recurrence and in terms of ethnic differences in response to the intervention PURPOSE 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 Introduction Self-management has been identified as an important opportunity to improve health outcomes among cancer survivors . However , few evidence -based interventions are available to meet this need . Methods The effectiveness of an adapted version of the Chronic Disease Self-Management Program for cancer survivors called Cancer Thriving and Surviving was evaluated in a r and omized trial . Outcomes were assessed at baseline and 6-months post program via written survey among 244 participants in Colorado . Repeated measures analysis was used to analyze pre/post program change . Results Statistically significant improvement was observed among those in the intervention in the following outcomes : Provider communication ( + 16.7 % change ) ; depression ( −19.1 % ) ; energy ( + 13.8 % ) ; sleep ( −24.9 % ) and stress-related problems ( −19.2 % ) ; change over time was also observed in the controls for energy , sleep , and stress-related outcomes though to a lesser degree . Effect sizes of the difference in change over time observed indicate a net beneficial effect for provider communication ( 0.23 ) ; and decreases in depression ( −0.18 ) ; pain ( −0.19 ) ; problems related to stress ( −0.17 ) ; and sleep ( −0.20 ) . Conclusion Study data suggest that the self-management support from adaptation of the CDSMP can reach and appeal to cancer survivors , improves common concerns in this population , and can fill an important gap in meeting the ongoing need for management of post-diagnosis issues in this growing segment of the U.S. population Until now , little research has been conducted examining the reactive dimension , or the degree to which a symptom limits an individual 's life , in a multiplicity of symptoms . This research examines how problem-solving therapy organizes an intervention to decrease symptom limitations . The purpose was threefold : to determine if a cognitive behavioral intervention decreases the impact of symptom limitations among individuals newly diagnosed with cancer , who are receiving chemotherapy ; to determine , after adjusting for covariates , how symptom limitations change over time ; and to describe which symptoms are most limiting . This r and omized control trial was conducted in two comprehensive and four community cancer centers . Two hundred thirty-seven individuals , aged 31 - 87 , newly diagnosed with solid tumor cancers , participated . The experimental group ( 118 individuals ) received a 10-contact , 18-week cognitive behavioral intervention focused on cancer- and chemotherapy-related symptoms . The control group ( 119 individuals ) received conventional care . Interviews occurred at baseline , 10 , 20 , and 32 weeks . Data analysis used a two-level hierarchical linear model . Participants receiving the cognitive behavioral intervention had lower scores of symptom limitation than did participants in the control group . At the onset of the study , younger patients reported more symptom limitations than their older counterparts ; however , this was reversed by the end of the study . The cognitive behavioral intervention was key to decreasing symptom limitations . Findings also suggest that nursing interventions may be particularly helpful to younger individuals in managing cancer-related symptom limitations Background : Recent literature has indicated that a significant percentage of oncology patients describe finding some benefit ( e.g. , improved personal growth , sense of meaning , and enhanced interpersonal relationships ) in the cancer experience . However , few studies have investigated the role of group-based psychosocial interventions in improving benefit finding ( BF ) , and virtually none have investigated these constructs in men . Purpose : This study examined whether a cognitive-behavioral stress management ( CBSM ) intervention improves BF and quality of life ( QoL ) in men recovering from treatment for localized prostate cancer . Methods : Participants in this study were 191 men ( M age = 65.1 ) treated with radiation or radical prostatectomy for clinical ly localized ( i.e. , Stage I or II ) prostate cancer . Participants were primarily non-Hispanic White ( 40 % ) or Hispanic ( 41 % ) , followed by Black ( 18 % ) and other ethnicity ( 1 % ) , were an average of 65.1 years old ( SD = 7.7 ) , and earned an average of $ 47,800 annually ( SD = $ 41,000 ) . Participants were r and omized to either a 10-week group-based cognitive-behavioral stress management intervention or a half-day educational seminar as a control condition . All participants provided demographic information and completed the Positive Contributions Scale-Cancer to assess BF , the Functional Assessment of Cancer Therapy to measure quality of life , and a measure of perceived stress management skills . Structural equation modeling was utilized for all analyses . Results : Results indicated that the CBSM condition led to increases in BF and QoL and that these changes were mediated by the development of stress management skills . Conclusions : Results support the use of group-based cognitive-behavioral interventions in promoting QoL and BF in this population OBJECTIVE Women with gynecological cancers have reported poor health-related quality of life ( QOL ) , with complex physical and psychological needs post-surgery and during chemotherapy treatment . There are no studies reporting interventions addressing these needs post-hospital discharge in this population . METHODS Patients were r and omized into two groups . The intervention group received 6 months of specialized care by an Advanced Practice Nurse ( APN ) ; in addition , women with high distress were evaluated and monitored by a psychiatric consultation-liaison nurse ( PCLN ) . The attention control group was assisted with symptom management by a research assistant . The effects of the 6-month intervention were evaluated using self-report question naires at baseline ( 24 - 48 h after surgery ) , 1 , 3 , and 6 months post- surgery . QOL assessment s included the Center for Epidemiological Studies -Depression Scale , the ambiguity subscale of the Mishel Uncertainty in Illness Scale , the Symptom Distress Scale , and the Short-Form Health Survey ( SF-12 ) . The sample for the longitudinal analysis included 123 who completed QOL outcome measures  across three occasions post-surgery . RESULTS The APN intervention result ed in significantly less uncertainty than the attention control intervention 6 months after surgery . When the sub-group who received the APN plus PCLN intervention was compared with the total attention control group , the sub-group had significantly less uncertainty , less symptom distress , and better SF-12 mental and physical QOL over time . CONCLUSION Nurse tailored interventions that target both physical and psychological aspects of QOL in women recovering from cancer surgery and undergoing chemotherapy produce stronger outcomes than interventions that target solely one QOL aspect PURPOSE Evidence suggests that the re-entry phase ( ie , early period after medical treatment completion ) presents distinct challenges for cancer patients . To facilitate the transition to recovery , we conducted the Moving Beyond Cancer ( MBC ) trial , a multisite , r and omized , controlled trial of psychoeducational interventions for breast cancer patients . METHODS Breast cancer patients were registered within 6 weeks after surgery . After medical treatment , they completed baseline measures and were r and omly assigned to st and ard National Cancer Institute print material ( CTL ) ; st and ard print material and peer-modeling videotape ( VID ) ; or st and ard print material , videotape , two sessions with a trained cancer educator , and informational workbook ( EDU ) . Two primary end points were examined : energy/fatigue and cancer-specific distress . Secondary end points were depressive symptoms and post-traumatic growth . Perceived preparedness for re-entry was analyzed as a moderator of effects . RESULTS Of 558 women r and omly assigned to treatment , 418 completed the 6-month assessment and 399 completed the 12-month assessment . In analyses controlling for study site and baseline depressive symptoms , VID produced significant improvement in energy/fatigue at 6 months relative to CTL , particularly among women who felt less prepared for re-entry at baseline . No significant main effect of the interventions emerged on cancer-specific distress , but EDU prompted greater reduction in this outcome relative to CTL at 6 months for patients who felt more prepared for re-entry . Between-group differences in the primary outcomes were not significant at 12 months , and no significant effects emerged on the secondary end points . CONCLUSION A peer-modeling videotape can accelerate the recovery of energy during the re-entry phase in women treated for breast cancer , particularly among those who feel less prepared for re-entry OBJECTIVE The purpose of this study was to test for moderating effects of patient characteristics on self-management interventions developed to address symptoms during cancer treatment . Patient 's age , education , and depressive symptomatology were considered as potential moderators . METHODS A secondary analysis of data of 782 patients from two r and omized clinical trials was performed . Both trials enrolled patients with solid tumors undergoing chemotherapy . After completing baseline interviews , patients were r and omized to a nurse-delivered intervention versus intervention delivered by a ' coach ' in trial I and to a nurse-delivered intervention versus an intervention delivered by an automated voice response system in trial II . In each of the two trials , following a six-contact 8-week intervention , patients were interviewed at week 10 to assess the primary outcome of symptom severity . RESULTS Although nurse-delivered intervention proved no better than the coach or automated system in lowering symptom severity , important differences in the intervention by age were found in both trials . Patients aged ≤45 years responded better to the coach or automated system , whereas those aged ≥75 years favored the nurse . Education and depressive symptomatology did not modify the intervention effects in either of the two trials . Depressive symptomatology had a significant main effect on symptom severity at week 10 in both trials ( p = 0.03 and p < 0.01 , respectively ) . Education was not associated with symptom severity over and above age and depressive symptomatology . CONCLUSIONS Clinicians need to carefully consider the age of the population when using or testing interventions to manage symptoms among cancer patients Background : Few studies have evaluated an individualized home-based exercise prescription during and after cancer treatment . Objective : The purpose of this study was to evaluate the effectiveness of a home-based exercise training intervention , the Pro-self Fatigue Control Program on the management of cancer-related fatigue . Interventions / Methods : Participants ( N = 119 ) were r and omized into 1 of 3 groups : group 1 received the exercise prescription throughout the study ; group 2 received their exercise prescription after completing cancer treatment ; and group 3 received usual care . Patients completed the Piper Fatigue Scale , General Sleep Disturbance Scale , Center for Epidemiological Studies -Depression Scale , and Worst Pain Intensity Scale . Results : All groups reported mild fatigue levels , sleep disturbance , and mild pain , but not depression . Using multilevel regression analysis , significant linear and quadratic trends were found for change in fatigue and pain ( ie , scores increased , then decreased over time ) . No group differences were found in the changing scores over time . A significant quadratic effect for the trajectory of sleep disturbance was found , but no group differences were detected over time . No significant time or group effects were found for depression . Conclusions : Our home-based exercise intervention had no effect on fatigue or related symptoms associated with cancer treatment . The optimal timing of exercise remains to be determined . Implication s for Practice : Clinicians need to be aware that some physical activity is better than none , and there is no harm in exercise as tolerated during cancer treatment . Further analysis is needed to examine the adherence to exercise . More frequent assessment s of fatigue , sleep disturbance , depression , and pain may capture the effect of exercise Background While Web-based interventions have been shown to assist a wide range of patients successfully in managing their illness , few studies have examined the relative contribution of different Web-based components to improve outcomes . Further efficacy trials are needed to test the effects of Web support when offered as a part of routine care . Objective Our aim was to compare in regular care the effects of ( 1 ) an Internet-based patient provider communication service ( IPPC ) , ( 2 ) WebChoice , a Web-based illness management system for breast cancer patients ( IPPC included )  , and ( 3 ) usual care on symptom distress , anxiety , depression , ( primary outcomes ) , and self-efficacy ( secondary outcome ) . This study reports preliminary findings from 6 months ’ follow-up data in a 12-month trial . Methods We recruited 167 patients recently diagnosed with breast cancer and undergoing treatment from three Norwegian hospitals . The nurse-administered IPPC allowed patients to send secure e-messages to and receive e-messages from health care personnel at the hospital where they were treated . In addition to the IPPC , WebChoice contains components for symptom monitoring , tailored information and self-management support , a diary , and communication with other patients . A total of 20 care providers ( 11 nurses , 6 physicians , and 3 social workers ) were trained to answer questions from patients . Outcomes were measured with question naires at study entry and at study months 2 , 4 , and 6 . Linear mixed models for repeated measures were fitted to compare effects on outcomes over time . Results Patients were r and omly assigned to the WebChoice group ( n=64 ) , the IPPC group ( n=45 ) , or the usual care group ( n=58 ) .  Response rates to question naires were 73.7 % ( 123/167 ) at 2 months , 65.9 ( 110/167 ) at 4 months , and 62.3 % ( 104/167 ) at 6 months . Attrition was similar in all study groups . Among those with access to WebChoice , 64 % ( 41/64 ) logged on more than once and 39 % ( 25/64 ) sent e-messages to care providers . In the IPPC group , 40 % ( 18/45 ) sent e-messages . Linear mixed models analyses revealed that the WebChoice group reported significantly lower symptom distress ( mean difference 0.16 , 95 % CI 0.06 - 0.25 , P=.001 ) , anxiety ( mean difference 0.79 , 95 % CI 0.09 - 1.49 , P=.03 ) , and depression ( mean difference 0.79 , 95 % CI 0.09 - 1.49 , P=.03 ) compared with the usual care group . The IPPC group reported significant lower depression scores compared with the usual care group ( mean difference 0.69 , 95 % CI 0.05 - 1.32 , P=.03 ) , but no differences were observed for symptom distress or anxiety . No significant differences in self-efficacy were found among the study groups . Conclusions In spite of practice variations and moderate use of the interventions , our results suggest that offering Web support as part of regular care can be a powerful tool to help patients manage their illness . Our finding that a nurse-administered IPPC alone can significantly reduce depression is particularly promising . However , the multicomponent intervention WebChoice had additional positive effects . Trial Registration Clinical trials.gov : NCT00971009 ; http:// clinical trials.gov/show/NCT00971009 ( Archived by WebCite at http://www.webcitation.org/6USKezP0Y ) BACKGROUND This study aims to examine the effectiveness of a self-management multimodal comprehensive coping strategy program ( CCSP ) on quality of life ( QOL ) among breast cancer patients 1 year after treatment . METHODS Patients ( n = 110 ) with stage II , III , or IV breast cancer scheduled to receive high dose chemotherapy and autologous hematopoietic stem cell transplantation were r and omized to either CCSP treatment or control group . The CCSP intervention was taught 2 week before hospital admission with reinforcement at specified times during treatment and 3 months after discharge . The CCSP components included educational information , cognitive restructuring , coping skills enhancement , and relaxation with guided imagery . Instruments administered at baseline included the following : Quality of Life Index-Cancer Version ( QOLI-CV ) , State-Trait Anxiety Inventory , Beck Depression Inventory , and Coping Strategies Question naire . At 1-year follow-up , patients ( n = 73 ) completed and returned the follow-up QOLI-CV . RESULTS Patients were mainly ≥ 40 years of age , married , Caucasian , and diagnosed with advanced breast cancer . A model measuring effectiveness of CCSP on QOL ( total and subscale ) at 1-year follow-up showed that the CCSP group ( n = 38 ) had significant improvement in overall QOL ( p < 0.01 ) , health and functioning ( p < 0.05 ) , and socioeconomic ( p < 0.05 ) and psychological/spiritual well-being ( p < 0.01 ) compared with the control group ( n = 35 ) . The CCSP patients frequently used the CCSP to manage psychological ( 51 % ) and sleep problems ( 60 % ) . CONCLUSIONS The CCSP  improved QOL for patients at 1-year follow-up . Patients overwhelmingly reported that CCSP was beneficial . The CCSP as an effective coping intervention has potential as a self-management program for breast cancer survivors Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more 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 BACKGROUND Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer , but evidence to guide its management is scarce . We aim ed to assess the efficacy and cost of a nurse-delivered complex intervention that was design ed to treat major depressive disorder in patients who have cancer . METHODS We did a r and omised trial in a regional cancer centre in Scotl and , UK . 200 out patients who had cancer with a prognosis of greater than 6 months and major depressive disorder ( identified by screening ) were eligible and agreed to take part . Their mean age was 56.6 ( SD 11.9 ) years , and 141 ( 71 % ) were women . We r and omly assigned 99 of these participants to usual care , and 101 to usual care plus the intervention , with minimisation for sex , age , diagnosis , and extent of disease . The intervention was delivered by a cancer nurse at the centre over an average of seven sessions . The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale ( range 0 to 4 ) at 3 months after r and omisation . Analysis was by intention to treat . This trial is registered as IS RCT N84767225 . FINDINGS Primary outcome data were missing for four patients . For 196 patients for whom we had data at 3 months , the adjusted difference in mean Symptom Checklist-20 depression score , between those who received the intervention and those who did not , was 0.34 ( 95 % CI 0.13 - 0.55 ) . This treatment effect was sustained at 6 and 12 months . The intervention also improved anxiety and fatigue but not pain or physical functioning . It cost an additional pound sterling 5278 ( US$ 10 556 ) per quality -adjusted life-year gained . INTERPRETATION The intervention-Depression Care for People with Cancer-offers a model for the management of major depressive disorder in patients with cancer and other medical disorders who are attending specialist medical services that is feasible , acceptable , and potentially cost effective PURPOSE We evaluated the effectiveness of a low-intensity , home-based physical activity program ( Onco-Move ) and a moderate- to high-intensity , combined supervised resistance and aerobic exercise program ( OnTrack ) versus usual care ( UC ) in maintaining or enhancing physical fitness , minimizing fatigue , enhancing health-related quality of life , and optimizing chemotherapy completion rates in patients undergoing adjuvant chemotherapy for breast cancer . PATIENTS AND METHODS We r and omly assigned patients who were scheduled to undergo adjuvant chemotherapy ( N = 230 ) to Onco-Move , OnTrack , or UC .  Performance-based and self-reported outcomes were assessed before r and om assignment , at the end of chemotherapy , and at the 6-month follow-up . We used generalized estimating equations to compare the groups over time . RESULTS Onco-Move and OnTrack result ed in less decline in cardiorespiratory fitness ( P < .001 ) , better physical functioning ( P ≤ .001 ) , less nausea and vomiting ( P = .029 and .031 , respectively ) and less pain ( P = .003 and .011 , respectively ) compared with UC . OnTrack also result ed in better outcomes for muscle strength ( P = .002 ) and physical fatigue ( P < .001 ) . At the 6-month follow-up , most outcomes returned to baseline levels for all three groups . A smaller percentage of participants in OnTrack required chemotherapy dose adjustments than those in the UC or Onco-Move groups ( P = .002 ) . Both intervention groups returned earlier ( P = .012 ) , as well as for more hours per week ( P = .014 ) , to work than the control group . CONCLUSION A supervised , moderate- to high-intensity , combined resistance and aerobic exercise program is most effective for patients with breast cancer undergoing adjuvant chemotherapy . A home-based , low-intensity physical activity program represents a viable alternative for women who are unable or unwilling to follow the higher intensity program CONTEXT For patients with cancer-related pain and their physicians , routine oncology visits are an opportunity to adjust the analgesic regimen and secure better pain control . However , treatment intensification occurs haphazardly in practice . OBJECTIVES To estimate the effect of patient-centered tailored education and coaching ( TEC ) on the likelihood of analgesic treatment adjustment during oncology visits , and in turn , the influence of treatment adjustment on subsequent cancer pain control , we studied patients enrolled in a r and omized trial of TEC . METHODS Just before a scheduled oncology visit , 258 patients with at least moderate baseline pain received TEC or control ;  just after the same visit , they reported on whether the physician recommended a new pain medicine or a change in dose of an existing medicine .  Pain severity and pain-related impairment were measured two , six , and 12 weeks later . RESULTS Patients assigned to TEC were more likely than controls to report a change in the analgesic treatment regimen ( 60 % vs. 36 % , P<0.01 ) ; significant effects persisted after adjustment for baseline pain , study site , and physician ( adjusted odds ratio 2.61 , 95 % confidence interval 1.55 , 4.40 , P<0.01 ) . In a mixed-effects repeated measures regression , analgesic change ( but not TEC itself ) was associated with a sustained decrease in pain severity ( P<0.05 ) . CONCLUSION TEC increases the likelihood of self-reported , physician-directed adjustments in analgesic prescribing , and treatment intensification is associated with better cancer pain outcomes This study evaluated a supportive intervention for fatigue in patients undergoing chemotherapy . One hundred three chemotherapy-naïve patients were recruited , stratified by treatment regimen , and r and omly allocated to intervention or usual care . The intervention was conducted over three months . Recipients were provided with an investigator- design ed information pack and Fatigue Diary that they completed during the week following each treatment . Additionally , support nurses visited them monthly at home . They assessed fatigue , provided psychological support , and coached participants in self-care . The intervention group reported significantly less fatigue ( P < 0.05 ) , lower associated distress ( P < 0.05 ) , and less impact of fatigue on valued pastimes ( P < 0.05 ) than the control group . Further , they reported significantly less anxiety ( P < 0.05 ) and depression ( P < 0.05 ) and displayed more adaptive coping ( P < 0.05 ) . The intervention enabled patients to adapt to living with fatigue and contributed to their psychological/emotional well-being and ability to cope with their illness and treatment Summary This trial reveals the positive impact of a nursing intervention to improve  patients ' self‐management of cancer pain  and reduce care transition‐related problems . ABSTRACT Patients ' self‐management skills are affected by their knowledge , activities , and attitudes toward pain management . This trial aim ed to test the Self Care Improvement through Oncology Nursing (SCION)‐PAIN program , a multimodular structured intervention to reduce patients ' barriers to self‐management of  cancer  pain . Two hundred sixty‐three patients with diagnosed malignancy , pain > 3 days , and average pain ≥ 3/10 participated in a cluster‐r and omized trial on 18 wards in 2 German university hospitals . Patients on the intervention wards received , in addition to st and ard pain treatment , the SCION‐PAIN program consisting of 3 modules : pharmacologic , nonpharmacologic pain management , and discharge management . The intervention was conducted by specially trained cancer nurses and included components of patient education , skills training , and counseling . Starting with admission , patients received booster sessions every third day and one follow‐up telephone counseling session within 2 to 3 days after discharge . Patients in the control group received st and ard care . Primary end point was the group difference in patient‐related barriers to self‐management of cancer pain ( Barriers Question naire – BQ II ) 7 days after discharge . The SCION‐PAIN program result ed in a significant reduction of patient‐related barriers to pain management 1 week after discharge from the hospital : mean difference on BQ II was −0.49 points ( 95 % confidence interval −0.87 points to −0.12 points ; P = 0.02 ) . Furthermore , patients showed improved adherence to pain medication ; odds ratio 8.58 ( 95 % confidence interval 1.66–44.40 ; P = 0.02 ) . A post hoc analysis indicated reduced average and worst pain intensity as well as improved quality of life . This trial reveals the positive impact of a nursing intervention to improve  patients ' self‐management of cancer pain Background Cancer-related pain is common and under-treated . This article describes a study design ed to test the effectiveness of a theory-driven , patient-centered coaching intervention to improve cancer pain processes and outcomes . Methods / Design The Cancer Health Empowerment for Living without Pain ( Ca-HELP ) Study is an American Cancer Society sponsored r and omized trial conducted in Sacramento , California . A total of 265 cancer patients with at least moderate pain severity ( Worst Pain Numerical Analog Score > = 4 out of 10 ) or pain-related impairment ( Likert score > = 3 out of 5 ) were r and omly assigned to receive tailored education and coaching ( TEC ) or educationally-enhanced usual care ( EUC ) ; 258 received at least one follow-up assessment . The TEC intervention is based on social-cognitive theory and consists of 6 components ( assess , correct , teach , prepare , rehearse , portray ) . Both interventions were delivered over approximately 30 minutes just prior to a scheduled oncology visit . The majority of visits ( 56 % ) were audio-recorded for later communication coding . Follow-up data including outcomes related to pain severity and impairment , self-efficacy for pain control and for patient-physician communication , functional status and well-being , and anxiety were collected at 2 , 6 , and 12 weeks . Discussion Building on social cognitive theory and pilot work , this study aims to test the hypothesis that a brief , tailored patient activation intervention will promote better cancer pain care and outcomes . Analyses will focus on the effects of the experimental intervention on pain severity and impairment ( primary outcomes ) ; self-efficacy and quality of life ( secondary outcomes ) ; and relationships among processes and outcomes of cancer pain care . If this model of coaching by lay health educators proves successful , it could potentially be implemented widely at modest cost . Trial Registration [ Clinical Trials Identifier : NCT00283166 CONTEXT Breathlessness , fatigue , and anxiety are distressing symptoms for patients with advanced lung cancer . Usually managed as isolated symptoms , they often can occur simultaneously . Previous research often has addressed management of discrete symptoms rather than considering them as a cluster , which , in reality , is the situation faced by patients . OBJECTIVES This study aim ed to examine the effectiveness of a psychoeducational intervention ( PEI ) on the symptom cluster of anxiety , breathlessness , and fatigue , compared with usual care . METHODS A pretest/post-test , two-group , r and omized , controlled trial was conducted . Education on symptom management and coaching in the use of progressive muscle relaxation were delivered to patients one week prior to commencing radiotherapy ( RT ) , and repeated three weeks after beginning RT . Symptom data were collected at four time points : prior to the intervention , three weeks , six weeks , and 12 weeks postintervention . RESULTS One hundred forty lung cancer patients receiving palliative RT were recruited from a publicly funded hospital in Hong Kong . Doubly multivariate analysis of variance revealed a significant difference ( time × group interaction effect , P=0.003 ) over time between the PEI and usual care control group on the pattern of change of the symptom cluster . Significant effects on the patterns of changes in breathlessness ( P=0.002 ) , fatigue ( P=0.011 ) , anxiety ( P=0.001 ) , and functional ability ( P=0.000 ) also were found . CONCLUSION PEI is a promising treatment for relieving the symptom cluster and each of the individually assessed symptoms . More effort needs to be directed at study ing impact of interventions on common symptom clusters OBJECTIVE This pilot project evaluated the acceptability and estimated the effect size of a tailored multidisciplinary quality of life ( MQOL ) intervention for men who have biochemical recurrence of prostate cancer . METHODS Participants included 57 men with localized prostate cancer with biochemical recurrence ( Median=76 years ; 89 % White ) . Participants were r and omized to wait list control  which offered the intervention upon conclusion of the study ( n=27 ) or to an eight-session group-based , MQOL ( n=30 ) intervention . Assessment s were completed at baseline , end of treatment , and 6 months post-treatment . RESULTS MQOL was acceptable as indicated by favorable participant retention ( 100 % retained ) , treatment compliance ( 97 % attended > 6 treatment sessions ) , and high ratings of helpfulness ( 80 % rated helpfulness > 4 on 5-point scale ) . MQOL had a favorable impact on the mental health composite score of the Short Form-36 at the end of treatment but not at 6 months ( effect size=0.52 and -0.04 ) ; health-related QOL as measured by the Functional Assessment of Cancer Therapy-Prostate at the end of treatment and 6 months ( effect size=0.14 and 0.10 ) ; and prostate cancer specific anxiety as measured by the Memorial Anxiety Scale for Prostate Cancer at the end of treatment and 6 months ( effect size=0.45 and 0.23 ) . CONCLUSIONS This pilot project provides preliminary data supporting the premise that a tailored behaviorally based MQOL intervention for men with biochemical recurrence of prostate cancer is acceptable to men and might reduce prostate cancer specific anxiety and enhance QOL . Further research examining the efficacy of this intervention in a larger r and omized trial is warranted Purpose To profile the prescription for and adherence to  breast cancer-related lymphedema ( BCRL )  self-care modalities among breast cancer ( BrCa ) survivors with BCRL in a 12-month r and omized weightlifting trial . Methods We developed a question naire that assessed prescription for and adherence to 10 BCRL self-care modalities that included physical therapy exercise , pneumatic compression pump , medication , lymphedema b and aging , arm elevation , self-administered lymphatic drainage , therapist-administered lymphatic drainage , compression garments , skin care , and taping . We measured prescription for and adherence to BCRL self-care modalities at baseline , 3 , 6 , and 12 months . Longitudinal logistic regression was used to estimate the odds ratio ( OR ) and 95 % confidence interval ( 95 % CI ) associated with prescription for and adherence to BCRL modalities over time . Results This study included 141 BrCa survivors with BCRL . Women were prescribed an average of 3.6 ± 2.1 BCRL self-care modalities during the study . The prescription for  therapist-administered lymphatic drainage  ( OR = 0.92 , 95 % CI 0.88–0.96 ) ,  pneumatic compression pump  use ( OR = 0.94 , 95 % CI 0.89–0.98 ) , and b and aging ( OR = 0.96 , 95 % CI 0.93–0.99 ) decreased over 12 months of follow-up . No other prescribed BCRL self-care modalities changed during the study . Over 12 months , the average adherence to all BCRL self-care modalities varied with 13 , 24 , 32 , and 31 % of women reporting < 25 , 25–49 , 50–74 , and ≥75 % adherence , respectively . Over 12 months , there was a noticeable change from high to low adherence in self-administered lymphatic drainage , such that there was a 15 % increased likelihood of adherence < 25 % compared to ≥75 % ( OR = 1.15 ( 95 % CI 1.05–1.26 ) ; p = 0.002 ) . The adherence patterns of all other modalities did not change over follow-up . Conclusions Our findings suggest the prescription for BCRL self-care modalities is variable . The average adherence to BCRL self-care was non-optimal . Future research is necessary to prepare BrCa survivors with the knowledge , skills , abilities , and re sources necessary to care for this lifelong condition Background : Limited documentation exists on the effectiveness of psychoeducational group ( PEG ) versus support group ( SG ) interventions among breast cancer patients during primary care .  Support group is a component of the hospitals ’ routine breast cancer care . Objective : The aim of this study was to investigate which of these approaches provides the greatest benefits to participants , particularly to women with low optimism ( pessimists ) . The primary outcomes investigated here were anxiety , depression , and mental adjustment to cancer . Methods : A total of 367 women with early-stage breast cancer were r and omized to the PEG or SG intervention starting 1 to 8 weeks after surgery . The PEG intervention included health education , enhancement of problem-solving skills , stress management , and psychological support . Results : Participants in both groups showed improvement over time ; however , no significant differences in emotional distress were found . The PEG participants exhibited more positive attitude at 2 and 6 months ( P < .001 ) and less helplessness/hopelessness ( P = .01 ) at 2 months compared with the SG participants . However , no significant differences were found between the groups at 12 months . Pessimists did not benefit more from attending the PEG than they did from attending the SG . Conclusion : Both groups showed improvement in emotional distress and coping over time . Although the results were limited , the PEG intervention seems to enhance short-term , but not long-term , adaptive coping . Implication s for practice : Psychoeducational group intervention yields benefits during the difficult period when patients receive adjuvant chemotherapy or radiotherapy . Thus , the hospital ’s st and ard group interventions have been changed to include more health education and stress management , but within the same time frame as the original SG OBJECTIVE The purpose of this study is to determine whether patient activation  is a changing or changeable characteristic and to assess whether changes in activation also are accompanied by changes in health behavior . STUDY METHODS To obtain variability in activation and self-management behavior , a controlled trial with chronic disease patients r and omized into either intervention or control conditions was employed . In addition , changes in activation that occurred in the total sample were also examined for the study period . Using Mplus growth models , activation latent growth classes were identified and used in the analysis to predict changes in health behaviors and health outcomes . DATA SOURCES Survey data from the 479 participants were collected at baseline , 6 weeks , and 6 months . PRINCIPAL FINDINGS Positive change in activation is related to positive change in a variety of self-management behaviors . This is true even when the behavior in question is not being performed at baseline . When the behavior is already being performed at baseline , an increase in activation is related to maintaining a relatively high level of the behavior over time . The impact of the intervention , however , was less clear , as the increase in activation in the intervention group was matched by nearly equal increases in the control group . CONCLUSIONS Results suggest that if activation is increased , a variety of improved behaviors will follow . The question still remains , however , as to what interventions will improve activation Objective : To conduct a r and omized controlled trial and compare the effects on cancer survivors ’ quality of life in a 12-week group-based multidisciplinary self-management rehabilitation program , combining physical training ( twice weekly ) and cognitive-behavioral training ( once weekly ) with those of a 12-week group-based physical training ( twice weekly ) . In addition , both interventions were compared with no intervention . Methods : Participants ( all cancer types , medical treatment completed ≥3 months ago ) were r and omly assigned to multidisciplinary rehabilitation ( n = 76 ) or physical training ( n = 71 ) . The nonintervention comparison group consisted of 62 patients on a waiting list . Quality of life was measured using the R AND -36 . The rehabilitation groups were measured at baseline , after rehabilitation , and 3-month follow-up , and the nonintervention group was measured at baseline and 12 weeks later . Results : The effects of multidisciplinary rehabilitation did not outperform those of physical training in role limitations due to emotional problem ( primary outcome ) or any other domains of quality of life ( all p > .05 ) . Compared with no intervention , participants in both rehabilitation groups showed significant and clinical ly relevant improvements in role limitations due to physical problem ( primary outcome ; effect size ( ES ) = 0.66 ) , and in physical functioning ( ES = 0.48 ) , vitality ( ES = 0.54 ) , and health change ( ES = 0.76 ) ( all p < .01 ) . Conclusions : Adding a cognitive-behavioral training to group-based self-management physical training did not have additional beneficial effects on  cancer survivors  ’ quality of life . Compared with the nonintervention group , the group-based self-management rehabilitation improved cancer survivors ’ quality of life . PT = physical training ; CBT = cognitive-behavioral training ; PT+CBT = physical training plus cognitive-behavioral training ; WLC = waiting-list comparison ; QoL = quality of life ; ANOVA = analysis of variance ; ES = effect size 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 Objective : Supporting patients ’ self care could have a major effect on the management of long-term conditions , which has led to worldwide interest in effective self care interventions . In Engl and , self care support is being developed through the “ Expert Patients Programme ” , which provides lay-led generic courses to improve patients ’ self care skills . However , the clinical and cost effectiveness of such courses remains unclear . Methods : Two-arm pragmatic r and omised controlled trial design with waiting list control in community setting s in Engl and . 629 patients with a wide range of self-defined long-term conditions were studied . The lay-led self care support group involved 6-weekly sessions to teach self care skills . Primary outcomes were self-efficacy , reported energy and routine health services utilisation at 6 months . A cost-effectiveness analysis was also conducted . Results : Patients receiving immediate course access reported considerably greater self-efficacy and energy at 6-month follow-up , but reported no statistically significant reductions in routine health services utilisation over the same time period . The cost-effectiveness analysis showed that patients receiving immediate course access reported considerably greater health related quality of life , and a small reduction in costs . If a quality adjusted life year was valued at £ 20 000 ( $ 39 191 ; € 30 282 ) , there was a 70 % probability that the intervention was cost effective . Conclusions : Lay-led self care support groups are effective in improving self-efficacy and energy levels among patients with long-term conditions , and are likely to be cost effective over 6 months at conventional values of a decision-maker ’s willingness to pay . They may be a useful addition to current services in the management of long-term conditions 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 BACKGROUND In this study we investigated the effects of a clinical nursing symptom control intervention on utilization of physician , hospital and emergency room services . MATERIAL / METHODS Two hundred twenty-two patients currently undergoing chemotherapy were recruited for the study , and were r and omized into either the 10-contact , 20-week experimental intervention group ( 110 ) , where the intervention focused on assisting the patient in managing their symptoms , or to a conventional care control group ( 112 ) . RESULTS A r and om effects regression model revealed that patients in the intervention group reported fewer emergency room visits than patients in the control group ( p=0.050 ) . Greater symptom severity and more comorbid conditions were also predictive of more emergency room visits . The intervention was effective in reducing the number of hospital visits for the subgroup of patients who at baseline reported above average symptom severity ( p=0.023 ) . CONCLUSIONS These findings suggest that a nursing intervention focusing on educating patients regarding specific strategies to be applied for controlling symptoms may be worthwhile , as the patients may regain some control in managing their symptoms and thus ultimately require fewer emergency room services and hospital visits . Such a straightforward approach may empower patients , enhance their quality of life and reduce overall costs of cancer care OBJECTIVE Fatigue is a common cancer-related symptom and exacerbated by chemotherapy . Psychological interventions for fatigue show promise . One , Beating Fatigue , was adapted for delivery by telephone and evaluated in an exploratory trial . METHODS Eight patients and 12 professionals contributed to focus groups that guided adaptation of the intervention . The intervention , modified for delivery by telephone using motivational interviewing , was tested in an exploratory trial . Forty-four patients were recruited to the trial and r and omized between the intervention ( n=23 ) and control ( n=21 ) . Outcome data were collected on fatigue intensity , fatigue distress , fatigue self-efficacy , anxiety and depression at baseline and following completion of chemotherapy . These data were augmented by interviews conducted to inform underst and ing of the intervention 's mechanism , feasibility and acceptability . RESULTS The intervention was both feasible and acceptable to patients and most reduced fatigue distress ( Effect Size ES=0.62 ) . It also reduced fatigue intensity ( ES=0.18 ) , fatigue self-efficacy ( ES=-0.34 ) , and anxiety ( ES=0.31 ) . It did not reduce depression . CONCLUSION These preliminary data are encouraging and support the delivery of interventions for cancer-related fatigue by telephone . Motivational interviewing appeared key to the intervention 's success . A larger definitive RCT is indicated . PRACTICE IMPLICATION S Opportunities should be sought to deliver psychologically-based interventions for fatigue by telephone Background : Use of oral chemotherapy agents to treat cancer has increased . Patients are responsible for adhering to complex regimens while managing symptoms from adverse effects of the chemotherapy . Objective : This study examined an intervention to manage symptoms and adherence to oral agents . Methods : A 3-group pilot study determined how an Automated Voice Response ( AVR ) system alone ( n = 40 ) , or the AVR with strategies to manage symptoms and adherence ( n = 40 ) , or the AVR with strategies to manage adherence ( n = 39 ) reduced symptom severity and improved adherence . Participants received a Symptom Management Toolkit , completed a baseline interview , and were r and omized to receive 8 weekly AVR calls . An exit interview occurred at 10 weeks . Results : Mean age was 59.6 years , with 70 % female and 76 % white , and 42 % were nonadherent , with missed doses increasing with regimen complexity . Symptom severity declined over time in all groups . No difference was found in adherence rates , and higher adherence was related with lower symptom severity across groups . Conclusions : Adherence , a significant clinical problem , can affect efficacy of the cancer treatment . The AVR intervention alone was just as effective as the AVR plus the nurse intervention at promoting adherence and managing symptoms from adverse effects . Implication s for Practice : Nurses need to focus on patient education by ensuring patient underst and ing of oral agent regimen and the need to adhere to the oral agent for efficacious cancer treatment . Nurses can promote the use of medication reminders and self-management of symptoms from adverse effects , to support adherence to the oral agent Background Sleep disruption and fatigue are ubiquitous among cancer patients and are sources of stress that may compromise treatment outcomes . Previously , we showed that a cognitive behavioral stress management ( CBSM ) intervention reduced anxiety and other stress-related processes in women undergoing primary treatment for breast cancer . Purpose This study examined secondary outcomes from a CBSM intervention trial for women with early-stage breast cancer to test if CBSM would improve sleep quality and fatigue among these patients at a single site in southern Florida .  CBSM-related effects have already been demonstrated for indicators of psychosocial adaptation ( e.g. , general and cancer-related anxiety ) . Methods Patients were r and omized to CBSM ( n= 120 ) or a 1-day psychoeducation control group ( n= 120 ) . The  Pittsburgh Sleep Quality Index ( PSQI ) and Fatigue Symptom Inventory  were completed prior to r and omization and 6 and 12 months after the baseline assignment . Results In latent growth analyses , women in CBSM reported greater improvements in PSQI sleep quality scores than controls , although there were no significant differences between conditions on PSQI total scores . Women in CBSM also reported greater reductions in fatigue-related daytime interference than controls , though there were no significant differences in changes in fatigue intensity . Changes in sleep quality were associated with changes in fatigue . Conclusions Future work may consider integrating sleep and fatigue content into stress management interventions for women with early-stage breast cancer & NA ; We aim ed to determine the effectiveness of a lay‐administered tailored education and coaching ( TEC ) intervention ( aim ed at reducing pain misconceptions and enhancing self‐efficacy for communicating with physicians ) on cancer pain severity , pain‐related impairment , and quality of life . Cancer patients with baseline “ worst pain ” of ⩾4 on a 0–10 scale or at least moderate functional impairment due to pain were r and omly assigned to TEC or enhanced usual care ( EUC ) during a telephone interview conducted in advance of a planned oncology office visit ( 265 patients r and omized to TEC or EUC ; 258 completed at least one follow‐up ) . Patients completed question naires before and after the visit and were interviewed by telephone at 2 , 6 , and 12 weeks . Mixed effects regressions were used to evaluate the intervention adjusting for patient , practice , and site characteristics . Compared to EUC , TEC was associated with increased pain communication self‐efficacy after the intervention ( P < .001 ) ; both groups showed significant ( P < .0001 ) , similar , reductions in pain misconceptions . At 2 weeks , assignment to TEC was associated with improvement in pain‐related impairment ( −0.25 points on a 5‐point scale , 95 % confidence interval −0.43 to −0.06 , P = .01 ) but not in pain severity ( −0.21 points on an 11‐point scale , −0.60 to 0.17 , P = .27 ) . The improvement in pain‐related impairment was not sustained at 6 and 12 weeks . There were no significant intervention by subgroup interactions ( P > .10 ) . We conclude that TEC , compared with EUC , result ed in improved pain communication self‐efficacy and temporary improvement in pain‐related impairment , but no improvement in pain severity . Compared with control , tailored education and coaching for patients with cancer‐related pain  improved communication self‐efficacy and reduced pain‐related impairment in the short term but had no sustained benefits PURPOSE The results of a r and omized , intervention study done in 1993 of psychoeducation for patients with early-stage malignant melanoma showed a beneficial effect on recurrence and survival 6 years after the intervention . In the present study , we replicated the study with 258 Danish patients with malignant melanoma . We also compared recurrence and survival among the participants in the r and omized study with 137 patients who refused to participate . PATIENTS AND METHODS We r and omly assigned 262 patients with primary malignant melanoma to a control or an intervention group . Patients in the intervention group were offered six weekly 2-hour sessions of psychoeducation . Participants and non participants were followed up for vital status and recurrence 4 to 6 years after surgical treatment . Prognostic factors ( thickness of the tumor and lymph node status ) , sex , and age were adjusted for in a Cox regression model ( proportional hazards regression ) to derive an adjusted survival rate ratio and an adjusted relapse-free survival rate ratio , with 95 % CIs . RESULTS The hazard ratio was 1.30 ( 95 % CI , 0.5 to 3.5 ) for survival and 0.73 ( 95 % CI , 0.3 to 1.9 ) for recurrence . Being a nonparticipant increased the risk for death by more than two-fold ( hazard ratio , 2.26 ; 95 % CI , 1.0 to 5.2 ) over that of participants . CONCLUSION Psychoeducation did not increase survival or the recurrence-free interval among patients with malignant melanoma ; however , non participants had a statistically significantly greater risk for death than participants BACKGROUND Regular exercise and dietary practice s have been shown to affect the health-related quality of life ( HRQOL ) and survival of breast cancer patients . OBJECTIVE The current study aim ed to investigate whether the WSEDI was a feasible and primarily effective method for promoting exercise and dietary behaviours for breast cancer patients . DESIGN A 12-week r and omized , controlled trial . SETTING Oncology outpatient treatment clinics at 3 university hospitals and 1 National Cancer Center in South Korea . PARTICIPANTS Fifty-nine breast cancer patients who had received curative surgery and completed primary cancer treatment within 12 months prior to the study and who had been diagnosed with stage 0-III cancers within 2 years prior to the study were recruited . METHODS Participants were r and omly assigned to either the intervention group , which used a Web-based self-management exercise and diet intervention program incorporating transtheoretical model (TTM)-based strategies ( n=29 ) , or to the control group , which used a 50-page educational booklet on exercise and diet ( n=28 ) . The intervention efficacy was measured at the baseline and 12 weeks via a Web-based survey that addressed the promotion of exercise and consumption of 5 servings of fruits and vegetables ( F&V ) per day , dietary quality , HRQOL , anxiety , depression , fatigue , motivational readiness , and self-efficacy . RESULTS The proportion of subjects who performed at least moderate-intensity aerobic exercise for at least 150 min per week ; ate 5 servings of F&V per day ; and had overall improvements in dietary quality , physical functioning and appetite loss ( HRQOL ) , fatigue , and motivational readiness was greater in the intervention group than in the control group . The self-efficacy with respect to exercise and F&V consumption was greater in the intervention group than in the control group . A Web-based program that targets changes in exercise and dietary behaviours might be effective for breast cancer survivors if the TTM theory has been used to inform the program strategy , although further research with a larger sample size is required to enable definitive conclusions PURPOSE To determine the effectiveness of the Alleviating Depression Among Patients With Cancer ( ADAPt-C ) collaborative care management for major depression or dysthymia . PATIENTS AND METHODS Study patients included 472 low-income , predominantly female Hispanic patients with cancer age > or= 18 years with major depression ( 49 % ) , dysthymia ( 5 % ) , or both ( 46 % ) . Patients were r and omly assigned to intervention ( n = 242 ) or enhanced usual care ( EUC ; n = 230 ) . Intervention patients had access for up to 12 months to a depression clinical specialist ( supervised by a psychiatrist ) who offered education , structured psychotherapy , and maintenance/relapse prevention support . The psychiatrist prescribed antidepressant medications for patients preferring or assessed to require medication . RESULTS At 12 months , 63 % of intervention patients had a 50 % or greater reduction in depressive symptoms from baseline as assessed by the Patient Health Question naire-9 ( PHQ-9 ) depression scale compared with 50 % of EUC patients ( odds ratio [ OR ] = 1.98 ; 95 % CI , 1.16 to 3.38 ; P = .01 ) . Improvement was also found for 5-point decrease in PHQ-9 score among 72.2 % of intervention patients compared with 59.7 % of EUC patients ( OR = 1.99 ; 95 % CI , 1.14 to 3.50 ; P = .02 ) . Intervention patients also experienced greater rates of depression treatment ( 72.3 % v 10.4 % of EUC patients ; P < .0001 ) and significantly better quality -of-life outcomes , including social/family ( adjusted mean difference between groups , 2.7 ; 95 % CI , 1.22 to 4.17 ; P < .001 ) , emotional ( adjusted mean difference , 1.29 ; 95 % CI , 0.26 to 2.22 ; P = .01 ) , functional ( adjusted mean difference , 1.34 ; 95 % CI , 0.08 to 2.59 ; P = .04 ) , and physical well-being ( adjusted mean difference , 2.79 ; 95 % CI , 0.49 to 5.1 ; P = .02 ) . CONCLUSION ADAPt-C collaborative care is feasible and results in significant reduction in depressive symptoms , improvement in quality of life , and lower pain levels compared with EUC for patients with depressive disorders in a low-income , predominantly Hispanic population in public sector oncology clinics Objectives The purpose of this present study was to evaluate Self-care Improvement through Oncology Nursing ( SCION ) program to reduce distressing anorexia , nausea , and emesis ( ANE ) in cancer patients undergoing chemotherapy . Methods Two hundred eight patients receiving chemotherapy with moderate to high emetogenic potential participated in a cluster r and omized trial on 14 wards in two German university hospitals . Additionally to st and ard antiemetic treatment , patients from the intervention wards received the SCION program consisting of four modules : advisory consultation , optimizing emesis prophylaxis , nutrition counseling , and relaxation . Patients from the control group received st and ard antiemetic treatment and st and ard care . Primary outcome was the group difference in ANE intensity assessed by Common Terminology Criteria for adverse events (CTCAE).Main results The SCION program did not result in a significant difference in the incidence of ANE symptoms as compared to st and ard care : mean difference on CTCAE scale was 0.24 pts ( 95%CI , −1.17 to 1.66 pts ; P = 0.733 ) . No difference could be found regarding patients ’ knowledge of side effects , self-care interventions , and agency . Health-related quality of life was significantly better for patients in the control group ( mean difference 10.2 pts ; 95%CI , 1.9 to 18.5 ; P = 0.017 ) . Conclusions Contrary to our expectations , the groups did not differ in ANE intensity caused by the overall low acute or delayed symptom intensity . Symptom hierarchy in cancer patients alters and challenges nursing interventions targeting the patients ’ self-care strategies PURPOSE / OBJECTIVES To evaluate the effectiveness of a psychoeducational program ( i.e. , PRO-SELF Pain Control Program ) compared to st and ard care in increasing patients '  knowledge regarding  cancer pain management .  DESIGN R and omized clinical trial . SETTING Seven outpatient setting s in northern California . SAMPLE 174 out patients with cancer and pain from bone metastasis . METHODS Following r and omization into either the PRO-SELF or st and ard care group , patients completed the Pain Experience Scale ( PES ) prior to and at the completion of the intervention . MAIN RESEARCH VARIABLES Total and individual item scores on the PES . FINDINGS Total PES knowledge scores increased significantly in the PRO-SELF group ( 21 % ) compared to the st and ard care group ( 0.5 % ) . Significant improvements in knowledge scores for patients in the PRO-SELF group were found on five of the nine PES items when compared to baseline scores . CONCLUSIONS The PRO-SELF Pain Control Program was an effective approach to increase patients '  knowledge of cancer pain management . IMPLICATION S FOR NURSING The use of a structured paper- and -pencil question naire , such as the PES , as part of a psychoeducational intervention provides an effective foundation for patient education in cancer pain management . Oncology nurses can use patients ' responses to this type of question naire to individualize the teaching and to spend more time on the identified knowledge deficits . This individualized approach to education about pain management may save staff time and improve patient outcomes 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 We tested the effects on problem-solving , anxiety and depression of 12-week group-based self-management cancer rehabilitation , combining comprehensive physical training ( PT ) and cognitive-behavioural problem-solving training ( CBT ) , compared with PT . We expected that PT + CBT would outperform PT in improvements in problem-solving ( Social Problem-Solving Inventory-Revised ( SPSI-R ) ) , anxiety and depression ( Hospital Anxiety and Depression Scale ( HADS ) ) , and that more anxious and /or depressed participants would benefit most from adding CBT to PT . Cancer survivors ( aged 48.8 ± 10.9 years , all cancer types , medical treatment completed ) were r and omly assigned to PT + CBT ( n = 76 ) or PT ( n = 71 ) . Measurement occasions were : before and post-rehabilitation ( 12 weeks ) , 3- and 9-month follow-up . A non-r and omised usual care comparison group ( UCC ) ( n = 62 ) was measured at baseline and after 12 weeks . Longitudinal intention-to-treat analyses showed no differential pattern in change between PT + CBT and PT . Post-rehabilitation , participants in PT and PT + CBT reported within-group improvements in problem-solving ( negative problem orientation ; p < 0.01 ) , anxiety ( p < 0.001 ) and depression ( p < 0.001 ) , which were maintained at 3- and 9-month follow-up ( p < 0.05 ) . Compared with UCC post-rehabilitation , PT and PT + CBT  only improved in anxiety ( p < 0.05 ) . CBT did not add to the effects of PT and had no extra benefits for higher distressed participants . PT was feasible and sufficient for durably reducing cancer survivors ’ anxiety PURPOSE In 1993 , a r and omized intervention study among patients with malignant melanoma showed a significant decrease in psychological distress and increased coping capacity 6 months after the intervention and enhanced survival 6 years later . We applied a similar intervention with a few modifications in a r and omized controlled trial among Danish patients with malignant melanoma and evaluated results on immediate and long-term effects on psychological distress and coping capacity . PATIENTS AND METHODS A total of 262 patients with primary cutaneous malignant melanoma were r and omly assigned to the control or intervention group . Patients in the intervention group were offered six weekly sessions of 2 hours of psychoeducation , consisting of health education , enhancement of problem-solving skills , stress management , and psychological support . The participants were assessed at baseline before r and om assignment and 6 and 12 months after surgery . The analyses of the main effects of the intervention were based on analyses of covariance . RESULTS The patients in the intervention group showed significantly less fatigue , greater vigor , and lower total mood disturbance compared with the controls , and they used significantly more active-behavioral and active-cognitive coping than the patients in the control group . The improvements were only significant at first follow-up . CONCLUSION The findings of this study support the results of an earlier intervention study among patients with malignant melanoma and indicate that a psychoeducational group intervention for such patients can decrease psychological distress and enhance effective coping . However , this effect is short term and the clinical relevance is not obvious BACKGROUND High levels of distress and need for self-care information by patients commencing chemotherapy  suggest that current prechemotherapy education is suboptimal . We conducted a r and omised , controlled trial of a prechemotherapy education intervention ( ChemoEd ) to assess impact on  patient distress , treatment-related concerns , and the prevalence and severity of and bother caused by six chemotherapy side-effects . PATIENTS AND METHODS One hundred and ninety-two breast , gastrointestinal , and haematologic cancer patients were recruited before the trial closing prematurely ( original target 352 ) . ChemoEd  patients received a DVD , question -prompt list , self-care information , an education consultation≥24 h before first treatment ( intervention 1 ) , telephone follow-up 48 h after first treatment ( intervention 2 ) , and a face-to-face review immediately before second treatment ( intervention 3 ) . Patient outcomes were measured at baseline ( T1 : pre-education ) and immediately preceding treatment cycles 1 ( T2 ) and 3 ( T3 ) . RESULTS ChemoEd did not significantly reduce patient distress . However , a significant decrease in sensory/psychological ( P=0.027 ) and procedural ( P=0.03 ) concerns , as well as prevalence and severity of and bother due to vomiting ( all P=0.001 ) , were observed at T3 . In addition , subgroup analysis of patients with elevated distress at T1 indicated a significant decrease ( P=0.035 ) at T2 but not at T3 ( P=0.055 ) in ChemoEd patients . CONCLUSIONS ChemoEd holds promise to improve patient treatment-related concerns and some physical/psychological outcomes ; however , further research is required on more diverse patient population s to ensure generalisability OBJECTIVE To evaluate the mode of delivery of a stress management intervention , in a group or individual setting , on  self-reported cancer-related traumatic stress symptoms .  A secondary aim was to evaluate a stepped care approach . METHODS All study participants ( n = 425 ) , who were female , newly diagnosed with breast cancer and receiving st and ard oncological care were offered Step I of the stepped care approach , a stress management education ( SME ) . Thereafter , they were screened for cancer-related traumatic stress symptoms , and , if present ( n = 304 ) , were invited to join Step II , a more intense intervention , derived from cognitive behavioral therapy , to which they were r and omized to either a group ( n = 77 ) or individual ( n = 78 ) setting . To assess cancer-related traumatic stress symptoms , participants completed the Impact of Event Scale and the Hospital Anxiety and Depression Scale at the time of inclusion , three-months post- inclusion and approximately 12-months post- inclusion . RESULTS The SME did not significantly decrease any of the cancer-related traumatic stress symptoms . No statistically significant differences were found between the group and the individual setting interventions . However , only 54 % of the participants attended the group setting compared to 91 % for the individual setting . CONCLUSION The mode of delivery had no effect on the cancer-related traumatic stress symptoms ; however , the individual setting was preferred . In future studies , a preference-based RCT design will be recommended for evaluating the different treatment effects OBJECTIVE This study assessed longer-term outcomes of low-income patients with cancer ( predominantly female and Hispanic ) after treatment in a collaborative model of depression care or in enhanced usual care .  METHODS The r and omized controlled trial , conducted in safety-net oncology clinics , recruited 472 patients with major depression symptoms . Patients r and omly assigned to a 12-month intervention ( a depression care manager and psychiatrist provided problem-solving therapy , antidepressants , and symptom monitoring and relapse prevention ) or enhanced usual care ( control group ) were interviewed at 18 and 24 months after enrollment . RESULTS At 24 months , 46 % of patients in the intervention group and 32 % in the control group had a ≥50 % decrease in depression score over baseline ( odds ratio=2.09 , 95 % confidence interval=1.13 - 3.86 ; p=.02 ) ; intervention patients had significantly better social ( p=.03 ) and functional ( p=.01 ) well-being . Treatment receipt among intervention patients declined ( 72 % , 21 % , and 18 % at 12 , 18 , and 24 months , respectively ) ; few control group patients reported treatment receipt ( 10 % , 6 % , and 13 % , respectively ) . Significant differences in receipt of counseling or antidepressants disappeared at 24 months . Depression recurrence was similar between groups ( intervention , 36 % ; control , 39 % ) . Among patients with depression recurrence , intervention patients were more likely to receive treatment after 12 months ( 34 % versus 10 % ; p=.03 ) . At 24 months , attrition ( 262 patients , 56 % ) did not vary by group ; 22 % were deceased , 20 % declined further participation , and 14 % could not be located . CONCLUSIONS Collaborative care reduced depression symptoms and enhanced quality of life ; however , results call for ongoing depression symptom monitoring and treatment for low-income cancer survivors PURPOSE OF THE RESEARCH The purpose s of this paper are to describe the methods used and the knowledge gained during a pilot study that evaluated the effects of a self-management intervention for cancer pain , as well as the adaptations that were made for a larger clinical trial . METHODS AND SAMPLE In a r and omized controlled trial , the adapted German version of the PRO-SELF ( © ) Plus Pain Control Program ( PCP ) , a 10-week intervention to support self-management of pain in adult oncology out patients and their family caregivers , was compared to attention control . Primary endpoints were average and worst pain measured at 6 , 10 , 14 , and 22 weeks after enrollment . KEY RESULTS A total of 39 patients ( 19 intervention , 20 control ) were recruited over 18 months . During the study , inclusion criteria were exp and ed . Furthermore , the structured timing of the intervention visits was too static for a dynamic symptom like cancer pain . The intervention was exp and ed to include symptoms that severely impacted pain self-management including chemotherapy-induced nausea and vomiting . CONCLUSIONS Apart from the provision of information and skills building , coaching cancer patients across a complex treatment is an important function of an intervention to support pain self-management . The pilot study proved to be highly useful in order to adapt planned study procedures , to balance burden and benefit for participants , and to customize the intervention to patients ' needs and abilities in order to enhance feasibility and effectiveness . Findings from this pilot study will be fully integrated in a larger r and omized controlled trial . CLINICAL TRIAL REGISTRATION NUMBER NCT00920504 PURPOSE : This r and omized controlled trial compared 2 methods of ostomy care instruction to determine their effect on patients '  knowledge , skills , and confidence related to postoperative ostomy care . SUBJECTS AND SETTING : Eighty-eight adults with newly created ostomies were r and omly assigned to 1 of 2 groups . Of the 88 enrolled patients , 68 completed the study : 10 patients were discharged from the hospital prior to completion of the study interventions ; 10 others were withdrawn because they no longer met study inclusion criteria . The remaining subjects , who were equally split between men and women , ranged in age from 23 to 84 years . There were 23 colostomy and 45 ileostomy patients in our sample . The study setting was 2 acute care hospitals within a large tertiary health care system in the Midwestern United States . METHODS : We used a posttest-only experimental design to compare 2 methods of postoperative ostomy education . Traditional education comprised 3 WOC nurse – led instruction sessions and the experimental intervention comprised 2 nurse-led instruction sessions plus DVD instruction that could be accessed in between nurse-led sessions . All patients received one-on-one instruction from certified WOC nurse at their bedside . Patients completed a written test of ostomy knowledge , a self-care skills demonstration , and a Visual Analog Scale rating their confidence with ostomy self-care . RESULTS : There were no significant differences between the 2 teaching methods or type of ostomy with regard to knowledge of ostomy care ( F3,64 5 1.308 , P 5 0.28 ) , ostomy care skills ( F3,64 5 0.163 , P 5 0.92 ) , or confidence in performing ostomy self-care ( F3,64 5 0.629 , P 5 0.59 ) . Differences between the study groups ' self-reported learning style , education level , age , room type , and gender also did not significantly impact their knowledge , skills , or confidence . CONCLUSION : When teaching first-time ostomy patients postoperative self-care , a Nurse Instruction plus DVD method is as effective as Nurse Instruction alone Background Regular physical activity ( PA ) provides health benefits ; however , at least 60 % of the population fails to engage in the recommended amount of PA required to produce these health benefits . Purpose The primary purpose of the study was to examine over a 12-week structured exercise program the effect of a multifaceted efficacy intervention ( MEI — i.e . , task and specific types of self-regulatory efficacy ) on objective ly measured exercise behavior . Secondary purpose s were to examine the effect of the MEI on both task and self-regulatory efficacy levels ; and to determine whether efficacy beliefs could predict exercise behavior . Methods Relatives of colon cancer patients ( N = 140 ) were enrolled in an exercise program , and were r and omized to either a MEI or attention control condition  , and took part in  classroom sessions .  Behavior was assessed throughout the 12-week program using objective measures of frequency , duration , and intensity of exercise , and dropout rates , while self-reported task , barrier , scheduling , goal - setting , and relapse prevention efficacy were assessed at baseline and weeks 4 , 8 , and 12 . Results The MEI group exercised for longer duration in the early phase of the program ( i.e. , 0–4 weeks ) ; however , no significant differences were noted for exercise frequency and intensity . Differential dropout was found favoring the MEI group at weeks 8 and 12 . No treatment condition differences were found for reported efficacy beliefs . Proceeding self-efficacious beliefs were associated with objective measures of behavior . Conclusions A MEI grounded in Social Cognitive Theory was partially effective in influencing colon cancer relatives ’ exercise behavior PURPOSE / OBJECTIVES To evaluate the effectiveness of a cognitive behavioral intervention in decreasing symptom severity in patients with advanced cancer undergoing chemotherapy .  DESIGN Prospect i ve , r and omized clinical trial based on cognitive behavioral theory . SETTING Six urban cancer centers in the midwestern United States . SAMPLE 124 patients 21 years of age or older were recruited and r and omized to receive conventional care or conventional care and an intervention .  Participants were newly diagnosed with stage III , stage IV , or recurrent cancer ( solid tumor or non-Hodgkin lymphoma ) , undergoing chemotherapy , cognitively intact , and able to read and speak English . METHODS Data were gathered via telephone interviews at baseline and 10 and 20 weeks after r and omization . Nurses with experience in oncology delivered a five-contact , eight-week intervention aim ed at teaching patients problem-solving techniques to affect symptom severity . MAIN RESEARCH VARIABLES Gender , site of cancer , age , symptom severity and depressive symptoms at baseline , group ( i.e. , experimental versus control ) , and total symptom severity . FINDINGS Patients in the experimental group and those with lower symptom severity at baseline had significantly lower symptom severity at 10 and 20 weeks ; the experimental difference at 20 weeks occurred primarily in those 60 years of age and younger . Depressive symptoms at baseline predicted symptom severity at 20 weeks ; however , age , gender , and site of cancer did not affect symptom severity at either time point . CONCLUSIONS A cognitive behavioral intervention to teach problem-solving skills can be effective for patient symptom self-management during and following an intervention . IMPLICATION S FOR NURSING Problem-solving strategies should be included in educational programs for patients with advanced cancer , particularly those 60 years of age and younger BACKGROUND Research has shown that self-directed stress management training improves mental well-being in patients undergoing chemotherapy . The present study extends this work by evaluating separate and combined effects of stress management training and home-based exercise . METHOD Following assessment of mental and physical well-being , depression , anxiety , exercise , and stress reduction activity before chemotherapy started , patients were r and omized to stress management training ( SM ) , exercise ( EX ) , combined stress management and exercise ( SMEX ) , or usual care only ( UCO ) . Outcomes were reassessed 6 and 12 weeks after chemotherapy started . Significance testing of group-by-time interactions in 286 patients who completed all assessment s was used to evaluate intervention efficacy . RESULTS Interaction effects for mental and physical well-being scores were not significant . Depression scores yielded a linear interaction comparing UCO and SMEX ( p = 0.019 ) , with decreases in SMEX but not UCO . Anxiety scores yielded a quadratic interaction comparing UCO and SMEX ( p = 0.049 ) , with trends for changes in SMEX but not UCO . Additional analyses yielded quadratic interactions for exercise activity comparing UCO and SMEX ( p = 0.022 ) , with positive changes in SMEX but not UCO , and for stress management activity comparing UCO and SM ( p < 0.001 ) and UCO and SMEX ( p = 0.013 ) , with positive changes in SM and SMEX but not UCO . CONCLUSION Only the combined intervention yielded effects on quality of life outcomes , and these were limited to anxiety and depression . These findings are consistent with evidence that only the combined intervention yielded increases in both exercise and stress management activity . Future research should investigate ways to augment this intervention to enhance its benefits Methods We conducted a cohort study with optional r and omisation comparing seclusion and mechanical restraint among in- patients with acute psychotic disorders . We determined an ethical aspect as main outcome variable : the restriction of human rights from the patients ' point of view , measured by a scale developed for this purpose , Human DIgnity during COercive Procedures , DICOP . In addition we screened for posttraumatic stress disorder ( PTSD ) . After one year a follow-up was conducted by telephone interviews . We reassessed the incidence of PTSD after coercive measures by the Impact of Event Scale ( IES ) The results of a r and omized controlled trial that tested the effects of eight-week , six-contact multidimensional interactive interventions for symptom management are presented . Four hundred and thirty-five cancer patients with solid tumors undergoing chemotherapy were r and omized to receive either nurse-assisted symptom management ( NASM ) or automated telephone symptom management ( ATSM ) . A prior trial established the effectiveness of NASM compared with conventional care . Seventeen symptoms commonly experienced by patients undergoing chemotherapy were rated on a scale from 0 to 10 and were evaluated at baseline , at each of the six intervention contacts , and postintervention observation at 10 weeks . Both groups achieved significant reduction in symptom severity over baseline , and there was no difference between groups on symptom severity at 10 weeks . R and omization accounted for possible reductions in severity due to response shifts . Severity of symptoms reported by patients at each of the six intervention contacts was measured using a Rasch model . Symptom pattern was different for lung and non-lung cancer patients , and they were analyzed separately . Longitudinal analyses revealed that lung cancer patients with greater symptom severity withdrew from later intervention contacts of the ATSM . The results suggest that both NASM and ATSM achieved a clinical ly significant reduction in symptom severity . The NASM may be more effective than ATSM in retaining lung cancer patients in the intervention . Further testing of ATSM supplemented by NASM for patients with severe symptoms is warranted PURPOSE OF THE RESEARCH This paper reports findings from a r and omized controlled pilot study evaluating the PRO-SELF Plus Pain Control Program , a U.S.-developed cancer pain self-management intervention , regarding feasibility and effect sizes in a German patient sample . METHODS AND SAMPLE Thirty-nine German oncology out patients were r and omized to intervention ( n = 19 ) and control ( n = 20 ) groups . The intervention group received the PRO-SELF Plus Pain Control Program in 6 visits and 4 phone calls a 10-week period . The control group received st and ard education and care . The intervention employed three key strategies : information provision , skills building , and nurse coaching . Primary outcomes were changes in average and worst pain intensity . Secondary outcomes included changes in pain-related knowledge , opioid intake , and self-efficacy . Data were collected at enrollment , then at 6 , 10 , 14 , and 22 weeks . KEY RESULTS The group-by-time effect showed a statistically significant increase in knowledge ( week 10 : p = 0.04 ; week 22 : p < 0.01 ) . Despite slight reductions in average and worst pain , no statistically significant changes were found for pain , opioid intake , or self-efficacy . CONCLUSIONS This study is the first to evaluate and demonstrate the feasibility of a U.S.-developed cancer pain self-management intervention in a German patient population .  Pain self-management related knowledge improved significantly and effect sizes for pain reduction were determined . Findings from this pilot RCT provide the basis for planning a larger RCT . CLINICAL TRIAL REGISTRATION NUMBER NCT00920504 PURPOSE This study sought to continue research on psychosocial interventions for patients being treated with radiation therapy  across multiple centers and to replicate positive findings of a single-center study of patients being treated with chemotherapy .  The primary objective of this study was to determine if a stress management intervention was effective in improving quality of life and decreasing psychological distress in patients undergoing radiotherapy for cancer . PATIENTS AND METHODS A total of 310 patients about to begin radiotherapy treatment were r and omly assigned to receive usual care only or self-administered stress management training .  Quality -of-life assessment s occurred at baseline and for 3 weeks after the beginning of radiotherapy treatment . RESULTS Overall , patients assigned to receive stress management training did not report significantly less psychological distress on the Medical Outcomes Study 36-Item Short Form ( SF-36 ) Mental Component Summary Scale than did those assigned to usual care . When divided into subgroups based on the SF-36 Mental Component Summary Scale scores immediately after their first radiotherapy treatment , patients with above-average levels of psychological distress ( scores < or = 50 ) who were r and omly assigned to the intervention condition reported significant improvement in their distress compared with those assigned to usual care only on the SF-36 Mental Health Subscale and the Center for Epidemiologic Studies Depression Scale . CONCLUSION This study found that self-administered stress management training is effective only in those radiotherapy patients with initially higher levels of psychological distress . Additional research should examine the benefits of stress management training targeted specifically to patients experiencing heightened distress Aim To measure the impact of a nurse led asthma clinic on the quality of life of patients with asthma . Design A r and omised controlled trial with delayed intervention in the control group . Outcomes Primary outcome measure : the Juniper Asthma Quality of Life Instrument . Secondary outcome measure : the EQ4D generic quality of life score . Results We analyzed data from 55 patients who were invited to attend an asthma clinic compared with 46 patients who received normal GP care .  Due to a high drop out rate we were unable to demonstrate significant changes in our outcome measures . However , when we analysed only those patients attending the clinic there were significant improvements . Conclusion Our trial was small and limited to one practice . Due to the high dropout rate we were unable to demonstrate a positive benefit of the intervention of an asthma nurse on the quality of life of asthma sufferers using an intention to treat analysis . This study illustrates the difficulties of undertaking trials on interventions that are well established BACKGROUND Colorectal cancer is a major public health problem . There is growing support for colorectal cancer survivors who are experiencing problems after cancer treatment to engage in self-management programs to reduce symptom distress . However , there is inconclusive evidence as to the effectiveness of such program especially in Asian region . OBJECTIVES This study tested the effects of a six-month nurse-led self-efficacy-enhancing intervention for patients with colorectal cancer , compared with routine care over a six-month follow up . DESIGN A r and omized controlled trial with repeated measures , two-group design . SETTING Three teaching hospitals in Guangzhou , China . PARTICIPANTS One hundred and fifty-two Chinese adult patients with a diagnosis of colorectal cancer were recruited . The intervention group ( n=76 ) received self-efficacy-enhancing intervention and the control group ( n=76 ) received st and ard care . METHOD The participants were r and omized into either intervention or control group after baseline measures . The outcomes of the study ( self-efficacy , symptom distress , anxiety , depression and quality of life ) were compared at baseline , three and six months after the intervention . RESULTS Sixty-eight participants in the intervention group and 53 in the control group completed the study . Their mean age was 53 ( SD=11.3 ) . Repeated measure MANOVA found that the patients in the intervention group had significant improvement in their self-efficacy ( F=7.26 , p=0.003 ) and a reduction of symptom severity ( F=5.30 , p=0.01 ) , symptom interference ( F=4.06 , p=0.025 ) , anxiety ( F=6.04 , p=0.006 ) and depression ( F=6.96 , p=0.003 ) at three and six months , compared with the control group . However , no statistically significant main effect was observed in quality of life perception between the two groups . CONCLUSIONS The nurse-led self-efficacy enhancing intervention was effective in promoting self-efficacy and psychological well-being in patients with colorectal cancer , compared with st and ard care . The intervention can be incorporated into routine care . Future empirical work is required to determine the longer term effects of the intervention Background : The undertreatment of cancer pain remains a significant clinical problem . Objective : The aim of this r and omized controlled trial was to evaluate the efficacy of the PRO-SELF Pain Control Program that was modified for Norwegian cancer patients in decreasing pain and increasing opioid intake compared with control care . Interventions / Methods : Oncology out patients with pain from bone metastasis were r and omized into the PRO-SELF ( n = 87 ) or control ( n = 92 ) groups . A nurse visited patients in the PRO-SELF group in their home at weeks 1 , 3 , and 6 and conducted telephone interviews at weeks 2 , 4 , and 5 . Patients in both groups completed a daily diary of pain intensity ratings and analgesic intake . Results : For both groups , significant decreases in pain intensity scores and in hours per day in pain ( both , P < .001 ) were found over the 6 weeks of the study . However , no significant group × time interactions were found for any of the pain measures . In both groups , total dose of opioid taken increased over time . However , no significant group × time interactions were found for changes over time in the total dose , around-the-clock dose , or as-needed dose of opioid analgesics taken . Conclusions : Possible reasons for the lack of efficacy include an inadequate dose of the psychoeducational intervention , inadequate changes in analgesic prescriptions , and /or the impact of attention provided to the control group . Implication s for Practice : Coaching , nursing support , and the use of a pain diary may be important interventions to reduce pain intensity
Purpose This systematic review was intended to identify the effectiveness and inclusion of essential components of self-management education interventions to support patients with cancer in developing the skills needed for effective self-management of their disease and the acute or immediate , long-term , and late harmful effects of treatments .