Influence of psychological response on survival in breast cancer: a population-based cohort study Psychologic intervention improves survival for breast cancer patients Evaluation of a palliative care service: problems and pitfalls Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Effectiveness of a short-term group psychotherapy program on endocrine and immune function in breast cancer patients: an exploratory study. Physical Functioning: Effect of Behavioral Intervention for Symptoms Among Individuals With Cancer Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality-of-life indices for gynecologic and breast brachytherapy patients. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications Meeting the support and information needs of women with advanced breast cancer: a randomised controlled trial Effects of counseling for late stage cancer patients Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. A feasibility study of psychosocial group intervention for breast cancer patients with first recurrence Impact of a peer-delivered telephone intervention for women experiencing a breast cancer recurrence. Lessons Learned: Outcomes and Methodology of a Coping Skills Intervention Trial Comparing Individual and Group Formats for Patients with Cancer Education and peer discussion group interventions and adjustment to breast cancer. A presurgical psychosocial intervention for breast cancer patients. psychological distress and the immune response. The efficacy of a mind-body-spirit group for women with breast cancer: a randomized controlled trial. Difference in patient's acceptance of early versus late initiation of psychosocial support in breast cancer Effects of a family intervention on the quality of life of women with recurrent breast cancer and their family caregivers. A Randomized Controlled Trial of Psychosocial Interventions Using the Psychophysiological Framework for Chinese Breast Cancer Patients Distress reduction from a psychological intervention contributes to improved health for cancer patients Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer Quality of life pilot intervention for breast cancer patients: use of social cognitive theory. Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial. Effects of cognitive-behavioral strategies on pain in cancer patients. A hypothesis about Spiegel et al.'s 1989 paper on Psychosocial intervention and breast cancer survival. Evaluation by multidimensional instruments of health-related quality of life of elderly cancer patients undergoing three different “psychosocial” treatment approaches Counseling women with breast cancer using principles developed by Albert Bandura. Psychological support for patients undergoing breast cancer surgery: a randomised study A psychosocial group intervention for Japanese women with primary breast carcinoma A randomized, controlled study of Internet peer-to-peer interactions among women newly diagnosed with breast cancer. Improving the quality of life of geriatric cancer patients with a structured multidisciplinary intervention: a randomized controlled trial. Psychological distress two years after diagnosis of breast cancer: frequency and prediction. Long-term telephone therapy outcomes for breast cancer patients. Electronic support groups for breast carcinoma Will Improvement in Quality of Life (QOL) Impact Fatigue in Patients Receiving Radiation Therapy for Advanced Cancer? Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Relaxation and Imagery for Anxiety and Depression Control in Community Patients With Advanced Cancer Social support, life stress, pain and emotional adjustment to advanced breast cancer. PSYCHOLOGICAL RESPONSE TO BREAST CANCER: EFFECT ON OUTCOME Signal versus noise in the evidence base for medicine: an alternative to hierarchies of evidence? A Randomized Controlled Trial of the Effects of Transcendental Meditation on Quality of Life in Older Breast Cancer Patients
BACKGROUND The psychological response to breast cancer , such as a fighting spirit or an attitude of helplessness and hopelessness toward the disease , has been suggested as a prognostic factor with an influence on survival . We have investigated the effect of psychological response on disease outcome in a large cohort of women with early-stage breast cancer . METHODS 578 women with early-stage breast cancer were enrolled in a prospect i ve survival study . Psychological response was measured by the  mental adjustment to cancer ( MAC ) scale , the Courtauld emotional control ( CEC ) scale  , and the  hospital anxiety and depression ( HAD ) scale 4 - 12 weeks and 12 months after diagnosis . The women were followed up for at least 5 years . Cox 's proportional-hazards regression was used to obtain the hazard ratios for the measures of psychological response , with adjustment for known clinical factors associated with survival . FINDINGS At 5 years , 395 women were alive and without relapse , 50 were alive with relapse , and 133 had died . There was a significantly increased risk of death from all causes by 5 years in women with a high score on the HAD scale category of depression ( hazard ratio 3.59 [ 95 % CI 1.39 - 9.24 ] ) . There was a significantly increased risk of relapse or death at 5 years in women with high scores on the helplessness and hopelessness category of the MAC scale compared with those with a low score in this category ( 1.55 [ 1.07 - 2.25 ] ) . There were no significant results found for the category of " fighting spirit " . INTERPRETATION For 5-year event-free survival a high helplessness/hopelessness score has a moderate but detrimental effect . A high score for depression is linked to a significantly reduced chance of survival ; however , this result is based on a small number of patients and should be interpreted with caution The question of whether stress poses a risk for cancer progression has been difficult to answer . A r and omized clinical trial tested the hypothesis that cancer patients coping with their recent diagnosis but receiving a psychologic intervention  would have improved survival compared with patients who were only assessed Abstract Objective : To evaluate a palliative care home support team based on an inpatient unit . Design : R and omised controlled trial with waiting list . Patients in the study group received the service immediately , those in the control group received it after one month . Main comparison point was at one month . Setting - A city of 300 000 people with a publicly funded home care service and about 200 general practitioners , most of whom provide home care . Main outcome measures : Pain and nausea levels were measured at entry to trial and at one month , as were quality of life for patients and care givers ' health . Results : Because of early deaths , problems with recruitment , and a low compliance rate for completion of question naires , the required sample size was not attained . Conclusion : In design ing evaluations of palliative care services , investigators should be prepared to deal with the following issues : attrition due to early death , opposition to r and omisation by patients and referral sources , ethical problems raised by r and omisation of dying patients , the appropriate timing of comparison points , and difficulties of collecting data from sick or exhausted patients and care givers . Investigators may choose to evaluate a service from various perspectives using different methods : controlled trials , qualitative studies , surveys , and audits . R and omised trials may prove to be impracticable for evaluation of palliative care AIM This paper is a report of a study to describe the efficacy of cognitive behavioural therapy for insomnia on fatigue , mood and quality of life in breast cancer survivors . BACKGROUND Women who receive primary treatment for breast cancer often complain of insomnia . Rarely evaluated in insomnia intervention studies is the effect of cognitive behavioural treatment on the psychosocial outcomes of fatigue , mood and quality of life . METHOD Data were collected between December 2002 and March 2004 with 72 women who were at least 3 months post-completion of primary treatment without current evidence of disease . Women were r and omly assigned to either the cognitive behavioural therapy for insomnia group , which received stimulus control instructions , sleep restriction therapy and sleep education and hygiene , or the component control group which received sleep education and hygiene only . The 10-week study consisted of 2 weeks of pre-treatment , 6 weeks of treatment and 2 weeks of post-treatment . Fatigue , mood and quality of life were measured at pre- and post-treatment . FINDINGS Women receiving cognitive behavioural therapy for insomnia had significant improvements in fatigue , trait anxiety , depression and quality of life . The component control group also had statistically significant increases in quality of life , with a trend suggestive of lower depression at post-treatment . CONCLUSION Globally , as the number of survivors in this population continues to grow , it is imperative that nurses continue testing interventions that may positively affect quality of life and the commonly experienced symptoms of fatigue , anxiety and depression OBJECTIVES We evaluated recurrence and survival for 68 patients with malignant melanoma who participated in a 6-week structured psychiatric group intervention 5 to 6 years earlier , shortly after their diagnosis and initial surgical treatment . We also explored the role of several factors as possible predictors of outcome . DESIGN This was a r and omized controlled experimental study . The Cox proportion hazards regression model was used to quantify the relationship between treatment and the outcomes adjusted by the covariates ( age , sex , Breslow depth , tumor site , baseline Profile of Mood States Total Mood Disturbance , baseline active-behavioral coping , baseline natural killer cell activity , and treatment [ ie , group intervention ] ) . The stepwise procedure was used for covariate selection . RESULTS For control patients , there was a trend for recurrence ( 13/34 ) and a statistically significant greater rate of death ( 10/34 ) than for experimental patients ( 7/34 and 3/34 , respectively ) . We found that being male and having a greater Breslow depth predicted greater recurrence and poorer survival . Analysis of multiple covariates found that only Breslow depth and treatment ( ie , group intervention ) were significant . Adjusting for Breslow depth , treatment effect remained significant . Finally , baseline affective distress and baseline coping were significant psychobehavioral predictors for recurrence and survival . Surprisingly , higher levels of baseline distress as well as baseline coping and enhancement of active-behavioral coping over time were predictive of lower rates of recurrence and death . CONCLUSION Psychiatric interventions that enhance effective coping and reduce affective distress appear to have beneficial effects on survival but are not proposed as an alternative or independent treatment for cancer or any other illness or disease . However , the exact nature of this relationship warrants further investigation Cancer patients who had been treated for early stage breast cancer and were diagnosed with either positive axillary lymph nodes or distant metastases were r and omly assigned to either a 13-week experiential-existential group psychotherapy ( EEGP ) program or a waiting list control ( WLC ) condition .  Endocrine and immune measures were obtained before and after the intervention period . The findings of this study are that , after the 13 weeks of the experiment , patients in the EEGP group showed lower levels of plasma cortisol and lower levels of prolactin as well as lower percentages of natural killer cells , CD8 cells , and CD4 cells in addition to a lower proliferative response to pokeweed mitogen than patients in the WLC group . Importantly , this was only found in those breast cancer patients presenting relatively high endocrine and immune baseline levels , suggesting that the patients ' profile with regard to endocrine and immune function at the start of a program can have an important effect . If replicated on a larger scale , the current results may be relevant for the treatment of breast cancer Background : Individuals with cancer receiving chemotherapy suffer deterioration in physical functioning due to symptoms arising from the cancer disease process and its treatment . Objectives : To determine if age , chronic health conditions ( comorbidity ) , stage of cancer , depressive symptomatology , symptom limitations , sex , and site of cancer moderate the effects of cognitive behavioral intervention on physical function and to determine if symptom limitations mediate the effect of the intervention on physical functioning . Methods : Two hundred thirty-seven individuals with solid tumor cancer ( 118 experimental and 119 control group ) participated in this 10-contact , 18-week r and omized control trial . Cognitive behavioral theory guided the nurse-delivered problem-solving experimental intervention . The control group received conventional care . Interviews occurred at baseline and 10 , 20 , and 32 weeks . Results : Women with breast cancer had significantly better physical functioning than women with lung cancer . Chronic health conditions , symptom limitation , and depressive symptomatology at baseline were found to moderate the effect of intervention on physical function . Symptom limitation , however , was not found to mediate the effect of intervention on physical functioning . Discussion : The intervention was shown to affect physical function trajectories differently for individuals with different personal and health characteristics . Because poor physical functioning is strongly associated with mortality and poor quality of life , this information may be used by health professionals to target interventions to those who might be most responsive BACKGROUND We conducted a r and omised , controlled trial of cognitive-existential group therapy ( CEGT ) for women with early stage breast cancer receiving adjuvant chemotherapy with the aim of improving mood and mental attitude to cancer . METHODS Women were r and omised to 20 sessions of weekly group therapy plus 3 relaxation classes or to a control arm receiving 3 relaxation classes . Assessment s , independently done at baseline , 6 and 12 months , included a structured psychiatric interview and vali date d question naires covering mood , attitudes to cancer , family relationships , and satisfaction with therapy . RESULTS Three hundred and three of 491 ( 62 % ) eligible patients participated over 3 years .  Distress was high pre-intervention : 10 % were diagnosed as suffering from major depression , 27 % from minor depression and 9 % from anxiety disorders . On an intention-to-treat analysis , there was a trend for those receiving group therapy ( n=154 ) to have reduced anxiety ( p=0.05 , 2-sided ) compared to controls ( n=149 ) . Women in group therapy also showed a trend towards improved family functioning compared to controls ( p=0.07 , 2-sided ) . The women in the groups reported greater satisfaction with their therapy ( p<0.001 , 2-sided ) , appreciating the support and citing better coping , self-growth and increased knowledge about cancer and its treatment . They valued the CEGT therapy . Overall effect size for the group intervention was small ( d=0.25 ) , with cancer recurrence having a deleterious effect in three of the 19 therapy groups . Psychologists as a discipline achieved a moderate mean effect size ( d=0.52 ) . CONCLUSION CEGT is a useful adjuvant psychological therapy for women with early stage breast cancer . Interaction effects between group members and therapists are relevant to outcome . Group-as-a-whole effects are powerful , but the training and experience of the therapist is especially critical to an efficacious outcome PURPOSE The r and omized study aim ed to determine the efficacy of psychological intervention consisting of relaxation and guided imagery to reduce anxiety and depression in gynecologic and breast cancer patients undergoing brachytherapy during hospitalization . METHODS AND MATERIAL S Sixty-six patients programmed to receive brachytherapy in two hospitals in Barcelona ( Spain ) were included in this study . The patients were r and omly allocated to either the study group ( n=32 ) or the control group ( n=34 ) . Patients in both groups received training regarding brachytherapy , but only study group patients received training in relaxation and guided imagery . After collection of sociodemographic data , all patients were given a set of question naires on anxiety and depression : the Hospital Anxiety and Depression Scale ( HADS ) , and on quality of life : Cuestionario de Calidad de Vida QL-CA-AFex ( CCV ) , prior to , during and after brachytherapy . RESULTS The study group demonstrated a statistically significant reduction in anxiety ( p=0.008 ) , depression ( p=0.03 ) and body discomfort ( p=0.04 ) compared with the control group . CONCLUSIONS The use of relaxation techniques and guided imagery is effective in reducing the levels of anxiety , depression and body discomfort in patients who must remain isolated while undergoing brachytherapy . This simple and inexpensive intervention enhances the psychological wellness in patients undergoing brachytherapy . State : This study has passed Ethical Committee review The purpose of this study was to classify breast carcinomas based on variations in gene expression patterns derived from cDNA microarrays and to correlate tumor characteristics to clinical outcome . A total of 85 cDNA microarray experiments representing 78 cancers , three fibroadenomas , and four normal breast tissues were analyzed by hierarchical clustering . As reported previously , the cancers could be classified into a basal epithelial-like group , an ERBB2-overexpressing group and a normal breast-like group based on variations in gene expression . A novel finding was that the previously characterized luminal epithelial/estrogen receptor-positive group could be divided into at least two subgroups , each with a distinctive expression profile . These subtypes proved to be reasonably robust by clustering using two different gene sets : first , a set of 456 cDNA clones previously selected to reflect intrinsic properties of the tumors and , second , a gene set that highly correlated with patient outcome . Survival analyses on a subcohort of patients with locally advanced breast cancer uniformly treated in a prospect i ve study showed significantly different outcomes for the patients belonging to the various groups , including a poor prognosis for the basal-like subtype and a significant difference in outcome for the two estrogen receptor-positive groups Addressing psychosocial and quality of life needs is central to provision of excellent care for people with advanced cancer . This study tested a brief nurse-delivered intervention to address the needs of urban women with advanced breast cancer . This study was conducted at four large urban hospitals in Australia . One hundred and five women with advanced breast cancer were recruited and r and omised to receive the intervention or usual care , then asked to complete the European Organisation of Research and Treatment of Quality of life Q-C30 version ( 2.0 ) ( EORTC Q-C30 ) ( version 2 ) and Supportive Care Needs Survey ( SCNS ) at 1 month and 3 months postrecruitment . No significant differences were detected between intervention and usual care groups in the SCNS or the EORTC Q-C30 subscale scores . However , when the groups were divided into high needs ( score of above 50 ) and low baseline needs ( score of 50 or below ) for each SCNS subscale , a significant difference between intervention and usual care groups was found in the psychological/emotional subscale among women with high baseline needs . In conclusions , this study demonstrated that a face-to-face session and follow-up phone call with a breast care nurse significantly reduced the psychological and emotional needs of those with high initial needs . There was no evidence of the intervention influencing the quality of life ; or perceived needs of women with low initial psychological/emotional needs or perceived needs in other domains . Possibly , the intervention was not sufficiently intense to achieve an effect Much has been written about working with the dying . Few , if any , controlled studies have examined the application of principles set forth . The authors evaluate the effectiveness of working with dying cancer patients by assessing changes in quality of life , physical functioning , and survival .  One‐hundred twenty men with end‐stage cancer were r and omly assigned to experimental or control groups ; the 62 experimental group patients  were seen regularly by a counselor . Patients were assessed before r and om assignment and at one , three , six , nine , and 12 months on quality of life and functional status . Experimental group patients improved significantly more than the control group on quality of life within three months . Functional status and survival did not differ between groups . A sub sample of lung cancer patients provided cross‐validation of findings . Although survival was not expected to differ , it was predicted that functioning would be enhanced if quality of life improved . One interpretation is that little can be done to alter physical function and survival when intervention occurs late in the progression of a fatal disease . This in no way reduces the value of improving overall quality of life , since enhancing the quality of survival for end‐stage cancer patients is a high priority medical goal Existential issues often accompany a diagnosis of cancer and remain one aspect of psychosocial oncology care for which there is a need for focused , empirically tested interventions . This study examined the efficacy of a novel psychological intervention specifically design ed to address existential issues through the use of meaning-making coping strategies on psychological adjustment to cancer . Eighty-two breast or colorectal cancer patients were r and omly chosen to receive routine care ( control group ) or up to four sessions that explored the meaning of the emotional responses and cognitive appraisal s of each individual 's cancer experience within the context of past life events and future goals ( experimental group ) . This paper reports the results from 74 patients who completed and returned pre- and post-test measures for self-esteem , optimism , and self-efficacy . After controlling for baseline scores , the experimental group participants demonstrated significantly higher levels of self-esteem , optimism , and self-efficacy compared to the control group . The results are discussed in light of the theoretical and clinical implication s of meaning-making coping in the context of stress and illness Goals of workThe effects of psychosocial group interventions on improving quality of life ( QOL ) for patients with recurrent breast cancer are not well known . The objective of this study was to assess the feasibility of a psychosocial group intervention in Japanese women with first recurrence of breast cancer . Patients and method The subjects were consecutively selected from among patients who were diagnosed with a first recurrence of breast cancer . We conducted a 6-week psychosocial group intervention .  QOL was assessed using the Profile of Mood States ( POMS ) , the Impact of Event Scale — Revised , the Mental Adjustment to Cancer ( MAC ) scale , and the European Organization for Research and the Treatment of Cancer ( EORTC ) Quality of Life Question naire — Cancer 30/Breast module 23 ( QLQ-C30/Br23 ) at baseline then immediately and 3 and 6 months after completion of the intervention . Results Among 58 eligible patients , written consent was obtained from 28 ( 48 % ) , and the final evaluation was conducted on 19 subjects . The repeated measured analysis of variance ( ANOVA ) revealed a significant change in tension – anxiety , depression – dejection , anger – hostility and total mood disturbance on the POMS , helplessness/hopelessness on the MAC scale , and body image and future perspective on the QLQ-C30/Br23 . Dunnett ’s test revealed a significant difference in these scores between baseline and 3 months after the intervention but no difference between baseline and 6 months after the intervention . Conclusion These results suggested the possibility of a short-term effectiveness of the intervention ; however the results were inconclusive because of selected small sample PURPOSE A first breast cancer recurrence creates considerable distress , yet few psychosocial interventions directed at this population have been reported . The Southwest Oncology Group conducted a phase III r and omized trial to evaluate the effectiveness of a brief telephone intervention . PATIENTS AND METHODS Three hundred five women experiencing a first recurrence of breast cancer were r and omly assigned to st and ard care or intervention . The intervention consisted of four to eight telephone calls delivered over a 1-month period . The calls were conducted by trained peer counselors at a breast cancer advocacy organization , the Y-ME National Breast Cancer Organization , and followed a st and ard curriculum . Psychosocial distress ( Cancer Rehabilitation Evaluation System-Short Form [ CARES-SF ] ) and depressive symptoms ( Center for Epidemiologic Studies Depression Scale [ CES-D ] ) outcomes were assessed at baseline and 3 and 6 months . The 3-month assessment was the primary end point and is the focus of this article . RESULTS Analysis revealed no differences in distress or depressive symptoms at 3 months between the intervention and control groups ; at 3 months , 70 % of control patients and 66 % of intervention patients reported psychosocial distress , and 40 % of control patients and 47 % of intervention patients exhibited depressive symptoms . CONCLUSION Telephone peer counseling did not lead to better psychosocial outcomes . The persistent distress in these women supports the urgent need for the development and testing of more intensive or different supportive interventions for this group of patients Objective : Nucare , a short-term psychoeducational coping skills training intervention was evaluated in a r and omized controlled clinical trial ( RCT ) of 225 newly diagnosed breast and colon cancer patients . Method : Measures of psychosocial distress , well being and optimism were evaluated every four months during a one-year period . Patients were r and omized to one of four arms : Nucare presented in an individual basis ; Nucare presented in a group format ; a non-directive supportive group ; and a no-intervention control . The interventions were provided in five sessions of ninety minutes each . Results : Patients with breast cancer who received Nucare  presented in an individual format showed more significant improvements in well-being over time compared to those in the control and group arms . Conclusions : We were unable to develop functioning groups within the RCT . Partial explanations for the latter finding include the structural limitations of the RCT : the groups were small , difficult to schedule and patients indicated that they would have preferred to choose whether or not to participate in a group . The positive changes in women with breast cancer who received Nucare persisted at 12 months BACKGROUND We report a clinical trial comparing the effectiveness of education-based and peer discussion -based group interventions on adjustment to breast cancer . METHODS Women with stage I , II , or III breast cancer ( n = 312 ) were r and omly assigned to 1 of 4 group conditions : control , education , peer discussion , or education plus peer discussion ( combination ) . Seven groups ( each comprising 8 - 12 women ) were conducted in each of the 4 conditions ( 28 groups total ) . Adjustment was measured before the intervention , immediately after the intervention , and 6 months after the intervention . RESULTS Consistently positive effects on adjustment were seen in the education groups both immediately following and 6 months after the intervention . There were no benefits of participation in peer discussion groups , and some indications of adverse effects on adjustment at both follow-up examinations . The effects could be explained by changes in self-esteem , body image , and intrusive thoughts about the illness . CONCLUSIONS Education-based group interventions facilitated the initial adjustment of women diagnosed with early stage breast cancer . There was no evidence of benefits from peer discussion group interventions OBJECTIVE The present study evaluated the feasibility and potential immunological benefit of a presurgical intervention for breast cancer patients . METHODS Forty-one newly diagnosed breast cancer patients were r and omized into control ( st and ard care ) and intervention groups . In addition to st and ard care , intervention group members received a two-session psychosocial intervention . Blood was drawn at three timepoints : ( 1 ) at preintervention ; ( 2 ) at postintervention/presurgery ; and ( 3 ) at postsurgery . RESULTS Examination of the immunological data revealed evidence of suppression of interferon-gamma ( IFN-gamma ) in the control group over time , but not in the intervention group . Secondary findings related to psychological assessment generally paralleled the IFN-gamma results . CONCLUSION The relevance and applicability of these findings to future breast cancer intervention research is detailed Increasing numbers of women with breast cancer are seeking alternatives to st and ard group support in coping with their illness . This study examines outcomes for 181 women with breast cancer r and omized to either a 12-week st and ard group support or a 12-week complementary and alternative medicine ( CAM ) support intervention .  Participants in the CAM group were taught the use of meditation , affirmation , imagery and ritual . The st and ard group combined cognitive-behavioral approaches with group sharing and support . Both interventions were found to be associated with improved quality of life ( CAM , P=0.008 ; St and ard , P=0.006 ) , decreased depression ( CAM , P=0.004 ; St and ard , P=0.02 ) , decreased anxiety ( CAM , P=0.0003 ; St and ard , P=0.02 ) and increased " spiritual well-being " ( CAM , P=002 ; St and ard , P=0.003 ) . Only the CAM group showed increases in measures of Spiritual Integration ( P=0.001 ) which were also significant between groups ( P=0.003 ) . The St and ard group was associated with decreased confusion ( P=0.01 ) and decreased helplessness/hopelessness ( P=0.01 ) , while the CAM group was associated with decreased avoidance ( P=0.01 ) . None of these latter changes were significant between groups . At baseline , very high correlations were noted between measures of quality of life , mood , and spiritual integration . At the end of the intervention , the CAM group showed higher satisfaction ( P=0.006 ) and fewer dropouts ( P=0.006 ) compared to the st and ard group . Better outcomes in quality of life in the CAM group were associated with lower initial fighting spirit ( r=-.39 , P=0.001 ) . No baseline factors predicted better outcomes in the St and ard group . In summary , the study found equivalence on most psychosocial outcomes between the two interventions The present study was performed to assess the difference in acceptance of psychosocial counseling and result ing benefits between patients with breast cancer with early or late onset . In a prospect i ve r and omized controlled study conducted over 6 months , 41 women with a new diagnosis of early breast cancer ( group 1 ) and 43 patients with advanced breast cancer ( group 2 ) received individually tailored psychosocial support and were compared against controls . This therapy was free of charge , and the duration of support was determined by the patients ' wishes and needs . Among the patients with new onset of disease acceptance of the  psychosocial counseling  was high , and these patients experienced significant improvements in their quality of life . In contrast , acceptance of psychosocial counseling  was low in the advanced breast cancer group and the therapy did not improve quality of life over the observation period of 6 months . Early psychosocial support in patients with breast cancer meets with a high acceptance rate and improves quality of life BACKGROUND The purpose of this study was to determine if patients with advanced breast cancer and their family caregivers , who participated in a family based intervention , report better quality of life and other psychosocial outcomes than dyads who received st and ard care alone . METHODS Using a r and omized clinical trial , 134 patients and their family caregivers were assigned to usual care ( control ) or to usual care plus the family intervention ( experimental condition ) . Dyads were assessed at baseline , three- and six-months later . The intervention consisted of five sessions and addressed  family involvement , optimistic attitude , coping effectiveness , uncertainty reduction , and symptom management . RESULTS Patients in the family intervention reported significantly less hopelessness and less negative appraisal of illness than controls ; their family caregivers reported significantly less negative appraisal of caregiving . Intervention effects were evident at three-months , but were not sustained at six-months . No difference was found in the quality of life of dyads in experimental or control conditions . CONCLUSIONS Although the family intervention had positive effects initially , these effects were not sustained over time . Future studies need to consider program dose and duration of effect , outcome measures that are more sensitive to change , and realistic end-points for patients with advanced cancer Abstract This study aim ed to investigate the psychophysiological outcomes of different psychosocial interventions for breast cancer patients . Participants were r and omly assigned into 3 intervention groups , namely , Body-Mind-Spirit ( BMS ) , Supportive-Expressive ( SE ) , and Social Support Self-Help ( SS ) groups ; a no-intervention group was used as control .  Salivary cortisol was used as the physiological stress marker . Distress level , mental adjustment , emotional control , and social support were measured . Data were collected at baseline , 4 month , and 8 month . Preliminary results indicated that BMS intervention produced the greatest and the most sustained effects . It enhanced positive social support , reduced psychological distress , emotional control , and negative mental adjustment . Total salivary cortisol was lowered after 8 months . Most participants in SE groups indicated the treatment helpful , but changes in psychophysiological outcomes were not statistically significant . Participants in SS groups seemed less likely to benefit from the intervention . The no intervention control group indicated a reduction in social support . These outcomes suggest that active professional intervention is more likely to yield therapeutic effects . In particular , psychosocial intervention attending to the spiritual dimension contributes to positive outcomes PURPOSE Psychological interventions are efficacious in reducing emotional distress for cancer patients . However , it is not clear whether psychological improvements are , in turn , related to improved health . A clinical trial tests whether a psychological intervention for cancer patients can do so , and also tests two routes to achieve better health : ( a ) reducing patients ' Emotional Distress , and /or ( b ) enhancing their functional immunity . METHODS Post-surgery , 227 breast cancer patients were r and omized to intervention or assessment only Study Arms . Conducted in small groups , intervention sessions were offered weekly for 4 months and followed by monthly sessions for 8 months . Measures included psychological ( distress ) , biological ( immune ) , and health outcomes ( performance status and evaluations of patient 's symptomatology , including toxicity from cancer treatment , lab values ) collected at baseline , 4 months , and 12 months . RESULTS A path model revealed that intervention participation directly improved health ( p<.05 ) at 12 months . These effects remained when statistically controlling for baseline levels of distress , immunity , and health as well as sociodemographic , disease , and cancer treatment variables . Regarding the mechanisms for achieving better health , support was found for an indirect effect of distress reduction . That is , by specifically lowering intervention patients ' distress at 4 months , their health was improved at 12 months ( p<.05 ) . Although the intervention simultaneously improved patients ' T-cell blastogenesis in response to phytohemagglutinin ( PHA ) , the latter increases were unrelated to improved health . CONCLUSION A convergence of biobehavioral effects and health improvements were observed . Behavioral change , rather than immunity change , was influential in achieving lower levels of symptomatology and higher functional status . Distress reduction is highlighted as an important mechanism by which health can be improved BACKGROUND A diagnosis of breast cancer and treatment are psychologically stressful events , particularly over the first year after diagnosis . Women undergo many dem and ing and anxiety-arousing treatments such as surgery , radiation and chemotherapy . Psychosocial interventions that promote psychosocial adaptation to these challenges may modulate physiological processes ( neuroendocrine and immune ) that are relevant for health outcomes in breast cancer patients . METHODS Women with Stages 1 - 3 breast cancer recruited 4 - 8 weeks after surgery were r and omized to either a 10-week group-based cognitive behavioral stress management ( CBSM ) intervention or a 1-day psychoeducational control group and completed question naires and late afternoon blood sample s at study entry and 6 and 12 months after assignment to experimental condition . RESULTS Of 128 women initially providing psychosocial question naire and blood sample s at study entry , 97 provided complete data for anxiety measures and cortisol analysis at all time points , and immune assays were run on a subset of 85 of these women . Those assigned to a 10-week group-based CBSM intervention evidence d better psychosocial adaptation ( lower reported cancer-specific anxiety and interviewer-rated general anxiety symptoms ) and physiological adaptation ( lower cortisol , greater Th1 cytokine [ interleukin-2 and interferon-gamma ] production and IL-2:IL-4 ratio ) after their adjuvant treatment compared to those in the control group . Effects on psychosocial adaptation indicators and cortisol appeared to hold across the entire 12-month observation period . Th1 cytokine regulation changes held only over the initial 6-month period . CONCLUSIONS This intervention may have facilitated a " recovery or maintenance " of Th1 cytokine regulation during or after the adjuvant therapy period . Behavioral interventions that address dysregulated neuroendocrine function could play a clinical ly significant role in optimizing host immunologic resistance during a vulnerable period OBJECTIVE The purpose of this article is to evaluate an 8-week pilot intervention based on Social Cognitive Theory to improve quality of life for women with breast cancer . METHODS A total of 32 breast cancer patients were r and omized to either the intervention or st and ard care .  Outcome variables included quality of life , mood , self-efficacy , outcome expectations , and self-regulation . RESULTS Effect sizes were calculated to examine the impact of the intervention , with moderate to large effect sizes found for several subscales of the outcome expectations variable : learning about cancer and treatment ( d = 0.85 ) , having a positive attitude ( d = 0.54 ) , talking about cancer ( d = 1.02 ) , engaging in relaxation ( d = 0.62 ) , and setting goals ( d = 1.58 ) . SIGNIFICANCE OF RESULTS A nonparametric sign test was conducted , indicating that women in the intervention condition either improved more or showed less decline than the women in st and ard care , p = .034 , two-tailed . Implication s and suggestions for the content and delivery of future psychosocial interventions with cancer patients are review ed OBJECTIVES An increasingly important concern for clinicians who care for patients at the end of life is their spiritual well-being and sense of meaning and purpose in life . In response to the need for short-term interventions to address spiritual well-being , we developed Meaning Centered Group Psychotherapy ( MCGP ) to help patients with advanced cancer sustain or enhance a sense of meaning , peace and purpose in their lives , even as they approach the end of life . METHODS Patients with advanced ( stage III or IV ) solid tumor cancers ( N=90 ) were r and omly assigned to either MCGP or a supportive group psychotherapy ( SGP ) . Patients were assessed before and after completing the 8-week intervention , and again 2 months after completion . Outcome assessment included measures of spiritual well-being , meaning , hopelessness , desire for death , optimism/pessimism , anxiety , depression and overall quality of life . RESULTS MCGP result ed in significantly greater improvements in spiritual well-being and a sense of meaning . Treatment gains were even more substantial ( based on effect size estimates ) at the second follow-up assessment . Improvements in anxiety and desire for death were also significant ( and increased over time ) . There was no significant improvement on any of these variables for patients participating in SGP . CONCLUSIONS MCGP appears to be a potentially beneficial intervention for patients ' emotional and spiritual suffering at the end of life . Further research , with larger sample s , is clearly needed to better underst and the potential benefits of this novel intervention PURPOSE The primary goal of this study was to evaluate the feasibility and effectiveness of a structured , multidisciplinary intervention targeted to maintain the overall quality of life ( QOL ) , which is more comprehensive than psychosocial distress , of patients undergoing radiation therapy for advanced-stage cancer . PATIENTS AND METHODS Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0 % to 50 % were r and omly assigned to either an eight-session structured multidisciplinary intervention arm or a st and ard care arm . The eight 90-minute sessions addressed the five domains of QOL including cognitive , physical , emotional , spiritual , and social functioning . The primary end point of maintaining overall QOL was assessed by a single-item linear analog scale ( Linear Analog Scale of Assessment or modified Spitzer Uniscale ) . QOL was assessed at baseline , week 4 ( end of multidisciplinary intervention ) , week 8 , and week 27 . RESULTS Of the 103 participants , overall QOL at week 4 was maintained by the patients in the intervention ( n = 49 ) , whereas QOL at week 4 significantly decreased for patients in the control group ( n = 54 ) . This change reflected a 3-point increase from baseline in the intervention group and a 9-point decrease from baseline in the control group ( P = .009 ) . Intervention participants maintained their QOL , and controls gradually returned to baseline by the end of the 6-month follow-up period . CONCLUSION Although intervention participants maintained and actually improved their QOL during radiation therapy , control participants experienced a significant decrease in their QOL . Thus , a structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment The purpose of this pilot study was to examine the effects of a combination of cognitive and behavioral nursing interventions on pain perception , pain control , and mood in metastatic breast cancer patients who were experiencing physical pain . A pretest-posttest experimental research design was utilized in this pilot study . Twenty-four patients with metastatic breast cancer who were experiencing physical pain were r and omly assigned to a control group , to a treatment group who received relaxation and visualization training , or to a treatment group who received relaxation , visualization , and cognitive coping skills training . Measures of the subjects ' pain intensity , pain distress , pain control , ability to decrease pain , and mood were taken pre- and posttreatment . Significant differences were found between the treatment groups and the control group in ability to decrease pain . There were no significant differences found in pain intensity or distress or mood . The results indicate that these cognitive-behavioral interventions could be useful clinical nursing interventions for selected cancer patients experiencing physical pain In a r and omized prospect i ve study of 86 metastatic breast cancer patients by Spiegel et al. in 1989 , the 50 who took part in a group psychosocial intervention  survived on average 18 months longer than the 36 controls who did not . Because the control survival curve looked unusually steep , lacking an expected right-skewed tail , both curves were compared with that of a population from the same region having metastatic breast cancer . When transformed to life-table format , the curves of the control sample and the regional population , neither group having had an intervention , were almost identical for a year , and differed strikingly after 20 months . This led to the hypothesis that the 12 control patients surviving for more than 20 months were an extremely aberrant sample , being subject to the strong biasing influence of possible confounders , of which a considerable number are known , but not including those accounted for in the study . Corollaries to the hypothesis are that the intervention had no effect ; that the intervention curve was in fact equivalent to a control curve with mild sampling departure from that of the regional population ; and that , therefore , the repetition of the study now under way would not yield confirmation of the 1989 study , but rather , would support the hypothesis and the first two corollaries Our study belongs to the clinical trials in which the health-related quality of life ( HQL ) evaluation constitutes the primary endpoint . It was carried out with the aim of comparing the impact of three different types of psychological intervention , namely a psychopharmacological treatment alone , the same treatment plus social support carried out by volunteers ( SSV ) and a third treatment modality including “ structured psychotherapy ” ( autogenous training ) , on improving the HQL of elderly cancer patients undergoing antineoplastic therapy with symptoms of anxiety and /or depression related to their disease . The eight question naires used for HQL evaluation were generally . self-rated and multidimensional but unidimensional models were also employed . Seventy-four patients aged over 65 years with either solid tumors in different sites or hematological malignancies , generally in advanced stages ( III – IV ) , were enrolled in the study . Of these patients , 72 ( 42 men and 30 women , mean age 70.68 years , range 66–85 ) were evaluable . Our study high-lighted the usefulness of the pharmacological therapy ( alprazolam + sulpiride ) and of other specific ancillary treatments in reducing the incidence of the main HQL-related side-effects of antineoplastic therapy and the superiority of an “ integrated ” strategy , based both on psychopharmacology and psychosocial interventions , such as SSV with or without structured psychotherapy . The one-way analysis of variance carried out by us did not allow us to draw definitive conclusions about which of the two integrated treatments was to be considered the treatment of choice , as they proved to be almost equally effective PROBLEM Although research ers suggest treatments that provide patients with an active coping strategy may increase patients ' sense of self-efficacy , previous studies have not measured patients ' self-efficacy . METHODS Eighteen women receiving chemotherapy for breast cancer were r and omized to  efficacy-enhancing experimental  ( n = 10 ) and usual-care control  ( n = 8) groups . The experimental group received five interventions delivered monthly . Variables-- quality of life , symptom distress , and self-care self-efficacy -- were measured at baseline and at 4 and 8 months later . FINDINGS At 4 and 8 months the interaction effects for the Functional Assessment of Cancer Treatment-Breast , used to measure quality of life , ranged from small for functional concerns to large for social concerns . Interaction effects for symptom distress , measured by the Symptom Distress Scale , were large . Interaction effects for self-care self-efficacy ranged from small for Enjoying Life and Stress Reduction , medium for Stress Reduction , and large for Making Decisions . CONCLUSIONS Interventions to promote self-efficacy may increase quality of life and decrease distress for women diagnosed with breast cancer Abstract Objective : To evaluate the effect of support from a nurse specialising in breast care and a voluntary support organisation on prevalence of psychological morbidity  after surgery for breast cancer . Design : Prospect i ve r and omised study . Setting : Three teaching hospitals in Glasgow with established breast clinics . Subjects : 272 women aged less than 70 years undergoing surgery for breast cancer . Interventions : Patients were r and omly allocated to receive routine care from ward staff , routine care plus support from breast care nurse , routine care plus support from voluntary organisation , or routine care plus support from nurse and organisation . Main outcome measures : Prevalence of psychological morbidity as assessed by self rating scales : 28 item general health question naire and its subscales , and hospital anxiety and depression scale . Measurements were made at first postoperative clinic visit and at three , six , and 12 months after surgery . Results : On each self rating scale , psychological morbidity tended to fall over the 12 month period . For each scale , scores were consistently lower in patients offered support from breast care nurse alone compared with the other groups , which were similar to each other . Differences were significant or nearly so : P values were 0.015 ( 28 item general health question naire ) , 0.027 ( anxiety and insomnia ) , 0.072 ( severe depression ) , 0.053 ( somatic symptoms ) , 0.031 ( social dysfunction ) , 0.093 ( hospital anxiety ) , and 0.003 ( hospital depression ) . Conclusion : Support from breast care nurse can significantly reduce psychological morbidity , as measured by self rating scales , in women undergoing breast cancer surgery . Key messages Key messages The value of different forms of psychological support for breast cancer patients is uncertain We compared effect of four different types of support for patients undergoing surgery for breast cancer : routine care from ward staff , routine care plus support from specialist breast care nurse , routine care plus support from voluntary organisation , or routine care plus support from nurse and organisation Scores of psychological morbidity were consistently lower in patients offered support from breast care nurse alone compared with the other groups , which were similar to each other Psychological support from an experienced breast care nurse can reduce psychological morbidity in patients undergoing surgery for breast To the authors ' knowledge , there had been no evidence for the efficacy of psychosocial intervention among Japanese cancer patients . The objective of this study was to determine the effect of a psychosocial group intervention in reducing psychologic distress and enhancing coping in this population in a r and omized controlled trial OBJECTIVE Peer-to-peer interactions are associated with enhanced psychosocial adjustment among women with breast cancer . Millions of women with cancer and others with various health conditions use the Internet to establish peer relationships , usually without professional moderation . This paper reports findings from the first r and omized , controlled study of the benefits of these types of Internet-based peer interactions . METHODS This pilot study involved seventy-eight women who were recently diagnosed with breast cancer . Participants were r and omly assigned to either an Internet peer support condition or Internet-based educational control condition . Data were gathered at baseline and 4- and 12-months . Primary outcomes of interest were psychological distress and quality of life . RESULTS Contrary to hypotheses , participants in the Internet peer support condition tended to do worse over time on primary outcome measures . There were no differences between groups on secondary outcomes of perceived social support , self-efficacy , or hope . Paradoxically , many women in the Internet peer support condition actively participated and reported high levels of satisfaction , suggesting some self-perceived benefits . CONCLUSIONS These results suggest that Internet based peer-to-peer interactions may not necessarily be universally beneficial despite the positive experiences reported by many participants . Further research is needed to underst and the magnitude of this effect with a larger sample . Moreover , these results raise questions about the need to underst and the comparative effectiveness of Internet-based communications by group structure ( i.e. , unstructured/structured ; unmoderated/moderated ) and the effect of content ( i.e. , expression of fear/anxiety , insightful disclosures , etc . ) on outcomes OBJECTIVE To examine the potential impact of elderly age on response to participation in a structured , multidisciplinary quality -of-life ( QOL ) intervention for patients with advanced cancer undergoing radiation therapy .  METHODS Study design was a r and omized stratified , two group , controlled clinical trial in the setting of a tertiary care comprehensive cancer center . Subjects with newly diagnosed cancer and an estimated 5-year survival rate of 0%-50 % who required radiation therapy  were recruited and r and omly assigned to either an intervention group or a st and ard care group . The intervention consisted of eight 90-min sessions design ed to address the five QOL domains of cognitive , physical , emotional , spiritual , and social functioning . QOL was measured using Spitzer uniscale and linear analogue self- assessment ( LASA ) at baseline and weeks 4 , 8 , and 27 . RESULTS Of the 103 study participants , 33 were geriatric ( 65 years or older ) , of which 16 ( mean age 72.4 years ) received the intervention and 17 ( mean age 71.4 years ) were assigned to the st and ard medical care . The geriatric participants who completed the intervention had higher QOL scores at baseline , at week 4 and at week 8 , compared to the control participants . SIGNIFICANCE OF RESULTS Our results demonstrate that geriatric patients with advanced cancer undergoing radiation therapy will benefit from participation in a structured multidisciplinary QOL intervention . Therefore , geriatric individuals should not be excluded from participating in a cancer QOL intervention , and , in fact , elderly age may be an indicator of strong response to a QOL intervention . Future research should further explore this finding The present prospect i ve study aim ed at ( 1 ) investigating the frequency of high levels of psychological distress in women with early-stage breast cancer almost two years after diagnosis and ( 2 ) identifying characteristics associated with long-term distress . One hundred and seventy women participated on two occasions . Two months after surgery , patients completed question naires measuring psychosocial variables ( e.g. , stressful life-events , health complaints , sleep problems , social support , subjective distress , personality factors ) , demographic and biomedical variables ( e.g. , TNM status , type of surgery ) . At the second measurement , subjective distress was assessed for a second time by means of the Impact of Events Scale ( IES ) . Almost two years after diagnosis , 16 % of the women reported a high level of psychological distress as measured by the Intrusion scale ( IES ) . Best predictors of a high level of distress were : intrusive thoughts about the disease , trait-anxiety , health complaints and problems with sleeping . No significant association was found between previous life-events , social support or biomedical variables and levels of distress We present the results of a breast cancer clinical trial that tested two therapy interventions delivered by telephone . Women ( N = 218 ) with Stages I , II , or III breast cancer were r and omly assigned to breast cancer health education or emotional expression interventions , or to a st and ard care control condition . Outcome and process measures were obtained at baseline , 6-month and 13-month follow-ups . Oncology certified nurses conducted the therapies in six , 30-minute individual phone sessions . Women in the health education condition reported significantly better knowledge and less perceived stress compared to women in the emotional expression and control conditions . No treatment effects , however , were obtained for quality of life or mood , and all women generally improved on these measures over time . Secondary analyses showed that younger women and women with a more advanced stage of breast cancer reported significantly greater avoidant coping . The data show that telephone therapy is a viable delivery modality and that distress improves with time for most women . Overall , this study showed that neither of the two telephone interventions tested had a meaningful effect on quality of life or mood A recent Pew Charitable Trust study found that 52,000,000 individuals used the Internet to obtain health/medical information . Clinical trials of face‐to‐face breast carcinoma support groups show evidence of 1 ) improvement in quality of life , 2 ) reduction of psychologic symptoms , 3 ) improvement in coping responses , and 4 ) a reduction in pain . To the authors ' knowledge , a few studies published to date have investigated Internet‐delivered electronic support groups ( ESGs ) for cancer . The most sophisticated is the Comprehensive Health Enhancement Support System ( CHESS ) program , which provides integrated information , referral , and a newsgroup‐based social support program . However , to the authors ' knowledge , no studies published to date have examined the impact of a breast carcinoma ESG in a clinical trial Background : Fatigue has a significant impact on the quality of life ( QOL ) of cancer patients . Recent research has suggested that physical activity can reduce fatigue in patients receiving active cancer treatment . In this project , we examined the impact that participation in a r and omized controlled trial of a multidisciplinary intervention design ed to impact overall QOL had on fatigue for advanced cancer patients actively receiving treatment . Methods : Patients with newly diagnosed cancer were r and omly assigned to an 8-session structured multidisciplinary intervention or a st and ard-care arm at the beginning of their course of radiotherapy ( RT ) design ed to impact QOL . Ninety-minute sessions were led by either a psychiatrist or psychologist , collaborating with a nurse , physical therapist , chaplain , or social worker , depending on the session 's theme . The fatigue assessment s used in this trial included the Linear Analogue Self Assessment ( LASA ) , the Profile of Mood States ( POMS ) , Spielberger 's State-Trait Anxiety Inventory ( STAI ) , and the Symptom Distress Scale ( SDS ) . Results : There were 115 participants enrolled and the 2 r and omization arms were well balanced in terms of baseline characteristics and treatment received except for increased commuting distance for the patients in the intervention arm ( P = 0.042 ) . Most of scores indicated less fatigue ( higher score ) in the st and ard treatment group , but there were no statistically significant differences found at baseline and weeks 4 , 8 , and 27 except for SDS at week 8 ( P = 0.018 ) with less patients reporting significant fatigue in the st and ard treatment arm . For the entire participant population , fatigue levels initially worsened with radiotherapy , stabilized at week 8 , and returned to baseline by week 27 . Disease site , chemotherapy use , and radiotherapy dose did not have a significant impact on fatigue levels . Conclusions : Radiotherapy initially caused a worsening of fatigue but with time fatigue levels returned to baseline . Clinical ly , this structured multidisciplinary intervention had no impact on fatigue , and there was the suggestion the multiple sessions may have contributed to worse fatigue during active cancer treatment BACKGROUND To determine whether sleep quality and fatigue associated with breast cancer adjuvant chemotherapy treatments can be improved with behavioral therapy ( BT ) [ Individualized Sleep Promotion Plan ( ISPP ) ] including modified stimulus control , modified sleep restriction , relaxation therapy , and sleep hygiene . METHODS R and omized-controlled trial based on Piper Integrated Fatigue Model , 219 stages I-IIIA breast cancer patients . Prior to the initial chemotherapy treatment , BT participants developed an ISPP plan that was regularly reinforced and revised . Controls received healthy eating information and attention . Pittsburgh Sleep Quality Index ( PSQI ) , daily diary , actigraph , and Piper Fatigue Scale ( PFS ) data were collected 2 days prior , during the 7 days after each treatment , and 30 days after the last treatment . Repeated measures analysis of variance was used . RESULTS Prior to chemotherapy , participants reported mild fatigue and fairly poor sleep quality . All variables changed over time . A group by time interaction was found for sleep quality ( PSQI ) improving in the BT group . Diary revealed group differences on number of awakenings , minutes awake after sleep onset , and sleep efficiency . Fatigue ( PFS ) was similar between groups . CONCLUSIONS The BT group showed improved sleep quality over time and better sleep ( diary ) . Perceptions of improved sleep quality over time are not consistently associated with diary or actigraph , or result in lower fatigue A community-based nursing study was conducted in Sydney , Australia , to compare the effects of progressive muscle relaxation and guided imagery on anxiety , depression , and quality of life in people with advanced cancer . In this study , 56 people with advanced cancer who were experiencing anxiety and depression were r and omly assigned to 1 of 4 treatment conditions : ( 1 ) progressive muscle relaxation training , ( 2 ) guided imagery training , ( 3 ) both of these treatments , and ( 4 ) control group . Subjects were tested before and after learning muscle relaxation and guided imagery techniques for anxiety , depression , and quality of life using the Hospital Anxiety and Depression scale and the Functional Living Index — Cancer scale . There was no significant improvement for anxiety ; however , significant positive changes occurred for depression and quality of life The purpose of this study was to examine relationships between emotional adjustment to advanced breast cancer , pain , social support , and life stress . The cross-sectional sample was compromised of 102 women with metastatic and /or recurrent breast cancer who were recruited into a r and omized psychosocial intervention study . All women completed baseline question naires assessing demographic and medical variables , social support , life stress , pain , and mood disturbance . Three types of social support were assessed : ( 1 ) number of persons in support system ; ( 2 ) positive support ; and ( 3 ) aversive support . On the Profile of Mood States ( POMS ) total score , we found significant interactions between life stress and social support ; having more people in the patient 's support system was associated with less mood disturbance , but only among patients who had undergone greater life stress . Also , aversive social contact was significantly related to total mood disturbance ( POMS ) , and having more aversive social contact was particularly associated with total mood disturbance ( POMS ) among patients who had undergone greater life stress . Pain intensity was associated with greater total life stress , and was not significantly related to social support . These results are consistent with the ' buffering hypothesis ' that social support may shield women with metastatic breast cancer from the effects of previous life stress on their emotional adjustment ; however , aversive support may be an additional source of life stress associated with emotional distress . Also , pain is greater among women with greater life stress , regardless of social support A prospect i ve , multidisciplinary , 5-year study of 69 consecutive female patients with early ( T0,1N0,1M0 ) breast cancer was conducted . Patients ' psychological responses to the diagnosis of cancer were assessed 3 months postoperatively . These responses were related to outcome 5 years after operation . Recurrence-free survival was significantly common among patients who had initially reacted to cancer by denial or who had a fighting spirit than among patients who had responded with stoic acceptance or feelings of helplessness and hopelessness Clinical practice frequently generates questions that are not easily answered by r and omized trials . On conventional hierarchies of evidence , ' weaker ' study design s are often more feasible . Also , much research is not well design ed . Yet we still need to make best use of the available evidence . Systematic review s must therefore address the danger of underestimating the evidence from relevant literature if it includes only that of a certain method ological quality . This would run the risk of missing or distorting the true message that the review is trying to identify . We propose a classification of research which does not reject studies on the basis of design alone , but recognizes the importance of assessing the message or ' signal ' within each piece of research . It explicitly introduces judgement into the appraisal and synthesis of evidence , and affords more flexibility in attaching weight to evidence that might otherwise be lost . It includes an assessment of method ological quality , balancing this against the weight of its message , rather than rejecting studies which are below a certain threshold for quality . Fundamentally flawed research will still be rejected , but more commonly papers can still be used , tempering the importance that we attach to their signal by the amount of ' noise ' around that signal . The balance of these two elements may be termed the ' signal to noise ratio ' This single-blind , r and omized controlled trial evaluated the impact of the Transcendental Meditation program plus st and ard care as compared with st and ard care alone on the quality of life ( QOL ) of older women ( ≥55 years ) with stage II to IV breast cancer . One hundred and thirty women ( mean age = 63.8 ) were r and omly assigned to either experimental ( n = 64 ) or control ( n = 66 ) groups . Functional Assessment of Cancer Therapy — Breast ( FACT-B ) , Functional Assessment of Chronic Illness Therapy— Spiritual Well-Being ( FACIT-SP ) , and Short-Form (SF)-36 mental health and vitality scales were administered every 6 months over an average 18-month intervention period . Significant improvements were found in the Transcendental Meditation group compared with controls in overall QOL , measured by the FACT-B total score ( P = .037 ) , emotional well-being ( P = .046 ) , and social well-being ( P = .003 ) subscales , and SF-36 mental health ( P = .017 ) . Results indicate that the Transcendental Meditation technique improves the QOL of older breast cancer patients . It is recommended that this stress reduction program , with its ease of implementation and home practice , be adopted in public health programs
BACKGROUND Psychological symptoms are associated with metastatic breast cancer .
This is the basis for exploring the impact of psychological interventions on psychosocial and survival outcomes .
One early study appeared to show significant survival and psychological benefits from psychological support while subsequent studies have revealed conflicting results .
This review is an up date of a Cochrane review first published in 2004 and previously up date d in 2007 .
OBJECTIVES To assess the effects of psychological interventions on psychosocial and survival outcomes for women with metastatic breast cancer .