A randomised controlled trial to evaluate the effects of a self-help workbook intervention on distress, coping and quality of life after breast cancer diagnosis. Internet-based guided self-help for glioma patients with depressive symptoms: design of a randomized controlled trial Randomized pilot of a self-guided internet coping group for women with early-stage breast cancer Exercise and stress management training prior to hematopoietic cell transplantation: Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 0902. Effects of a brief psychosocial intervention in patients with cancer receiving adjuvant therapy. U-CARE: Internet-based stepped care with interactive support and cognitive behavioral therapy for reduction of anxiety and depressive symptoms in cancer - a clinical trial protocol Internet-based program for coping with cancer: a randomized controlled trial with hematologic cancer patients. Protocol of a multi-centre randomised controlled trial of a web-based information intervention with nurse-delivered telephone support for haematological cancer patients and their support persons Finding My Way: protocol of a randomised controlled trial evaluating an internet self-help program for cancer-related distress A pilot randomized controlled trial of the feasibility of a self-directed coping skills intervention for couples facing prostate cancer: Rationale and design Preliminary results of a randomised controlled trial of an online psychological intervention to reduce distress in men treated for localised prostate cancer. Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. Effect of brief psychoeducation using a tablet PC on distress and quality of life in cancer patients undergoing chemotherapy: a pilot study. Use and Helpfulness of Self-Administered Stress Management Therapy in Patients Undergoing Cancer Chemotherapy in Community Clinical Settings Effects of self-directed stress management training and home-based exercise on stress management skills in cancer patients receiving chemotherapy. Effects of self-directed stress management training and home-based exercise on quality of life in cancer patients receiving chemotherapy: a randomized controlled trial. The impact of an informational self-management intervention on the association between control and illness uncertainty before and psychological distress after radiotherapy. An online stress management workbook for breast cancer Self-administered stress management training in patients undergoing radiotherapy. A brief self-administered psychological intervention to improve well-being in patients with cancer: results from a feasibility study.
OBJECTIVE To evaluate the efficacy of an interactive self-help workbook in reducing distress , and improving quality of life ( QOL ) and coping for women recently diagnosed with breast cancer . DESIGN R and omised controlled trial comparing the use of the workbook and that of an information booklet . PARTICIPANTS AND SETTING 49 women with Stage 0 to II breast cancer diagnosed in the previous month and recruited from 1 February 2007 to 1 February 2008 , in two urban Australian public hospitals . MAIN OUTCOME MEASURES The primary outcome measures were depression , anxiety , and posttraumatic stress . Secondary outcomes included QOL , body image , and the coping styles helplessness/hopelessness , cognitive avoidance and anxious preoccupation . RESULTS After controlling for baseline levels , interactions at 3-month follow-up showed that participants in the workbook group had significantly lower levels of posttraumatic stress ( F[1,89 ] = 7.01 ; P = 0.01 ) , helplessness/hopelessness ( F [ 1,89 ] = 4.75 ; P = 0.03 ) , and cognitive avoidance ( F [ 1,89 ] = 4.95 ; P = 0.03 ) than those in the control ( information booklet ) group . However , women in the workbook group had significantly poorer body image than those in the control group ( F [ 1,89 ] = 6.43 ; P = 0.01 ) . At 6 months , only the body image interaction remained significant ( F [ 1,93 ] = 7.44 ; P = 0.01 ) . CONCLUSION These results suggest that a self-help workbook can be an effective , short-term intervention for improving posttraumatic stress , cognitive avoidance , and certain depressive symptoms in women recently diagnosed with breast cancer . However , issues related to body image need to be dealt with differently . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Background Among glioma patients , depression is estimated to be more prevalent than in both the general population and the cancer patient population . This can have negative consequences for both patients and their primary informal caregivers ( e.g. , a spouse , family member or close friend ) . At present , there is no evidence from r and omized controlled trials for the effectiveness of psychological treatment for depression in glioma patients . Furthermore , the possibility of delivering mental health care through the internet has not yet been explored in this population . Therefore , a r and omized controlled trial is warranted to evaluate the effects of an internet-based , guided self-help intervention for depressive symptoms in glioma patients . Methods / design The intervention is based on problem-solving therapy . An existing 5-week course is adapted for use by adult glioma patients with mild to moderate depressive symptoms ( Center for Epidemiology Studies Depression Scale score ≥12 ) . Sample size calculations yield 126 glioma patients to be included , who are r and omly assigned to either the intervention group or a waiting list control group .  In addition , we aim to include 63 patients with haematological cancer in a non- central nervous system malignancy control group . Assessment s take place at baseline , after 6 and 12 weeks , and after 6 and 12 months . Primary outcome measure is the change in depressive symptoms . Secondary outcome measures include health-related quality of life , fatigue , costs and patient satisfaction . In addition , all patients are asked to assign a primary informal caregiver , who does not participate in the intervention but who is asked to complete similar assessment s. Their mood , health-related quality of life and fatigue is evaluated as well . Discussion This is the first study to evaluate the effects of problem-solving therapy delivered through the internet as treatment for depressive symptoms in glioma patients . If proven effective , this treatment will contribute to the mental health care of glioma patients in clinical practice .Trial registration Netherl and s Trial Register Background : Internet-based methods for provision of psychological support and intervention to cancer survivors hold promise for increasing the public impact of such treatments . Purpose : The goal of this controlled pilot study was to examine the effect and potential mechanisms of action of a self-guided , Internet-based coping-skills training group on quality of life outcomes in women with early-stage breast cancer . Methods : Sixty-two women completed baseline evaluations and were r and omized into either a small online coping group or a waiting-list control condition . Results : No main effects for treatment were observed at the 12-week follow up . However , there was a significant interaction between baseline self-reported health status and treatment , such that women with poorer self-perceived health status showed greater improvement in perceived health over time when assigned to the treatment condition . Linguistic analyses revealed that positive changes across quality of life variables were associated with greater expression of negative emotions such as sadness and anxiety , greater cognitive processing , and lower expression of health-related concerns . Conclusions : These results demonstrate the potential efficacy of self-guided Internet coping groups while highlighting the limitations of such groups Studies show that engaging patients in exercise and /or stress management techniques during hematopoietic cell transplantation ( HCT ) improves quality of life . The Blood and Marrow Transplant Clinical Trials Network tested the efficacy of training patients to engage in self-directed exercise and stress management during HCT . The study r and omized 711 patients at 21 centers to receive 1 of 4 training interventions before HCT : a self-directed exercise program , a self-administered stress management program , both  ,  or neither .  Participants completed self-reported assessment s at enrollment and up to 180 days after HCT . R and omization was stratified by center and transplant type . There were no differences in the primary endpoints of the Physical Component Summary and Mental Component Summary scales of the Medical Outcomes Study Short Form 36 at day + 100 among the groups , based on an intention-to-treat analysis . There also were no differences in overall survival , days of hospitalization through day + 100 post-HCT , or in other patient-reported outcomes , including treatment-related distress , sleep quality , pain , and nausea . Patients r and omized to training in stress management reported more use of those techniques , but patients r and omized to training in exercise did not report more physical activity . Although other studies have reported efficacy of more intensive interventions , brief training in an easy-to-disseminate format for either self-directed exercise or stress management was not effective in our trial PURPOSE / OBJECTIVES To test the effects of a brief psychosocial intervention using CD-ROM ( BPIC ) on psychosocial ( fighting spirit , helplessness or hopelessness , anxiety , and depression ) and behavioral ( self-care behaviors ) outcomes in patients with cancer receiving adjuvant therapy . DESIGN Quasi-experimental . SETTING A comprehensive cancer center in Seoul , South Korea . SAMPLE 71 patients undergoing adjuvant therapy .  METHODS The study participants were assigned to either BPIC or a control group . The experimental group underwent a two-week psychosocial intervention via CD-ROM , booklet , and telephone counseling . MAIN RESEARCH VARIABLES Fighting spirit , helplessness or hopelessness , anxiety , depression , and self-care behaviors . FINDINGS After BPIC , the experimental group showed significantly higher scores than the control group for fighting spirit ( p = 0.005 ) and self-care behaviors ( p < 0.001 ) . However , the groups showed no significant differences in helplessness or hopelessness ( p = 0.42 ) , anxiety ( p = 0.279 ) , and depression ( p = 0.068 ) . CONCLUSIONS BPIC use improved fighting spirit and self-care behaviors in study participants . The results partially support the effectiveness of BPIC for adaptation among patients with cancer receiving adjuvant therapy . IMPLICATION S FOR NURSING A brief psychosocial intervention using multimedia can be used effectively in clinical oncology setting s to accelerate adaptation among patients with cancer in the adjuvant phase Background Approximately 20–30 % of patients with cancer experience a clinical ly relevant level of emotional distress in response to disease and treatment . This in itself is alarming but it is even more problematic because it is often difficult for physicians and nurses to identify cancer patients who experience clinical ly relevant levels of anxiety and depression symptoms . This can result in persistent distress and can cause human suffering as well as costs for individuals and to the community . Methods Applying a multi-disciplinary and design -oriented approach aim ed at attaining new evidence -based knowledge in basic and applied psychosocial oncology , this protocol will evaluate an intervention to be implemented in clinical practice to reduce cancer patient  anxiety and depression . A prospect i ve r and omized design will be used . The overarching goal of the intervention is to promote psychosocial health among patients suffering from cancer by means of self-help programmes delivered via an Internet platform . Another goal is to reduce costs for individuals and society , caused by emotional distress in response to cancer . Following screening to detect levels of patient distress , patients will be r and omized to st and ard care or a stepped care intervention . For patients r and omized to the intervention , step 1 will consist of self-help material , a chat forum where participants will be able to communicate with each other , and a  Frequently Asked Questions  ( FAQ ) section where they can ask questions and get answers from an expert . Patients in the intervention group who still report symptoms of anxiety or depression after access to step 1 will be offered step 2 , which will consist of cognitive behavioral therapy ( CBT ) administered by a personal therapist . The primary end point of the study is patients ’ levels of anxiety and depression , evaluated longitudinally during and after the intervention . Discussion There is a lack of controlled studies of the psychological and behavioral processes involved in this type of intervention for anxiety and depressive disorders . Since anxiety and depressive symptoms are relatively common in patients with cancer and the availability of adequate support efforts is limited , there is a need to develop evidence -based stepped care for patients with cancer , to be delivered via the Internet . Trial registration Clinical Trials.gov Identifier : OBJECTIVE Psychosocial patient care in oncology is no longer limited to the inpatient setting . Outpatient services are in dem and . Internet-based interventions could aid in optimizing service delivery across disciplines . The effectiveness of an Internet-based program for hematologic cancer patients was tested in a r and omized controlled trial under field experimental conditions . METHODS A 4-week cognitive-behavioral program for coping with cancer was offered to hematologic cancer patients online . One hundred eighty-six registrants were r and omly assigned to an intervention group ( n = 105 ) or a waiting list ( n = 81 ) . The outcome measures , ' mental adjustment ' ( MAC ) and ' psychological distress ' ( BSI ) , were assessed at registration and after 4 weeks . Patient satisfaction was assessed ( ZUF-8 ) , and complete-cases and intention-to-treat analyses were performed . RESULTS At registration , the majority of participants displayed clinical ly significant distress ( BSI ) and lacked alternative access concerning psychosocial care . One hundred eleven patients filled out the post question naire at 4 weeks . In contrast to the waiting list , the intervention group displayed a significant increase in fighting spirit ( d = 0.42 ; CI 95 % , 0.04 to 0.80 ) . The effect was confirmed by intention-to-treat analysis ( d = 0.33 ; CI 95 % , 0.04 to 0.62 ) . Otherwise , no effects were observed . Patient satisfaction with the program was high . CONCLUSION The results demonstrate the potential efficacy of Internet-based programs while highlighting their limitations . Future research is needed to clarify and optimize efficacy , taking different program components and patient characteristics into particular consideration Background High rates of anxiety , depression and unmet needs are evident amongst haematological cancer patients undergoing treatment and their Support Persons . Psychosocial distress may be minimised by ensuring that patients are sufficiently involved in decision making , provided with tailored information and adequate preparation for potentially threatening procedures . To date , there are no published studies evaluating interventions design ed to reduce psychosocial distress and unmet needs specifically in patients with haematological cancers and their Support Persons . This study will examine whether access to a web-based information tool and nurse-delivered telephone support reduces depression , anxiety and unmet information needs for haematological cancer patients and their Support Persons . Methods / Design A non-blinded , parallel-group , multi-centre r and omised controlled trial will be conducted to compare the effectiveness of a web-based information tool and nurse-delivered telephone support with usual care .  Participants will be recruited from the haematology inpatient wards of five hospitals in New South Wales , Australia . Patients diagnosed with acute myeloid leukaemia , acute lymphoblastic leukaemia , Burkitt ’s lymphoma , Lymphoblastic lymphoma ( B or T cell ) , or Diffuse Large B-Cell lymphoma and their Support Persons will be eligible to participate . Patients and their Support Persons will be r and omised as dyads . Participants allocated to the intervention will receive access to a tailored web-based tool that provides accurate , up-to- date and personalised information about : cancer and its causes ; treatment options including treatment procedures information ; complementary and alternative medicine ; and available support . Patients and Support Persons will complete self-report measures of anxiety , depression and unmet needs at 2 , 4 , 8 and 12 weeks post-recruitment . Patient and Support Person outcomes will be assessed independently . Discussion This study will assess whether providing information and support using web-based and telephone support address the major psychosocial challenges faced by haematological patients and their Support Persons . The approach , if found to be effective , has potential to improve psychosocial outcomes for haematological and other cancer patients , reduce the complexity and burden of meeting patients ’ psychosocial needs for health care providers with high potential for translation into clinical practice .Trial registration ACTRN12612000720819 Background A cancer diagnosis elicits greater distress than any other medical diagnosis , and yet very few studies have evaluated the efficacy of structured online self-help therapeutic programs to alleviate this distress . This study aims to assess the efficacy over time of an internet Cognitive Behaviour Therapy ( iCBT ) intervention ( ‘ Finding My Way ’ ) in improving distress , coping and quality of life for individuals with a recent diagnosis of early stage cancer of any type . Methods / Design The study is a multi-site R and omised Controlled Trial ( RCT ) seeking to enrol 188 participants who will be r and omised to either the Finding My Way Intervention or an attention-control condition .  Both conditions are delivered online ; with 6 modules released once per week , and an additional booster module released one month after program-completion . Participants complete online question naires on 4 occasions : at baseline ( immediately prior to accessing the modules ) ; post-treatment ( immediately after program-completion ) ; then three and six months later . Primary outcomes are general distress and cancer-specific distress , with secondary outcomes including Health-Related Quality of Life ( HRQoL ) , coping , health service utilisation , intervention adherence , and user satisfaction . A range of baseline measures will be assessed as potential moderators of outcomes . Eligible participants are individuals recently diagnosed with any type of cancer , being treated with curative intent , aged over 18 years with sufficient English language literacy , internet access and an active email account and phone number . Participants are blinded to treatment group allocation . R and omisation is computer generated and stratified by gender . Discussion Compared to the few prior published studies , Finding My Way will be the first adequately powered trial to offer an iCBT intervention to curatively treated patients of heterogeneous cancer types in the immediate post-diagnosis/treatment period . If found efficacious , Finding My Way will assist with overcoming common barriers to face-to-face therapy in a cost-effective and accessible way , thus helping to reduce distress after cancer diagnosis and consequently decrease the cancer burden for individuals and the health system . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12613000001796 Background Although it is known both patients ’ and partners ’ reactions to a prostate cancer diagnosis include fear , uncertainty , anxiety and depression , with patients ’ and partners ’ reactions mutually determining how they cope with and adjust to the illness , few psychosocial interventions target couples . Those that are available tend to be led by highly trained professionals , limiting their accessibility and long-term sustainability . In addition , it is recognised that patients who might benefit from conventional face-to-face psychosocial interventions do not access these , either by preference or because of geographical or mobility barriers . Self-directed interventions can overcome some of these limitations and have been shown to contribute to patient well-being . This study will examine the feasibility of a self-directed , coping skills intervention for couples affected by cancer , called Coping-Together , and begin to explore its potential impact on couples ’ illness adjustment . The pilot version of Coping-Together includes a series of four booklets , a DVD , and a relaxation audio CD . Methods / design In this double-blind , two-group , parallel , r and omized controlled trial , 70 couples will be recruited within 4 months of a prostate cancer diagnosis through urology private practice s and r and omized to : 1 ) Coping-Together or 2 ) a minimal ethical care condition . Minimal ethical care condition couples will be mailed information booklets available at the Cancer Council New South Wales and a brochure for the Cancer Council Helpline . The primary outcome ( anxiety ) and additional secondary outcomes ( distress , depression , dyadic adjustment , quality of life , illness or caregiving appraisal , self-efficacy , and dyadic and individual coping ) will be assessed at baseline ( before receiving study material ) and 2 months post-baseline . Intention-to-treat and per protocol analysis will be conducted . Discussion As partners ’ distress rates exceed not only population norms , but also those reported by patients themselves , it is imperative that coping skills interventions target the couple as a unit and enhance both partners ’ ability to overcome cancer challenges . This pilot study will examine the feasibility and potential efficacy of Coping-Together in optimising couples ’ illness adjustment . This is one of the first feasibility studies to test this innovative coping intervention , which in turn will contribute to the larger literature advocating for psychosocial care of couples affected by prostate cancer . Trial registration Australian New Zeal and Clinical Trials Registry BACKGROUND Prostate cancer ( PCa ) poses many emotional and physical challenges for men following treatment . The unmet support needs of these men are well documented , and access to psychosocial support remains problematic . OBJECTIVES To assess the efficacy of an online psychological intervention for men who have localised PCa . DESIGN , SETTING , AND PARTICIPANTS We undertook a r and omised controlled trial to evaluate the intervention . Participants were r and omly allocated to one of three conditions :  My Road Ahead ( MRA ) alone ( MRA Only ) , MRA plus access to an online forum ( MRA+Forum ) , and access to the forum alone ( Forum ) . INTERVENTION The intervention was a 10-week self-guided online psychological intervention called My Road Ahead that consisted of six themed modules design ed to facilitate improved emotional well-being in the context of PCa as well as a moderated peer forum . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Pre- and postintervention assessment s of psychological distress ( the 21- question Depression , Anxiety and Stress Scale ) [ 1 ] and the Prostate Cancer-related Quality of Life scale [ 2 ] were conducted . Multivariate analysis of variance , regression , and structural equation modelling were used to analyse the data . RESULTS AND LIMITATIONS In total , 142 participants were r and omly allocated to one of the three intervention arms . The mean age of participants was 61 yr of age ( st and ard deviation : 7 ) , and 88 % had undergone radical prostatectomy . A significant improvement in psychological distress was observed for participants who had access to the combined condition ( MRA+Forum ) with a moderate effect size ( p=0.02 ; partial η(2)=0.07 ) . In particular , the decline in the mean level of psychological distress was 8.8 units larger for the MRA+Forum group than the Forum group ( 95 % confidence interval [ CI ] , 0.9 - 16.7 ) . Although the decline in the mean level of psychological distress was 7.0 units larger for the MRA+Forum group than for the MRA Only group , this difference was not significant ( 95 % CI , 1.1 - 15.1 ) . Structural equation modelling indicated that reductions in health worry and regret contributed significantly to the reductions in psychological distress for the MRA+Forum condition . CONCLUSIONS This study is the first , to our knowledge , that has evaluated a self-guided online psychological intervention tailored to the specific needs of men who have PCa . The findings of this study indicate the potential for this programme to deliver support that men may not otherwise receive . PATIENT SUMMARY This study found that men who have localised prostate cancer who received access to the online psychological intervention called My Road Ahead combined with the online peer discussion forum had significantly improved reductions in distress compared with those who received access to the online intervention alone or the forum alone PURPOSE Professionally administered psychosocial interventions have been shown to improve the quality of life of cancer patients undergoing chemotherapy . The present study sought to improve access to psychosocial interventions during chemotherapy treatment by evaluating the efficacy and costs of a patient self-administered form of stress management training that requires limited professional time or experience to deliver . PATIENTS AND METHODS Four hundred eleven patients about to start chemotherapy were r and omly assigned to receive usual psychosocial care only , a professionally administered form of stress management training , or a patient self-administered form of stress management training .  Quality -of-life assessment s were conducted before r and omization and before the second , third , and fourth treatment cycles . Intervention costs were estimated from both payer and societal perspectives . RESULTS Compared with patients who received usual care only , patients receiving the self-administered intervention reported significantly ( P < or = .05 ) better physical functioning , greater vitality , fewer role limitations because of emotional problems , and better mental health . In contrast , patients who received the professionally administered intervention fared no better in terms of quality of life than patients receiving usual care only . Costs of the self-administered intervention were estimated to be 66 % ( from a payer perspective ) to 68 % ( from a societal perspective ) less than the average costs of professionally administered psychosocial interventions for patients starting chemotherapy . CONCLUSION Evidence regarding the efficacy and favorable costs of self-administered stress management training suggests that this intervention has the potential to greatly improve patient access to psychosocial intervention during chemotherapy treatment BACKGROUND Managing distress has become crucial in optimized cancer care . Psychoeducation using tablet PCs has potential as a novel intervention to reduce distress in cancer patients . We examined the benefit of a single-session psychoeducation using a tablet PC during chemotherapy . METHODS Thirty-six cancer patients with significant levels of distress , as determined by the Hospital Anxiety and Depression Scale ( HADS ) , enrolled from the chemotherapy unit in Seoul National University Cancer Hospital . Participants were quasi-r and omized into either the  intervention ( n = 19 ) or control ( n = 17 ) group . Twenty-minute-long psychoeducation on distress management was provided via tablet PCs during chemotherapy infusion . HADS , Short-form 8 Health Survey , MD And erson Symptom Inventory , Insomnia Severity Index , and Impact of Event Scale-Revised ( IES-R ) were administered at baseline and 3 weeks later . The use of psychosocial services was review ed 6 months later . RESULTS Compared with controls , the intervention group showed a superior 3-week clinical trajectory regarding the score changes of the HADS depression subscale ( U = 69.0 ; p = 0.006 ) , mental component summary score of the Short-form 8 Health Survey ( U = 75.5 ; p = 0.011 ) , Impact of Event Scale-Revised avoidance subscale ( U = 89.0 ; p = 0.036 ) , and Insomnia Severity Index total score ( U = 82.5 ; p = 0.021 ) . There was no significant between-group difference regarding the use of psychosocial services after 6 months . CONCLUSIONS A tablet PC-based psychoeducation during chemotherapy infusion could be an effective intervention on managing depression , sleep disturbance , and quality of life in cancer patients suffering from distress The purpose of this multicenter longitudinal r and omized controlled trial was to examine the efficacy of self-administered stress management training ( SSMT ) in improving quality of life and reducing psychological distress among patients receiving cancer chemotherapy . Participants were r and omized to SSMT ( n = 111 ) or usual psychosocial care only ( n = 109 ) . Mixed linear modeling demonstrated no significant improvements in primary outcome measures ; however , participants assigned to SSMT reported using significantly more relaxation techniques ( p < 0.0001 ) , showed improvements on emotional adjustment scores , and demonstrated a stabilizing effect on the functional adjustment scores . Findings highlight the usefulness of SSMT in community clinical setting Although exercise may be used by some to decrease distress , little is known about how it may contribute to stress management ( SM ) among patients receiving chemotherapy . We evaluated whether exercise separately or in combination with SM training is effective at increasing perceived ability to manage stress .  Patients receiving chemotherapy ( N = 391 ) were r and omized to receive usual care only ( UCO ) , SM , exercise ( EX ) , or stress management and exercise ( SMEX ) .  They completed the Measure of Current Status prior to receiving chemotherapy and 12 weeks after the first infusion . We hypothesized that participants r and omized to an intervention condition would report improvements in relaxation , awareness of tension , getting needs met and coping confidence compared with those receiving UCO . Results indicated significant group-by-time interactions for the following : relaxation ( UCO versus SM , p = 0.008 ) , awareness of tension ( UCO versus SMEX , p = 0.029 and UCO versus EX , p < 0.001 ) , getting needs met ( UCO versus SMEX , p = 0.020 ) and Measure of Current Status total score ( UCO versus SMEX , p = 0.007 and UCO versus EX , p = 0.016 ) . There were no group-by-time interactions for coping confidence ( p-values > 0.05 ) . This study provides support for including an exercise component in SM interventions for cancer patients receiving chemotherapy ( clinical trials.gov identifier : NCT00740038 ) 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 Many studies have reported that cancer patients who show difficulties maintaining perceptions of control report more psychological distress than patients who are higher in control . Besides perceptions of control , feelings of illness uncertainty have also been regarded as a predictor of psychological distress . Given these strong relationships between perceptions of low control and high illness uncertainty and psychological distress , the present study examined whether an informational self-management intervention ( booklet ) could moderate this relationship . The booklet contained general and specific information about cancer and cancer treatment , information about possible coping strategies , and social comparison information , which consisted of short stories of other patients . Prior to radiotherapy  , 209 patients with cancer completed baseline measures , including control and illness uncertainty . After completing radiotherapy , patients were r and omly allocated to receive either a booklet ( experimental group ; N=103 ) or no booklet ( control group ; N=106 ) . Three months after the intervention , aspects of psychological distress were assessed , including tension , anger , depression , fatigue and vigour . The results supported our hypotheses and suggested that a self-management intervention is relevant in reducing the relationship between control and illness uncertainty before radiotherapy and psychological distress after radiotherapy . This seems important , especially for high-risk patients who perceive little control and much illness uncertainty Cognitive behavioral stress management groups have been shown to be decrease psychological symptoms and increase adaptive coping in breast cancer patients , but dissemination of this effective intervention has been challenging . The goal of the present project was to develop an online cognitive behavioral stress management intervention for early stage breast cancer survivors and evaluate its effectiveness using a 2 group × 3 time r and omized , waitlist-controlled design . Intervention and waitlist control group participants were assessed at three time points : at baseline ; at 10 weeks , after which only intervention participants had used the workbook ; and at 20 weeks , after which both groups had used the workbook . Results indicate that at 10 weeks intervention participants showed improved self-efficacy for coping with their cancer and for regulating negative mood and lower levels of cancer-related post-traumatic symptoms as compared to the control group , suggesting that an internet stress management intervention could be effective for helping breast cancer patients increase their confidence in their ability to cope with stress 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 BACKGROUND Patients with cancer have relatively high rates of anxiety and distress , adversely affecting their well-being and quality of life . Recent studies indicate that addressing these symptoms could result in better response to cancer treatment . Research ers have found that interventions that focus on increasing mental awareness and the frequency of positive experiences may have a greater impact on reducing psychological morbidity and increasing quality of life than interventions that target relief of psychological symptoms . AIM To develop and test a brief , easy to use intervention that could improve well-being and quality of life in cancer patients . METHODS We developed a simple well-being intervention that made few dem and s on patient time and required little training re source . Participants were r and omly assigned to an intervention group or a deferred entry group .  Measures of anxiety , depression , well-being and quality of life were administered at baseline and at follow-ups . RESULTS Twenty-two women with metastatic breast cancer and 24 men with metastatic prostate cancer were recruited from oncology clinics . Thirteen women and 14 men completed the study . Both qualitative and quantitative data showed that the intervention was acceptable to users . There was statistically significant improvement in quality of life scores on WHOQOL-BREF post-intervention ( p=0.046 ) . Compliance with the intervention was good . CONCLUSIONS This brief well-being intervention appears to be a promising technique for improving quality of life of cancer patients , without making undue dem and s on staff re sources or patient time . If further studies confirm its effectiveness , it could prove to be a cost-effective intervention
OBJECTIVE People with cancer can experience psychological distress  but do not always desire , or engage with , professional support to assist with managing distress .
Interventions that are self-directed or guided by patients may hold promise as they allow patients to engage with interventions as they need .
The objective of this review is to describe and appraise the evidence for effectiveness of self-guided interventions that aim to manage psychological distress in people with cancer .