Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma Reducing symptom limitations: a cognitive behavioral intervention randomized trial. Effects of a nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers. Outcomes from the Moving Beyond Cancer psychoeducational, randomized, controlled trial with breast cancer patients. A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Development and pilot testing of a psychoeducational intervention for oral cancer patients. Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. Management of depression for people with cancer (SMaRT oncology 1): a randomised trial Assessment is not enough: a randomized controlled trial of the effects of HRQL assessment on quality of life and satisfaction in oncology clinical practice. Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Can a brief psychological intervention prevent anxiety or depressive disorders in cancer patients? A randomised controlled trial. Anxiety and depression among long-term survivors of cancer in Australia: results of a population-based survey. How coping mediates the effect of optimism on distress: a study of women with early stage breast cancer. The Effects and Expense of Augmenting Usual Cancer Clinic Care With Telephone Problem-Solving Counseling A pilot study into the use of a multisensory environment (Snoezelen) within a palliative day-care setting. Evaluation of an internet support group for women with primary breast cancer A problem‐solving approach to stress reduction among younger women with breast carcinoma Preliminary Results of an Individually Tailored Psychosocial Intervention for Patients with Advanced Hepatobiliary Carcinoma Psychological and fitness changes associated with exercise participation among women with breast cancer. Active for Life After Cancer: a randomized trial examining a lifestyle physical activity program for prostate cancer patients. A new psychosocial screening instrument for use with cancer patients. Measuring cancer patients' psychological distress and well-being: a factor analytic assessment of the Mental Health Inventory. The effects of a professionally produced videotape on education and anxiety/distress levels for patients with newly diagnosed melanoma: a randomized, prospective clinical trial. Short-term effects of telephone therapy for breast cancer patients. Screening for distress in cancer patients: is the distress thermometer a valid measure in the UK and does it measure change over time? A prospective validation study. Three methods for minimally important difference: no relationship was found with the net proportion of patients improving. Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial. Depression and Anxiety in Women With Breast Cancer and Their Partners A Randomized, Wait-List Controlled Clinical Trial: The Effect of a Mindfulness Meditation-Based Stress Reduction Program on Mood and Symptoms of Stress in Cancer Outpatients Uncertainty Intervention for Watchful Waiting in Prostate Cancer Measuring health-related quality of life and neutropenia-specific concerns among older adults undergoing chemotherapy: validation of the Functional Assessment of Cancer Therapy–Neutropenia (FACT-N) Use of preferred music to reduce emotional distress and symptom activity during radiation therapy. Improving quality of life in men with prostate cancer: a randomized controlled trial of group education interventions. A randomized study of the effectiveness of a brief psychosocial intervention for women attending a gynecologic cancer clinic. Are we using appropriate self-report questionnaires for detecting anxiety and depression in women with early breast cancer? Long-term telephone therapy outcomes for breast cancer patients. The prevalence of psychiatric disorders among cancer patients. Self-administered stress management training in patients undergoing radiotherapy. Improving the quality of life of patients with prostate carcinoma The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes. Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer.
Research suggests that stress‐reduction programs tailored to the cancer setting help patients cope with the effects of treatment and improve their quality of life .  Yoga , an ancient Eastern science , incorporates stress‐reduction techniques that include regulated breathing , visual imagery , and meditation as well as various postures . The authors examined the effects of the  Tibetan yoga ( TY ) practice s of Tsa lung and Trul khor , which incorporate  controlled breathing and visualization , mindfulness techniques  , and low‐impact postures  in patients with lymphoma Until now , little research has been conducted examining the reactive dimension , or the degree to which a symptom limits an individual 's life , in a multiplicity of symptoms . This research examines how problem-solving therapy organizes an intervention to decrease symptom limitations . The purpose was threefold : to determine if a cognitive behavioral intervention decreases the impact of symptom limitations among individuals newly diagnosed with cancer , who are receiving chemotherapy ; to determine , after adjusting for covariates , how symptom limitations change over time ; and to describe which symptoms are most limiting . This r and omized control trial was conducted in two comprehensive and four community cancer centers . Two hundred thirty-seven individuals , aged 31 - 87 , newly diagnosed with solid tumor cancers , participated . The experimental group ( 118 individuals ) received a 10-contact , 18-week cognitive behavioral intervention focused on cancer- and chemotherapy-related symptoms . The control group ( 119 individuals ) received conventional care . Interviews occurred at baseline , 10 , 20 , and 32 weeks . Data analysis used a two-level hierarchical linear model . Participants receiving the cognitive behavioral intervention had lower scores of symptom limitation than did participants in the control group . At the onset of the study , younger patients reported more symptom limitations than their older counterparts ; however , this was reversed by the end of the study . The cognitive behavioral intervention was key to decreasing symptom limitations . Findings also suggest that nursing interventions may be particularly helpful to younger individuals in managing cancer-related symptom limitations OBJECTIVE Women with gynecological cancers have reported poor health-related quality of life ( QOL ) , with complex physical and psychological needs post-surgery and during chemotherapy treatment . There are no studies reporting interventions addressing these needs post-hospital discharge in this population . METHODS Patients were r and omized into two groups . The intervention group received 6 months of specialized care by an Advanced Practice Nurse ( APN ) ; in addition , women with high distress were evaluated and monitored by a psychiatric consultation-liaison nurse ( PCLN ) . The attention control group was assisted with symptom management by a research assistant . The effects of the 6-month intervention were evaluated using self-report question naires at baseline ( 24 - 48 h after surgery ) , 1 , 3 , and 6 months post- surgery . QOL assessment s included the Center for Epidemiological Studies -Depression Scale , the ambiguity subscale of the Mishel Uncertainty in Illness Scale , the Symptom Distress Scale , and the Short-Form Health Survey ( SF-12 ) . The sample for the longitudinal analysis included 123 who completed QOL outcome measures  across three occasions post-surgery . RESULTS The APN intervention result ed in significantly less uncertainty than the attention control intervention 6 months after surgery . When the sub-group who received the APN plus PCLN intervention was compared with the total attention control group , the sub-group had significantly less uncertainty , less symptom distress , and better SF-12 mental and physical QOL over time . CONCLUSION Nurse tailored interventions that target both physical and psychological aspects of QOL in women recovering from cancer surgery and undergoing chemotherapy produce stronger outcomes than interventions that target solely one QOL aspect PURPOSE Evidence suggests that the re-entry phase ( ie , early period after medical treatment completion ) presents distinct challenges for cancer patients . To facilitate the transition to recovery , we conducted the Moving Beyond Cancer ( MBC ) trial , a multisite , r and omized , controlled trial of psychoeducational interventions for breast cancer patients . METHODS Breast cancer patients were registered within 6 weeks after surgery . After medical treatment , they completed baseline measures and were r and omly assigned to st and ard National Cancer Institute print material ( CTL ) ; st and ard print material and peer-modeling videotape ( VID ) ; or st and ard print material , videotape , two sessions with a trained cancer educator , and informational workbook ( EDU ) . Two primary end points were examined : energy/fatigue and cancer-specific distress . Secondary end points were depressive symptoms and post-traumatic growth . Perceived preparedness for re-entry was analyzed as a moderator of effects . RESULTS Of 558 women r and omly assigned to treatment , 418 completed the 6-month assessment and 399 completed the 12-month assessment . In analyses controlling for study site and baseline depressive symptoms , VID produced significant improvement in energy/fatigue at 6 months relative to CTL , particularly among women who felt less prepared for re-entry at baseline . No significant main effect of the interventions emerged on cancer-specific distress , but EDU prompted greater reduction in this outcome relative to CTL at 6 months for patients who felt more prepared for re-entry . Between-group differences in the primary outcomes were not significant at 12 months , and no significant effects emerged on the secondary end points . CONCLUSION A peer-modeling videotape can accelerate the recovery of energy during the re-entry phase in women treated for breast cancer , particularly among those who feel less prepared for re-entry BACKGROUND Physical activity provides a number of physical and psychological benefits to cancer survivors , including lessening the impact of detrimental cancer-related symptoms and treatment side-effects ( e.g. fatigue , nausea ) , and improving overall well-being and quality of life . The purpose of the present pilot study was to examine the physical and psychological benefits afforded by a 7-week yoga program for cancer survivors . METHOD Eligible participants ( per-screened with PAR-Q/PAR-MED-X ) were r and omly assigned to either the  intervention ( n=20 ) or control group ( n=18 ) . All participants completed pre- and post-testing assessment s immediately before and after the yoga program , respectively . RESULTS The yoga program participants ( M age=51.18 ( 10.33 ) ; 92 % female ) included primarily breast cancer survivors , on average 55.95 ( 54.39 ) months post-diagnosis . Significant differences between the intervention and the control group at post-intervention were seen only in psychosocial ( i.e. global quality of life , emotional function , and diarrhea ) variables ( all p 's < 0.05 ) . There were also trends for group differences , in the hypothesized directions , for the psychosocial variables of emotional irritability , gastrointestinal symptoms , cognitive disorganization , mood disturbance , tension , depression , and confusion ( all p 's < 0.10 ) . Finally , there were also significant improvements in both the program participants and the controls from pre- to post-intervention on a number of physical fitness variables . CONCLUSIONS These initial findings suggest that yoga has significant potential and should be further explored as a beneficial physical activity option for cancer survivors . Future research might attempt to include a broader range of participants ( e.g. other types of cancer diagnoses , male subjects ) , a larger sample size , and a longer program duration in an RCT OBJECTIVE Oral cancer elicits considerable distress in both the pre and post-treatment periods . This paper details the development , validation and pilot-testing of a psychoeducational intervention for oral cancer patients . METHOD An educational booklet covering information about oral cancer and its treatment and effective coping strategies was developed by a multi-disciplinary team . It was evaluated by patient focus groups and content/educational experts , delivered to subjects in pre and post-operative presentations by a health educator , and pilot-tested in a r and omized controlled trial versus st and ard care . RESULTS Pilot data from 19 subjects ( 10 psychoeducation , nine st and ard care )  indicates that the intervention is feasible and highly acceptable . At follow-up the intervention group showed a gain in knowledge , less body image disturbance , lower anxiety and a trend toward higher wellbeing . CONCLUSION This program , which is currently being evaluated in a larger RCT with extended follow-up , should prove useful in reducing the psychosocial burden of oral cancer and its treatment 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 BACKGROUND Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer , but evidence to guide its management is scarce . We aim ed to assess the efficacy and cost of a nurse-delivered complex intervention that was design ed to treat major depressive disorder in patients who have cancer . METHODS We did a r and omised trial in a regional cancer centre in Scotl and , UK . 200 out patients who had cancer with a prognosis of greater than 6 months and major depressive disorder ( identified by screening ) were eligible and agreed to take part . Their mean age was 56.6 ( SD 11.9 ) years , and 141 ( 71 % ) were women . We r and omly assigned 99 of these participants to usual care , and 101 to usual care plus the intervention , with minimisation for sex , age , diagnosis , and extent of disease . The intervention was delivered by a cancer nurse at the centre over an average of seven sessions . The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale ( range 0 to 4 ) at 3 months after r and omisation . Analysis was by intention to treat . This trial is registered as IS RCT N84767225 . FINDINGS Primary outcome data were missing for four patients . For 196 patients for whom we had data at 3 months , the adjusted difference in mean Symptom Checklist-20 depression score , between those who received the intervention and those who did not , was 0.34 ( 95 % CI 0.13 - 0.55 ) . This treatment effect was sustained at 6 and 12 months . The intervention also improved anxiety and fatigue but not pain or physical functioning . It cost an additional pound sterling 5278 ( US$ 10 556 ) per quality -adjusted life-year gained . INTERPRETATION The intervention-Depression Care for People with Cancer-offers a model for the management of major depressive disorder in patients with cancer and other medical disorders who are attending specialist medical services that is feasible , acceptable , and potentially cost effective The potential benefits of health-related quality of life ( HRQL ) assessment in oncology clinical practice include better detection of problems , enhanced disease and treatment monitoring and improved care . However , few empirical studies have investigated the effects of incorporating such assessment s into routine clinical care . Recent r and omized studies have reported improved detection of and communication about patients ' concerns , but few have found effects on patient HRQL or satisfaction . This study examined whether offering interpretive assistance of HRQL results would improve these patient outcomes . Two hundred and thirteen participants with metastatic breast , lung or colorectal cancer were r and omly assigned to one of three conditions : usual care ; HRQL assessment or HRQL assessment followed by a structured interview and discussion . Interviews about patients ' assessment responses were conducted by a research nurse , who then presented HRQL information to the treating nurse . HRQL and treatment satisfaction outcomes were assessed at 3 and 6 months . No significant differences were found between study conditions in HRQL or satisfaction . Results suggest that routine HRQL assessment , even with description of results , is insufficient to improve patient HRQL and satisfaction . It is suggested that positive effects may require supplementing assessment results with specific suggestions for clinical management changes 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 The purpose of this study was to gather data on the efficacy of a newly developed psychosocial group intervention for cancer patients , called mindfulness-based art therapy ( MBAT ) .  One hundred and eleven women with a variety of cancer diagnoses were paired by age and r and omized to either an eight-week MBAT intervention group or a wait-list control group .  Ninety-three participants ( 84 % ) completed both the pre- and post- study measurements . As compared to the control group , the MBAT group demonstrated a significant decrease in symptoms of distress ( as measured by the Symptoms Checklist-90-Revised ) and significant improvements in key aspects of health-related quality of life ( as measured by the Medical Outcomes Study Short-Form Health Survey ) . This investigation of MBAT provides initial encouraging data that support a possible future role for the intervention as a psychosocial treatment option for cancer patients BACKGROUND We tested whether a brief psychological intervention could prevent anxiety or depressive disorders among newly diagnosed cancer patients . PATIENTS AND METHODS Patients free of anxiety or depressive disorder were r and omised to receive immediate intervention ( start of cancer treatment ) , delayed intervention ( 8 weeks after starting treatment ) or usual care . They were stratified according to risk of developing anxiety or depressive disorders . Primary outcome was measured using a st and ardised psychiatric interview to detect any anxiety or depressive disorder at 6 and 12 months following the cancer diagnosis . Analyses used conditional odds logistic regression models adjusting for age , gender , concerns and past history to compare outcome of all intervention patients with usual care . RESULTS A total of 465 patients were recruited . In all , 313 ( 79 % ) of the 397 well enough to be interviewed completed the study . At 12 months , there was no difference between the groups receiving the intervention and usual care [ odds ratio ( OR ) = 0.69 , 95 % confidence interval ( CI ) 0.41 - 1.17 , P = 0.17 ] . In high-risk patients , those who received the intervention were less likely to develop an anxiety or depressive disorder compared with those who received usual care ( OR = 0.54 , 95 % CI 0.29 - 1.00 , P = 0.050 ) . In low-risk patients , there was no difference ( OR = 1.50 , 95 % CI 0.51 - 4.43 , P = 0.47 ) . CONCLUSION A brief intervention , delivered by nonspecialists , promoted adjustment among newly diagnosed cancer patients at high risk of developing anxiety or depressive disorders OBJECTIVE To assess the prevalence and predictors of anxiety and depression among a heterogeneous sample of long-term adult cancer survivors . DESIGN AND PARTICIPANTS Cross-sectional survey of 863 adults diagnosed with a new histologically confirmed cancer ( local or metastatic ) between 1 April and 30 November 1997 and still alive in 2002 , living in NSW , able to read and underst and English adequately , physically and mentally capable of participating , and aware of their cancer diagnosis , who were r and omly selected from the New South Wales Central Cancer Registry . MAIN OUTCOME MEASURES Prevalence of anxiety and depression assessed by the  Hospital Anxiety and Depression Scale ;  and factors ( patient , disease , and treatment characteristics ; coping style ; social support ) predicting clinical or borderline levels of anxiety and depression . RESULTS Levels of anxiety and depression were low ; only 9 % of participants reported clinical ly important levels of anxiety and 4 % reported depression . The strongest predictive factors of borderline or clinical anxiety were previous treatment for psychological illness , maladaptive coping styles ( helplessness-hopelessness , anxious preoccupation ) and poor social support . Borderline or clinical depression was most strongly predicted by previous treatment for psychological illness , being an invalid pensioner , maladaptive coping style ( helplessness-hopelessness ) and poor positive social interaction . CONCLUSIONS By 5 years after diagnosis , most survivors had adjusted well to their cancer experience , with levels of anxiety and depression similar to those of the general population . Nevertheless , a small and important group of long-term survivors continue to experience adverse psychological effects and need assistance . Monitoring of psychological wellbeing and referring patients when appropriate need to be integrated into routine care for cancer survivors At diagnosis , 59 breast cancer patients reported on their overall optimism about life ;  1 day presurgery , 10 days postsurgery , and at 3- , 6- , and 12-month follow-ups , they reported their recent coping responses and distress levels . Optimism related inversely to distress at each point , even controlling for prior distress . Acceptance , positive reframing , and use of religion were the most common coping reactions ; denial and behavioral disengagement were the least common reactions . Acceptance and the use of humor  prospect ively predicted lower distress ; denial and disengagement predicted more distress . Path analyses suggested that several coping reactions played mediating roles in the effect of optimism on distress . Discussion centers on the role of various coping reactions in the process of adjustment , the mechanisms by which dispositional optimism versus pessimism appears to operate , third variable issues , and applied implication This study was done to assess the effectiveness and efficiency of individualized , problem-solving counseling provided by baccalaureate nurses over the telephone to prevent the onset of depression in persons with breast , lung , or prostate cancer . Of 175 persons r and omized , 149 completed the 8-month follow-up . The primary outcome measures were changes in the Jalowiec Coping Scale , the Centre for Epidemiologic Studies in Depression Scale , and the Derogotis Psychosocial Adjustment to Illness Scale . In addition , expenditures for people 's use of all health and social services were computed at baseline and follow-up . Telephone counseling improved the use of more favorable coping behaviors , prevented a clinical ly important but not statistically significant decline into depression , and poor psychosocial adjustment in a group of people with mixed cancer . These results were associated with a greater total per person per annum expenditure for use of all other health and social services in the community compared with the control group . In a situation of limited re sources and a service producing more effect for more costs , one needs either to examine what services to forgo to offer this service or to carefully target the new service to those most likely to benefit Sensory environments may potentially provide an atmosphere of calm and refreshment . This small pilot study used a r and omized controlled trial ( RCT ) design and semi-structured interviews to investigate the use of the Snoezelen multisensory environment in palliative day care . Its second aim was to explore the feasibility of the RCT design in advance of a possible larger trial . The study compared Snoezelen with a normal ' quiet room ' setting . Following screening for anxiety , 26 patients were recruited and r and omly assigned to the control of experimental group . Anxiety and depression were assessed using the Hospital Anxiety and Depression scale and quality of life assessed using the European Organisation for Research and Treatment of Cancer Core 30 question naire . A significant reduction in anxiety was seen with the experimental group ( P=0.01 ) but no changes were observed in any of the quality -of-life subscales . However , the results should be viewed with caution , as there were some differences between the groups in two of the quality -of-life subscales . Data from semi-structured interviews suggested Snoezelen might promote relaxation . It is concluded that Snoezelen is feasible for use with this patient group and recommendations are made for further research Women with breast carcinoma commonly experience psychologic distress following their diagnosis . Women who participate in breast cancer support groups have reported significant reduction in their psychologic distress and pain and improvement in the quality of their lives .  Web‐based breast cancer social support groups are widely used , but little is known of their effectiveness . Preliminary evidence suggests that women benefit from their participation in web‐based support groups Previous research indicates that younger women ( i.e. , ≤ 50 ) with breast carcinoma experience greater emotional distress than older women ( i.e. , > 50 ) and that coping style is significantly related to the psychosocial adjustment of women with this disease . The purpose of this study was to evaluate through a r and omized controlled trial the effectiveness of a problem‐solving training intervention design ed to empower women with breast carcinoma to cope with a range of difficulties when diagnosed in mid‐life Abstract Background : A plethora of research now exists documenting the benefits of psychosocial interventions for cancer patients ; however , no studies have been conducted with people diagnosed with hepatobiliary carcinoma . Methods : A total of 28 patients agreed to participate in the study in which 14 patients were r and omized to the intervention arm of the study and 14 patients to an attention-st and ard of care arm . Evaluation of the benefits of the intervention was performed using the Functional Assessment of Cancer Therapy-Hepatobiliary ( FACT-Hep ) , the Center for Epidemiological Studies -Depression , the State Trait Anxiety Index ( STAI ) to assess anxiety , peripheral blood leukocytes to measure immune system modulation , and survival . Results : Results indicate that patients who were r and omly assigned to the intervention arm of the study reported clinical ly , but not statistically , significant improvements on symptoms of depression and anxiety , disease-related symptoms and treatment side effects , health-related quality of life ( HRQL ) , and modest improvements in peripheral blood leukocytes and survival when compared with the st and ard of care group . Conclusions : The findings of this study suggest that the individually tailored intervention was feasible and preliminary data suggested that the intervention may improve patients ' HRQL , mood , and had modest improvements in immune system functioning and survival . Further research is needed with a larger sample size to test the statistical significance and generalizability of the individually tailored intervention Exercise participation has been shown to improve cardiovascular fitness and reduce psychological distress  among women receiving chemotherapy and /or radiation . The purpose of this pilot study was to examine the changes in distress and body image , and fitness following exercise participation among 24 women who had been diagnosed with breast cancer within the previous 3 years . The women were r and omly assigned to participate in a 12-week supervised aerobic exercise program in a hospital setting or a wait-list control group . Assessment s of distress and body image were conducted at pre- and post-treatment . Data showed that the women in the exercise group improved significantly in body image ( Physical Condition and Weight Concerns subscales ) vs control group participants at post-treatment . Reductions in distress were also noted in the exercise group , but these were nonsignificant . At post-treatment , there were modest improvements in fitness in the exercise group BACKGROUND Active for Life After Cancer is a r and omized trial evaluating the efficacy of a 6-month group-based lifestyle physical activity program ( Lifestyle ) for prostate cancer patients to improve quality of life ( QOL ) including physical and emotional functioning compared to a group-based Educational Support Program and a St and ard Care Program ( no group ) . METHOD A total of 134 prostate cancer patients receiving continuous and rogen-ablation were r and omly assigned to one of the three study conditions . RESULTS Results indicated no significant improvements in QOL at 6 or 12 months . Both group-based programs were positively received and yielded good attendance and retention . Lifestyle participants demonstrated significant improvements in most theoretical mediators proposed by the Transtheoretical Model and Social Cognitive Theory to affect physical activity . Despite these improvements , no significant changes were found for most physical activity measures . CONCLUSIONS Results suggest a lifestyle program focusing on cognitive-behavioral skills training alone is insufficient for promoting routine physical activity in these patients The authors performed a principal components factor analysis on the 18-item Brief Symptom Inventory ( BSI-18 ) , a new brief screening inventory . The factor analysis , in which four factors were specified , is consistent with findings in a previous community sample . The study sample consisted of 1,543 cancer patients who completed the full BSI as part of their entry into care at a regional cancer center . The reliability of the BSI-18 was determined based on the calculation of the internal consistency , mean item scores , and correlations with the total score of the BSI . In addition , sensitivity and specificity was calculated to determine the ability of the BSI-18 to discriminate positive and negative cases . The BSI-18 is a shortened version of the BSI that can serve as a brief psychological screening instrument . The BSI-18 can be incorporated into outpatient clinics to prospect ively and rapidly identify cancer patients with elevated levels of distress who are in need of clinical interventions . Early identification of distress with appropriate interventions can reduce distress , enhance quality of life , and decrease health care costs This study examined the psychometric structure of the Mental Health Inventory ( MHI ) in 433 cancer patients . Using structural equation modeling , confirmatory factor analyses ( CFAs ) were conducted . Next , exploratory factor analysis ( EFA ) was used to explore an alternative MHI factor structure with a r and omly chosen sub sample . Finally , CFAs were conducted on 6 MHI models with the second sub sample . Convergent validity was examined by administering the  Positive and Negative Affect Schedule ( PANAS ) and the  Dyadic Adjustment Scale ( DAS ) .  The CFAs with the original MHI factor structure indicated inadequate fit , supporting the need to conduct an EFA . Results of the EFA indicated support for a 5-factor solution but numerous differences in item factor loadings . The CFA indicated that the 5-factor correlated model was the best fitting model . Correlations between the PANAS and the DAS with the MHI provided preliminary support for the convergent validity of the MHI . Together , these results indicate that the original MHI factor structure may require modification for use in patients with cancer OBJECTIVE Little is known about the effects of videotape-based education on knowledge and anxiety levels among patients with melanoma . We sought to evaluate effects of a professionally produced videotape on the knowledge and distress levels among patients with newly diagnosed melanoma . Secondarily , we sought to compare these effects with those of a traditional clinic visit . METHODS We conducted a r and omized controlled trial involving 217 patients . An intervention group underwent question naire-based testing of melanoma knowledge and anxiety/distress levels before and after viewing an educational videotape . A control group underwent similar testing before and after a clinic visit . RESULTS The videotape and clinical encounter significantly increased knowledge and decreased anxiety . Improvement in knowledge levels was significantly greater after viewing the videotape compared with the clinic visit , whereas anxiety levels decreased to a greater degree after the clinical encounter . Whether or not a synergistic relationship may exist between exposure to an educational videotape and a physician visit was not specifically evaluated in this study . CONCLUSION Videotape-based education may be more effective than that provided by a clinic visit , whereas the clinical encounter appears to be more effective in alleviating patient anxiety/distress The authors report the short-term effects of a clinical trial testing 2 telephone therapies for breast cancer patients . Women ( N = 222 ) with breast cancer were recruited and r and omly assigned to cancer education , emotional expression , or st and ard care . Oncology nurses conducted 6 individual 30-min-therapy phone sessions . Women in the cancer education condition reported greater perceived control than women in the st and ard care condition . No treatment effects were obtained for mood or quality of life . These are the 1st data from a large-scale study testing telephone therapy , and they suggest that such therapies may be ineffective . Explanations for the results include therapy type and delivery , participant characteristics , short- versus long-term results , therapy conent , and whether therapy is necessary for breast cancer patients A prospect i ve validation study was conducted in 171 consenting patients from oncology and palliative care outpatient clinics to vali date the Distress Thermometer ( DT ) against the  Hospital Anxiety and Depression Scale ( HADS ) ,  General Health Question naire-12 ( GHQ-12 )  and  Brief Symptom Inventory-18 ( BSI-18 ) at baseline , four weeks and eight weeks . Receiver Operating Characteristic analysis was used to examine the sensitivity and specificity of the DT scores against the clinical ly significant cut-off scores of the criterion measures reporting 95 % confidence intervals . St and ardised response means were used to compare DT scores with criterion measures over time . For a cut-off of 4 vs 5 , sensitivity against HADS was 79 % , specificity 81 % ; against GHQ-12 , sensitivity was 63 % , specificity 83 % ; and against BSI-18 , sensitivity was 88 % , specificity 74 % . At both four and eight weeks , DT scores tended to change significantly in the same direction as the criterion measures . Ninety-five percent of patients found completing the DT acceptable . The DT is valid and acceptable for use as a rapid screening instrument for patients in the UK with cancer . Our results indicate that it can be used to monitor change in psychological distress over time , but further work is needed to confirm this OBJECTIVE To determine the impact on a responder type analysis of using three published methods to obtain the minimally important difference ( MID ) on the conclusion of a r and omized controlled trial ( RCT ) . STUDY DESIGN AND SETTING Using data from an RCT of supportive-expressive group therapy ( SEGT-intervention ) vs. st and ard care ( control ) in women with metastatic breast cancer , we measured individual responsiveness to change according to three levels of predefined MID ( 0.2 SD , 0.5 SD , and 1 st and ard error of measurement ) of the following six vali date d question naires : Profile of Mood States , Impact of Event Scale , Psychosocial Adjustment to Illness Scale , EORTC Quality -of-Life Question naire Core-30 , Mental Adjustment to Cancer , and a pain visual analog scale . The proportion of women improved by SEGT  and the number needed to treat according to three levels of MID were calculated . RESULTS There was no consistent difference in the net proportion of women improving with the SEGT vs. control arm according to the three different levels of MID . CONCLUSION The choice between different levels of distribution-based MID did not make an important difference in the net proportion of women improving with the SEGT . Future research should compare MID derived from clinical anchors , in particular patient opinions PURPOSE To test the effectiveness of supplementing usual supportive care with aromatherapy massage in the management of  anxiety and depression in cancer patients through a pragmatic two-arm r and omized controlled trial in four United Kingdom cancer centers and a hospice . PATIENTS AND METHODS Two hundred eighty-eight cancer patients , referred to complementary therapy services with clinical anxiety and /or depression , were allocated r and omly to a course of aromatherapy massage or usual supportive care alone . RESULTS Patients who received aromatherapy massage had no significant improvement in clinical anxiety and /or depression compared with those receiving usual care at 10 weeks postr and omization ( odds ratio [ OR ] , 1.3 ; 95 % CI , 0.9 to 1.7 ; P = .1 ) , but did at 6 weeks postr and omization ( OR , 1.4 ; 95 % CI , 1.1 to 1.9 ; P = .01 ) . Patients receiving aromatherapy massage also described greater improvement in self-reported anxiety at both 6 and 10 weeks postr and omization ( OR , 3.4 ; 95 % CI , 0.2 to 6.7 ; P = .04 and OR , 3.4 ; 95 % CI , 0.2 to 6.6 ; P = .04 ) , respectively . CONCLUSION Aromatherapy massage does not appear to confer benefit on cancer patients '  anxiety and /or depression  in the long-term , but is associated with clinical ly important benefit up to 2 weeks after the intervention Background : Psychosocial interventions can improve psychological quality of life ( symptoms of depression and anxiety ) of both women with breast cancer and their partners , but are not offered routinely to women and their partners . Objective : To test the hypotheses that telephone-delivered psychosocial interventions decrease depression and anxiety in women with breast cancer and their partners . Methods : The design of the study was a three-wave repeated measures with a between-subjects factor ( treatment group ) . Ninety-six women and their 96 partners were assigned r and omly to participate in one of three different 6-week programs : ( a ) telephone interpersonal counseling ( TIP-C ) ; ( b ) self-managed exercise ; or ( c ) attention control ( AC ) . Results : The mixed-model analysis of variance for symptoms of depression among women with breast cancer revealed  women 's depressive symptom scores decreased over time in all groups . For anxiety , women 's symptoms of anxiety decreased in the TIP-C and exercise groups over time , but not in the AC group . A parallel set of analyses was conducted on  partners ' depression and anxiety data . Symptoms of depression and anxiety among the partners decreased substantially over the course of the investigation . Similar to the women , partners '  symptoms of anxiety decreased significantly in the TIP-C and exercise groups , but not in the AC group . Discussion : Findings from this study support that these telephone-delivered psychosocial interventions were effective for decreasing symptoms of depression and anxiety to improve psychological quality of life when compared to an AC group Objective The objective of this study was to assess the effects of participation in a mindfulness meditation – based stress reduction program on mood disturbance and symptoms of stress in cancer out patients . Methods A r and omized , wait-list controlled design was used . A convenience sample of eligible cancer patients enrolled after giving informed consent and were r and omly assigned to either an immediate treatment condition or a wait-list control condition . Patients completed the Profile of Mood States and the Symptoms of Stress Inventory both before and after the intervention . The intervention consisted of a weekly meditation group lasting 1.5 hours for 7 weeks plus home meditation practice . Results Ninety patients ( mean age , 51 years ) completed the study . The group was heterogeneous in type and stage of cancer . Patients ’ mean preintervention scores on dependent measures were equivalent between groups . After the intervention , patients in the treatment group had significantly lower scores on Total Mood Disturbance and subscales of Depression , Anxiety , Anger , and Confusion and more Vigor than control subjects . The treatment group also had fewer overall Symptoms of Stress ; fewer Cardiopulmonary and Gastrointestinal symptoms ; less Emotional Irritability , Depression , and Cognitive Disorganization ; and fewer Habitual Patterns of stress . Overall reduction in Total Mood Disturbance was 65 % , with a 31 % reduction in Symptoms of Stress . Conclusions This program was effective in decreasing mood disturbance and stress symptoms in both male and female patients with a wide variety of cancer diagnoses , stages of illness , and ages Watchful waiting is a reasonable alternative to treatment for some older men with localized prostate cancer , but it inevitably brings uncertainty . This study tested the effectiveness of the watchful waiting intervention ( WWI ) in helping men cognitively reframe and manage the uncertainty of watchful waiting . Based on Mishel 's Reconceptualized Uncertainty in Illness Theory ( Image . 1990 ; 256–262 ) , the WWI was tested with a convenience sample of 41 men . Experimental subjects received 5 weekly intervention calls from a nurse . Control subjects received usual care . Outcomes were new view of life , mood state , quality of life , and cognitive reframing . Repeated measures of analysis of variance were used to test the effectiveness of the WWI . The sample was 86 % Caucasian and 14 % African American , with an average age of 75.4 years . Intervention subjects were significantly more likely than controls to view their lives in a new light ( P = .02 ) and experience a decrease in confusion ( P = .04 ) following the intervention . Additionally , intervention subjects reported greater improvement in their quality of life than did controls ( P = .01 ) and believed their quality of life in the future would be better than did controls ( P = .01 ) . This study 's findings document the benefits of the WWI for patients living with uncertainty Objective The present study established the psychometric properties of the Functional Assessment of Cancer Therapy – Neutropenia ( FACT-N ) , a self-report instrument to assess neutropenia-specific concerns and health-related quality of life ( HRQL ) , in a sample of adults 65 years of age and older . Material s and methods Participants were undergoing chemotherapy for lung , breast , or ovarian cancer or non-Hodgkin ’s lymphoma ( n = 852 ) and were r and omly assigned to receive  pegfilgrastim beginning with cycle 1 ( primary prophylaxis ) or pegfilgrastim subsequent to cycle 1 at their clinicians ’ discretion ( usual care ) . Participants completed a  self-report assessment  on day 1 of each cycle ( up to six cycles ) and at the expected nadir of the white blood cell count of each cycle . Using factor analysis , three subscales were identified in the 19-item FACT-N subscale : Malaise , Worry , and Flu-like symptoms . Results and discussion sThe FACT-N and each of the subscales were sensitive to the presence of neutropenia although did not correlate with the absolute neutrophil count ( ANC ) . While ANC is a marker of the impact of chemotherapy on the myeloid precursors of the bone marrow and is correlated with risk of febrile neutropenia , however the constellation of symptoms and patient experience vary throughout the period of neutropenia as the ANC first declines and then recovers . The 19-item neutropenia subscale can be used alone ; however , evidence supporting reliability and validity was most robust for aggregate scores from the FACT-N and the Trial Outcome Index — Neutropenia ( TOI-N ) . Conclusion Underst and ing the impact of neutropenia on HRQL through the availability of a vali date d self-report measure will , ideally , lead to interventions to reduce the burden associated with cancer and its treatments Music therapy has decreased anxiety levels in many medical setting s. This r and omized clinical trial examined the effectiveness of a music listening intervention , delivered by a board-certified music therapist , in patients undergoing curative radiation therapy ( RT ) .  Emotional distress ( anxiety , depression , and treatment-related distress ) and symptoms ( fatigue and pain ) were measured at baseline , mid-treatment , and end of treatment in 63 patients undergoing RT .  Although patients who listened to self-selected music reported lower anxiety and treatment-related distress , there was a decline in these outcomes for patients in both groups over the course of RT .  Depression , fatigue , and pain were not appreciably affected by music therapy . Within the music group , there was a significant correlation between number of times music was used/week and the change in treatment-related distress , suggesting that higher doses of music produced greater declines in distress . While these findings provided some support for the use of music in reducing distress during RT , further research demonstrating clear differences between intervention and control conditions is needed . Physical symptoms were not affected by the use of music over the course of RT Men who were recently treated for prostate cancer ( N=250 ) were r and omly assigned to a control group , a group education intervention ( GE ) , or a group education-plus- discussion intervention ( GED ) . Both GE and GED  increased prostate cancer knowledge . In the year postintervention , men in the GED condition were less bothered by sexual problems than men in the control condition , and they were more likely to remain steadily employed ( 93.0 % ) than men in the GE ( 75.6 % ) or control ( 72.5 % ) conditions . Among noncollege graduates , GED and GE result ed in better physical functioning than the control condition , and GED result ed in more positive health behaviors than the control or GE condition . Among college graduates , controls were comparable with the GE and GED groups in physical functioning and positive health behaviors OBJECTIVES While there are many psychosocial interventions for cancer patients , few are brief in nature . The aim of this study was to investigate the usefulness of a single-visit psychosocial intervention for gynecologic cancer patients . METHODS One hundred women attending a gynecologic cancer clinic as new patients were r and omized to receive  no intervention or a one-time meeting with a psychologist who discussed issues and concerns the woman might have about her cancer diagnosis . Thirty-eight of the women had a current or previous cancer . The women were given question naires measuring mood and quality of life at baseline , two weeks and three months after the intervention . RESULTS At baseline , 43 of the women in the control group completed question naires , as did 45 women r and omized to the intervention . 21 of these women received the intervention . Women who received the intervention had greater decreases in anxiety , depression and overall distress over time . The control group also had decreases in anxiety and overall distress over time , but had an increase in depression . The women in the intervention group increased in physical , emotional , functional , and overall well being , while the control group only had a slight increase in overall well being over time . The difference between the groups in emotional well being at Time 2 approached significance ( p=.08 ) . The intervention group had increases in positive coping at Time 2 , while the control group decreased ( p 's ranged from .02-.10 ) . Three month follow-up data were available for 23 women in the control group and 15 in the intervention group . At Time 3 functional well being was significantly higher in the intervention group ( p=.04 ) . Information seeking and affect regulation remained higher in the intervention than the control group ( p's=.002 and .02 , respectively ) . When the women with cancer or previous cancer were examined , significant differences were seen for affect regulation at baseline ( p=.0007 ) , and anger two weeks later ( p=.04 ) , with the women in the control group being more angry . Utilization of other cancer re sources was low with 12 % of the women reporting that they used the Cancer Re source Center . CONCLUSIONS The results of this study show that there was a positive effect towards coping and quality of life for a one-time psychosocial intervention after the first visit to a gynecologic oncology practice . Women who were r and omized to the intervention but did not go were more distressed at baseline than the women who did go . This suggests that incorporating psychosocial services as an integrated part of the new patient consultation may be very important to address patient 's distress . Future studies with larger sample sizes may reveal more significant differences . Strategies to overcome the poor utilization of the cancer re source center are also clearly needed to improve awareness of these re sources The aim of this prospect i ve study was to identify the psychiatric morbidity associated with the diagnosis and treatment of early breast cancer . At each of five time points , 269 women were interviewed using a shortened version of the Present State Examination ( PSE ) and 266 completed self- assessment question naires , the Hospital and Anxiety Depression Scale ( HADS ) and the Rotterdam Symptom Checklist ( RSCL ) . This paper compares the ability of the question naires to detect psychiatric morbidity with that of the PSE . The majority of women who experienced anxiety and /or depression did so within 3 months of their initial surgery . The clinical interview identified anxiety disorder in 132 of 266 women ( 49.6 % ) and depressive illness in 99/266 ( 37.2 % ) during the first 3 months . Using the recommended threshold of > or = 11 for caseness , the sensitivities for both tests were very low at 24.2 % ( HADS anxiety ) and 14.1 % ( HADS depression ) and 30.6 % ( RSCL psychological distress scale ) . Lowering the threshold value to > or = 7 on the HADS improved the sensitivity to 72 % for the anxiety subscale , but it remained low at 37.4 % for the depression subscale . A threshold of > or = 7 for the RSCL scale raised sensitivity to 66.7 % . Lowering the threshold values raised the sensitivity of both the instruments but decreased their specificity : the lower the threshold , the greater the number of women who were identified as false positives which would increase the work load for clinic staff if used as a screening tool . Given that the HADS was inadequate in discriminating for depressive illness , it was not surprising that its use as a unitary scale with a threshold value as low as 12 result ed in a sensitivity of only 42.7 % . In the light of these findings , we question the use of both the HADS and the RSCL as suitable research or screening instruments for detection of psychological morbidity in early breast cancer 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 Two hundred fifteen r and omly accessed cancer patients who were new admissions to three collaborating cancer centers were examined for the presence of formal psychiatric disorder . Each patient was assessed in a common protocol via a psychiatric interview and st and ardized psychological tests . The American Psychiatric Association 's DSM-III diagnostic system was used in making the diagnoses . Results indicated that 47 % of the patients received a DSM-III diagnosis , with 44 % being diagnosed as manifesting a clinical syndrome and 3 % with personality disorders . Approximately 68 % of the psychiatric diagnoses consisted of adjustment disorders , with 13 % representing major affective disorders ( depression ) . The remaining diagnoses were split among organic mental disorders ( 8 % ) , personality disorders ( 7 % ) , and anxiety disorders ( 4 % ) . Approximately 85 % of those patients with a positive psychiatric condition were experiencing a disorder with depression or anxiety as the central symptom . The large majority of conditions were judged to represent highly treatable disorders 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 Treatments for clinical ly localized prostate carcinoma are accompanied by sexual , urinary , and bowel dysfunction and other sequelae that can result in significant distress and reduced well being . Methods capable of improving quality of life are needed that can be integrated into clinical practice . To address this need , a nurse‐driven , cancer care intervention was developed and tested Physical exercise has been shown to enhance quality of life ( QOL ) in cancer survivors using pretest-posttest design s and compared to usual care ( i.e. no intervention ) . In the present study , we conducted a r and omized controlled trial to determine if exercise could improve QOL in cancer survivors beyond the known benefits of group psychotherapy ( GP ) . We matched 22 GP classes ( N=108 ) on content and then r and omly assigned 11 ( n=48 ) to GP alone and 11 ( n=60 ) to GP plus home-based , moderate-intensity exercise ( GP+EX ) . Participants completed a physical fitness test and QOL measures ( e.g. Functional Assessment of Cancer Therapy scales ) at the beginning and end of GP classes ( about 10 weeks ) . We had excellent recruitment ( 81 % ) , retention ( 89 % ) , and adherence ( 84 % ) rates and a modest contamination ( 22 % ) rate . Using intention-to-treat repeated measures analyses of variance , we found significant Time by Condition interactions for functional well-being , fatigue , and sum of skinfolds . We also found borderline significant interactions for physical well-being , satisfaction with life , and flexibility . All interactions favored the GP+EX condition . We conclude that a home-based , moderate intensity exercise program may im-prove QOL in cancer survivors beyond the benefits of GP , particularly in relation to physical and functional well-being PURPOSE Persistent insomnia is a common complaint in cancer survivors , but is seldom satisfactorily addressed . The adaptation to cancer care of a vali date d , cost-effective intervention may offer a practicable solution . The aim of this study was to investigate the clinical effectiveness of protocol -driven cognitive behavior therapy ( CBT ) for insomnia , delivered by oncology nurses . PATIENTS AND METHODS R and omized , controlled , pragmatic , two-center trial of CBT versus treatment as usual ( TAU )  in 150 patients ( 103 females ; mean age , 61 years . ) who had completed active therapy for breast , prostate , colorectal , or gynecological cancer . The study conformed to CONSORT guidelines . Primary outcomes were sleep diary measures at baseline , post-treatment , and 6-month follow-up . Actigraphic sleep , health-related quality of life ( QOL ) , psychopathology , and fatigue were secondary measures . CBT comprised five , small group sessions across consecutive weeks , after a manualized protocol . TAU represented normal clinical practice ; the appropriate control for a clinical effectiveness study . RESULTS CBT was associated with mean reductions in wakefulness of 55 minutes per night compared with no change in TAU . These outcomes were sustained 6 months after treatment . St and ardized relative effect sizes were large for complaints of difficulty initiating sleep , waking from sleep during the night , and for sleep efficiency ( percentage of time in bed spent asleep ) . CBT was associated with moderate to large effect sizes for five of seven QOL outcomes , including significant reduction in daytime fatigue . There was no significant interaction effect between any of these outcomes and baseline demographic , clinical , or sleep characteristics . CONCLUSION CBT for insomnia may be both clinical ly effective and feasible to deliver in real world practice
Objective The objective of this paper is to inform choice of optimal patient-reported outcome measures ( PROMs ) of anxiety , depression and general distress for studies evaluating psychosocial interventions for English-speaking adults with heterogenous cancer diagnoses .